One of the problems with brain injury is that the victim lacks understanding of the fact of their injury. This is a key point in both the Self Therapy book and in Awareness of Deficit after Brain Injury : Clinical and Theoretical Issues.

The injured state is an experience entirely new and unexpected. The brain trauma victim cannot obtain awareness of this injured state prior to the injury itself. The literature on brain injury suggests significant variance in the victim’s mode of understanding of his/her injury. The experience of injury is unique to the individual.

There is a corollary to the awareness of the injury and its associated deficits. This has to do with the fact that the victim may or may not have a firm awareness of what it means to be uninjured. This is difficult to explain. I will use my experience as an example.

Prior to the injury, I did not spend time considering my cognitive functioning. I was in the world, I performed a wide variety of human actions, had normal human appetites and desires. I was one member of a community of beings and I shared most traits with other members of that community. To the degree that I had unique individual characteristics these were not noted by me, but were reported to me by others. Or these characteristics were derived from such things as objective IQ testing, or by my placement in class rankings, and similar measures.

People rarely proceed through life obsessing over the conduct of quotidian life processes. People live their lives, interact with others, and, over time, acquire tacit knowledge that informs the conduct of life. I don’t think I have met anyone who treated having a cup of tea as a life defining moment. There is a requirement for boiling water, a method and time of steeping, some decision making in regard to cream or milk, lemon, sugar, or honey. But all these aspects of tea making remain subordinate to a higher purpose – showing hospitality to a spouse, a friend, or a guest. The tea functioned as a sort of prop within the social environment and the true pleasure was derived from friendly laughter and dialog, the meeting with another mind, the shared experience of lived life.

After the injury it becomes necessary to mistrust that which we spent our entire lives learning to trust. We are forced by events to acknowledge error in the simplest of things. The act of making a cup of tea, or putting away the groceries, is fraught with potential error. We are forced into relearning our lives. And this relearning demands an attention to detail near impossible to imagine. Everything, even the most insignificant of actions, has the potential to go fantastically wrong.

Citation

Awareness of Deficit after Brain Injury : Clinical and Theoretical Issues. Prigatano, George P., and Schacter, Daniel L., Oxford University Press, USA, 1991
Available on Google Books