Ego-identity: Can it be reconstituted after a brain injury?
Cognitive alterations are frequently observed and studied in persons who present with psychiatric and neurological disorders. Recently an increased number of investigations on the self and attendant processes have interested psychologists, psychiatrists, and neuropsychologists, particularly when a person has suffered brain damage that upsets their daily function in economic, social, personal, behavioural, and emotional ways. At the same time, many theories have been developed to explain the observable changes in ego-identity of persons with brain injury as well as diverse rehabilitation programs centred on the re-establishment of the ego-identity changes. The present article focuses on: ( 1) the elucidation of the construct of self in current personality theoretical formulations; ( 2) the major negative effects of brain impairments on the cognitive, neurobehavioural, emotional, and personality functions of persons with brain injuries; ( 3) the conceptual underpinnings of Kurt Goldstein's views on the neuropsychological rehabilitation endeavour; ( 4) the illustration, using several clinical examples, that it is possible, following intensive neuropsychological rehabilitative interventions, to restore the shattered self of some brain-injured persons; and ( 5) the growing number of holistic programs of rehabilitation for brain-injured persons all over the world. In conclusion, the sequelae of brain injury not only imply alterations in neurological or cognitive process, but also involve changes in personality aspects. Nevertheless the number of holistic programs has increased, and a particular model of the holistic approach to the neuropsychological rehabilitation of persons with brain injury has been implemented in diverse countries such as Australia, Belgium, Denmark, England, Finland, France, Germany, Holland, Israel, Italy, South Africa, and the United States. Although each one of these programs has been modified to resolve the particular necessities and resources of the different countries, all of them implement Kurt Goldstein's ideas concerning the rehabilitation of persons with brain injuries