The judgement of personality change following acquired brain injury (ABI) is a powerful subjective and social action, and has been shown to be associated with a range of serious psychosocial consequences. Traditional conceptualisations of personality change (e.g., Lishman, 1998) have largely derived from individualist concepts of personality (e.g., Eysenck, 1967). These assume a direct link between neurological damage and altered personhood, accounting predominantly for their judgements of change. This assumption is found as commonly in family accounts of change as in professional discourse. Recent studies and perspectives from the overlapping fields of social neuroscience, cognitive approaches to self and identity and psychosocial processes following ABI mount a serious challenge to this assumption. These collectively identify a range of direct and indirect factors that may influence the judgement or felt sense of change in personhood by survivors of ABI and their significant others. These perspectives are reviewed within a biopsychosocial framework: neurological and neuropsychological deficits, psychological mechanisms and psychosocial processes. Importantly, these perspectives are applied to generate a range of clinical interventions that were not identifiable within traditional conceptualisations of personality changes following ABI.

This article introduces the concept of posttraumatic growth and briefly reviews the limited number of empirical studies on posttraumatic growth in survivors of brain injury. The relationship between posttraumatic growth and psychological understandings of human spirituality is then explored and it is argued that posttraumatic growth is a type of spirituality that is of particular theoretical and practical interest to healthcare professionals. Specific aspects of the situation of people with acquired brain injury are then considered in this light and some suggestions are made for the integration of spiritual care aimed at supporting personal resilience and promoting posttraumatic growth into rehabilitation practice.

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This paper compares the situation of the person with acquired brain injury to that of the people of Israel in the sixth century BCE (before the current era) during the period of exile in Babylon. Both situations are characterized by traumatic multiple losses, and a struggle to regain a sense of identity: personal, national or spiritual. Evidence from the literature on both brain injury rehabilitation and from the Hebrew Scriptures indicates that models of restoration of function and transformation of suffering have been applied to both situations. The relative strengths and weaknesses of these models are considered, and it is argued that models of transformation of suffering have much to offer, especially in the longer term psychotherapeutic rehabilitation of people with acquired brain injury, when restoration of function has reached its limits.

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