Self-care and grooming

How in heaven's name is your normal brain involved in self-care like grooming (i.e. combing your hair, washing yourself) or taking care of your finances? Well, it is involved a lot! I wrote all these pages just to show you this because it is hardly ever realized or even understood by medical professionals, psychologists or family members.

First of all, you have to have some sort of feeling for hygiene or shame, or self-care. That is usually brought upon you in your upbringing or education at home. The media play a role here too because they bombard us constantly with people looking very neat and shiny. But this kind of feeling for self-care is actually residing in your brain, probably in your prefrontal brain regions. It is also coupled with anxiety, in the form of what we call 'shame'. Normally, we have learned to have some anxiety about being too undressed or unhygienic. So that is why most normal people do show embarrassment when their fly is open, have a stain on their T-shirt or face. When such embarrassment is absolutely gone or unnoticeable something is wrong. That's the reason a psychiatrist or neuropsychologist carefully looks at someone's selfcare, his hygiene and clothing. You can notice psychiatric patients who usually are not dressed quite well or have a stink around them because they did not wash themselves for weeks.

In daily life, when having a role like a payed job, we care about how we look and smell, we take care of ourselves. So we shave our faces (and more), put on make-up and/or a nice perfume, and carefully select our clothes. All signs of good self-care. Of course, everyone is different in choosing the right colors of clothing together. Taste is very personal. However, things do become different when someone's hygiene or appearance suddenly changes. Especially, when someone's really getting dirty, start smelling. Normally, that is a clear reason to start worrying about that person. Emotional problems but also an emerging brain disorder can be a cause of such kind of behavior. So, take a good look at your colleague or partner: is he/she starting to look like a bum? Then it may be time to call a doctor...

Self-care and your house-keeping

House-keeping (part of self-care) involves cleaning up your bed, your living-room, vacuum cleaning, dusting, but also washing your clothes and taking care of enough food in your refrigerator and preparing meals. What is normal brain functioning in this area? How can you tell someone is just plain dirty or develops a brain disorder? That is indeed quite difficult to tell.

However, as a neuropsychologist I certainly look at how someone manages his house-keeping. It tells me a lot. For example, when someone's place at home is a mess, it's quite dirty because the dishes haven't been done for weeks, the garbage bin is full and hasn't been emptied for days, and his clothes are not washed, then something is clearly wrong. It certainly can point to being unable to organize or plan things, or it can result from a mood disorder like a depression. The interesting detective work here is to find out whether it is someone's legitimate choice to live like this, or a symptom of a brain or emotional disorder. When such changes clearly deviate from someone's normal behavior for the last couple of years, that is definitely a reason to consult a (neuro)psychologist or doctor.

You can convince yourself by looking at other people: did you notice that most elderly in their 80s with a dementia do not take much care of their personal hygiene? Did you notice that little children between 1 - 3 years do not mind that much how dirty they are? They are not really capable yet to take care of this or feel very ashamed about it. Their self-care is obviously not developed enough.

To go back to house-keeping: it really requires knowledge and planning skills. You have to know a little about clothes and washing machines and washing powder. You certainly have to foresee when you need new clothes, when it is time to change the bed linen, when dust is getting a serious health problem. You'll need knowledge about these things but you also need appropriate emotions for this. Not having any shameful feelings or worries about hygiene or health hazards can be suspect of frontal lobe disorders. Even when someone says he's okay or 'just wants to live like this'.

Self-care and doing your finances

There is a large variability in the way people (with healthy brains) manage their finances, another part of self-care. How can a neuropsychologist tell whether there are signs of brain dysfunction by just looking at doing your finances? Well, actually he can't. Not without knowing how someone does his finances for the last couple of months, not without knowing if someone has the appropriate skills for doing his finances.

What are the necessary (brain) skills for doing your finances then? First of all, you have to understand numbers and the basics of math. That is something a neuropsychologist always checks in his assessment. Finding math problems can suggest problems in doing your finances. But your memory has to be sufficient as well. You have to be able to remember that you have outstanding bills. You also have to have planning abilities: to foresee if there will be enough money in 3 months. Memory, math abilities and planning skills can be inadequate or insufficient even in 'normal' people and can explain that their handling of finances can be a mess.

Another problem with money can be more emotional: spending too little (less common) or too much (fairly common). In the first condition normally too much anxiety plays a role, being anxious to loose your money. In the second condition, spending too much, can result from obsessions for new things, not being able to resist exciting new things, wanting to be more than just an average person, getting kicks through addictive gambling. There actually are many reasons why one spends too much, especially when emotions are concerned. In rare occasions a brain tumor can damage the frontal lobes so that impulsive behavior increases, or the normal anxiety for loosing precious money is lost. But in such conditions usually other abnormal behavior can become obvious as well. Such as abnormal risk-taking behavior at work or in traffic.

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