Insight And Problem Solving Without Self-Awareness

By Dr. Douglas Lee

For individuals with moderate to severe brain injuries it is oftentimes very challenging to be able, particularly in the moment, to see their role within the context of an event. This can be observed as them not anticipating that their actions may lead to a problem and/or not seeing themselves as at least partially responsible for things going wrong as they occur.  On the other hand, they may be quite good at being able to assess the situation and other people’s behavior when being an observer.

This can lead people working with such individuals to think that someone with a brain injury is simply trying to shift blame to others or are trying to avoid blame.

In running anger management groups for individuals with moderate to severe injuries, I developed homework assignments for each person to track events specific to their situation and lead to anger or aggressive outbursts.

As this is a group who has limited patience and insight, the task was reduced to filling out a small set of fill-in-the-blank items on a business card. Each person was given a set of pre-printed business cards with a small foldable card case and a pen. They were instructed to fill out one card each time an incident happened.

By the fourth week of the group, individuals had started to collect enough cards (I was going for a minimum of 8-10 cards) that it might be possible to look for trends in their data. Each session for the remainder of the group, 1-2 participants per session would present their findings (I would help as required).

The format was for the person to briefly talk about each incident specifically using the information from each card. Once they were finished reviewing each card, they were asked if they could see any pattern in the information they presented (i.e., all incidents occurred between 4-6 PM or all incidents occur when standing in line-ups of more than two people).

Across the board, the response was that they could see no reason or pattern for the incidents.  From their body language, it was very clear that for many individuals they were clearly completely baffled about why these events were occurring to them.

When I asked the participants who were listening to the presentation to respond, the response from the audience was completely different. Hands shot up almost instantly and typically very clear and concise answers were given as to what potential patterns were present in the data presented.  Clearly there were times when patterns were more or less obvious, but in general the audience responses were realistic interpretations.

The point here is that when the participant was the presenter, they almost universally had little to no awareness of the patterns that audience participants saw clearly.

The presenter would then become an audience member and have no problem identifying the behavior patterns of other presenters. 

To take this further, while a few participants appeared to try and articulate this obvious response pattern, no one was able to clearly articulate the issue. Most participants seemed completely unaware of their divergent behavior as presenter or audience member.

The observation that someone with a moderate to severe brain injury, given external support, can function well, but show great challenges when operating independently, is consistent with the findings of these anger management groups.

Contextualized self-awareness, that we all take for granted, is typically greatly impaired in individuals with moderate to severe brain injury.