Abstract
M.A.
With the advances achieved in medical technology in recent years, society is
increasingly faced with the issue of determining how fit individuals are for
reintegration in society following the event of traumatic brain injury. Together with
Neurology and it's diagnostic capabilities, many other disciplines such as
Neuropsychology, Physiotherapy and Occupational Therapy, to name but a few,
have placed strong emphasis on the rehabilitation of individuals with brain
damage, with a view to reintegrate them into society. Besides the physical
rehabilitation which aims at normalizing the individual's physical health, issues
such as psychological ,cognitive and social functioning have been the focus of a
great body of research in recent years. Whereas in the past the prognosis for
many such patients in respect of returning to a normal life style were
discouraging, health workers are now more optimistic in most cases regarding the
individuals' probability to achieve a higher level of functioning after recovery. In
this context, the individuals' ability to function in society, their ability to be
integrated into the family and working environment and competence to be active
and valued members of society have thus become the new aims which the
therapeutic team together with the patient strive to achieve. With this in mind,
rehabilitation teams now place greater emphasis and effort on optimizing recovery
in the areas of cognitive and emotional competence. Amongst these issues, the
individuals' competence to make moral judgements and socially adequate decisions in everyday living is of the utmost importance. This impacts on their
ability to abide by social rules and norms which will determine their competence
and desirability as active members in the family, social and working
environments. This is the main focus of the present study.
The issue of moral judgement and behaviour is central to this discussion, and a
delineation of what defines morality and moral judgement is mandatory.
Contributions to this analysis were found in the writings of the various authors
and schools of thought presented here, and each of them has dealt with the
theme of morality, moral behaviour and judgement from a different theoretical
perspective. Theorists such as Lawrence Kohlberg made a major contribution to
the understanding of the development of moral judgement through his stage
theory, which forms one of the cornerstones of the present study. The site and the severity of the brain injury is paramount to the prognosis for
rehabilitation. The frontal lobes have been described as the structures
responsible for the widest range of symptoms and seen as the seat of intellect,
responsible for deviations in moral and emotional functioning. An overview of the
frontal lobes and associated cognitive functions as well as behaviors observed as
a result of injury to these structures is presented.
The existential-phenomenological system of inquiry has been described by its
proponents as the most adequate to investigate phenomena relating to human
behaviour, when an understanding of the subjective experience of the individuals
involved is desired. For this reason this methodology is used in the present study
to facilitate a qualitative analysis of the experience of brain injury particularly in
respect of possible alterations in moral judgement and behaviour following the
accident. The present investigation is based on interviews with three subjects
and their primary caretakers, who answered questions regarding moral dilemmas.
These dilemmas aim at tapping the individual's underlying reasoning processes
when faced with the decision of what is right and wrong.
The analysis and integration of the data obtained through these interviews
reveals a complex cluster of alterations in thought and behaviour, much in line
with those expected from patients suffering traumatic injury of the frontal lobes.
Although different behaviours were revealed by each participant in this study,
they were generally in line with the alterations described in the literature resulting
from injury to the described brain areas.
The value of this study lies in projecting a clearer picture of the experience of
brain injury from the point of view of the victims as well as the close family
members. Furthermore, analysis of data obtained in this investigation highlights
certain typical behaviors and responses observed in individuals with such brain
injuries, as described in the literature presented here.