”It is not possible to comprehend the devastating impact of apparently minor cognitive changes without understanding the nature of how we maintain our sense of self. “Sense of self” refers to the balance, the integrity, the system the feedback that we all instinctively establish to keep constant our identity”, our sense of self of who we are. It involves the ability to do certain things and not others, to react and perform in ways that are predictable and expected, and generally run our lives based on what we have learned we are able to do.

”This appears to be the case because the deficits encountered after minor head injury are unexpected and not apparent to anyone else. Without appearing or feeling any different, the lawyer suddenly is unable to prosecute his cases with the same success. The salesman failed to persuade his clients. The housewife cannot cope with three children in the house to organize. The writer loses her creativity.

”When these things begin to happen for no apparent reason, our sense of who we are shaken. We begin to lose confidence. We begin to doubt ourselves. What was once automatic, we now find ourselves thinking about. We begin the second – gas out every move, and anxiety becomes condition to new situations where we worry that we may not succeed. What differentiates this process from anxiety of neurosis, is that it is grounded in an organically – based dysfunction. While anxiety may build to proportion to go beyond the extent of the original dysfunction, one cannot deal with the anxiety without taking into account the very real dysfunction that fuels it.

”Eventually, the anxiety becomes one of the factors fueling the cognitive breakdowns, and the doubt becomes a self – fulfilling prophecy. Confidence in the ability to negotiate life smoothly, automatically, and efficiently is lost; the sense of self is shaken, and may ultimately be destroyed.