Meaning in Life After Traumatic Brain Injury

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Meaning in Life After
Traumatic Brain Injury
George P. Prigatano, Ph.D.
State of the Science Conference for the RRTC on
Community Integration of Persons with Traumatic
Brain Injury
April 12-13, 2007 Arlington, Virginia
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The question of how to help persons who suffer
traumatic brain injury (TBI) establish or
reestablish a sense of meaning in life after
their brain injuries can best be answered by
comparing patients who have achieved this goal
vs. those who have not.
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• There are, however, no randomized control studies
  on this topic, or an empirical literature that
  guides clinical practice.
• A recent Pub Med computer search on papers
  dealing with meaning of life after traumatic
  brain injury, spinal cord injury (SCI), CVA or
  stroke, and dementia revealed very few
  references.

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Search for meaning of life and neurological
disorders Database PubMed Span 1996-2006 La
nguage English
Many papers emanated from the nursing literature
and provided primarily qualitative analysis of
what patients report experiencing in their
life. Thanks to Franziska Maier, M.A. for
conducting the PubMed search
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• An exceptionally insightful paper focused on the
  existential concerns of family members in the
  care of late-stage demented patients (Albinsson
  and Strang, 2003, Journal of Palliative Medicine,
  6 225-235).
• Citing Yaloms (1980) work, Albinsson and Strang
  (2003) note that existentialism deals with
  questions of life, its origin and its conditions,
  and the basic condition of being human.

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Yalom (1980) identifies four recurring basic
conditions that present a challenge to mans
existence. These four conditions capture the
central elements of existentialism and comprise
(1) death, (2) freedom that involves
responsibility and choices, and therefore also
anxiety and guilt, (3) existential isolation,
which forces us to establish relationships, and
(4) meaninglessness, which makes us to search for
meaning or create meaning.
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In my clinical experience, these four issues are
indeed extremely important anytime individuals
face major losses in life. What follows are my
clinical observations which emanate from
clinically directing two neuropsychological
rehabilitation programs (Prigatano et al., 1984
Prigatano et al., 1994) and my continued efforts
at psychotherapeutic interventions with patients
who have suffered severe TBI and their family
members (Prigatano, 1999).
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Some assumptions based on animal behavior,
writings in the humanities, and
psychoanalytic/analytic theory that influence the
study of meaning in life

• Human beings need each other for survival and for
  personal (psychological) sense of well-being.
• Yet, human beings consistently fight with one
  another when placed in small (and large) groups.
• The reasons for the discontent with one another
  are many, but often include

• Establishment of a dominance hierarchy.
• Allocation of resources (food, shelter, money,
  availability of a sexual partner).
• Establishing a niche where the individual meets
  the needs of the group, while at the same time
  meeting their own need to express their
  individuality (i.e., get their individual goals
  met as well).

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• To keep the discontent and fighting to a minimum,
  different groups establish different rules for
  controlling the behavior of group members (which
  is necessary for physical and psychological
  survival/quality of life).
• The activation/maintenance of these rules
  requires symbols which guide and control behavior
  (including cognitive and affective reactions).

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Clinical observations Patients with TBI who can
still relate to the symbols which evoke a
personal sense of well-being often report meaning
in their life. Patients who cannot relate to
such symbols report meaninglessness and this is
often associated with uncontrolled
anger/depression.
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• Three popular symbols in our culture that
  brain-dysfunctional patients can no longer relate
  to are
• Being highly intelligent.
• Physical beauty.
• Being 1 - always winning.

Prigatano, G.P. (1995). 1994 Sheldon Berrol,
MD, Senior Lectureship The problem of lost
normality after brain injury. The Journal of
Head Trauma Rehabilitation, 10(3), 87-95.
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• Patients who can relate to the symbols of
• Work (be productive provide a product or
  service that is valuable to another)
• Love (experience another persons
  well-being as important as your
  own)
• Play be true to yourself live the life
  you fantasize living (conscious
  and unconscious motivations)
• Often report their life as meaningful.

Prigatano, G.P. (1989, September). Work, love
and play after brain injury. Bulletin of the
Menninger Clinic, 53(5), 414-431.
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Patient examples Those who have achieved meaning
in their life

• The mailman from Minnesota.
• The accountant who gives the gift of love.
• The Vietnamese immigrant who placed his brain
  injury into a philosophical perspective
  consistent with his cultural beliefs.

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Patient examples Those who did not achieve
meaning

• There is safety in silence The TBI patient who
  refused to speak in groups.
• I hate having to use compensations The young
  woman who refused to sustain voluntary work
  activity after a moderately severe TBI.
• I can do anything I want to do, but people are
  continually putting me down. The severely
  impaired TBI patient who showed signs of
  anosognosia 15 years post TBI.

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Summary and conclusions

• Helping persons who suffer TBI establish meaning
  in life requires drawing on a wide body of
  knowledge that ultimately helps people deal with
  losses while functioning within small groups.
• The underlying motivation for seeking meaning in
  life is to establish a psychological sense of
  well-being. It is a major challenge that that
  human beings experience as a part of our
  existence before or after brain injury.
• This psychological sense of well-being can be
  achieved in many ways, but ultimately it relates
  to whether or not an individual can relate to
  symbols that exist in their society, which help
  them deal with their personal suffering, while at
  the same time contributing to the group effort
  (i.e., the physical and psychological quality of
  life of others).

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