A psychotherapist was surprised to discover this idea worked. Barbara A. Hogan, Ph.D., thought that most professionals involved with brain injury rehabilitation would view the use of narrative therapy with a brain injury survivor who suffered a severe traumatic brain injury (he suffered severe deficits of speech, reading and writing) as lacking meaning (e.g., an “unlikely treatment choice”) but she persisted and discovered it helped the survivor overcome barriers (“Narrative therapy in rehabilitation after brain injury: a case study.” Neurorehabilitation. Vol. 13. 1999. pp. 21-25.). Her approach used writing and co-authoring (collaboration) to reconstruct story that had used “… fragmentary, enigmatic, and emotionally charged language …” (Hogan 21). In her published article, informing readers of her single case, she recognized that “ … the stories people live by are keys to mental health and illness” and that there was “ … always more than one story or one way to interpret any part [of a story] …” (Hogan 22). The therapist can “ … help a person discern … other possibly more creative ways to tell the story” (Hogan 22). Dr. Hogan was surprised when her brain injured patient “… began to expand or explain his meanings” after she read to him the substance of his comments from their previous therapy session. Hogan had, in what seems to have been a venture into a virtually experimental territory – collaboration with a brain injured patient to build story, begun collaborating with her patient to help him build upon his story narratives from session to session (not in writing, as I propose, but she eventually got to his writing).
While her article is a valuable single case study, it represents the efficacy of collaboration between therapist and patient in deconstructing and reconstructing stories initially based upon memory fragments. Each time the story was revisited, the patient expanded upon the story or explained meanings within the story based upon additional memory access. Over time, the patient was able to revise his stories and discovered he had “… a great ear for the cadences of language, a consciousness of audience, and a deep desire to be heard and understood” (Hogan 22). She discovered her narrative therapy would “help dramatize and actualize meaning …[,] … keep stories alive …[,] help people make the stories they are authoring thicker and more multi-stranded … by connecting past, present, and future” (Hogan 23). She realized that “[t]he narrative therapist works with people to help them tell their stories in ways that might lead to understanding, connection, acceptance, and liberation for themselves and other people around them or whose lives they have the potential to touch” (Hogan 24). She did not write about the dramatically improved memory access, speech improvement, organizing deficit improvement, and improvement of other deficit but those improvements are inferred in her writing.
While it seems that others in neuroscientific rehabilitation fields might have considered studies of multiple patients and normative to further examine this potentially explosive use of writing in narrative therapy, most studies have focused on grammar, language, locating memory regions, or other narrowly defined issues. In “Where the brain appreciates the moral of a story,” the scientists used normal adults for their study, examining each with a PET scan as they asked questions as and after each subject read a story (Nichelli, P, et a., Cognitive Neuroscience and Neuropsychology. Vol. 6, No. 17. 27 November 1995). The stories used were from “Aesop’s Fables,” ensuring that each had a moral (an exposition of the moral teaching or practical lesson contained in a literary work; that part of a work which expounds or contains the moral meaning). While they tested for grammar and semantics as well, my interest is in their ability to locate those parts of the brain that comprehend the moral of a story. The brain regions used by the subjects were consistent when comprehension of the moral was read or explained. The regions included the right inferior frontal gyrus, the right midtemporal gyrus. They studied not only comprehension but memory storage of the moral and theme of the stories (four of “Aesop’s Fables” were used).
Such memory is encoded and distributed for storage in right brain regions concerned with thematic representations. The study demonstrates that a brain injury to the right frontal and temporal regions may inhibit comprehension of the theme and moral of a story. In turn, such injury would naturally inhibit the survivor from remembering parts of a story as she attempts to write or tell it and from using partially accessed memories to recreate the story or moral. Repeated efforts with a therapist collaborator to find a neural link to access the memories or images related to the story, crucial to the survivor’s ability to expound upon the story fully, may allow the survivor to form new pathways and relink to those encoded memories. The more emotionally charged the memory, the more embedded is the imagery and story encoding, offering greater opportunities for the survivor to find access pathways to the memories.
The moral or theme of a story is central to effectively writing a story to inform the reader of the value of the story to the writer and, similarly, so that the reader can comprehend the story’s value and, if a therapist, efficiently collaborate with the survivor-writer to access other memories to expound upon the story. While this study is similar to others revealing the regions of the brain in and from which memory access and creative activities occur, it demonstrates that when the ABI survivor’s brain injured regions are identified, that information may be used to consider specific modes of rehabilitation therapy, including collaborative narrative (story) therapy using writing. It is well known that the activities of one’s brain are spread around the brain, especially memory, and neural pathway development may be accomplished even if the mentioned brain regions are injured. The brain, mysteriously to most, finds a way when the survivor makes concerted and repeated efforts to recall or create story. I argue that my suggested writing therapy method can and should be implemented early and throughout rehabilitation so that those treating the ABI survivor can motivate the survivor to continue her story or narrative, collaboratively building upon it to provide the survivor with the greatest personal insight possible.