Florence reviews ‘The Problem of Insight: An Interpretive Phenomenological Approach to Understanding Awareness Following Acquired Brain Injury’ research article

Review written by Florence Moore-Ceaton
Brain Injury Case Manager

The Problem of Insight: An Interpretive Phenomenological Approach to Understanding Awareness Following Acquired Brain Injury

Research article written by David Bennett, Alyson Norman and Mark Holloway

This study explores the challenges individuals with acquired brain injury experience with executive impairments, recognising, interpreting, and adapting to the cognitive consequences resulting from their injury. It highlights the misunderstandings that can arise between individuals and professionals assessing need and how professionals can make incorrect assumptions about an individual’s abilities due to the often subtle and difficult-to-identify nature of executive function. The authors draw on Crosson et al.’s (1989) model of awareness, distinguishing between intellectual, emergent, and anticipatory awareness, the later the most nuanced of the three.

In practice, the problem of insight is often discussed in theoretical terms, yet less frequently considered in the complexity of lived experience. This study focuses on individuals who display a relatively high level of independent daily functioning, have average or above-average intelligence, and have an otherwise typical presentation. The interpretative phenomenological approach (IPA) used in this study emphasises that insight is not simply a cognitive deficit, but complex and nuanced. It demonstrates how awareness is not binary, but dynamic and fluid. Rather than conceptualising insight as either present or absent, this approach IPA supports and calls for the need for person-centred assessment to develop a meaningful understanding of an individual’s experience and support needs. The study also questioned caseworkers with a longitudinal history of the participant to understand the extent to which impairments impacted upon participants daily lives.

This article provides an important reminder for reflective practice: insight, as a neurological phenomenon, requires client-specific exploration to understand how an individual perceives and experiences their own awareness. It also highlights the limitations of relying solely on self-report measures and pen-and-paper assessment, emphasising the need for multi-faceted functional assessment approaches, particularly in regard to the Mental Capacity Act. The study explores three themes following the IPA; the participants understanding of their brain injury, recognition of the impact of their brain injury including insight into the origin of their impairment and planning for the impact of brain injury. Finally, the study underscores the significant consequences of traditional assessment and how misunderstanding an individual’s executive impairments and awareness can have far-reaching implications for the support they receive, their rehabilitation outcomes, and their overall wellbeing.

Read the article here

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