Awareness Challenges

  • Introduction
  • Loss of insight, Loss self, and Loss of Self-awareness
  • Other Contributors to Awareness Challenges

Introduction – Awareness Challenges

Some outcomes of brain injury are less well known, discussed, and understood among people living with brain injury and their families, than other impairments such as memory.


There are several ‘hidden outcomes,’  buried in the complexity of neurological dysfunction which, although they affect more people than were previously appreciated, are rarely taken into account outside of clinical and professional settings.

However, these ‘hidden’ outcomes are pretty horrendous for people to live with, and often cause confusion that makes it difficult for people to be aware of why they are struggling so much.

The problem is that if these are an outcome of your brain injury you can’t explain it to anyone else. You don’t know what you don’t know – literally!

These outcomes can have a significant impact on how well someone can rehabilitate because their effects percolate into other issues.

For example, a loss of insight will make it much harder for someone to grasp that they need any help and, when they do get help, it can make it much harder for therapists to help them understand the significance or relevance of strategies and therapies.

The tool people need to utilise to be able to understand why compensatory strategies are needed, might also be missing. Called, ‘Metacognitive Self Awareness,’ this is possibly the most crucial element of thinking we have.

Loss of insight, Loss self, and Loss of Self-awareness

Because these different outcomes of brain injury are often used interchangeably, there can be a lot of confusion about what they mean.

Loss of Insight

Loss of Insight refers to the inability or difficulty people have with turning intellectual information or awareness into realisation. Think of unprocessed knowledge failing to become common sense or wisdom. 

Loss of Self

‘Loss of Self‘ generally refers to the feelings people struggle with when they consciously compare their life now, to how it was before. It is about the loss of self-identity connected with ambiguous loss and grief. 

Loss of Self-Awareness

Loss of Self-awareness refers to changes in the multi-skilled and aware ‘auto-pilot’ self which navigated our lives for us before brain injury. Not only can you lose your concept of who you are, am I kind, am I selfish, and so on, but you can lose the knowledge of how your own thinking processes used to work.

These losses can happen individually or might be coexistent.

For example, where a loss of insight and a loss of self-awareness happen together, the grief stage experienced in ‘loss of self,’ is often missed entirely because people often don’t have the cognitive capacity to consider the changes in their lives fully. 

To be able to feel and acknowledge the loss of self, or loss of self-identity, you need to be able to compare and remember consciously.

Further, because the loss of insight can happen in varying degrees, and doesn’t necessarily encompass a loss of experiential memories, many people will also feel an ambiguous loss of identity.

The terms ‘loss of self’ and ‘loss of self-awareness’ are often used interchangeably. However, the causes are very different, as is the way people feel these two experiences.

Other contributors to awareness challenges

Many outcomes are contemporaneous and make it difficult for people to understand and to be able to specify what their struggles are.
 
There can be many grey areas about what is causing a particular changed behaviour. Further problems can be caused when the general symptoms of brain injury are confused with, or overlap with, pre-existing psychological or mental health challenges.

Breaking understanding about outcomes and effects down into manageable chunks, can be difficult because of these overlaps.

People can also struggle with asking pertinent questions to help elaborate understanding and very often, because of this, people forget that they have options and choices available to them. Cognitive impairments can seriously affect flexible thinking.

Other complications include:

  • Traumatic memories associated with the brain injury event
  • Negative emotions related to the brain injury event and lack of acceptance of changes
  • Grief and ambiguous loss
  • Changes in the dynamics in relationships
  • Lack of understanding of the importance of recreating positive practical and psychological habits
  • Lack of awareness about the importance of creating and recreating positive beliefs
  • Detachment from emotional intelligence or previous emotional aspects of memory

Giving attention to each of these areas can affect outcomes and rehabilitative possibilities.

With support and encouragement, people can regain the ‘inner familiarity’ that we refer to as self, which gives them greater clarity and understanding of remaining cognitive impairments.

A neuropsychologist will help you, or someone you love, to address any of these challenges. Ask your doctor for a referral and be aware there may be a waiting list.