EMOTIONAL AND PSYCHOSOCIAL PROBLEMS AFTER BRAIN INJURY

Emotional and psychosocial disorders of brain-damaged patients have a strong impact upon the outcome of the rehabilitation. However, owing to methodological difficulties, and to the intrinsic complexity of such disorders, these issues have received only a limited amount of interest. The aim of this paper is to try to disentangle some of the major factors underlying these disturbances, making a schematic distinction between three main categories: (1) neurological factors; (2) psychological (or psychodynamic) factors; (3) psychosocial factors. Emotional disorders stem directly from neurological factors when they result from the disruption of specific neural mechanisms subserving the modulation and control of emotional and social behaviour. Patients with severe traumatic head injury are, in general, the more prototypical instances of this category, as in them the lesion usually involves some of the most important cortical components of the limbic system. According to some authors, poststroke depression should also be included in this category. Psychological or psychodynamic factors, on the other hand, consist of those personal attitudes towards the disability that result from an implicit or explicit awareness of the defect and of its implications as to the future quality of life of the patient. These factors are linked to the personality of the patient, to their life-style and to their whole system of values. Finally, psychosocial factors can be considered as the interconnected set of consequences that the handicap, resulting from the functional impairment, will produce on the patient's social activities and on their network of social relationships. An important component of this category consists of the burden that the cognitive and personality change produced by the lesion represents for the close relatives of the patient, of their reaction to this burden, and of the influence that these reactions can have on the process of recovery.