• The Splintering of the Self: Annie Liontas on Life After Concussion

    “I tell myself that the brain injury did not take away a self, rather it revealed many other selves heretofore unknown to me.”

    In March 2019, twenty-three-year-old Olympic silver medalist Kelly Catlin took her own life in her college dorm. A month earlier—the day she was scheduled to meet the queen of Spain—she had tried and failed to kill herself by asphyxiation. Her family and coaches rushed in after the first attempt. She was referred to two sports psychologists, but neither could see her. She tried calling a suicide hotline multiple times, was once put on hold. Another time, no one answered.

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    Kelly was a member of the US cycling team, a three-time world champion in the four-rider group race called the team pursuit. She was earning a degree at Stanford University in computational math and engineering. She spoke Chinese fluently, was a natural athlete, a gifted classical violinist, had plans to be a data scientist. This all changed for her after a slick winter ride in December when, two months before her suicide, she suffered a head injury. Her family insists: “The concussion changed her.”

    I think about what it must have been like for Kelly in the weeks before her death, struggling through tough math problems and headaches, unable to withstand even a “coffee ride” with her coach. I imagine her putting her violin to her chin and grasping for Niccolò Paganini, touching only air. At one point, in four pages of frenetic journaling, she writes—If I am not an athlete, I am nothing.

    “We didn’t know about the racing thoughts and the obsessing,” Kelly’s sister Christine says.

    In his paper on behavior analytical approaches, clinical psychologist Stephen M. Myles blames ruptures of identity after TBI on the “inconsistencies between her post-injury functioning and pre-injury conceptualized self.” With a brain injury, even those we don’t define as serious, there is the persistent sensation that you are not you. This is the Crisis of the Conceptualized Self.

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    You look the same, therefore should be the same, and people react to you as if you are the person they remember. They talk to you as if you are still the silver medalist, even if your heart races after only moderate exertion. They do not know you are now somebody new—a secret person, a stranger to yourself—who researches and rents two cylinders of compressed helium for an exit plan, and in the end you are the body that your roommate finds in the dorm now filled with noxious gas. They expect you to be the same uninterrupted line you have always been. For a while—because identity is the natural formation that arises where we meet others—you fight to return to that person, too.

    The split self arises from self-estrangement, the evaluation of deficits, enduring emotional distress.

    After my third concussion, I sit in the chair, wrestle with the empty page. I do this out of terror and habit. Nothing comes. This is not writer’s block. I have lost the gift of sight—I can no longer look into that space ahead and conjure something out of the fictive world. It is less like blindness, more a body part gone numb.

    I forget how to imagine. I forget words entirely, how to set them alongside one another. It is as if someone has hidden language behind a curtain, and I can only see the shadow it makes on the blank wall. I’m able to hold on to certain pieces of the narrative if I concentrate, but I can’t build much out of them.

    Specifically, I am showing indication of low idea density and nonspecific language lacking detail (empty words—“anyone,” “something”—keep creeping up). I try talking into a voice recorder, write entire chapters this way. When I play it back, it sounds like someone else’s book, so I throw it out. Dear god, I pray, please make me whole if only on the page.

    On my desk is a notebook, Post-its, a photo of Whitney Houston, a plastic pirate, a rubber octopus, some precious rocks, a puppet playing a lute, a very dramatically thirsty plant, a red daruma, and other writing talismans given to me by friends or found in the wild. On the bookshelf beside my desk, the sky-blue spines of my first novel stare back at me. The greatest kindness I ever felt from Mom was when she called me up and said, Of course I was going to read it, why would you think I wouldn’t? and then, You can see why people like it, it’s different. But I am very far from that book right now.

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    I get the distinct feeling that the novel was written by someone else—another writer, someone I am outside of, somebody who could never recognize me. Overnight, my work has become no longer mine because I am not me anymore. I tell myself that writers always spurn their first books or else they would never write a second, and that every book written is many selves ago.

    I tell myself that, per neuroscientist Anil Seth, all reality is a “controlled hallucination.” But then I look again at the blue spines. I turn the books so they face backwards, with the gray pages fanning out. Now the novel might have been written by anybody.

    Kelly—and the whole Catlin clan—were overachievers. In third grade, Kelly started following The Code, strict guidelines to live by, which she wrote into a notebook and which included no crying. In eleventh grade, Kelly enrolled in classes at the University of Minnesota and got perfect SAT scores. She shut herself away for twelve-hour study sessions and went on sixty-mile bike rides. The only time she watched movies was on a stationary bike, and her $20 allowance was contingent on how much she had exercised that week.

    Her parents, who wanted to prepare their daughter for the future they believed she deserved, pushed her to excel. Her mother, Carolyn, after Kelly’s death, said: “So many parents automatically just say, Good job. Their kids are successful getting a fork to their mouth: Good job!” Whatever Kelly did—origami, competitive shooting, riding, suicide note—it had to be perfect.

    Her brother Colin says of Kelly, “She always wanted to basically be this monolithic, terrifying force of power.”

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    *

    In Oliver Sacks’s An Anthropologist on Mars, a painter goes color-blind after his concussion. Everything appears in black-and-white, like an old television. Everything looks misty, bleached. His abstract paintings, once full of intense color, are now gray to him, meaningless. His dinner plate is full of gray, dead food; when he closes his eyes and tries to picture a tomato, it’s black. He sticks to black and white foods, olives and rice, coffee and yogurt. Flowers, museum paintings, are all wrong. He is depressed by rainbows. The flesh of his own wife looks to him “rat-colored.”

    He dreams he is about to see color, and then he wakes up. In his sorrow, he sits for hours staring at his lawn, willing green to life. Sacks writes, “He knew all about color, externally, intellectually, but he had lost the remembrance, the inner knowledge, of it that had been part of his very being. He had had a lifetime of experience in color, but now this was only a historical fact.” The color-blind painter tells himself, If I can’t go on painting, I don’t want to go on at all.

    *

    After brain injury, we lose the words we once used to describe ourselves—strong, industrious, clever, creative, talented, resilient, imaginative. We are left with something unspeakable, a core self that can be frightening and exhilarating to meet, a stranger who wears our shoes and smells like us.

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    The me I used to know chose freedom over obedience and left home at seventeen. The me I once was graduated college at the top of the class, feeling herself behind everyone else but never showing it. The me I once was—but apparently no longer am—did not give into failure or fears of being an impostor, because scrappiness overcame almost any hurdle. I pushed and pushed.

    A year after my first head injury, I travel south for a job interview, where I am asked to read and speak about my first book. I smile through it and deliver the jokes from page one. I sign copies of the book, as if I’m doing a favor for the real author. When I am offered the job, I can’t help but feel like I’ve stolen someone else’s work, that the nice people on this committee believe I’m somebody I’m not.

    John Locke’s idea of psychological continuity suggests that someone who comes through a struggle can still recognize herself on the other side if some idea of her continues to exist. Philosopher Carsten Korfmacher further explains this notion: “In order for a person X to survive a particular adventure, it is necessary and sufficient that there exists, at a time after the adventure, a person Y who psychologically evolved out of X.”

    Yet, with brain injury, the shift is so abrupt, so decisive, that there is a cleaving—only the before and after, was and is, war and prisoner. After injury, who you were on Sunday is not who you are on Monday. After injury, the person giving the interview is not the person on the page.

    I stop seeking out readings. When sales are down, I think, let it die, it’s dead already. I accumulate pages toward a new novel, but deep down (I know it, my agent knows it), they are brittle. It is not just the words. I am locked out. My characters are at a party in the apartment next door, and all I can hear are their muffled conversations.

    It is slowly dawning on me that I am alienated not only from my body, from my brain, but also from my imagination. I cannot see into that distance where creation happens. My wife says, Don’t worry you still have your voice. It takes years to figure out that what she actually means is I still have my soul.

    Q: What do you call a writer who cannot write?

    A:

    The painter tries to paint in color again: it doesn’t work. His friends, even his wife, tell him it’s not a big deal—but the colorless colors are repulsive to him.

    *

    Catlin Kelly is not the only female athlete to die by suicide after concussion.

    A year before Kelly’s suicide, Ellie Souter, the British snowboarder who won a bronze medal in snowboard cross, kills herself in a remote woodland on her eighteenth birthday. Seven concussions between 2013 and 2018, airlifts off mountains. No one suspects depression, her uncle describes her as “chirpy.” Her father says: “I truly believe today that my daughter would be alive had I had any inkling, you know, even the smallest bit of information.”

    A year after Kelly’s suicide, in 2020, Australian football player Jacinda Barclay kills herself. An autopsy reveals that there is significant degradation of the white matter in her brain, not unlike the CTE diagnosed posthumously in American football players.

    In November 2018, a little over a month before her accident, three-time world champion Kelly stands at the podium at a World Cup track cycling race. She looks past the cheering fans, waving flags, all the way out to Tokyo 2020—where she’s predicted to win gold. She sees the bright future she has been training for all her life, the one owed her.

    “As far as we knew,” Catlin’s father says, “she was never a person that suffered from depression.”

    *

    In his biography, first recorded in the late first century, Plutarch asks if we are still who we once were if those recognizable parts of us go missing. In the Theseus paradox, Theseus, hero of Athens, returns victorious from my home island of Crete, having slayed the Minotaur. The Athenians are so in awe, they decide to preserve his broken-down ship by replacing it plank for plank. Plutarch poses the question, If an object has had all of its components replaced, is it still fundamentally the same entity? If you replace all the boards on a ship, is it still the same ship? If someone takes those old boards and builds an entirely new ship, do you now have two ships?

    If this new Kelly Catlin can no longer race, sees in herself someone who is physically weak, without stamina, a person who fails after a lifetime of excellence, who might not be able to compete in Tokyo, who has unexpected dark, spinning thoughts, whose very body and brain are betraying her, is she the same Kelly Catlin?

    With brain injury, there has been a disruption of borders: because a sequential self requires proximity to the past self for association to occur, the present unknown self is disquieting, mistrusted. The injured brain, unlike the ship that has been built back together from parts, is fractured. The split self arises from self-estrangement, the evaluation of deficits, enduring emotional distress.

    This is the untold legacy of head trauma. It is so common that it is described as being the sine qua non of brain injury. “Certain qualitative changes in a person’s psychology or physiology may kill the person,” Korfmacher says. “The question a criterion of personal identity answers is: what kind of changes does a person survive?”

    “She was not the Kelly we knew she spoke like a robot,” Kelly’s father, Mark, said. “We could get her to talk but we wondered, what has happened to our Kelly?” Yet even now, when Kelly Catlin is covered in the media, almost no one—outside her family—talks about the concussion.

    About the time that Kelly Catlin falls off her bike, I attend the Mind Your Brain Conference in Philadelphia. The keynote speaker is a snowboarder whose professional career was cut short by a bad ride—an Olympian, like Kelly, an athlete to rival Shaun White. In the audience are medical professionals, students of neurology, but mostly, the attendees are people with brain injuries.

    There is a free lunch. I tell myself I’m here to conduct research for a new novel since, little by little, over five years’ recovery, I have been regaining the ability to write—not just put down mangled words, but to see true shapes. I show up late to the conference, I’m jittery and don’t know why. The back of my neck prickles. I can’t shake the uncanniness, as if this is all an elaborate set with hired actors whose job it is to fold me into their ranks.

    People sitting on plush chairs, eating apples. People flipping through the schedule. A woman with blond curls sauntering up to a table for free swag. Then I realize my unease—the hundreds of people wandering the booths and finding their seats are entirely unremarkable. They look just like me. What were you expecting? I ask myself. Limping? Dark glasses? Someone helping them down the stairs? Eye patches? We look mostly the same.

    I sit in on Dr. Ann Marie McLaughlin’s astounding presentation on emotional health, entitled “I Am Not Me,” and learn just how many of the walking wounded are troubled by a divided self. This comes as a revelation, because all this time I think I’ve just been coping badly. And it turns out, I have. Apparently, overachievers with perfectionist tendencies—Kelly Catlin, Annie Liontas—have the worst time adjusting to cognitive disruption.

    Dr. McLaughlin compares us to homes in a Class 3 hurricane. We have not all suffered the same damage. This house over here is okay. This second house is a mess, foundation gone, insurance wants to know if the symptoms correlate with the accident or if it was always a run-down house whose owners are now trying to scam the system. This house way out here is narcissistic and grandiose and is bound not to know itself after the storm tears down its walls.

    Then you realize—there is something to be found in the darkness.

    Suicide, she tells us, is at three times the population norm. We are seeking to understand the relationship between white matter changes in the brain and suicidality.

    Then Dr. McLaughlin pulls up a slide called “Living in the Basement.” The Basement, Dr. McLaughlin explains, is where a lot of people with brain injuries end up. This is not a metaphor. Thousands of survivors can no longer live upstairs: 20 to 30 percent are wracked by vestibular symptoms, another 19 percent suffer from vision problems and headache, all are in “psychic distress or withdraw.”

    I know the Basement. Despite my childhood avoidance of basements (the philosopher Gaston Bachelard calls it the dark, subterranean, irrational entity of the house, the place from which fear springs), I have been living in one. My Basement is the blue scarf I’ve kept wrapped around my face for the greater part of four years. It is the separation I have felt from people even when we’re in the same room. My Basement has no staircase, it is just one long step down. It is at this very moment that I realize I’ve sensed my old self missing, I just haven’t understood where she’d gone.

    I look at all the people sitting around me—the people too sick to even make it here today, Kelly Catlin who is only beginning to suffer—me with my snotty nose, all these people in their own dark basements but all of us somehow together. Somebody in the next row sees this is too much for me, passes a napkin that smells like a ham sandwich, and this feels like a great kindness.

    I tell myself that the brain injury did not take away a self, rather it revealed many other selves heretofore unknown to me.

    Mark Doty writes, “That is a relief, is it not, to acknowledge that we do not after all know what a self is? A corrective to human arrogance, to the numbing certainty that puts a soul to sleep.” He goes on, in The Art of Description, to say, “Consciousness can’t be taken for granted when there are, plainly, varieties of awareness.”

    I rewrite the book until it is a different book; then I rewrite it until I am a different writer.

    *

    One morning, as the painter is driving, he sees the sun coming up over the highway, the reds all blacks. “The sun rose like a bomb, like some enormous nuclear explosion,” he says. He starts working again, abstracts as before in a series called Nuclear Sunrise, with one big difference: he paints in black and white. He never gets green back, but he sees black/ white in an entirely new light.

    There is a philosophy experiment that is even better known than Theseus’s ship, and that is “People Who Divide Like an Amoeba.” In this puzzle, philosopher Derek Parfit asks you to imagine that your brain is sawed in half and placed into two different bodies. Both brains survive, both go on to live different lives.

    Parfit, who most of all does not want people to suffer (the idea of anyone in pain, even Hitler, makes him want to cry) wants us to remember that even the divided self can never fully be divided. “They can be different people and yet be me, just in the way the Pope’s three crowns are one crown.” I can be both the writer and the non-writer. The artist can see in color, and also see no color.

    Kelly’s parents beg her to quit school, quit everything. Come home, forget classes, heal, be somebody else for a while. Her sister sends her articles on a little Italian town where Stradivarius violins are made by hand. Wouldn’t it be nice to go there? Maybe Kelly considers the possibility, briefly. Maybe she can almost reach out and touch that other life of Kelly Catlin, before it disappears for good.

    In her final words, she writes, “I was dancing before the end. Just so you know. I woke up, danced a dance, played my fiddle, and died.” After her death, still seeking answers, her family donates her brain to concussion research at Boston University’s CTE Center.

    The colorblind painter who paints in black and white is a night person now. He drives to random cities, Boston, Baltimore, pulling up at dusk, wandering the streets for much of the night. He is drawn to diners. He says, “Everything in diners is different at night, at least if it has windows. The darkness comes into the place, and no amount of light can change it. They are transformed into night places.”

    The basement is still dark, but little by little you get used to it, and then you realize—there is something to be found in the darkness.

    __________________________________

    Excerpted from Sex with a Brain Injury: On Concussion and Recovery by Annie Liontas. Copyright © 2024 by Annie Liontas. Reprinted by permission of Scribner, a Division of Simon & Schuster, LLC.

    Annie Liontas
    Annie Liontas
    Annie Liontas is the genderqueer author of the novel Let Me Explain You and the coeditor of A Manner of Being: Writers on their Mentors. Her work has appeared in The New York Times Book Review, Gay Magazine, NPR, Electric Literature, BOMB, The Believer, Guernica, McSweeney’s, and other publications. A graduate of Syracuse University’s MFA program, she is a professor of writing at George Washington University. Annie has served as a mentor for Pen City’s incarcerated writers and helped secure a Mellon Foundation grant on Disability Justice to bring storytelling to communities in the criminal justice system. She lives in Philadelphia.





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