Is concreteness the invisible link between altered emotional processing, impaired awareness and mourning difficulties after traumatic brain injury?

Abstract

Deficits in awareness are a common problem after traumatic brain injury (TBI), often compromising the process of emotional adjustment, including mourning. Unfortunately, there is little understanding of how the specific profile of cognitive impairment and emotional change often presented by individuals with TBI influences awareness and mourning. Concrete behavior has been often described as a feature of TBI, with a difficulty detaching from immediate experience (both internal and external) as its signature. From a self-psychology perspective, concrete behavior can be understood as a change in the cohesion and structure of the self, where temporal and representational domains are modified. This paper offers a novel approach to problems of awareness and mourning after TBI, by considering how temporal and representational changes in the phenomenology of the self alter individuals' emotional landscape. More specifically, it describes how concreteness modifies several aspects of emotional life that are central to awareness and mourning, such as emotional reactivity, emotional regulation, emotional understanding, and signal anxiety. The impact that concreteness has in awareness and mourning is also discussed in detail throughout the paper, as well as the technical challenges implied. Finally, some general guidelines to address changes in the phenomenology of the self in a therapeutic context are briefly described.

Keywords:

• awareness
• mourning
• concrete behavior
• emotion
• traumatic brain injury
• self-psychology

Disclosure statement

No potential conflict of interest was reported by the authors.

Acknowledgments

We would like to thank Mrs. Maggie Cottam for her valuable help editing this manuscript.

Notes

1. It is interesting to note here that research exploring the relationship between concrete behavior and TBI is scarce. For example, an all-time search on PubMed and Web of Science, using the keywords concrete thinking/abstract thinking/TBI, only showed seven articles that directly explored, or described, concrete behavior after acquired TBI. This lack of publications contrasts with the wide use of the concept in clinical neuropsychology handbooks and appears to be related to the growing interest of the scientific community in executive functions and the functional divisions of the PFC.

2. We note that Mesulam's use of the term “default mode” is independent of its usage in the concept of the “default mode network,” a major intrinsic brain network associated with daydreaming or stimulus-independent thought (Raichle et al., 2001).

3. The idea of subjective and objective indices of loss has been adapted from Klonoff (2010).

Additional information

Funding

This article was supported by a Post-Doc grant from CONICYT (Chile) and a research grant from the Neuropsychoanalysis Foundation, both awarded to Dr Christian Salas R.