Spirituality in the presence of brain injury

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Spirituality in the presence of brain injury

• Joanna Colllicutt McGrath

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What is spirituality?
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Spiritual IntelligenceGardner (1999)

• Concern with cosmic or existential issues
• Achievement of a state of being
• Effect on others charisma

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The Spiritual Life(Collicutt McGrath, 2003)

• Is informed by values and higher order goals
• Takes subjective experience and the inner life
  seriously
• Consciousness
• Emotion
• Reflection, which may be directed towards the
  transcendent
• Has a social place reflected in coherent and
  integrated roles and relationships

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The unspiritual life

• No values and largely hedonistic goals
• Little engagement with subjective experience and
  the inner life
• Fragmented social roles and relationships
• worst form involves treating other people as
  objects.

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A Judaeo- Christian theological perspective on
the spiritual person

• Imago dei
• St. Augustine and the human trinity
• Memoria
• Intellectus
• Amor

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Questions raised by acquired brain injury

• Loss of abilities necessary for the spiritual
  life
• Loss of personal identity
• Loss of human status (loss of the image of
  God?)

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What is acquired brain injury?
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Key characteristics

• Sudden-onset cerebral event in adulthood in the
  context of previously normal brain function
• Psychological, and often physical, impairment of
  varying types, degrees, and combinations
• Non-progressive course
• Initial relatively rapid recovery followed by a
  slower phase, with full recovery of past function
  very rarely achieved.
• Normal life expectancy (often not always)
• Effect on families at least as significant as on
  identified patient

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Types of impairments

• Motor
• Sensory
• Visual
• Auditory
• Emotional
• Emotionalism, alexithymia
• Cognitive
• Attention
• Visual perception
• Action (praxis)
• Language
• Memory
• Executive

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Example 1 The Amnesic Syndrome

• Normal working memory
  (telephone numbers)
• Normal semantic memory
  (general knowledge)
• Normal IQ
  (problem-solving)
• Retrograde amnesia
  (memory from before the injury is lost)
• Dense anterograde amnesia
  (new memories are not laid down)

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Example 2 Dysexecutive Syndrome

• Impaired planning and execution of goal directed
  behaviour
• Impulsiveness
• Disinhibition
• Poor self-monitoring
• Concrete thinking
• Perseveration
• Egocentricity
• Lack of initiation

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Personal Identity

• Physical identity and integrity
• Free and independent movement and action
  (autonomy)
• Habitual behaviours and behavioural style
• Social place (roles and relationships)
• Personal narratives

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Other key questions for people with ABI

• Will I be normal?..
• Why did this happen to me?
• Is life worth living after this brain injury?
• Prigatano (1991)
• Existential questions about self (identity and
  worth), the meaning of life, and the future a
  search for significance and hope

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Paradox

• Religion-spirituality is a search for
  significance in ways related to the sacred
• Religion-spirituality comes to life in critical
  situations
• Pargament (1997)
• Spirituality emerges because of the loss of
  psychological bases of personal spirituality -
  the edge of efficacy

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Some Religious/Spiritual/Existential Themes

• Transformation of suffering
• Frankls logotherapy
• Posttraumatic growth
• Religious images of ambiguous twilight zones
• Sheol
• The grace of God
• Humanity, identity, and worth conferred by
  significant other(s), not intrinsic to individual

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• What is man?
• That Thou art mindful of him (Psalm 8.1)
• What if I cant remember anything?
• Can a mother forget the baby at her
  breastthough she may forget, I will not forget
  you (Isaiah 49.15)
• What if I no longer have the capacity to
  understand about God?
• you know God- or rather are known by God
  (Galatians 4.9)
• now I know in part then I shall know fully,
  even as I am fully known. (1 Corinthians 13.12)

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• What if I am not capable of loving God?
• This is love not that we loved God, but that he
  loved us (1 John 4.10)
• What if my behaviour is poorly controlled,
  impulsive, and immature?
• Let the little children come to me and do not
  hinder them, for the kingdom of heaven belongs to
  such as these (Matthew 19.14)
• For it is by grace you have been saved through
  faith and this not from yourselves, it is a
  gift of God not by works, so that no-one can
  boast. (Ephesians 3.9)

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Clinical applications

• Spiritual agenda to be addressed
• Loss
• Hope
• Acceptance of a new and ambiguous identity
• with both patient and family
• Helpful religious forms
• Sacred narratives wilderness journeys, exile
• Ritual for the negotiation of liminal states
• Mode of delivery
• Support for impaired language
• Multimodal
• Support for impaired memory, including routine
  and repetition
• Godly Play?

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References

• McGrath, J. (2003). Beyond restoration to
  transformation Positive outcomes in the
  rehabilitation of acquired brain injury. Clinical
  Rehabilitation 18, 767-775.
• Collicutt McGrath, J. Linley, P.A. (2006).
  Posttraumatic growth following acquired brain
  injury. Brain Injury 20, 767-773.
• Collicutt McGrath, J. (2007). Ethical practice in
  brain injury rehabilitation. Oxford University
  Press, Oxford.
• Collicutt McGrath, J. (2007). Recovery and
  rehabilitation from brain injury. In Joseph, S.
  Linley, P. A. (eds) Trauma, recovery and growth
  Positive psychological perspectives on
  posttraumatic stress. Wiley, New York (in press).