Varieties of the catastrophic reaction to brain injury: a self psychology perspective.
Patients with traumatic brain injury sometimes manifest varieties of what Goldstein (1952) called the "catastrophic reaction." Recognizing the particular form of catastrophic reaction is important both to determine proper behavioral management and to help patients accept the effects of the brain injury. Applying Kohutian theory and self psychology constructs, the authors present several case studies to show how the patients shared the same underlying experience of shame and anxiety over their injury-related impairments. These patients participated in an outpatient, milieu-oriented rehabilitation program intended to increase their independence at home and to facilitate their return to productive work. The rehabilitation therapist's role was to help patients move from a state of being unable to accept their deficits to one of setting and pursuing attainable goals. The authors discuss ways of managing these catastrophic reactions.
Klonoff
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PS
Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013-4496.
Lage
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GA
Chiapello
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DA
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D001521:Behavior Therapy; D001925:Brain Damage, Chronic / Q000523:psychology* / Q000534:rehabilitation; D001930:Brain Injuries / Q000523:psychology* / Q000534:rehabilitation; D003674:Defense Mechanisms; D006801:Humans; D008297:Male; D009289:Narcissism; D011574:Psychoanalytic Theory; D011889:Rage; D012803:Sick Role