The age, gender, nationalities, and details of medical facilities of those discussed are changed to protect the identities of those discussed throughout the article.
(3,434 words)
Introduction:
The topic of the quality of how we choose to spend our free time is not new. With mobile phones and tablets vying for every moment of our attention, this topic has been beaten to death in many circles. As a result, it has caused a lot of the population to give up and simply succumb to the siren call of the nearest glowing screen. One only needs to look at how many parents have given up the concept of regulating their children’s screen time, especially after the pandemic.
This article strives to bridge the relevance gap in a conversation that has come to be viewed as middling and uselessly obvious. Recent events in my life have given me experiences that, when used with my background in psychology and rehabilitation, have given me insight into the matter and a few promising and troubling findings. The event in question was a senior who suffered physical trauma in the form of an infection which directly impacted their central nervous system and subsequently experienced a severe decline in their physical and cognitive abilities. The treatments were simple, and the results in this very specific case were positive and informative for related and unrelated cases.
The conclusions that were drawn from this experience have relevance for the lives of people who are not seniors with natural or accelerated cognitive degenerations and for those who lead normal lives. The findings were that if the patient, or even a normal healthy adult, spent more time actively engaging their higher cognitive functions and retreating to a state of rest whenever they could, not only would their chances of rehabilitation after an illness or accident improve, but their normal lives would as well.
The Patient:
We all noticed as he started nodding off mid-conversation. It is not unusual for someone in his age bracket (low 80s) to start falling asleep, so some people did not seem concerned. There is a difference between someone who falls asleep and someone who uncontrollably loses consciousness. Sadly, we were dealing with the latter in this instance. First, the patient had spent many months in hospitals in the last two years and had recently just returned home. Second, he had recently suffered a mild infection impacting his central nervous system and was on antibiotics, so any change in his health was to be taken seriously. He had, at this point, fully recovered from the infection, and there had been a two-week gap since his last dosage of the prescribed antibiotic. Third, his breathing would not slow and deepen as he fell unconscious, as it normally would in a healthy person who was asleep, leading us to believe that he was not fully getting the rest that he needed. Since I did not live with this family, my opportunities to see his decline were limited, and thus I not only became concerned but was also frightened.
Over the next day, I found that his ability to focus, vocabulary, and general mobility had declined severely. When I asked how he spent his day, his wife said that he watched television and had the radio on. I asked if the radio was on at the same time as the television, and she said yes, and then added that the volume of both was high enough that he could not hear her as she approached. The remainder of his time was spent on his smartphone, looking at various social media platforms as he scrolled while falling in and out of consciousness.
Some Basic Terms and Concepts:
To make this article more easily digestible, we will simply use the neurological states that were the focus of treatment and break them up into three systems. These systems are the default, attention, and executive systems. The purpose of the treatment that followed the days after the patient’s decline was to activate and build their attention and executive systems endurance.
Think of the default system as your dream state. Whether you are asleep or daydreaming, it is when your brain is in a state of rest. The attention system is when you are actively aware of your surroundings and scan for the stimulus that may be relevant to your life. These forms of stimulus can be your partner trying to get your attention subtly or the threat of a snake in the field of short grass ahead of you. This is the state in which we navigate the world and perceive incoming threats. Lastly, we have the executive system where hard/high learning and problem-solving occur.
A good way of discerning how these systems exist alongside each other is to consider what makes a good driver. Bad drivers are those who spend most of their time behind the wheel of a vehicle in their default system, with only a peripheral priority put toward their attention system. They usually daydream and are not paying attention to their surroundings. Their vehicles are often seen swerving between lanes while keeping an unsafe distance from the vehicle in front. Their thousand-yard stares are often accompanied by loud music – the point about an overriding and powerful stimulus and its role will be discussed later. Good drivers have their attention system fully activated, and their executive system is fully engaged. They are constantly scanning the road and sidewalks ahead of them and their mirrors for threats and how to get to their destination economically and safely.
The patient had been increasingly spending all his time solely in the default system/state while being under a constant bombardment of senseless and overpowering stimuli. Stimuli, such as loud music or a highly active bright screen (such as on your smartphone), offer enough distraction to mute all other stimuli in your surroundings. Thus, it makes it easier to enter the default state and start daydreaming or get lost in one’s thoughts as he mindlessly scrolled on his phone, going from one piece of stimuli to the next until ultimately losing consciousness.
Given that his body had recently undergone a trauma (both the infection and the stress induced by the antibiotics), his body and mind did what all our bodies would do. It went into hibernation mode, thereby conserving energy to heal. Except in his case, he stayed in his hibernation mode well after the infection and antibiotic treatment had passed. None of his higher two systems were being activated. He was entering periodic states of what resembled a coma to observers, where his brain activity would flatline, only to recover slightly before retreating. This is why those in his family became deeply concerned.
Over the next few days, in my spare time, when I could, I went over to his house and started a basic physiotherapy program and a set of very simple cognitive exercises. Damaging points of stimulus such as the blaring television, radio, and smartphone were also reduced and replaced with an e-reader. The results were unexpectedly good, and it gave me pause about how I lead my life and how others do as well. I started to become overly concerned for those around me and the long-term effects of their lifestyle. Before we tackle this lifestyle, let us go over the basic treatments which were highly impactful, for the lessons from which we can derive from them will improve your life as well.
The Treatment Method
First, we shall tackle how the basic physiotherapy treatment was approached, implemented, and why. The physiotherapy included light massage and exercises. The first set of exercises focused on mindful breathing, activating his lungs fully. This included deep breathing exercises where the patient would control the amount of air they breathed in, held, and released in a controlled manner. These exercises are important for a senior with his level of immobility, for he does not naturally exercise his lungs. At first, the patient would cough as he inhaled deeply, but after the second day, his breathing dramatically improved. This also impacted his sleep quality, for he was having an easier time breathing in all circumstances. This not only helped activate his lungs but also helped him focus on the next series of exercises.
The next set of exercises consisted of basic yoga poses that were adapted to the patient sitting in his wheelchair. This allowed the patient to become slowly acclimated toward physical activity. The focus on his breathing continued from the prior breathing exercises. This focus on his breath would continue for the entire duration of the exercises. During the first couple of days, his eye contact became stronger, and his focus sharpened.
Next, on alternating days we practiced walking with his walker after doing a standing stress test to measure his progress. Then on alternating days, we either focused on basic strength training with 1–2-pound dumbbells or we focused on two games that he enjoyed. These games were boxing and playing catch. For the boxing, the patient would be instructed to throw either right or left jabs or crosses at my moving hands, which were his moving targets. The boxing helped the patient hone his reflexes and incorporated a degree of cardiovascular work as we ramped up the series of his punches. The pitching game was simple: if he struck out the batter by throwing three strikes before throwing four balls, he would be rewarded. If he threw four balls before throwing three strikes, he would playfully be tickled and teased as punishment. He seemed to enjoy both and eventually seemed to be aiming at my head with the tennis ball while laughing. Interestingly, after a few days, his catching and reflexes greatly improved to the point where he surprised himself.
Lastly, the cognitive exercise was a simple one. Instead of sitting and passively watching television, listening to the radio, or scrolling on his mobile phone, he would read books aloud. With the help of his caregiver and wife, he would look up any words he did not understand. This forced the patient to slow down, focus, and perform in front of other people. It also forced them to activate their executive system as he tried to make sense of what he was reading as he was reading aloud. This stopped the patient from the tendency that mostly everyone suffers from when they read: skim the page and not process what they are reading.
The Results
The impact of the treatment was almost immediate. I received a text message from his wife that the patient was more attentive and that he was not losing consciousness. Over the course of the next four days, the transformation was hard to believe. Furthermore, the patient himself was encouraged by the treatments and, under his own power, decided to do them every single day without me having to be there.
More than two weeks have passed, and the patient is more cognitively sharp than they were two years ago before their visits to hospitals, and he has a lot more energy throughout his day. At the time of editing this article, I visited his home, and all of the metrics for his health had improved dramatically, as had the quality of his life and that of his wife. However, there was one area in which he had regressed. He had stopped reading out of boredom, and his ability to carry on conversations with a sharp level of focus had declined. I could only suggest that he continue reading, but by using humour and deflection, they evaded the topic moving forward.
Lessons Learned from this Case, and Applications for Daily Life
What struck me the most about this case was that the detrimental environmental factors that contributed to the patient’s decline are ones that most of the population experiences and suffers from. The undercurrent of worry regarding most mindful humans is what would happen if we suddenly became ill or lost a certain degree of our health. Thus, resulting in a loss of physical or cognitive ability. The tendency for humans to conserve energy when possible and how we as a species had evolved to do so was briefly touched on above. This has some consequences when it comes to being prepared for periods of debilitating illness, for we only tend to act when Hannibal is at the gates. We naturally do not devote reserves of effort daily to maintaining the metaphorical gate unless we had either directly or indirectly thwarted one of Hannibal’s attacks in the recent past – the word recent is used for most people tend to return to their natural state of rest and start living their lives as if the threat would not happen again.
This brings us to how we use our spare time and the two ways that we need to devote our resources better to equip ourselves for periods of illness and cognitive decline: the first being physical conditioning; the second being cognitive conditioning.
The physical conditioning aspect and that of regular exercise are well known. It can either be hard or nearly impossible for working adults to adhere to a regular exercise regimen due to resources and time. Many adults with one or more full-time jobs must go to bed and wake up quite early to get their workouts in before life’s demands make it impossible to do so. The benefits of being physically in shape not only mean that you are capable of doing more at this moment, but it could also mean that the level of injury sustained and rehabilitation requirements from an incident or infection are greatly reduced.
The cognitive conditioning aspect is the one we will focus on, for there are a few recent threats that, when coupled with exiting the norms set by the COVID-19 pandemic, need to be addressed in more detail. Like the patient, most people spend their spare time looking at their phones or watching television, or listening to a podcast at a very high volume. As productive humans, we are asked to be deliberate when we are on the clock in everything that we do. This manifests itself in how we present ourselves, the exact word usage in emails or when conversing, and in reducing our breaks down to the second due to corporate surveillance on our work computers. We have become conditioned to think of being deliberate as a burden. The term “not when I’m off the clock” is one that can be heard as someone asks a friend to go over a work or school-related document, for they are simply seeking a state where their executive system lays at rest, and they can seemingly relax.
The new threat that has encroached on how we spend our time in a manner that our executive systems are actively engaged is that of passive forms of non-fiction entertainment. This threat is that of podcasts and how prevalent they have become. The threat posed to our executive system’s endurance by various social media platforms is a given and, more importantly, is socially unacceptable. However, the act of listening to informative podcasts is not socially frowned upon, for there is at least a perceived effort to improve oneself in the act. The proof that the listener’s executive system is not fully engaged is when conversing with them about a topic, and they inevitably drive the conversation toward a podcast they recently listened to. They always share the title of the podcast, the name of the host (who, the majority of the time, is a celebrity), and the guest. Often the guest’s name is omitted unless they have the link ready to share and to use for reference. Never are the thoughts or theories expanded upon, or are examples derived from the listener’s lives. The highlights are merely stated, and if anyone has anything to add to the topic that does not align with what they have listened to, they are never prepared to defend any position that they may have taken.
Of course, there is nothing wrong with listening to a podcast while doing chores, but substituting it for hard learning and passing it off as one’s own findings is not just a dishonest way of contributing to conversations; it is damaging the endurance of the person’s executive system. One way that some people get around this is they pause the podcast that they are listening to and use the Notes application on their phone to take quick notes that they may find of interest and return to these notes at a later time. This forces the listener to actively examine to the nuances of the topic that are being covered, take note of them, relate them to their own experiences and profession, and to do their own research either after, or while the podcast is paused. And no, pausing the podcast simply to add the guest’s book to your Amazon shopping cart does not count.
Conclusion:
There is no immediate harm in spending one’s spare time (that of not working) on passive tasks such as watching the television, listening to podcasts, or playing video games that rely on repetitive reflexes, not puzzles. Our brains need time to rest while we are awake and to recharge. The harm comes when we fall ill or are cognitively or physically incapacitated by an injury or accident. Activities such as reading require stamina that needs to be built over time. If we lose this stamina, our battle from a place of illness will be far steeper than if our brains had been conditioned to have its executive system engaged throughout the day. This does not mean that we have to spend the majority of our time reading or actively studying; we can relax but not have our executive system fully disengaged.
The best example of this is the act of simply going for a walk. Often people claim to have solved a problem for work or have come to an epiphany about how a personal relationship was handled while they went for a moderate to long walk. Often, after a confrontation, our natural response is to go for a walk or drive to not only escape the negative environment but to “clear our heads” and to think more intelligibly on the matter. While on a walk, our attention system is fully engaged as we keep an eye out for threats such as cars, muggers, and the aforementioned snake if on a trail, and our executive system is allowed to be engaged and relaxed.
I did not write this article after observing the positive and negative changes in the patient described above. Unknowingly, the manner in which I spent my spare time underwent a severe change, and it was after two conversations that I decided to write this article. Both conversations started with friends asking me why I was spending far less time on social media and in group chats that take place within the confines of applications such as WhatsApp. I naturally revolted at my natural reaction to reach for my phone at every spare moment, and instead, I reached for my Kindle (if only to mindfully read a single paragraph of an article), or I got up and went for, you guessed it, a walk. What resulted was that I was mentally sharper in the mornings and needed less time to “boot up” to accomplish tasks that had consequences tied to them. I found that I was able to make references to articles and books that I had read in the past more effectively and quickly within social and professional environments. Lastly, I found that during times of physical stress, such as while on a long run, I was better able to monitor the nuances of my running technique and to make the appropriate corrections, thus lessening the chances of injury.
My answer to my two friends was disheartening. I simply said, “I am not finding any value in spending time on these platforms,” for it was on both occasions interpreted as in that I found little to no value in their friendship. Both friends knew this not to be true, and both understood the costs far outweighed any of the benefits found in merely “checking in” on them on these platforms.
Most of you reading this live in relative comfort. This being that your safety is not threatened. Sure, you may have minor concerns regarding your finances and health (minor in that you can easily purchase food and are not on your deathbed), but you are not currently living in fear of having your neighbourhood flattened in an air raid. It would be prudent for us not to dwell and to literally have our executive system and functions waste away simply because it is the easiest thing to do.
Hannibal may not be at your gates at the moment, but he has your address and is simply making his rounds.
Note: the turn of phrase “Hannibal is at the gates” (“Hannibal ad portas” in Latin) is from the Roman Empire and the distress caused by the Carthaginian General Commander-in-Chief. Not the fictional character Hannibal Lector.
Time of writing: February 23rd, 2023