by Dr Ruth MacQueen & Dr Paul Fisher
Picture: famous brain injury patient, Phineas Gage.
Men are twice as likely to experience a traumatic brain injury (TBI) as women. This suggests that aspects of masculinity, such as choosing risky jobs and sports, play an important role in how people acquire their brain injury. Research also suggests that masculine identity has an impact on how people manage the experience of illness. Adjustment to traumatic brain injury can involve changes in cognitive, behavioural, emotional and physical functioning. Given the potential disruptive consequences of TBI, the day-to-day lived experience of being in the world can be, and often is, altered for the individual.
Our chapter in the Palgrave Handbook of Male Psychology and Mental Health summarises research which explores masculine identity in relation to how men experience these adjustments. Individuals who have had a TBI can experience a changed sense of personal identity (Levack, Kayes, & Fadyl, 2010) and changes to the self tend to be viewed negatively in comparison to the pre-injury self (Carrol & Coetzer, 2011). Identity as a man can be threatened by the changes in interactions and activity which can lead to a loss of traditional male roles such as being a provider, being strong, protecting others, having physical strength, and self-reliance (Addis & Mahalik, 2003; Connell, 2005). Roles which men have, for example within their occupation and relationships can therefore be lost or changed and men may face challenges in coping with this loss and adapting to the changing roles. Masculine identity is therefore an important consideration for neuropsychological therapy and rehabilitation particularly because part of the process of rehabilitation concerns helping individuals with their sense of self.
Some evidence suggests that adherence to masculine ideals can be negatively associated with rehabilitation outcomes in TBI (Meyers, 2012). Barriers to engaging in rehabilitation services may include that working with professionals is viewed as requiring help and therefore suggests that the individual lacks strength or self-sufficiency to be able to cope (MacQueen, Fisher and Williams 2018). Viewing the self as being reliant on others can lead to experiences of shame and the perception of the self as weak. This can mean that developing therapeutic relationships may conflict with ideals of independence (Good et al., 2006; Sullivan, 2011).
However, aspects of masculine identity may also promote wellbeing in the context of adjustment to TBI for men. For example, there is evidence which suggests that adherence to dominant masculine ideals such as higher success, power and competition are associated with the perception of fewer barriers to community functioning (Good et al., 2006). Similarly, Schopp et al. (2006) found that there was a positive effect on functional outcomes for men who adhered to ideals such as winning and seeking status and the authors suggest that therefore drawing on these values can promote positive outcomes after TBI.
It is important that gender identities are considered as part of rehabilitation and providing a gender-sensitive service can begin during initial discussions when men are referred to a service and should be considered throughout rehabilitation. In addition, given the higher prevalence of mental health problems in the TBI population (Seel et al., 2003) it seems particularly important to work with individuals in reducing the stigma of mental health problems after brain injury. Within the context of masculine identity, the application of positive psychology constructs may be particularly beneficial. Positive psychology has been applied within acquired brain injury (ABI) rehabilitation and these initial studies indicate that the application of positive psychotherapy may promote wellbeing following ABI (Andrewes, Walker, & O’Neill, 2014; Cullen et al., 2016). The concepts of growth, strength and resilience within positive psychotherapy may particularly encourage flexibility in identity which may facilitate adjustment for men.
The implications arising from the research in relation to issues around engagement and outcomes in neuropsychological therapy and rehabilitation are further considered within my chapter in the Palgrave Handbook of Male Psychology and Mental Health.
Dr. Ruth MacQueen completed the Doctorate in Clinical Psychology at the University of East Anglia in 2016. Her doctoral thesis employed a
qualitative methodology to research men’s experiences of masculine identity following traumatic brain injury. She has presented her research as a poster
publication at the Neurological Rehabilitation Specialist Interest Group of the World Federation for Rehabilitation conference and published in
Neuropsychological Rehabilitation. Since qualifying, Ruth has continued to work within neurorehabilitation in Bath, UK.
Dr. Paul Fisher is a Clinical Psychologist and Senior Clinical Lecturer with significant experience working clinically with people with neurological
impairments across a range of settings and as an academic and researcher. Paul has worked in the UK and Singapore. He has a long-standing interest
in issues of identity and identity change and adjustment which he uses within his clinical work and has been a focus for his research using qualitative
research methods. Paul currently works at the University of East Anglia in the Department of Clinical Psychology and in Norfolk and Suffolk NHS
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Sullivan, C., Gray, M., Williams, G., Green, D., & Hession, C. (2014). The use of real life activities in rehabilitation: The experience of young men with traumatic brain injuries from regional, rural and remote areas in Australia. Journal of Rehabilitation Medicine, 46(5), 424–429. https://doi.org/10.2340/16501977-1788