From unconscious to self-conscious : cognitive rehabilitation from the perspective of symbolic interactionism : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Social Policy and Social Work at Massey University
There is increasing awareness and concern that psychosocial problems prevent people with brain damage reestablishing an acceptable quality of life. Changes in perception and cognition appear to alter a person's relationships, preventing a successful reintegration into the community. As a result, many researchers and rehabilitation practitioners have been calling for more holistic models of recovery which recognise the psychosocial domain and which offer strategies to counteract these problems. In this study, the principles of symbolic interactionism are used to explore the experience of four people with traumatic brain injury. A life history was collected for each person and the four life histories were examined for common patterns and themes. A videocamera was then used to record their daily life in a residential rehabilitation programme. The film collected included formal one-to-one therapy sessions, group situations and informal interaction in the living areas, dining room and passageways etc. The four people (and also those with whom they interacted) were shown selected excerpts from this film and interviewed about what was happening. Several common themes emerged from this process and these themes are examined within a theoretical framework which recognises the central role of a dual, interacting and interpreting self, creating meaning through an adapting and accommodating process. Theory and literature about brain damage and about inner brain processes is revisited from this perspective of the person as a meaning negotiator and some conclusions are reached about the impact of brain damage upon lived experience. In particular, the role of a moral self or an inner conjured audience is considered, as well as the role of emotional intersubjectivity within relationships. Some new insights are offered as to how people resolve the problem of continuing to interact with their world when it is difficult for them to make sense of it or interpret it, and how other people's responses influence this process. The findings of the research suggest adaptations to both settings and relationships may be necessary for a successful recovery after brain injury. The importance of providing scaffolding of the meaning-negotiating process during a liminal period of recovery is noted. Some suggestions are offered as to interactive strategies which foster adaptive, purposeful and independent lifestyles. The thesis concludes that because realities are created through interaction, the principles of symbolic interactionism should become more central in the designing of rehabilitation programmes.