Stroke and liminality: narratives of reconfiguring identity after stroke and their implications for person-centred stroke care.
Joseph Hall, Frederike van Wijck, Thilo Kroll and 1 others
PMID 39691857WHAT IT FOUND
Stroke survivors described an identity crisis where they felt trapped between their old and new selves.
This liminal state often persisted indefinitely, driven by stigma, loss of autonomy, and a sense of powerlessness in healthcare. Professional psychological support was key to moving past this uncertainty.
Key findings
01Survivors experienced a 'liminal' state, feeling trapped between pre-stroke and post-stroke identities, which could persist indefinitely.
02Interactions with healthcare professionals often reinforced powerlessness, with 13 of 30 participants reporting misdiagnosis and many feeling their voice was ignored.
03Receiving professional psychological support was a singular factor that helped some survivors shift their perspective and exit this state of liminality.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted during the COVID-19 pandemic, which forced a shift to remote interviews. This resulted in a younger mean age for the remote group (50 years) compared to the face-to-face group (63 years). Recruitment was limited to Scotland and England, with no participants from Wales or Northern Ireland. There was a bias towards urban participants and those with less severe communicative impairments; no participants required the 'Talking Mat' support tool. The sample did not include stroke survivors approaching end-of-life care or those with severe cognitive/communicative impairments.
Declared interests
The study was funded by a PhD studentship at Glasgow Caledonian University. The authors declared no other conflicts of interest.
The easy way to misread this
Do not interpret the finding that psychological support helped some survivors as evidence that it works for all, or that it resolves the identity crisis quickly. The study shows liminality can be indefinite, and the support described was subjective and varied in context.