Institute of Psychology, Gdansk University, Gdansk, Poland.
Med Sci Monit. 2011 Feb;17(2):CS18-28. doi: 10.12659/msm.881381.
It is well known that traumatic brain injury often changes the way the patient perceives reality, which often means a distortion of the perception of self and the world. The purpose of this article is to understand the processes of identity change after traumatic brain injury.
We describe progressive deterioration in personal identity in a former physician who had sustained a serious head injury (1998), resulting in focal injuries to the right frontal and temporal areas. He regained consciousness after 63 days in coma and 98 days of post-traumatic amnesia, but has since displayed a persistent loss of autobiographical memory, self-image, and emotional bonds to family and significant others. Qualitative 'life-story' interviewing was undertaken to explore the mental state of a patient whose subjective, "first person" identity has been disengaged, despite the retention of significant amounts of objective, "third person" information about himself and his personal history (though this was also lost at a later stage in the patient's deterioration). Identity change in our patient was characterized by a dynamic and convoluted process of contraction, expansion and tentative balance. Our patient tends to cling to the self of others, borrowing their identities at least for the period he is able to remember. Identity is closely connected with the processes of memory.
The results will be examined in relation to the microgenetic theory of brain function. The brain mechanisms that may account for these impairments are discussed. Findings from this study have important implications for the delivery of person-focused rehabilitation.
众所周知，创伤性脑损伤常常改变患者感知现实的方式，这往往意味着自我和世界感知的扭曲。本文的目的是了解创伤性脑损伤后身份变化的过程。
我们描述了一位前医生的个人身份逐渐恶化的情况，他曾遭受严重的头部损伤（1998 年），导致右侧额颞区局灶性损伤。他在昏迷 63 天后和创伤后遗忘 98 天后恢复了意识，但此后一直表现出自传记忆、自我形象和与家人及重要他人的情感纽带持续丧失。我们对一位患者进行了定性的“生活故事”访谈，以探索其精神状态，尽管他保留了大量关于自己和个人历史的客观“第三人”信息（尽管在患者病情恶化的后期，这些信息也丢失了），但他的主观“第一人称”身份已经脱节。我们患者的身份变化的特点是收缩、扩张和试探性平衡的动态和复杂过程。我们的患者往往倾向于依附他人的自我，至少在他能够记住的那段时间里借用他们的身份。身份与记忆过程密切相关。
将根据大脑功能的微观发生理论来检查结果。讨论了可能导致这些损伤的大脑机制。这项研究的结果对提供以患者为中心的康复具有重要意义。
