Community re-integration after head injury: A disability ethnography.

Abstract

As a result of medical advancement and cultural patterns of Western society, traumatic head injury is increasingly a problem for the injured, their families, medical and social services professionals, and the community at large. Head trauma is remarkable because of the complex nature of the residual disabilities which include long lasting cognitive and emotional problems, social isolation, and family disruption. The purpose of this study was to re-examine the phenomenon of recovery after mild to moderate head injury using an ethnographic research approach. The data were based on the experiences of 21 disabled and their families in the community setting. The disabled represented a range of stages of recovery and severity of disability. The data was collected using three field work strategies: extensive semi-structured interviews, participant observation, and non-academic document review. After collection the data was subjected to thematic and content analysis, that resulted in the selection of themes that characterized the experiences for the head injured and their families. The themes for the head injured informants were: dead days, loneliness, and forgetting. The family members' experiences were represented in the themes: responsibility, vulnerability, tough love, gender differences, and reactions to the experience. Next the data were interpreted using five theoretical concepts from cultural anthropology: liminality, personhood, social labelling, sick role and double bind. In addition, the reflexive influence of the investigator on the research process was addressed. The trustworthiness of the ethnography was assessed in terms of credibility, transferability, dependability and confirmability. Several variables were found to be important to the long term outcome of head injury. These variables were: family directed therapy, double bind communication patterns, and lifelong recovery. Two other factors were found to be critical for the recovery of the head injured. These were economic disincentives to the return to employment and the importance of the social and family environment. In the final section the research and policy implications of the study were discussed in relation to management and service provisions.