Paper short abstract:

This paper explores how new identities are formed during intensive group rehabilitation, where patients with TBI acquire critical self-awareness skills. It argues that the objects used in therapy both nourish and help control the “new selves” that are defined collaboratively within Western norms.

Paper long abstract:

How does a person forge a new identity after experiencing traumatic brain injury (TBI)? At a New York City hospital, some individuals with TBI take part in Milieu Therapy, an intensive group treatment program that focuses on improving attention, memory and social communication by teaching self-awareness and compensatory skills. During this process, individuals define and create new selves within the context of their cognitive and physical limitations. Such a transitionary, self-reflective, school-like therapeutic milieu is replete with objects that help define, visualize and communicate the limitations, challenges and the goals of the new disabled self. In this paper, I use my clinical experiences as a trainee to elucidate these cognitive and behavioral therapeutic processes that rely on objects to trigger repeated self-examination (e.g., self-referential posters, behavioral contracts, notebooks, video-recordings). I demonstrate how individuals engage with the objects carefully infused in their milieu to define and forge new selves. I discuss how these educational tools are used to constantly remind cognitive and psychosocial deficits while also triggering newly-acquired behavioral responses. I also focus on how different parties (e.g., trainers, trainees, significant others) rely on these objects to instill new power hierarchies that both nourish and, if needed, control the new "self" that is being formed in accordance with Western norms during these holistic therapies. This notion of forging and modifying self-concept in holistic therapies is rarely subjected to critical gaze of STS. Through this analysis, I attempt to make this milieu more accessible and attractive for future STS research.