The Social Life of TBI: The Embodied and Constructed Meaning of Moderate/Severe Traumatic Brain Injury in the United States

Abstract

A Traumatic Brain Injury (TBI) is a physical head injury that occurs in a singleevent. Over the last decade, the CDC has recorded well over 2 million TBI-related emergency department visits, hospitalizations, and deaths per year, making the injury one of the most prominent causes of death and disability in the country. In this dissertation, I trace how one class of TBIs, those diagnosed as moderate-severe, inaugurate a host of bodily and social consequences for survivors of the injury, those closest to them, and their wider communities. These consequences muddy and multiply the acronym’s meaning, even as it remains tethered to its construction as the product of a singular event. TBI in this sense, the TBI that exists outside the clinic, is what it means to those it impacts at specific times and in specific interactions. TBI is not only embodied and constructed differently from person to person and time and place to time and place, but it is different. TBI is thus multiple. I identify these social meanings of TBI ethnographically, drawing on over a year of interviews and participant-observation with survivors and those with whom they interact in one specific context, the rapidly developing and gentrifying city of Seattle, WA. I find that TBI’s full meaning in the city, the multiple meaning that it holds as a distinct social object outside the esoteric worlds of biomedicine and rehab wards, is determined by the contexts in which it is invoked. The acronym is brought into being as a complex, shifting, and ultimately fungible concept that tacks back and forth between each individual, social, and political bodies with life-altering effects on survivors and those closest to them. Through this process, TBI is phenomenological and performative,embodied and constructed, the product of narratives, relationships, policies, and social organizations. In the final analysis, what I identify in the Social Life of TBI is an amorphous social object that takes on unique meanings in diverse social contexts. As those contexts shift and the acronym’s meaning multiplies, what is known as TBI comes to influence the embodied experiences of survivors and those closest to them in ways that expand far beyond head injury and its broad set of possible sequelae. These effects in turn further influence the acronym’s meaning, initiating a feedback loop that can exacerbate or ameliorate the problems many of my informants face in their daily lives. Through this entire process, a new TBI is born, one that is never not tethered to the original bodily injury that give it its name but is always also multiple, amorphous, inherently social, and politically inflected.