Los modos de dominación

The findings of the present study indicate that wives of men who have sustained severe and disabling injuries, especially the wives of men with closed head injuries are at considerable risk of developing symptomatology, and of reporting marital dissatisfaction in the years following their husband's injury.

The extent of symptomatology reported among women whose husbands had suffered closed head injuries was such that these women must be considered as a patient group in themselves, and be offered a variety of preventative and clinical services accordingly. Very few of the women surveyed felt that they had received the level and type of support that they required from health agencies following their

husband's accident. Women in both groups expressed a desire to be involved in their husband's rehabilitation, to be advised on management when he is discharged from hospital, and advised of possible

personality and other changes and their resultant problems. They also expressed the need for joint counselling for themselves and their husbands, both while their husbands were in hospital, and in the years following.

Health agencies need to provide a variety of services to wives of men who have sustained closed head injuries. Firstly, as the women themselves pointed out, they need information. Specifically, they need to be warned of the possible sequelae of head injury, especially of the more subtle personality and behavioural changes, as such changes are consistently found to be detrimental to wives' well-being. They need to be aware of the fact that despite apparent physical recovery, their husbands may not be able to perform many of the marital roles which they had previously carried out. The distribution of household tasks could be discussed in counselling and more complex tasks could

be reassigned to the wife, children or to outside helpers. While such a formal reassignment of tasks may not always be possible, at least the wife would be psychologically prepared for such a redistribution of tasks. This preparation could prevent the distress which can arise as a consequence of the wife's resentment of her task over-load, or from her frustration at trying to enlist her head injured husband to perform his pre-injury task-load.

Secondly, the women need to be taught the skills required to effectively manage the mental and behavioural sequelae of closed head injury ( eg. behaviour modification, learning when to withdraw from co n flict). Such training would equip them with effective coping

strategies, and so minimize the escalation of distress that is produced by maladaptive or ineffective coping strategies.

Thirdly, the women need support, both from medical and related health agencies and from self help groups. The nature of this support would change over time, but results of the present study indicate that this support must continue, if not be escalated, once the husband leaves hospital. The present findings indicate that the personality changes which accompany closed head injury cause most distress in spouses, and that these personality changes are related to marital role changes and also to a loss of emotional support from the husband. Given such changes, it is not suprising that wives of closed head injured men report little marital satisfaction. As these women

be expected that they would experience some level of grieving for the relationship they had with their husband prior to his injury. The

women need to be supported through ongoing grief counselling. Her efforts to cope with her husband's personality changes also need to be acknowledged and supported.

It is clear that the wives of severely injured men (particularly CHI) need to be offered ongoing support services long after their husband is discharged from hospital. Interestingly, while a support group for relatives of the head injured exists in Australia (Headway), few of the women were aware of its existence and none were involved in the group. The women tended to be advised of support services in the early period after their husband's accident, at a time when they were probably overloaded with information, concentrating on their

husband's physical recovery and maintaining optimism for his future recovery. It would appear more useful, considering the results of the present study, to re-advise women of available support services some time after their husbands have returned home.

Finally, health agencies need to focus on the family as a whole as a unit of treatment following closed head injury. Specific sequelae of head injury such as loss of emotional control or sensitivity to noise are likely to have important repercussions for the whole family.

compromise not only the patient's post injury functioning but also put

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the spouse at increased risk of developing clinical levels of

symptomatology, children whose fathers have suffered closed head injury must be considered an 'at risk' group. It is likely that some level of grief is felt by children following closed head injury, as they notice that their father is 'different' and their mother unhappy.

Childrens reactions to this loss will vary, but it is possible that

increased behavioural problems, acting out, depression and regression to an earlier developmental stage may occur. These problems are likely to place further stress on the wife of the head injured man and thereby begin a cycle which exacerbates problems within the family system. As such cycles can become quickly entrenched, family

interventions (eg. family counselling ) soon after head injury serve a vital preventative function, as well as forming part of a comprehensive ongoing support network.