Tuesday 5th May.

Wade tells me the Clubhouse isn't so much about socailisation, it's a learning experience. He's not college educated, he says, but to him the Clubhouse is like a college education. 'I've learned things from people here. I've learned things from John. John has seizures, I have seizures.' He got his injury falling off a rock at the age of eight while in Korea with his family. His mother is Japanese. Today he has brought in a tray of sushi that she made. He lives in another town North of Cville, on the way to Culpeper. His father brings him in. He used to drive but four years ago he was in a car wreck. He was at a four-way intersection when he had a seizure and lost consciousness. They took his licence away. In the US you have to be clear of seizures for six months or a year or so before they give it you back. He isn't in a hurry to get it. 'I want to drive, but I also don't want to kill anyone.'

Brandon was in a car wreck too. He has a few small scars on his face. His mother died when he was four. She had an insurace policy. When he was eighteen he received a cheque for twenty thousand dollars. He got another cheque for twenty thousand each year until he was twenty five. His father had remarried, he didn't see much of him. 'Because of the kind of people I was hanging out with, I didn't see any of that money.' When he got out of hospital, another cheque was waiting. His friends called him up. He bought the drugs and the money was gone within a month. 'About eighty or eighty-five percent of my life before the injury is gone,' he says. 'The bad part is that all the things I remember are the bad things I did - the things I'd rather I didn't remember.' He's writing a thank you letter to Lisa, the owner of the recording studio he visited last night with Leigh. He wants to work in sound engineering. In the letter he says 'I expect you get a bunch of letters like this, but I think mine is the most sincere on account of my situation.' It's a good letter and I tell him so. He shows me a ring binder he carries with him. Inside are a notepad and 89 pages of computer printed text. I know there are 89 because he tells me. He wrote them in hospital. 'It's explicit,' he says 'there are curse words. A lot of it is poetry.' He says he was angry when he came round in hospital after the accident. He was angry til quite a long time after that. Now he says he's let it go. He's applied for college. He hopes to go back to Lisa's studio to learn more, may be when a band is there recording next time.

Scott was injured at work. He ran a construction company. He had a fall. He's done some work since his injury, but not a lot. This week he's going to drive down to his parents' house in the valley. It's a farmhouse with eight hundred acres, right on the Roanoke river. When he was eighteen he would spend the summers there on his own most years, working with the farm labourer the family employed. He goes down there now pretty regularly, but only in the summers. He goes fishing in the river. The have striped bass up to twenty pounds. He's caught one of fifteen pounds, he says. He holds his hands apart to show me how big. The bass are salt water fish that usually only come into the river's to breed. They got trapped there when they built the dam. Somehow they didn't mind living on in the fresh water and bred and now, if you're lucky and catch a shoal you get a fish on every cast. Some people go out on boats, stunning the fish and extracting their roe for breeding in farms. He doesn't know what happens to the fish, doesn't know how they get the eggs out of them.

Brandon, Wade, Scott.

Jason uses a computer to communicate. It's on an arm attached to his electric wheelchair. It has icons on the screen and a voice that speaks what he types. He also has software that makes the Clubhouse computers easier to use. He enters the data for the member hours and member days into a spreadsheet. He asks me about my relatives. I tell him about my cousins. I tell him they play ultimate frisbee. I say they're quite geeky about it, they have meetings. He laughs. To make sure I get the point he keys the words 'Ha ha ha' into his conole and has the machine speak it out. He's a sports fan but he thinks Ultimate is for losers. He's into baseball. I tell him I'll be sure to pass the message on to James and Oliver.

Leigh emails me to say she has checked the population figures: there are 147,000 living with brain injury in VA. This sounds more like it. I have to check with her about the costing she quoted. I am convinced I remembered it wrong. And what sort of programme was it? Tomorrow I will meet her early to go to Roanoke, where we'll visit the Phoenix Star Clubhouse.

Monday 4th May.

I go back to the Clubhouse.

I really had the big question answered already, on Friday afternoon when I came in first. When Leigh talked about the criteria for membership and said: 'You have to want to be here.' I poked a little further and she elaborated. Yes: the point of the Clubhouse is that it's about people who can consciously choose to attend, who know where they are and why they're there and what it is their aiming at. People who can't do these things (and there are plenty of them) won't do well - the Clubhouse isn't equipped for these people and doesn't suit them. Which is fine. It's good to know what it's about, to know that the model has a point and that that point is well defined. So. My visits will be about putting flesh on those bones and that's what I begin to do today. What I learn:

- The Main Street Clubhouse presently has 15 members.

- It has been open since 2001.

- 95% of its funding comes through the state.

- It's part of a larger organisation called Lake View Neurocare, which provide residential and inpatient rehabilitation for other groups with ABI including those from the military.

- This in turn is part of a broader network of services across Virginia including case management, transitional living, supported housing etc etc. It's a bit of a jumble for me still, but I will refine my grasp as I go.

Some fuzzy statistics also surface in conversation with Leigh today. At one point she mentions that VA has something like 7000 people with brain injury, which sounds very low to me (the population is 7,769,089 according to google). More alarmingly, she says that a recent estimate by the state costed a suggested programme for people with ABI, with 200 slots, at over $13million. I suppose this must be a life-time projection. But 200 people? $13million? I have to be distressed by this figure. My (political) agenda is predicated on the idea that services for people with disabilities should not be and don't have to be expensive, that people can and should be supported to do most of the work they need themselves and for each other. And this is what Clubhousing is about too. Although, as already established, a large section of the the BI population is excluded from the Clubhousing model as currently described (assuming the Cville branch is typical). The hypothetical millions are presumably ring-fenced for a population who aren't engaged in anything like this peer-support project.

Anna makes her way to the vending machines round the corner to collect the morning's newspaper. And safely back again. To get there you take a left out of the Clubhouse, and another left. No more than fifty yards. Sense of direction seems to be her big challenge. And crowds. Somebody suggests she show me where the post office is (this is another task - there's no post to go today, but it's good practice). Anna winces and puts a finger to her forehead. She can't remember if it's a left turn or a right turn to get there. She changes her mind a few times. She says it bothers her not to know which it is and I get the feeling she might rather avoid the trip. But she puts on her coat and we go for it. It's a right turn. Judy, the other staff member at the Clubhouse, points out the dark blue post bins about a hundred yards down on the other side of the street. Anna's nervous most of the way. She hasn't made this walk nearly as often, especially lately with the re-bricking going on. She pauses several times, sunglasses on, the rain spatting on her hood. 'I'm not confident about this,' she says. She does a good job and we get there and back with no problems, but I can see how her difficulties could be limiting. This is a big project from her and she gets a lot of encouragement from Leigh and Judy. From the sound of things, she is making real progress.

John and Leigh deal with the database. All the work is divided up carefully, broken down into subtasks and steps that the members can follow, with cues and procedures that keep you on track. Here John is entering the hours from last Friday - who came in at what time and when they left, which work team (kitchen, office) they were on for the day. John takes his time filling in the cells of the spreadsheet, methodically, but gets a little stuck at the end, unsure how to save his work. Leigh offers prompts from the other side of the room but something out of the ordinary is happening and she eventually steps in. Leigh explains that John has aspirations to get back into paid work. They have agreed that they will only support him in this goal once he can prove that he's able to make it in on time each day, to show he has the ability, in principle, to organise himself. The time sheets help test this. Realism seems to be a big thing here, and people aren't shy of a little confrontation. At the sink, John gets it in the neck from Anna when she thinks he's trying to barge in. She's getting more assertive, says Judy. 

Every time I step out of the front door of James' apartment I turn the wrong way. The stairwell is to the right (the brown double doors), but every single time I have so far turned to the left and walked towards the little hallway there. I have the same problem coming back in: opening the double doors I don't know which side the apartment is on. I can't explain it. I think about Anna and her lefts and rights.

James gives me an alarm clock. It doesn't work. You get what you pay for, he says.

Sunday 3rd May. I write an email to Larry Schutz, the director of the mentoring programme in Florida that I've penciled in for a May visit. I ask him whenabouts would be good, now that I'm here in Virginia. In his reply he tells me his programme has 'collapsed' and that he's moving to California to take up another job. He says something about a 'bankrupt state treasury', some problems with the University that was hosting the programme. It sounds bad. I feel disappointed. I'd been looking forward to meeting Larry. He'd been enthusiastic in earlier emails. He says he'd be happy to set me up with other TBI folks in Florida. I don't know who these might be. Would it be interesting to see the fall-out from the collapsed programme, meet the people who were on it? I don't know. I already start thinking about canceling this leg of the trip. Leigh had said on Friday the reason Virginia has so many programmes (including Clubhouses but also others) is that the sate funding stream is healthy. Do I want to see functioning programmes or failing ones? Perhaps not going to Florida would free up some time for other things - a visit to the West Side Health Authority in Chicago?

Saturday 2nd May. There is a bird here called a Cat Bird. It makes a noise just like a kitten calling its mother. At dawn, when it joins in with the other screw-ball bird I filmed yesterday, the courtyard sounds absurd, like some idiotic pet shop.

Friday 1st May (evening). As well as the re-bricking, Swine Flu comes up a lot. James says it isn't Swine Flu, it's Influensza H1N1. There are jokes about catching it off mosquitos, about how pigeons can carry it, but if that's the case then isn't it Bird Flu? About the stew my dad used to make, with pigeon and pork and rabbit whatever else came along. Can you get Rabbit Flu?

We go out to Main Street again and lot of people are there. It's Friday night. A lot of teenagers. A lot of students from the University. A girl at the crepe stall has a black eye. One of our party, another Anna, orders a crepe made with buckwheat and filled with ham, cheese and strawberries. It's a new combination she's trying. By the time she's eaten the top half, the bottom end has denatured into a shiny grey swamp. On the way back to the apartment, James and I talk about chronic pain syndromes, about fibromyalgia. He says what a disaster it is when people get referred to the University for diagnosis. How he thinks it might even be harmful to them. They get scans done, they discover an illness they can't understand because the doctors don't, nothing gets solved. People with fibromyalgia get chronic muscular pain, symmetrical aches in opposite parts of the body, plus a weird collection of diffuse symptoms affecting sleep, cognitive function, digestion and weight, vision, movement. I ask him if it's another name for what Freud called Hysteria? He says 'I could believe it.' There have been a lot of names for this. Cassandra Complex, Hysterical Neurosis, Hypochondriasis, Somatization Disorder, Conversion Disorder. It's a collection of problems, real things that people suffer from, with real pain, but with causes that are hard to find. Doctors don't like these things. They're hard to pin down. The conversation reminds me of something called Post-Concussion Syndrome. Most people get better after concussion. About 10% continue to have problems - headaches, loss of sleep, memory problems. Nobody knows why. It's something to do with anxiety, with being unhappy, with becoming hyper-vigilant for the symptoms of concussion. It's hard to treat. There's no medicine for it. Nothing you can give a person.

Friday 1st May. Cousin James is studying medicine at the University of Virginia. At his apartment he has some books on consciousness and the brain, some I've read, some I haven't. We talk about neurology a bit. We talk about Bill Murray's character in Wes Anderson's film The Royal Tennenbaums, the bearded neurologist who spends his time developing his diagnosis of a boy who with a collection of mild and apparently random difficulties (being colour-blind, being unable to complete block-puzzles etc.). In the film, Murray's character (based, surely, on famous neurologist Oliver Sacks) continually refines his investigation, searching for new ways to test his subject, but never offers anything in the way of advice, treatment, or reaction of any kind save to comment, with a flush of excitement, at each new discovery, 'How interesting, how bizarre!' 'That's what I'm starting to understand about neurology,' says James, 'the cases are interesting, they're fascinating, but there's damn all you can do about it.'

They are re-bricking Main Street. It's a topic that crops up a few times. Oliver tells me it's costing $7million. A lot of people are upset about the expense. I spend the afternoon at the Main Street Clubhouse. I meet Leigh Wion, the director, and some of the members. Leigh says the re-bricking has been a hard time for the Clubhouse but the new bricks are better. The old ones got loose and members used to trip over. It turns out Leigh knows my uncle Tom. He was her allergist. He works at the University of Virginia. She says she earned good money participating in his research programme. A girl called Anna shows me around and we talk for a while about how and why she comes to the Clubhouse. I learn that Anna is a brown belt in Tai Kwan Do. She can break cedar wood boards with her hands and her feet. She is also good at singing and learning music. She tells me she doesn't like crowds. If there's a crowd she puts on her sunglasses, even indoors, because it helps her concentrate and keep going in a straight line.

Leigh says the Clubhouse has only a few criteria. 'You have to want to be here. You can't be a threat to the Clubhouse.' She says how sometimes higher functioning members take a while to come round, to work out that it's not all about them, that everyone has a contribution to make, that everyone has their strengths and weaknesses. She says sometimes when a person has been more recently injured they may not be ready to come to the Clubhouse - it can take time for them to know what they need, and what they want. She says in her experience the hospital system can condition people not to take decisions, to rely on other people to organise them and take responsibility for their planning. The point of the Clubhouse is to help people stop being patients, start being people again. I say to them, 'It's your life.'

Leigh has booked me in to spend Monday and Tuesday with them. I'll team up with Anna and see what the day is like. Leigh also says she can put me in touch with Harvey Jacobs, a key figure in the Clubhouse movement, based in Richmond, a couple of hours to the East.

I have no idea what this bird is.

Thursday 30th April. I wouldn't normally do this. It's embarrassing. There are people around and I am wearing a rucksack. I do it quickly. In the name of journalism. 

The same building (in the middle) from much further away. I am on the 2:15pm 19 Crescent from New York Penn Station to Charlottesville, Virginia. It's a six hour trip that takes in Philadelphia, Wilmington, Baltimore, and Washington DC. 

60 seconds of New Jersey.

The railroad attracts the broken and derelict things in each town. Scrap metal piles up, like the rails are magnetized, held back by the fencing. A lot of old cars and trucks, stacked up. Long landscapes of discarded tires. Bizarre, abandoned industrial structures I can't explain. In Baltimore even the houses conform to this type with whole bombed-out streets within throwing distance of the train: windows boarded up, walls fallen away so you can see the insides, terraces crumbling at their ends.

A train on the way to DC has broken down and ours makes an extra stop to pick up the stranded passengers. A woman sits down next to me, breathing hard and shaking her head and answering phone calls. A little later I wake up and she seems to be feeling more relaxed. She wants to know about my trip. I try to explain. I say that in the UK we rely a lot on the statutory services when people get into trouble. The NHS is our safety net. In the USA people can't count on the state to the same degree. So when someone gets injured, communities in the US often have to come up with their own solutions. I tell her that's why I'm here, because the US has a diverse set of solutions to the same problem, and because many of those solutions have been developed by communities without direction from the state. I say that's what I've come to look at - the different solutions. It's an explanation I've used a few times now - on the plane, in the taxi in New York, now on the train. I can't tell if I came up with it before, when I was planning the trip, or if it's something that's appeared since I set out. It seems to sum it up well enough.

10:20pm. Arrive in Cville. My cousins Oliver (left) and James (right), and Lika the dog. I will be staying with them while I make my plans for the Virginia visits.

Under the sweater I am still wearing the Headway Dance Marathon t-shirt. Point made. I will wash it soon.

Wednesday 29th April. Before departure. I leave it a bit late with the packing.

On the plane they have a water dispenser with these little blue conical plastic cups. I watch Milk, the Gus Van Sant film about Harvey Milk, the San Francisco District Supervisor who campaigned for gay rights and was murdered in 1978. The film features a voiceover by Sean Penn, who plays Milk. Towards the end of the film Penn's voice revisits a famous speech by Milk in which he refers to the common cause of what he calls "the usses":

"without hope, not only gays, but those blacks, and the asians, the disabled, the seniors, the usses, the usses, without hope, the usses give up. I know that you cannot live on hope alone. But without it, life is not worth living. And you, and you, and you... got to give them hope."

It's a moving scene, as 30,000 people are shown marching the streets of San Francisco, each one holding a candle in mourning for Milk's death.

I have arranged to stay with my landlord's nephew, Paul, but when I arrive at Newark I can't get hold of him. My mobile phone doesn't work in the states. The payphones are temperamental. I call twice but he doesn't answer. I find the bus stop I need to get to the train station and a young hispanic guy says I can borrow his cell phone to call Paul. This time I get through. The young guy also gives me a dollar to get the bus (they only take exact money). The bus is very full. There are two white faces onboard and one of them is mine. I don't get it. I sit next to a slender old Asian man who speaks little English. He tells me Newark Penn is the last stop. After a while the crowd thins and he gets up and moves to an empty seat. People are laughing and talking to each other. A girl hits a black guy in a hoodie over the head with a carrier bag as she goes past, smiling. The Hispanic guy from earlier walks down from the back and sits opposite my old Asian friend. They touch each other on the arm and share a joke. It's like everybody knows each other on this bus. I borrow two more cell phones from strangers. One at Newark Penn (another Latino) and one at New York Penn (Manhattan), where a young black guy tells me that he is from England too. He was born in Birmingham, left there when he was eight years old. 'You lost your accent,' I say. 'Yeah,' he says, 'I can't get the girls no more.' He plugs his phone into a socket in the wall and lets me ring Paul.

At the bar. From the left: Ronen, Nik, Rich, Paul, me. It is an Irish bar in Midtown. The menu includes baked beans on toast for $6. They play Robbie Williams, they play Coldplay, they play an old hit by Garbage. I eat some food and drink a pint of India Pale Ale and feel fine. I drink half a second pint and feel a lot less fine. It's 10pm, New York time.

I stay at Rich and Ronen's place. They are friends of Paul's, working for the same company. I get to bed just after midnight, New York time, about 22 hours after I got out of bed in London. About 18 hours after I shaved my hair in Phil's bathroom in Islington. I wake up at intervals, thinking about what I should write in this blog.

Thursday 30th. In the morning I open the window and look out. The apartment building is at the North West corner of Central Park, at the bottom end of Harlem. Outside a man is shouting in the street. His words are clearly audible. Warning: this clip contains murder threats and strong language. 

Having caught it on video, I ask myself if I should take it to the police? Or try to find Steve? I don't think the man can be identified from the footage, can he?