Self-Reflective Meaning Making in Troubled Times

Abstract

Our aim with this article is to clarify the concept of change in self-identity following traumatic brain injury (TBI). We used concept analysis methodology-predominantly concept clarification. We identified 110 articles using a systematic literature search, and used critical appraisal, content analysis, and analytical questioning to explore attributes and boundaries. A reported change in self-identity is the ultimate expression of a variety of cognitive, psychological, and social sequelae of TBI. We present an integrative model of this process, identifying three potential levels of change: (a) component parts (egocentric self, sociocentric self, and "identity as shared with others"); (b) integral processes (self-awareness and expression via meaningful occupation and narratives); and (c) whole-system disruption. Change in self-identity after TBI is a highly individualistic process. The driver of this process is "self-reflective meaning making," giving a purpose and direction in life, providing motivation and goals for future behavior.

Recovery and adaptation after traumatic brain injury in New Zealand: Longitudinal qualitative findings over the first two years

“…The various processes that contribute to recovery and adaptation identified in the present study also further support findings from studies that have focused on aspects of long-term recovery and adaptation such as reconstruction of self-identity and life roles, and the importance and complexities of social connectedness (Gelech & Desjardins, 2011;Levack et al, 2010;Martin, Levack, & Sinnott, 2015;Nichols & Kosciulek, 2014;Salas et al, 2017;Sveen et al, 2016;Thomas, Levack, & Taylor, 2014). Our study brings together these and other elements in a way that offers a new conceptualisation of what recovery and adaptation after TBI entails over time from the perspectives of those living it (people with TBI and significant others).…”

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

“…In other areas of injury finding meaningful occupation is important for self-identity, which is constructed through interactions with others. 107 In this study those who lived alone or could not find meaningful activity struggled with getting on with life.…”

Neuroethics across the Disorders of Consciousness Care Continuum

“…It typically occasions unexpected, sudden, and dramatic diminution in core features of human identity, raising ethically fraught questions about life, death, and suffering. 67 68 69 70 71 Unlike other neurological conditions that emerge gradually and allow patients and families to prepare for signs and symptoms of disease, severe acute brain injury is abrupt, strikes without warning, and is immediately disabling. Ethical challenges in the hyperacute phase of DoC—in the moments immediately following injury until hospital arrival—often hinge on the sudden and unexpected nature of the medical condition.…”