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Shattering Blows

Antonio Puente

Confronting Traumatic Brain Injury: Devastation, Hope, and Healing. William J. Winslade. 220 pp. Yale University Press, 1998. $27.50.

A few days after I read Confronting Traumatic Brain Injury, one of my children suffered a mild, sports-related head injury. Although I work with brain-injured patients daily, I was not ready to personally experience what was now happening. William Winslade addresses the devastation, hope and healing as well as the prevention of such injuries.

These injuries are particularly problematic because symptoms are very difficult to diagnose, and the underlying injury is often impossible to document. Suppose a patient in an emergency room after an automobile accident reports headache and is confused. A brain scan may reveal no visible injury, and a mental-status examination may prove similarly benign. In such cases, the patient is often released with no further instructions or recommendations. When problems such as personality changes surface, medical professionals and significant others interpret them as psychiatric. To complicate the picture, many head injuries result in litigation. The role of insurance company defense attorneys is to disprove the allegations; they often resort to interpreting symptoms as personality traits that preceded the injury.

Confronting Traumatic Brain Injury offers a provocative and insightful look into the poorly understood world of the brain-injured person. Winslade is in a unique position to write this book: He is a head-injury survivor, a professor of philosophy in medicine at the University of Texas Medical Branch at Galveston's Institute for Medical Humanities and is associated with a head-injury research center there. Although his injury occurred during childhood (as in almost all cases like his, he does not recall the incident), he writes with compassion and understanding that is unusual on so technical a topic. One could assume that this is why the book contains dozens of case studies. Winslade presents a new view of today's most famous head-injury survivor, James Brady. Other case histories, such as one dealing with a parent's struggle with life-support issues, are eye-opening and heart-wrenching. In addition, Winslade's strong criticism of the rehabilitation industry is timely and on target. The depth of suffering associated with brain injury is not easily accessible to the outside world and is chronicled here in rich and painful detail.

Missing from the head-injury literature has been a nonmedical or neuropsychological perspective of this devastating condition. Although a few books have been published by survivors, these have had a very limited circulation, and the writing is unsophisticated. What is more, complex issues involving society's concerns—prevention and public policy, and the effects of the injury on the person, economy and society—are rarely addressed in any book about brain injury.

Considering the potential widespread readership of this book, I would have appreciated more information about the aftereffects on family members and on patients' emotional and cognitive makeup. Nevertheless, Winslade's insightful approach to this silent epidemic and his framing of disorders in their philosophical, economic and social context makes this a significant contribution to researchers, practitioners, families and policymakers.—Antonio E. Puente, Psychology, University of North Carolina at Wilmington

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