Sometimes an Imperfect (but Workable) Solution

One of the apparently permanent issues Dan has involves the intersection of anosognosia and incontinence. Anosognosia, as I explain in my book, is a mysterious but common problem for people who have a severe TBI. It is a sort of logical blind spot, that prevents those affected by it from realistically connecting one or more of their impairments with themselves. As a result, they don’t realize either the severity or the permanence of a problem that they might otherwise take steps to address and resolve. No matter how many other ways their thinking may be logical, they are frustratingly illogical in this way.

As I explain in the book, Dan doesn’t see his urinary incontinence as a problem, either in severity or permanence. It’s not that he doesn’t care about good grooming; although at present we’re having trouble at Harbor Health ensuring that he gets daily shaves and that his face and hand are wiped clean after meals, he wants to be neatly groomed and takes whatever steps he can in order to present himself well. I’m sure, then, that his insistence that he won’t—and doesn’t need to—wear pants protectors (my term for what are problematically referred to as “adult diapers” or “pull-ups,” a counterproductively infantilizing term for anyone who needs to wear them but understandably has misgivings about reverting to “diapers” as an adult) is a result of the logical disconnect of anosognosia, rather than mere stubbornness or denial.

For anyone unfamiliar with anosognosia, the disconnect does seem like stubbornness or denial. I’ve repeatedly raised with Dan his problem with urinary incontinence for over a decade, but particularly often over the past four and a half years that I’ve been his primary advocate, both for him and with him. When I suggest that he needs to wear pants protectors to enable a neat self-presentation, he has one of two reactions: he denies that he has a problem with incontinence, or he spells “FUTURE,” insisting that he will soon have the problem under control and so doesn’t need to take steps to mitigate it. Oh—and a third reaction if I press the issue: unrestrained fury.

We’ve struggled with this back-and-forth innumerable times. A little over a month ago, I told him that, while as an adult he’s free to make his own decisions, I am too, and I’ve decided that I’m not taking him on outings unless he’s wearing pants protectors. I’m no longer willing to be an accomplice to making the public statement formulated by a grown man soaked in urine. The first time I stuck to my guns and flat-out refused to take him out unless he put on pants protectors was about a month ago, when Dyke and I were going to take him to an appointment for a haircut that I’d made for him. He was infuriated—and so was I. I went to the barber shop, apologized that Dan was cancelling his appointment, and paid for both the appointment and a healthy tip. I told Dan that I would make him another appointment—when he agreed to wear pants protectors to the appointment. Although he was enraged by the ultimatum, which it had become clear I was serious about upholding, we both calmed down and made peace. But his hair, which he likes to keep short, was getting way too long for his taste.

And then I had the idea: I would get some hair clippers and cut his hair for him. That would bypass an outing, which would bypass my insistence on pants protectors.

When I was in the Navy, I had used manicure scissors to help some of my friends pass inspections by trimming their hair so that it didn’t touch their ears. Other than that, and an occasional attempt to shorten my own bangs when I couldn’t wait for my next haircut, I have never cut anyone’s hair. And Dan knew it. Almost to my surprise, he agreed. So this was quite a step for both of us.

Yesterday I oiled the new clippers, wrapped a towel around his shoulders, and gave him his first haircut in several months. I had watched a number of YouTube videos in preparation, but his hair had grown so long that I more or less disregarded instructions and thoroughly sheared him (although I did use several guards in an attempt to create layering). And, since I was in barber mode, threw in a shave at his request. We were both pleased with the results.

I’ll doubtlessly get better at layering his hair and creating clean edges. But it was a good first experience. I helped Dan to get a haircut without breaking the rule I’d set for myself (and for Dan, although he doesn’t see it that way). He got a haircut without having to wear the pants protectors he so loathes. While we may have just kicked the can down the road, sometimes it’s important merely to move the can, without violating the boundaries and sense of agency of either party.

And, as it turned out, it was kind of fun.