Social and institutional factors in adjustment to traumatic brain injury

A longitudinal case study of a working-class heterosexual White man who sustained a traumatic brain injury in a motor vehicle accident is used to delineate social and institutional factors that play a role in adjustment to brain injury. Data gathered from multiple sources (e.g., medical records, neuropsychological assessment, participant observation, and interviews) and sustained contact with the participant and his family over a 10-month time span reveal a complex and multidetermined view of the adjustment process. The case illustrates the critical need for an advocate, a requirement that becomes particularly acute when cognitive disabilities interfere with a person's ability to function effectively on his or her own. The factors that people with brain injuries and advocates must face include shifting of responsibilities, time, paperwork, negotiation of finances, and issues related to class and disability status. Moving beyond the individual focus on deficits and impairments to looking at the institutional, social, and cultural factors that influence the adjustment process will give clinicians and researchers a broader context for understanding brain injury and helping patients adjust.