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How do men deal with traumatic brain injury?

by Dr Ruth MacQueen & Dr Paul Fisher

Picture: famous brain injury patient, Phineas Gage.

contact: ruth.macqueen@nhs.net

 

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

Foundation Trust.

 

References

Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. The American Psychologist, 58(1), 5–14. doi:10.1037/0003-066X.58.1.5

Andrewes, H. E., Walker, V., & O’Neill, B. (2014). Exploring the use of positive psychology interventions in brain injury survivors with challenging behaviour. Brain Injury28(7), 965-971.

Carroll, E., & Coetzer, R. (2011). Identity, grief and self-awareness after traumatic brain injury. Neuropsychological Rehabilitation, 21(3), 289-305. doi: 10.1080/09602011.2011.555972

Connell, R. W. (2005). Hegemonic Masculinity: Rethinking the Concept. Gender & Society, 19(6), 829–859. doi:10.1177/0891243205278639

Cullen, B., Pownall, J., Cummings, J., Baylan, S., Broomfield, N., Haig, C., … & Evans, J. J. (2016). Positive PsychoTherapy in ABI Rehab (PoPsTAR): A pilot randomised controlled trial. Neuropsychological Rehabilitation, 1-17.  doi:10.1080/09602011.2015.1131722

Good, G. E., Schopp, L. H., Thomson, D., Hathaway, S., Sanford-Martens, T., Mazurek, M. O., & Mintz, L. B. (2006). Masculine roles and rehabilitation outcomes among men recovering from serious injuries. Psychology of Men & Masculinity, 7(3), 165.

Levack, W. M., Kayes, N. M., & Fadyl, J. K. (2010). Experience of recovery and outcome following traumatic brain injury: a metasynthesis of qualitative research. Disability and Rehabilitation 32(12), 986–999. doi:10.3109/09638281003775394

MacQueen, R., Fisher P., & Williams, D., (2018) A qualitative investigation of masculine identity after traumatic brain injury. Neuropsychological Rehabilitation doi: 10.1080/09602011.2018.1466714

Meyers, N. M. (2012). The effect of traditional masculine gender role adherence on community reintegration following traumatic brain injury in military veterans. (Doctoral Thesis) American University, Washington, D.C

Schopp, H., Good, E., Barker, B., Mazurek, O., & Hathaway, L. (2006). Masculine role adherence and outcomes among men with traumatic brain injury. Brain Injury, 20(11), 1155.

Seel, R. T., Kreutzer, J. S., Rosenthal, M., Hammond, F. M., Corrigan, J. D., & Black, K. (2003). Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation. Archives of Physical Medicine and Rehabilitation, 84(2), 177-184.

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

 

 

 

 

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ADHD: see the positives and get the balance right

by Dr Bijal Chheda-Varma                            

According to the NHS, attention deficit hyperactivity disorder (ADHD) is a behavioural disorder that includes symptoms such as inattentiveness, hyperactivity and impulsiveness. The ADHD Institute says that 50-65% of patients with ADHD in childhood will continue with their symptoms into adulthood.

The chapter in the Palgrave Handbook of Male Psychology and Mental Health focuses on the prevalence manifestation of ADHD in men. The neuro-developmental nature of ADHD means that it will occur from birth in men and contribute towards complexities and difficulties in men’s mental wellbeing.

Recognising the symptoms and difficulties early in life and forming a realistic approach to managing these through adapted cognitive behaviour therapy techniques and lifestyle management is the focus of this chapter. The chapter offers insights into the backdrop of ADHD from its early origins with the famous case of “Fidgety Phil,” through to more recent information from neuroscience.

Currently our understanding of ADHD helps us to identify the three main subtypes of ADHD in individuals. First there is the inattentive subtype with difficulties of concentration, focus and organization. Then there is the hyperactive/impulsive subtype with restlessness, fidgeting, disruptive behaviours and impulse management difficulties. Thirdly there is the combined type, where an individual struggles with all of the aforementioned symptoms. Identifying ADHD through more subtle traits when obvious hyperactivity/impulsivity is not present is a challenge in clinical work. Individuals who present with only inattention traits and moderate difficulties often remain in the revolving door of treatments and clinics, until such time as more clarity of traits becomes apparent.

Psychopharmacological interventions are focussed on managing the neurochemical and and brain activation issues. Medication helps in executive functions in individuals by improving focus, attention and overall activation.

Adapted cognitive behaviour therapy based on behavioural interventions – in particular organizational and activity scheduling, problem solving, working on sleep routines and implementation of graded steps – has been the key focus on treatment for ADHD.

Would the world be better off without the existence of ADHD symptoms and traits? Hardly. Strip away ADHD and we may take away our evolutionary pattern of neurodiversity. The hyperactivity and impulsivity when channeled in the right manner offers healthy risk taking, ability to perform high energy and intensity tasks and a mind that can think outside the box when a problem arises.

Hyperfocus aids individuals to attain higher performance and success when channeled into careers, passions, hobbies and inventions. For the deficits of the executive functions in the brain, sociability, emotional quotient and charm is aplenty. ADHD symptoms are part of the rich tapestry of human character and, in measure and in context, can be enriching for the individual and the world they are part of.

 

About the author

Bijal Chheda-Varma is a CPsychol Chartered Psychologist (BPS), Practitioner Psychologist (HCPC Reg.) and CBT Therapist Founder and Director, Foundation for Clinical Interventions, London. She is the founder and director of the Foundation for Clinical Interventions (FFCI) which specializes in the assessment, diagnosis and treatment/support for autism,Asperger’s syndrome, ADHD and other neurodevelopmental and neurocognitive conditions. Dr. Chheda-Varma’s niche is in offering intensive, but goal-oriented and time-limited treatment and therapy. She uses evidence-based treatment models and CBT is her predominant therapy style in both individual and group therapy. She sees a wide spectrum of clinical and complex psychological conditions but specializes in mood disorders, anxiety disorders, OCD and eating disorders. After beginning her career as a lead Psychologist within a rehabilitation unit for addictions, Dr. Chheda-Varma went on to be the lead clinician for the Nightingale Hospital’s CBT team from June 2013 until June 2014. Currently, she practises at the Nightingale Hospital, The Blue Door Practice alongside her own private clinic.

Dr Chheda-Varma is running a workshop on this topic at the Male Psychology Conference at UCL in June 2019. You can sign up for a place on the workshop here.

Dr Chheda-Varma’s chapter Attention Deficit Hyperactivity Disorder (ADHD): A Case Study and Exploration of Causes and Interventions, is in the new The Palgrave Handbook of Male Psychology and Mental Health, edited by Barry JA, Kingerlee R, Seager MJ and Sullivan L (Eds.) (2019). London: Palgrave Macmillan IBSN 978-3-030-04384-1   DOI 10.1007/978-3-030-04384-1

 

 

 

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