Friday, July 18, 2008

CCEF Paper #2: Counseling & Physiology

Theological/Practical Issues in Ministry to Sufferers of Traumatic Brain Injuries

Where to start? What wouldn’t be a practical/theological issue in ministry to someone who suffered from an accident like Alan Forman had in Where Is the Mango Princess? As Ms. Crimmins says, everything changes. Maybe they wake up from their accident. Maybe they don’t. Even if they do, no one know how much they will recover or when or how changed they will be.

Can he/she understand? A crucial element in effective personal ministry is that the one being ministered to embraces some portion of gospel truth and learns to apply it to their life. Many brain injury patients never regain the level of cognition needed to understand the gospel and its implications. Even in those who are “high functioning” like Mr. Forman, it’s hard to tell if they really know what’s going on.

It’s not just with amnesia that they struggle; it’s also agitation, confusion, focus, distraction, loss of object permanence, disorientation. Mr. Forman was, for most of the book, “oriented in only one sphere.” He knew who he was, but not where he was or when he was. All of these problems led to cognitive fatigue. These cognitive realities will create major obstacles for sharing biblical truth with a brain injury survivor. Even if they are increasingly “clearing” (getting better oriented), does that mean that they truly “get it?” The gospel is powerful truth, but it must be understood to have its full effect. Much patience and grace will be needed to share the truth with the sufferer.

Can he/she communicate? Of course, most biblical counseling doesn’t start with talking–it starts with listening. According to our book, the brain injured can be very hard to listen to: dysarthria (slurred speech), disinhibition, lack of self awareness, withdrawal, incontinence, denial of paralysis, duplication of significant people, aphasia (inability to find the right words), and confabulation (making up a story around a kernel of truth). Can I trust what this person is saying? Can I really know what is in their heart to minister to them? What is this relationship going to look like? Personal ministry will require the virtues of Colossians 3:12-14 in large doses.

What does growth look like? This is the main question for the Christ-follower who survives a traumatic brain injury. What does progressive sanctification look like if you can’t organize your life? What does faith-working-in-love look like if you can’t manage your time, struggle to initiate and then complete tasks, or are unable to understand what is appropriate in a given situation? How do you know if you’re growing if you seem lost in an endless stretch of repetitions and “perseverations.” How can you take responsibility for your life and actions, under the gaze of God, if you can’t remember them? The temptations to anger and fear would be mountainous if you can’t quite understand what is going on around you.

The answer to these questions is probably pretty simple. True gospel growth will look different for a TBI survivor than it would for another Christ-follower. It will probably look like much smaller–but actually more significant–victories.

Will the family survive? Effective ministry to the survivor will include ministry to their loved ones. Ms. Crimmins writes that less than 25 percent of couples stay together after a traumatic brain injury citing stress on the family, costs of medicine, grief, being forced into new roles (parentification), loneliness (yet the other person is still there!). It’s just as hard for the family.

Reborn? The book indicates that the hardest thing to deal with (and the most interesting for thinking about brain/soul issues) is that the person who emerges from the trauma appears to be significantly different than the person they were before. Is this the “same” person? Can “characterological change” happen because of a TBI? Biblically speaking, I don’t think so. Character can only be permanently changed by being reborn by the Spirit of God (John 3:1-16).

[Read my short review of this book.]