Performances in the workplace following traumatic brain injury: a dramaturgical metaphor to explain how return to work is supported

Abstract

Recovery from Traumatic Brain Injury (TBI) is a lengthy and complex journey. The ability to Return to Work (RTW) is often severely compromised and not easily predicted by medical sequelae. Recent qualitative research has highlighted the importance of the environment and the support available. Despite this, little is known about how people present in their workplaces, manage their own impressions and how they use support to re-establish their workplace identity. This qualitative study using a multiple case study approach explores two RTW journeys. Each case includes the person with TBI and others identified as being helpful in the process. Data were collected over two years at six time points using semi-structured and unstructured interviews, genograms and social networks diagrams. Analysis has been informed by the work of Goffman (1959). The findings are presented in keeping with Goffman’s dramaturgical metaphors. Individuals offer many performances that are shaped by their interactions with others, each performance requiring the actor to project an accepted front so that the audience may view their performance as authentic. The thesis highlights how workplace fronts become disconnected in four key areas (appearance, manner, emotion and work skills) following a TBI and how a sense of connectedness is re-established over time. The findings highlight the importance of stage areas and how these distinct areas impact on the type of performance given and how it is supported by workplace and non-workplace actors to shape and save the performances that a person with a TBI is required to give in the workplace. I conclude that RTW is not a simple linear process but involves complex interactions between the individual with TBI and the workplace environment, employers, health care professionals, family and friends. I propose that the dramaturgical metaphor offers a way of understanding the complexities associated with RTW and re-framing the possibilities for RTW programmes.

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