By Maria Hodermarska, LCAT, RDT/BCT
According to the Centers for Disease Control, traumatic brain injuries account for 30% of all injury deaths in the US. For those who survive, a range of challenges (cognitive, kinesthetic, sensory, vestibular, proprioceptive, visual and emotional) from mild to profound can be present[1].
Educator and researcher Pauline Boss’s concept of ambiguous loss acknowledges a grief process that can be experienced across life conditions and circumstances[2]. In the case of traumatic brain injury (TBI), we can consider the ambiguous loss experienced by people who are living in the same body, with the same family but whose cognitive, emotional, physical circumstances may be radically altered - here but not here as they were before. This is true from the perspective of their loved ones, as well. The surreal, existential confusion of being but not being as before is a quality that most people living with an acquired head injury might identify with. One way to consider the experience of living with a TBI is to consider it as a psycho-social process of navigating this ambiguous loss.
In drama therapy, my clinical practice, accepting life’s ambiguities or ambivalences or paradoxes is, in our case, a strived-for state of being. Learning to wrestle with and dwell in our complex, often divergent feelings about a single topic or relationship is the essence of effective drama therapy. I am a loving mother and also a wicked mother. I am a supportive partner and a demanding one. We are not problem solving in drama therapy: we are seeking to help people be both/and. Or, as drama therapist Robert Landy put it (borrowing from the Bard) we seek “To be and not to be”. In drama therapeutic practice, we nurture experiences that help people develop and inhabit their capacity for living in and with ambivalence.
From a drama therapeutic perspective, work with people with acquired head injury is a navigation of the complex nature of the me/not me duplexities, that occur, not by choice, but by catastrophe. In my early clinical work running a drug and alcohol treatment program for people with disabilities, I worked with a number of people living with TBIs. For quite a few, the head injury had occurred under the influence of psychoactive substances. Post injury, due to issues of diminished impulse control and dis-regulation of emotion, substance use was often one of the few “normalizing” activities and coping strategies. The cure for life’s challenging moments was the cause of the greatest challenge faced in life. Helping people negotiate that existential tragedy was the work.
“Learning to wrestle with and dwell in our complex, often divergent feelings about a single topic or relationship is the essence of effective drama therapy.”
A recent film that addresses the aftermath of brain injury: The Crash Reel (2013) directed by Lucy Walker demonstrates these sister notions of ambiguous loss and dramatic ambivalence in the aftermath of a TBI[3]. The Crash Reel is a documentary about snowboarder Kevin Pierce. It follows his recovery from a head injury sustained in a practice run before a competition.
In The Crash Reel, the viewer is taken inside the mostly white, affluent world of US snowboarding. Kevin Pierce is a contemporary of Olympic gold medal snowboarder Shaun White and in the first decade of this century was his greatest US competition. The film combines footage from competitions pre-injury (and of the injuring event itself) with video of recovery and life post injury. As viewers, we are brought directly into Kevin and his families’ ambiguous loss and how healthy ambivalence, assists psychological recovery
Kevin’s injury places him in a particularly difficult functional place—potentially competent enough to take risks but not competent to evaluate those risks.
A number of scenes in the film stand out in a discussion of disability, ambiguity and well-being. Several scenes focus on Kevin’s relationship with his younger brother, David, a person living with Down’s Syndrome.
In one scene, David, directly and poignantly, shares some of the challenges, including depression, that he faces living with his life-long disability. The genetic disorder becomes the lens through which older brother Kevin’s acquired disability can be understood. Suddenly, the we are challenged to consider, in that competitive filial way, who is “worse off” between the brothers. Kevin’s acquired injury is revealed, more sadly than ironically, for the initial able-bodied capability that produced it.
In another scene, David and Kevin’s father discusses David’s great strengths as a person and how he “wouldn’t have him any other way.” The audience is, once again, asked to consider if the same words would be spoken about Kevin and his TBI. We are asked to consider the performance of disability within the family.
In a later scene, we witness a devastating conversation around the dinner table when Kevin, who is living with life altering physical, cognitive and emotional impairments, announces that he wants to return to snowboarding. Another injury could result in death.
David is the one person at the dinner table with whom Kevin cannot argue about his desire to return to snowboarding. David is the one who articulates the most poignantly his worries about how a second injury could kill his brother. As the filmmaker has structured this scene--and throughout the film for that matter-- David’s disability and his ability to navigate and tolerate the ambivalence of his being and the ambiguous loss of
wondering what life would be like without Down’s Syndrome, offers Kevin an emotional roadmap for his recovery and a model for how to endure acquired disability.
We witness Kevin’s family ambivalently afford him the frightening but necessary dignity of risk (at times, he just doesn’t let them know what he is doing) as he experiments around the edges of physical exertion and harm on a snowboard or water skis. We watch them reason with Kevin and “emotion” with him to prevent him from a physical activity that could end his life. They occupy the liminal space, the ambiguous loss, in all of its love, complexity and grief.
“David is the one who articulates the most poignantly his worries about how a second injury could kill his brother.”
We observe Kevin slowly grow into a more healthy ambivalence of being. It’s painful and hard to watch him negotiate his new dis/abled hybrid persona. At times, we see him comforting people with more serious head trauma and urging them to be safe, at other times, we see him talking out loud to his mother in front of someone with a more serious TBI asking, “I’m not as bad as this guy, am I?” We watch his now awkward gait, his changing prismatic lenses on his glasses and we can’t imagine this body in a half pipe performing a double cork with a few feet of clearance from sheer ice.
The film does not end with Kevin’s acceptance of his situation nor does he demonstrate capacity for insight about how his injury places him at risk. Kevin is Icarus. His injury may keep him developmentally arrested in that place of youthful risk taking that afforded him the fearlessness that he needed to be a champion but is now the very thing that now can place him in harm’s way. The viewer is aware that it will be his capacity to accept fear that will help Kevin survive his life post injury.
This ambivalence of being is something that everyone lives with across the life spectrum: children learn that loving parents can be mean, adults learn about the physical limitations of bodies that once could do but now cannot. From a drama therapeutic perspective, it is learning to live in the paradox of human being that is the key to deepening insight and survival in a dangerous and ever-changing world.
[2] Boss, Pauline (2000). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press. ISBN 978-0674003811.
[3] https://www.telegraph.co.uk/men/active/10410244/Kevin-Pearce-my-four-year-recovery-from-a-snowboarding-injury.html
About the Author:
Maria Hodermarska, MA, RDT/BCT, LCAT is an Assistant Clinical Professor of Drama Therapy at New York University. She is a Licensed Creative Arts Therapist (LCAT), a Registered Drama Therapist (RDT) and Board Certified Trainer of Drama Therapy (BCT), a Credentialed Alcoholism and Substance Abuse Counselor (CASAC), and an Internationally Certified Alcohol and Drug Abuse Counselor (ICADAC). Her work spans both the creative and applied psychological uses of the theater arts, most often within NGOs, community-based mental health programs and alcohol/substance abuse treatment programs serving un-served or under-served populations.
Ms. Hodermarska is the coordinator of creative arts therapies for Project Common Bond, an international symposium for young people who have lost a family member to an act of terror, armed or inter-religious conflict. She is former Ethics Chair and current Ethics Committee member for the National Association for Drama Therapy and is a former Education Chairperson for the same organization.
