Family response in head injury: denial ... or hope for the future?

Denial is often seen as a major obstacle to successful adaptation in the family of the head-injured. In fact, it is typically inadequately understood in the rehabilitation setting. The term is frequently used in a simplistic way, with the social and cultural factors behind the denial, particularly the stigma of head injury, not examined or confronted. There is very little hard data on what constitutes successful family adaptation over the long term. Professionals have a tendency to focus exclusively on the patient's deficits and the family's difficulties, ignoring the positive ways in which people cope. This article suggests that there is a need for a paradigm shift, based on the transactional theory of stress and coping, in which denial is seen as a positive response in some situations. Instead of becoming locked into trying to dispel what is usually called denial and adopting an adversary stance to the family, it may be more beneficial for rehabilitation staff to work together with family members to understand why head injury is so difficult to deal with, develop positive models for living with the sequelae, and encourage hope for the future.