Acquired Brain Injury – A Case Example

 Memorandum about Mike – Difference and Change and work with a Young Man with an Acquired Brain Injury. 

• Mike’s acquired brain injury means he is lacking on the twin pillars of morality – reciprocity and compassion. 
• The first pillar of morality is reciprocity, ordinary give and take between people, over the ordinary matters of everyday life that make a relationship fair and just for all parties. 
• The emotional and cognitive foundations of justice for all of us are in our micro-detailed experience of reciprocity, inside the family, inside intimate relationships, and inside close functional and work relationships.
• Mike is not able to participate fully and reciprocally in an adult relationship is at this point in time. He thinks he can, but he cannot, and this forces others into a pattern of accommodation to him that makes the relationship between him and them fundamentally unequal. 
• It is not uncommon for the person in Mike‘s position to claim that the relationship is fundamentally unfair which is exactly what Mike does. Often the other person involved redoubles their efforts to make the relationship fair which, of course, acts in a contradictory way to increase the level of inequality
• Fairness in a relationship is something the two parties should be equally dedicated to, unless we are already dealing with an unequal relationship such as that between a parent and a child. That is exactly what has happened here; for Mike to survive, his mother needed to re-parent him.
• The second pillar of morality is compassion, empathy. Mike’s ability to feel what another person feels, knowing and trusting that the other person can really feel what he feels. Love is like this. 
• Mike is not able to feel what the other person feels. Mike does not trust that those close to him, and deeply attached to him, can feel what he feels. Love lost its bearings is like this.
• If Mike is going to progress, change, turn, he will need to progress on both fronts, reciprocity, and compassion. 
• His understanding and perception about the ordinary give and take between himself and other people will need to become more balanced and more equal. Most professional opinions from here would say that he will not improve much on either of these two fronts. I say, we do not know until we try.
• Mike would need to be able to participate in ordinary relationships with ordinary people and connect with those people, where reciprocity, give and take, in every aspect of the relationship is experienced, equally, from each person’s point of view, not just from one person’s point of view.
• If Mike is going to progress, he will need to recover some aspects of his compassion and empathy lost through the acquired brain injury. This is part of what makes a person trustworthy, that person can feel what you feel, and that person may even think about this in a similar way to you. 
• This is a tough call for a person with an acquired brain injury. A person in Mike‘s position has two different experiences of themselves in their lifetime, and these two different experiences are extremely difficult to reconcile. For that person with the acquired brain injury, and for everyone else around them.
• What is required is a process for the systematic noticing, noting, and amplifying ‘difference’. 
• Difference is the driver of ‘change’.
• The proposal on the table, is that you communicate positive change in and about Mike, in detail, to his parents, and perhaps other family members, and friends, as the situation warrants. 
• The process between you and Mike, for noticing, noting, and amplifying difference, needs to be fully collaborative, nuanced and very, refined. 
• I want this to be done according to the Bower Place protocols for noticing and amplifying difference, to be done in both word and image, verbally and in writing, diagrammatically, and if possible, physically. 
• For preference I want the notation of ‘difference’ to be done with, and as much as possible, by Mike. I want you to get the coloured pens into Mike‘s hand. I do not want this to be a bureaucratic process, at arm’s length, invisible to Mike. 
• The truth is that Mike has an ambivalent relationship with his acquired brain injury. On the one hand Mike hates that the acquired brain injury happened to him and on the other hand, he exploits the fact of his acquired brain injury, to push people around a to obtain greater freedom and benefits for himself, which then allows him to behave poorly and destructively, especially in relationship to alcohol and weed.
• My view is the ambivalent relationship Mike has to his acquired brain injury needs to be progressively challenged into the near future, in each context he functions in; music, home, with family, with carers, with friends and therapeutically.
• In terms of challenging Mike in this regard, I am not suggesting anything direct with him, as in my view that will make no difference. 
• I want to ensure that Mike is unable to avoid the truth about the ‘differences’ and ‘changes’ he is making and the truth about the implications of those changes. 
• I want these changes and these truths to be broadcast through Mike‘s entire relational world, and for his entire relational world to get behind these changes and these truths. 
• This is a comprehensive change process that I want in place around Mike, with the therapeutic work with you extending this into every location. I will address this with his carers, to bring this into everyday service delivery by them. This should become an integral part of their thinking and their Notes. I will also give this “Memorandum about Mike, Difference and Change” to his parents, so they fully grasp the process.
• This what I want you to do with Mike. My express aim here is to see how far we can go with him.