More serious brain injuries associated with more life satisfaction

Psychologists investigating the well-being of patients with an acquired brain injury (ABI) have documented a curious phenomenon, whereby the more serious a person’s brain injury, the higher their self-reported life-satisfaction.

With the help of the charity Headway UK, Janelle Jones and her colleagues recruited 630 people (aged 9 to 81) with an acquired brain injury. Most had sustained their injuries from road accidents, with other causes including stroke and falls. Based on the time they’d spent in a coma, the majority of the participants’ injuries were judged to be moderate to severe.

The participants answered a brief, 20-item questionnaire about their sense of identity (e.g. ‘I think of myself as someone who has survived a brain injury’), their social support, relationship changes since their injury, and their life-satisfaction.

Having a strong sense of identity, seeing oneself as a survivor, having plenty of social support and improved relationships were all independently related to higher life satisfaction. These different factors also influenced each other. ‘…[I]t is likely that personal identity and social network support factors operate in a cyclical way,’ the researchers said, ‘whereby becoming personally stronger from effectively relying on social support also makes individuals more likely to continue to seek out social support and, in that way, to develop social capital.’

Perhaps the most curious finding was that participants who’d sustained more serious injuries tended to report being more satisfied with their lives. This association was mediated by the social and identity factors – that is, participants who’d sustained a more serious injury also tended to identify more strongly as a survivor, and to have more social support and improved relationships.

An obvious suggestion is that the more seriously injured participants might not have complete insight into their lives. Jones and her colleagues doubt this is the case, in part because of the logic of the results, with identity and social support mediating the higher life satisfaction among these participants.

‘Sustaining a head injury does not always lead to a deterioration in one’s quality of life,’ the researchers concluded. ‘…[D]ata from this study serves to tell a coherent story about the way in which the quality of life of those who experience ABIs can be enhanced by the personal and social “identity work” that these injuries require them to perform. … Nietzsche, then, was correct to observe that that which does not kill us can make us stronger.’

Jones, J., Haslam, S., Jetten, J., Williams, W., Morris, R., and Saroyan, S. (2011). That which doesn’t kill us can make us stronger (and more satisfied with life): The contribution of personal and social changes to well-being after acquired brain injury. Psychology and Health, 26 (3), 353-369 DOI: 10.1080/08870440903440699

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

7 thoughts on “More serious brain injuries associated with more life satisfaction”

  1. I played football without a helmet for years, and people tell me I'm a very happy positive resilient person.

    Believe it or not, I'm not being facetious or dismissive here. Fascinating research, relevant research, and the kind of thing I wish would come across my desk as a medical editor.

  2. This reminds me of the finding that athletes tend to be happier with a bronze medal than a silver one. The explanation lies in what they compare it with – a bronze medal is only one step away from no medal at all, so is a good thing, whereas a silver medal is only one step short of gold, so a bad thing.

    In this case, a more severe brain injury is closer to death, so may be seen as the preferable outcome. This is consistent with higher levels of self identification as a survivor – survival being contrasted with death.

  3. “What doesn't kill us can either make us stronger or leave us permanently disabled.”

    More likely the latter, ask an actuary!

  4. The article’s authors must be praised for conducting the first empirical research to examine how personal identity and social relationships combine to explain outcomes in patients following acquired brain injury (ABI). Jones et al’s argument seems justified that the social identity approach offers an appropriate platform for the study of ABI and identity. Interested as we are in this area, we think it is worth suggesting that there might be more to these findings than is immediately apparent. Jones et al.’s conclusions are made from a questionnaire study with a group that may find the task of completing a survey challenging. With a response rate of 10% it is conceivable that this responder group may differ on particular dimensions of interest; potentially seeing themselves as ‘survivors’ and relatively ‘well’ where others affected by Brain Injury do not. We believe this standard methodological issue may have important implications not least because of other issues that arise when studying this group for a number of reasons.
    First, there are important issues of cognitive capacity or impaired awareness in those affected by acquired Brain Injury. Damaiso (2006) reports ‘dulled’ affect in his case study work (e.g. as with patient Elliot). Potentially, those with such an impairment are likely to express less life dissatisfaction. We suggest that measures of health and other outcomes post ABI are also necessary. Second, neuropsychological evidence indicates that ABI (acquired brain injury) is not a unitary phenomenon. In considering identity and ABI, the biology underlying the various forms of brain injury needs to be incorporated. For example, while there seems little doubt but that social identity impacts symptom appraisal, the deficits at the root of a condition such as anosognosia, more so than other forms of ABI, may be fundamentally rooted in the neuropsychogical injury and the social psychological processes. Third, identities are not unitary phenomena either. There is little doubt that cultivating a survivor rather than a victim identity is important in recovery from ABI. Crucially, Jones and her colleagues found that identity strength is rooted in social relationships and that developing strong group memberships allows survivors become stronger as individuals. Building on a study of stroke survivors by Haslam and colleagues (2008) Jones et al. suggest that the number of group memberships one has is related to one’s life satisfaction post ABI. But what about the nature and quality of social identities and roles: parental, occupational or sporting roles for example may have differential impacts. It would appear that identities (plural) require further attention.
    In conclusion, we hope that future research will orient to these important issues relating to the quality of identities, pre-morbid and post-morbid group memberships and continuity of group memberships across time. This important programme of work should also address issues related to selection biases, neuropsychological injury type and broaden the array of health outcomes measured in order to progress understanding. We welcome Jones et al’s paper an important first step for us all to build upon in order to increase understanding of the impact of social roles and identities to adjustment and health in those affected by ABI.

    Stephen Walsh, PhD Student, University of Limerick,
    Dr Stephen Gallagher, Lecturer, University of Limerick
    Professor Orla Muldoon, Founding Chair, University of Limerick

Comments are closed.