Case Study: Recovery Through the SELF-NARRATIVES of Others




Recovery From My Traumatic Experience




December 23rd 2009, just two days before the celebrated birth of Jesus, I almost lost my life. Waking up from a coma dazed and confused in excruciating pain after suffering a severe traumatic brain injury, I remember seeing nothing but the white ceiling wall above my head as if I were awaiting God to open the doors to let me into the pearly gates. I remember not being able to move any part of my body because my hands and feet were strapped down to the hospital bed. I wanted to move my head in different directions to see where I was but I could not because the nurse placed a cervical collar around my neck. I remember trying to scream, “HELP” but only loud incomprehensible murmurs coming out of my mouth. I remember viciously trying to release myself from the restraints but not being able to because of the massive mitts covering both of my hands. I wanted to scream my mothers name as tears dropped down my face. I remember my heart beating faster and harder than ever before as fear began to consume me. With tears falling down my face and sweat permeating through my pours, I felt alone and scared. Then, from the corner of my eye, I saw a figure moving towards me. It was a person, but someone I had never seen before. She had long dark hair and wore matching green clothes with a mask over her mouth and nose and gloves on both of her hands. This woman approached me very calmly and as she got close she slowly took the mask of her face and looked me in the eyes. It felt like eternity, as I lay there helpless just staring up into the eyes of this unknown woman. She finally opened her mouth and spoke very softly. She told me that she was a nurse. She told that I was in the hospital. And, she told me that everything would be okay.
IMG_1051.JPG

Unable to move, unable to speak, I had a throbbing headache but my mind was running at a million miles an hour. I wanted to ask the questions that were circulating through my head but when I tried none of the words made sense. The more I tried to create a cohesive sentence the worse my headache became. So I stopped trying to speak with the hope that someone would explain to me what had happened. As I lay there feeling helpless and confused my family entered the hospital room. Everyone was crying as they quickly approached my bed to see how I was doing. I was happy and relieved to see familiar faces but seeing them made me cry. At that time, the tears rolling down my cheeks were the only way for me to express emotion. My family was only there for a short period of time before the nurse told them they had to leave. Each of them leaned over and as they gave me a kiss goodbye I could feel their tears trickle down onto my face. I was once again alone and this time I knew I was going to be spending a longtime in this hospital.

The next six months of life would prove to be my greatest challenge ever. At the beginning I did not know what I was up against, the whole situation seemed almost surreal. It was not long after being released from the hospital that I began intensive rehabilitation process. Appointments with a neuropsychologist and a speech linguistic therapist became part of my weekly routine. These meetings were helpful for my recovery and as each week passed I began to fully understand the severity of my head injury. I do not remember the earliest years of my life, however I can imagine that each day of my early post-injury life was similar to my years as an infant. As I met with my linguistic therapist I would try my best to remember the words she had previously taught me but to no avail. Often I felt overwhelmed with the words she would have me remember. There was no connection between my brain and the images that were presented to me over and over again. Imagine trying to connect to the internet day after day but not being able to find a functional network connection, that's how I felt.

My psychologist would ask me questions like, “how are you feeling today” and “how are things going at home for you?” My thoughts were so disorganized it seemed as if I had writing an essay with the conclusion in the middle and no theoretical framework to base it off of. I was irritable and my temperament only seemed to be getting worse as the weeks passed. Time went by so slow and often my hope for a bright future would turn into despair. At home things were not much better. I knew that my family was there to help me in anyway possible, however I became self-absorbed and overbearing at times. I had lost compassion for the ones who loved me the most. The explosive personality I acquired was a result of my negative attitudes concerning my personal life as I saw all the cheerful and optimistic people around me.

I knew that I had to change the way I was acting because I could see that my passive aggressive attitude was negatively affecting my family. I began reading different books and attending group therapy sessions both of which gave me hope for a positive future through the narratives of other traumatic brain injury victims. In some of the narratives people described how spirituality and their belief in a higher being helped them through their recovery process. I was brought up Catholic and my family attended church every Sunday, but as I grew older I began to stray from my faith. This traumatic experience made me realize that now would be the best time to truly test my religious beliefs; so I turned to God for help. I figured that if spirituality could help others in dealing with similar situations then it was at least worth a try. I desperately needed assistance in my search for a positive sense of self-meaning. So every night I would lie in bed and reflect on the narratives of others, while comparing their experience’s to mine then praying to God that I would have the strength to overcome the hardships of my new post-injury life.

Through the narratives of traumatic experiences, an individual finds it easier to cope with the stress and hardships brought about in everyday life. Survivors of traumatic events seek to find meaning in their new lives. Narratives provide a form of post-traumatic growth to victims of traumatic brain injuries by creating a building block from which many individuals find hope and the ability to view their personal transformation as an optimistic reconstruction of self. This essay will observe the self-narrative of my traumatic brain injury experience and show how narratives of others can build a sense of community, while promoting strength, hope, and optimism to all. I will be using the site articles, “Fostering Posttraumatic Growth: A Narrative Elaboration” by Robert Neimeyer, and “Reconstructing Self-Narratives in Coping with Traumatic Brain Injury” by Masahiro Nochi. These articles will be used throughout my essay to help show how self-narratives are effective therapeutic methods for coping with and adjusting to life after experiencing a traumatic event. It is vital that the audience recognizes how much a person’s life can change as a result of a traumatic experience and that I am writing this essay only fifteen months post-injury. The objective of this essay is to present the idea that through the self-narratives of others victims of traumatic brain injuries are not alone in their recovery process.
IMG_1049.JPG


There are many different types of traumatic brain injuries and mine was categorized as a severe traumatic brain injury to the left side of my brain. A brain injury is diagnosed as a severe traumatic brain injury when an individual goes through a period of unconsciousness, in a coma, after suffering a severe blow to the head. The brain is divided into two hemispheres, the right hemisphere and the left hemisphere. The left side of the brain controls the right side of the body and the right side of the brain controls the left side of the body. A persons ability to speak, ability to read, ability to write, ability to analyze information, and memory are all controlled by the left-brain hemisphere. Therefore, a traumatic brain injury to the left side of the brain damages a person’s cognitive and linguistic functions. Individuals who suffer from a TBI to the left-brain can also experience immense emotional and physical problems. The long-term rate of recovery for a person with a severe traumatic brain injury is determined by the severity of the injury as well as the amount the individual recovers in the first month after their injury.

About two months into my post-injury life, I was going through a magazine in the hope of finding something interesting to read. I had a great deal of trouble understanding many of the words in this magazine and that frustrated me deeply, but I was determined to stimulate my brain. As I was flipping from one page to the next I stumbled upon a quote. The quote really stood out in this small article. It was taken out of a paragraph and placed in its own box on the side of the page. The big bold letters caught my attention, however, I did not know what any of the seemingly complex words meant. So I reluctantly asked my brother for help. He read, “The pessimist sees difficulty in every opportunity [while] the optimist sees the opportunity in every difficulty.” Even though I was able to understand the gist of it, I still could not fully comprehend the meaning of some of the words. So when my brother finished reading he told me the relevance of this quote and said that I should try to remember it because it could help in my recovery. I agreed with my brother and took his advice seriously. I read the quote day after day until it was embedded in my memory. This inspirational quote by Sir Winston Churchill worked as a vital aspect in my post-traumatic development as it gave me the strength and motivation I needed to build a positive and fruitful self-narrative.

Family support is an essential aspect of the rehabilitation process because without their willingness to help there would be no positive progression in posttraumatic growth. However, there are many other therapeutic forms of post-injury rehabilitation but only a few will be discussed in this essay. Linguistic therapy works to restore reading skills, while different forms of music therapy help to restore speech and communication as they improve the cognitive functions around the damaged areas of the brain. When meeting with a neuropsychologist they work on stabilizing ones post-traumatic stress through auditory narration of feelings and thoughts on an individual level. Although each of these therapeutic methods is essential in the recovery process, I found group therapy to be the most proficient. Group therapy and individual professional therapy can be used as therapeutic methods to help individuals cope with their dissociated narratives by accepting their past and looking for ways to benefit their future.

"Human systems are language-generating and, simultaneously, meaning-generating systems. Communication and discourse define social organization; that is, a sociocultural system is the product of social communication rather than communication being a product of organization. Hence, any human system is a linguistic or communicative system...Therapy is a linguistic event that takes place in what we call a therapeutic conversation. The therapeutic conversation is a mutual search and exploration through dialogue, a two-way exchange, a crisscrossing of ideas in which new meanings are continually evolving toward the "dis-solving" of problems and, thus, the dissolving of the therapy system and, hence, the problem-organizing, problem-dis-solving system. Change is the evolution of new meaning through dialogue." (Anderson, H. and Goolishian, H. A., 1988, pg.371)


For many people it is not easy to write about or discuss a traumatic experience because they are afraid of what might happen if they do. They fear having to relive their life changing episode through written dialog or that they might be criticized and ridiculed by society for their disability. Group therapy is a way in which trauma survivors can use oral narratives to voice their silent stories in safe environments. These therapeutic sessions build a sense of community for the group members because they each had to endure a similar situation. In group therapy individuals can release negative emotions and find meaning, hope, and community through the shared narratives of others. Group therapy was part of my outpatient rehabilitation program. My group consisted of other people who had experienced head injuries similar to mine and for six months we openly shared our thoughts and feelings with one another. Some of the group members had been attending the therapy session for many years after their accidents. It was through their self-narratives that I realized that my situation could be worse off than it is. I was able to compare their narratives with mine and in doing so I was able to find coping strategies that taught me what not to do in my hunt for a quick recovery. The self-narratives within group therapy prove to be an extremely effective process for fostering positive posttraumatic growth.

According to Robert Neimeyer, a psychology professor at the University of Memphis, there are many different dimensions from which a person can structure a narrative to help foster posttraumatic growth. In his article, "Fostering Posttraumatic Growth: A Narrative Elaboration", he discusses the three key dimensions for constructing a narrative as: (1) personal, (2) interpersonal, and (3) broadly social or cultural. Each of these narrative formations are used by people suffering from an event or injury that caused some level of posttraumatic stress, anxiety, or life changing scenario. "Literal use of narrative strategies through writing and reflecting on traumatic experiences might be more thoroughly and creatively developed to promote integration and transcendence of tragic transitions... [while] oral narrative methods hold promise in clinical settings [as] emotionally discrepant episodes in a client's self-narrative can be replayed through slow-motion and renarration, focusing the camera of therapeutic attention on particularly painful details, or panning out to the larger life pattern in which the problematic event was embedded." (Neimeyer, 2004, pg.57) Coping with stress and searching for social support is no easy task for a traumatized individual. However, finding a way to effectively manage these obstacles can lead to profound personal developments. Many doctors and psychologists have some sense of the struggles that haunt an individual after a traumatic event, but it is hard for even professionals to understand the full extent of the problem. This shows that narratives are not only beneficial to traumatized individuals, but that they are also useful for doctors and other cognitive professionals in trying to find efficient coping strategies. Narrative’s come in various forms and for many people the best narrative, for fostering the development of posttraumatic growth, is writing about their personal struggles and strengths. It is true that therapeutic journals often lead to noticeable cognitive health benefits, while helping survivors find meaning in their lives.

The fact that not many people know about the traumatizing effects a traumatic brain injury (TBI) has on an individual is unfortunate because it can significantly hinder an individual’s everyday life for many years. According to the World Health Organization (WHO), traumatic brain injuries will exceed many diseases as the major cause of death and disability by the year 2020. On the global scale there has been an average of approximately 10 million people affected by traumatic brain injuries each year, making it a pressing public health and medical concern. (NeuroRehabilitation, 2007, Pg. 341) In spite of these alarming facts, people in the United States who suffer from a traumatic brain injury are for the most part fortunate in comparison to other parts of the world. Because each brain injury is different this means that each person requires different rehabilitation methods to advance their posttraumatic growth. Support from his or her family and community always plays a significant role in the recovery process. However, many times a person's religious, cultural, and socioeconomic backgrounds also must be taken into consideration when trying to find an effective form of rehabilitation. This aspect is mostly relevant when dealing with some form of clinical and professional therapy. Knowing this makes recovery through the self-narratives of others more easily accessible and fiscally viable.

In the article by Masahiro Nochi, ten traumatic brain injury individuals were interviewed in a research study trying to see how effective self-narratives work as a type of rehabilitation practice. All of the “informants” used in the study had grown to feel comfortable with their lives, after their accidents, but still had to work on coping with cognitive and emotional problems. It was found that, when coping with their changed lives, traumatic brain injury individuals often edit their self-narratives by changing their past and future appearances. The self-narratives of the informants who have effectively managed to cope with their new lives, in a positive manner, seem to provide the most information for strategies and tips on various coping mechanisms. Dr. Nochi did in-depth data analysis on each informant and came up with five categories that relate to each informant’s, positive or neutral, reconstructed self-narrative.
Screen_shot_2011-04-17_at_11.04.31_PM.png

According to Dr. Nochi, “a narrative is a story constructed with language, which meaningfully connects concrete events and has a beginning and an end.” (pg.1796) In creating a self-narrative it is essential to express thoughts and feelings and while doing so incorporate the episodes, situations, or events that may have triggered them. The first of the five categories, created by Dr. Nochi, is called “the self better than others” and it is related to the individuals who understand that things could have been worse off for them. In this category, individual self-narratives show that some people with traumatic brain injuries can find ways to obtain higher motivation for their future lives by talking to others with traumatic brain injuries that are worse off. Reading self-narratives of other individuals with more severe traumatic brain injury cases can bring hope and influence the readers to better themselves. I find that this category, as well as others that will be presented later in the reading, can relate to my self-narrative and recovery experience.

The two weeks after my accident, when I was in the hospital, I was unable to speak, unable to write, unable to walk, unable to get to the toilet by myself, unable to eat without being helped; I felt hopeless, however, I was able to do one thing. I was able to think. So as my recovery process progressed, I began thinking positive thoughts. These positive thoughts would give me the courage and strength to overcome all the obstacles that I would have to face in the months to come. When I was finally released from the hospital I was still extremely aphasic, making me unable to communicate properly because the words in my head couldn’t seem to find their way out my mouth. Group therapy is a great method for recovery as one can compare their situation to the oral self-narratives of others. Every time my group would meet I sat and I listened to how depressed and despondent many of the group member’s were after their accidents. As I listened to their self-narratives I began telling myself how I never wanted to be like them and this motivated me to work harder in doing whatever I could to get back to the way I was before.

Another category created by Nochi that I can relate to is called, “the recovering self”, which focuses on individuals who concentrate on restoring their previous self throughIMG_1050.JPG strong recovery efforts. Confidence is a key factor in every category, but particularly in this one because if individuals with traumatic brain injuries strongly believe that they will be back to their previous self then their rehabilitation efforts will be more fruitful. December 23rd, 2009 is a date that I will never forget because it was the nearly fatal evening when I was ejected from a golf cart traveling close to thirty miles per hour. I lost consciousness as my head smashed the concrete multiple times. When I arrived at the hospital the doctor cut open my head and drilled through the left part of my skull to insert a tube that would release the pressure from the growing clot of blood. My brain surgery operation took roughly four hours and I suffered from a severe traumatic brain injury with damages to my left frontal epidural hematoma associated with mass effect. The excessive bleeding in my skull was a result of a peripheral cortical hemorrhagic contusion and a subarachnoid hemorrhage. A left parietal skull fracture extended into the squamous portion of the temporal bone disrupting the coronal sutures. After undergoing the craniotomy my doctor had to replace the missing part of my skull with a titanium plate to protect my exposed, swollen brain. I know that my injury was bad and I hope that no one close to me will ever have to experience an accident leading to a traumatic brain injury. For weeks after the operation I experienced repeated migraines and had to strong painkillers to stop my head from throbbing. Doctors and therapists have told me that I will never reach 100 percent recovery, bringing me back to my previous self. They have also told me that the average recovery time for my type of injury is 3 to 5 years. I have come to terms with what the doctors have told me, but that does not stop me from continuing cognitive rehabilitation and working hard each day on positive brain stimulation. It only took a few months after my accident for me to start believing that through hard work and maintaining a positive outlook on life I will be able to get as close as possible to 100 percent.

The last category by Nochi that I found to be relevant to my self-narrative is, “the grown self”. In this category individuals have found positive life changing characteristics after their traumatic brain injury experience. For many people, including myself, a traumatic brain injury is a stepping-stone for positive change from their pre-injury to post-injury lives. According to Nochi, people use their brain injury recovery experience as a way to overcoPhoto_45.jpgme obstacles as they can look back at how many difficulties they had to overcome to get to where they are now. While I was in the hospital, my family spent many days and nights by my bed and, despite being able to speak, they had each learned to understand the different ways in which I would communicate. I had made significant improvement from not being able to talk, walk, or take care of myself over the two weeks of my hospitalization. I relearned how to walk and take care of myself just a few days before I was released from the hospital. It felt good to finally be home even though I knew that my life was never going to be the same as before. Being home with my family was a very conducive environment for my recovery because my family gave me their full support and would always be there to help if I had any trouble. Throughout my early recovery process my family would play different board games with me and have me try to name objects around the house to stimulate my brain. When I would become frustrated with myself for not knowing how to say the names of basic objects or not get the numbers and colors right while playing UNO my family was always there to steer me in a positive direction. The first six months after my accident I spent most of my time either at home, at the hospital, or at the gym. Working out became a huge part of my daily routine and I would spend hours each day at the gym, something that I would have never done before in my pre-injury life. Lifting weights, running on the treadmill, drinking protein shakes, and eating healthy food became some of the biggest positive changes to enhance my cognitive and physical performance in my post-injury life.


Constructing a self-narrative on a personal level through journals and memoirs is often beneficial for posttraumatic growth. However, this form of narrative construction can also act as a counterproductive recovery method for authors with negative perspectives on life. My experience has taught me that when people chose to create an interpersonal self-narrative through the narrative's of others they tend to develop strategies and coping mechanisms, which allows that person to accept their situation and move forward in a positive and productive fashion. The struggles surrounding a person’s life after a traumatic brain injury are often overbearing and strenuous on the mind and body. However, the self-narrative of others can be a vital tool for post-traumatic rehabilitation, whether you simply listen and retain or chose to write down specific aspects that can be used to benefit the changes in your new life. In many ways my road to recovery has just begun. For many people life is no easy task especially when trying to balance school and a social life, while continuing to meet with therapists, neurologists, advisers and counselors. I look to the self-narratives of others when I feel as if my life is spiraling out of control or that my goals have become too overbearing. Narratives give me the ability to overcome my obstacles and build on my strengths. I can keep my head up high knowing how much I have recovered so far. For other people who have experienced a head injury similar to mine, the best piece of advice I can give is to stay positive even when times get tough because there is always someone worse off then you.



IMG_1030.JPG


Sources


Nochi, Masahiro. "Reconstructing Self-narratives in Coping with Traumatic Brain Injury." Social Science & Medicine 51 (2000): 1795-804. ELSEVIER. Web. 02 Apr. 2011.

Neimeyer, Robert A. "Fostering Posttraumatic Growth: A Narrative Elaboration." Psychological Injuiry 15.1 (2004): 53-59. JSTOR. Web. 02 Apr. 2011.

"The Impact of Traumatic Brain Injuries: A Global Perspective." NeuroRehabilitation (2007): Vol. 22 No. 5 Pgs. 341-53

ANDERSON, H. and GOOLISHIAN, H. A. (1988). "Human Systems as Linguistic Systems: Preliminary and Evolving Ideas about the Implications for Clinical Theory." Family Process, 27 Pgs. 371–393.