Awareness of Disability after Acquired Brain Injury: Subjectivity within the Psychosocial Context

Abstract

The application of the neuropsychoanalytic formulation of anosognosia (Kaplan-Solms & Solms, 2000) is considered in relation to an emerging literature exploring the dimension of social context for awareness of disability after acquired brain injury (ABI). The contribution of this account is understood in terms of its post-Cartesian exploration of material/neurological parameters within an interpersonal focus. A contextual elaboration of the formulation is suggested, drawing on contemporary poststructuralist applications of psychoanalysis. The value of this application is formally explored through a qualitative study of sense-making and accounting of disability after ABI. Three participants with ABI who were identified by clinicians and relatives as demonstrating difficulties with awareness of disability, and three relatives, were interviewed. The qualitative analysis of the interview material is a social-constructionist discourse-analysis approach informed by psychoanalytic concepts. The findings highlight important contextual parameters of subjectivity in accounting for disability after ABI: availability and use of premorbid meanings, relational histories, and incongruity in wider family sense-making. The conceptualization of material parameters within this contextualized frame is explored using neuropsychoanalytic concepts. These findings and concepts are considered in terms of existing theory and applications to clinical practice.