**7.3 Carving a novel path forward**

Beyond strong relationships, empathy, and social support from peers and loved ones, another significant factor in building a sense of well-being for participants was their ability to carve out novel behaviors, goals, and routines in the aftermath of the TBI. For both participants Roger and Philip, their respective careers in sport were definitively ended after their final TBI. Therefore, moving forward into novel endeavors was essential for a myriad of professional, motivational and emotional reasons. Though she was not forced into definitive retirement, Maryann chose to step away from rock-climbing after her serious TBI as the presence of being in the arena caused psychological and somatic symptoms that were difficult to bear. Ultimately, all participants in this study were put in a position where carving out new behaviors, goals, and routines would be essential in moving forward in their professional and recreational lives.

Maryann expresses sentiments of needing to, in some ways, fundamentally restructure her habits, routines, and professional approach. She expresses how she experienced relief through streamlining her professional approach at work and establishing a sense of stoic efficiency:

*I had to change my whole approach. You really have to because there's no time. All these students are really counting on you and relying on you, your department. There's no time for you to be sitting at home and crying that you are hurt. You just have to get up and do it, so what do you need to be able to get that done? It's like alright it happened, okay. Let us do what we have to, we have to run through to the end. No tears until you get home. And what do you need, like what do you need to be able to get it done? Like, to get through this day, what do you need today? And to finally ask yourself what do you need, not how much can I take from you but what do you need to be able to get through because we need to get this done. So, it's really developed a different relationship with myself.*

As mentioned throughout, Maryann feels a tremendous sense of accountability to her students and peers. Originally, this led to her decision to not take the proper amount of recovery time after her serious TBI. However, Maryann is able to find a novel way to move forward despite the limiting circumstances due to PCS. Her ability to adjust - to shift course and construct novel tendencies and behaviors in her day to day work - opens a space for her to overcome the immediate psychological and cognitive deficiencies in the aftermath of her TBI. As is the case with all three participants in this study, we argue that it is this ability to adapt after the TBI that

*Social Support, Identity, and Meaning: A Phenomenological Analysis of Post-Concussion… DOI: http://dx.doi.org/10.5772/intechopen.95541*

supports wellbeing, psychosocial functionality, and the amelioration of symptoms for participants.

Though Philip still seems to be struggling with aspects of leaving sport - especially the emotional void that can come with leaving competition - he consistently describes how there a series of behaviors and outlets in his life that can replicate this emotional void. He expresses how he is optimistic about the possibility of his future career and its ability to fill any emotional void after football:

*P: Being with all the guys; that's one thing that I'll definitely miss. But I think the work that you put into it just to win a football game, you realize that the entire work that you put into something made this product of a win. I know there's obviously other things in life where you put in so much time and you have a great outcome too but I think it's that one feeling when you run out onto the field and Sean Payton actually has a quote, he said, "You'll never get the same feeling when you run out onto a football field on a Friday night or a Saturday but you're going to get it in small pieces in your life" and that's like when you get married or have your first kid, you are going to get that same feeling. But it's just not going to come every single Saturday in the fall.*

*I: Do you believe that? Do you believe that you will get tastes of it?*

*P: Yeah, I think I definitely believe it. There's going to be aspects of my life later on where it's going to be those same emotions, those same strong feelings that I'm going to get while I'm playing football.*

*I: Sure, but what about in your career? Do you think it will? Do you think in business, going into business it will replicate some of these, you said it well, strong emotions?*

*P: I think so. Business is a competitive environment as well so I think the aspects that you need to be a collegiate athlete kind of transform into the business world too, so, I would say it would come here and there.*

Furthermore, he explains how deeper engagement in his academic work as a student and volunteer work outside of the classroom was deeply beneficial in the aftermath of TBI and, consequently, retirement:

*I: What about as a student? Do you ever get it as a student?*

*P: Yes. I think so.*

*I: Does anything in academics or anything right now...is there anything that you do on a semi-regular basis that provides a similar kind of cathartic release to sports, or to football I should say?*

*P: I do not know that's a tough one. I think I have not experienced the extent of some football emotions that you get while you are playing in the classroom but I think it's still a competitive environment obviously, you want to do better than some of the other students in the class.*

*I: What about the solidarity thing? You said that you felt really connected to your teammates. Is there anything that you do outside of sports that makes you feel connected to the people around you? Even on a spectrum level? If it's not the same*  *extent, is there anything that you do that falls on the spectrum of connection and solidarity?*

*P: I do Big Brother Big Sisters so I've had a little brother over in the [College City] project for the past four years and I developed a really good relationship with him and just seeing him grow these past couple of years I think that's been a great experience as well. That's been something that I would say is pretty close to that team connection.*

Philip is fortunate enough to be at a college and in a social-professional culture that worked to promote a more holistic sense of identity beyond any exclusive notion of athletic identity. He describes how he feels like he can move between student-identity and service-identity after his athletic-identity is no longer available. These complementary forms of identity form a holistic sense of self and open space for him reconceptualize and broaden identity after sport. This allows him to experience how novel behaviors - intellectual engagement and service - can allow for a similar sense of satisfaction, solidarity, and competition after sport.

Finally, Philip expresses how he is relatively at peace with the end of his career and is anticipating the next chapter of life after football. He expresses how the combination of social support from his family, personal and team accomplishments have left him in a place where he is comfortable walking away:

*I think I've definitely come to conclusions with my playing career. As I've thought about it, I'm like, okay, I got to play here at [College], I had a great experience, I had a really good career here. I played in high school. That was a great four years. I won a state championship in [State] with my best friends in high school and that was an unbelievable experience. I played my entire life with Pop Warner and as I've gone back and thought about my entire football career, I could not be more proud of myself. My parents could not be more proud of me so I think hearing that from them and I think look in the mirror at the end of the day and just actually being happy with myself and in my career I think it's made it a lot easier. I'm ready for the next chapter now.*

Philip's experience of PCS in the aftermath of a series of severe TBI and his consequent transition out of sport was undoubtedly the most expedited and successful in this study. This passage almost fully encapsulates the psychosocial factors that convalesce for P3 in order to navigate this transition so smoothly. The combination of both flexible identity and social solidarity, offer a clear sense of career perspective for him. Ultimately, this provides him a space to be open, adaptable, and hopeful about the inevitable shift that his life is undergoing.

#### **7.4 Gaining a new sense of purpose**

Participants experienced a higher level of life-satisfaction by gaining a new sense of purpose. TBI forces individuals to make significant alterations to their lives, routines, habits, and careers. This came more easily for Maryann and Philip than for Roger.

Roger's university playing career had only just begun, and his identity as a football player (which provided a full-tuition scholarship) was tied to his identity as a student, and he withdrew from school. After building relationships at his new job, Roger is able to look back with a heavy heart at those who suffer similarly from TBI, and has a compassion that only comes from having lived through it:

*Social Support, Identity, and Meaning: A Phenomenological Analysis of Post-Concussion… DOI: http://dx.doi.org/10.5772/intechopen.95541*

*When I was talking to my psychologist, in his report, it says that I show signs of CTE. And it's like, wow, this is something I read about and saw it in a movie and I show signs of it, that's crazy. Now I want to help people and hopefully slow things down for future players or get better helmets or something because I feel like my last concussion was because the school did not have proper equipment. But, that's besides the fact, we just need to find the right combination for guys. It is something I want to be a part of.*

TBI's have fundamentally shifted the course of Roger's life and career. They have forced him to fully retire from football and withdraw from college. However, over time Roger describes how he begins to gain a sense of perspective on his own personal trauma. This leads to a deepening desire to offer solidarity and support to peers and former athletes who may have shared a similar experience of trauma. Roger continues, expressing a sense of compassion and desire to forward his support and care to other former contact-sport athletes who may also be suffering from the effects of head trauma:

*I remember I was talking to my cousin and he works at a strip club and there was a guy who played for the Falcons. He's retired now but he's always there. I'm pretty sure he has CTE, but he's always drunk and he's fighting people and stuff like that. Him telling me that, while I was going through this is what made me step back from the situation and have a perspective on it. I do not want to be like that because that's the guy I did look up to when I was younger. (Player's name), I mean he played for the (NFL Team) and he was pretty good and to hear how he's doing in life now, after football, I do not want to be like that. I want to be able to still have intelligent conversations and talk to people just like this. Not "ah ugh you want to have a beer man?" No, that's not me. Of course, I can loosen up and have some fun but just to be yelling at people in the club because I'm drunk and mad for no reason? That's not me. I cannot do that and I hate that for him. And I told my cousin, if you can get in contact with him, I want to talk to him. Not on being a fan, I just want to talk to him just to help because he may have some insight for myself or I may have some insight for him. You never know. I do not care that he's an NFL player and played 16 years. I want to help because I feel as though in five years, we may be saying that (NFL Player) killed himself in a car accident or with a gun. Because that's crazy for him to really be having mood swings and drinking as much as he says he drinks, it's not good. It's not good at all. They're a person. We look at them like a piece of meat like, "Oh yeah, he made these plays or this play." But that's only inside of the helmet. He has a family. His purpose in life, in the world, may be bigger than just football to his family. That's what I look at it as. [...] Football is not, it does not define us, but it does get us to different places in life. It got me to college. And at times I did not think I was going to go to college, not coming from the neighborhood I came from. [...] So, seeing people from my same background doing things that I wanted to do and now he's going through that as far as being drunk all the time and being angry and all that stuff? That's not good. That's not good at all. I want to prevent that for someone maybe in my generation or the future generations, maybe even help people that are like him right now.*

Roger feels compelled to take up a greater sense of commitment to supporting individuals who, like himself, are possibly struggling in the aftermath of excessive TBI and career transition out of sport. He is able to recognize the stark reality that many face in the aftermath of their careers and the aftermath of head trauma. Though he did not make it to the NFL, he finds a shared sense of connection and experience with former NFL players who are facing a similar dark journey in the

#### *Frontiers in Clinical Neurosurgery*

aftermath of TBI and their careers. He is clear here in recognizing that the difficulties of retirement are not merely limited to head trauma.

Finally, Roger mentions how symptoms of PCS are ameliorated when he is engaged in an activity that he is passionate about. He describes how his level of focus increases significantly when reading articles that are in the range of either his academic or personal interest:

*I: And have you noticed any activities or even books or articles or movies that you do get really focused, that you can focus on?*

*P: Sports. Anything with sports I can focus in good on. And it's frustrating because I was talking to my agent. She was like, normally what happens, because she's a psychology major, normally what happens is things that you get excited about, you are going to remember. I was just like, that sounds about right. But, I want to get excited about everything and remember everything. But that's just not how stuff is going to work. But it's just like, how do I get my brain to where I can retain what I used to retain? About things that are outside of sports?*

*I: What about the research that you said that you did into the effects of marijuana on sleep? Were you able to focus on those things?*

*P: Yeah because it was something that it was going to help me. Researching that it was more so reading what certain, what the certain strands did and the effects that it would have. And then if I was able to get my hands on it to see what it did to me, and most of the time if I got anything it was just I would get sleepy or I would get focused. And that was awesome to be able to focus in and do my work.*

Put simply, the presence of somatic and cognitive symptoms do not present universally for Roger. Instead, when he is engaged in an activity that finds personal passion and meaning in, many of the cognitive difficulties and symptoms are ameliorated. His description elucidates the role that meaning is likely to have on building focus and cognitive endurance even after a severe amount of TBI.

Maryann finds a sense of purpose in her recovery process and establishing a novel sense of purpose brings her to a greater position of well-being in the midst of her experience of PCS. She describes how getting back to the work she felt she owed her students was what drove her forward and helped her overcome the most difficult aspects of PCS:

*I think part of the recovery was actually having something to do. You know, somewhere to be. Something to heal for because I did not want to let my students down. So that was really helpful in recovering and getting through the semester and being a bigger person for them.*

Similar to Roger, Maryann experiences a sense of cognitive endurance and the amelioration of symptoms when she is engaged in purpose-directed and meaningful activity. As mentioned throughout, she feels a sense of accountability to her peers and students and this drives her to return so quickly to work. Despite the difficulties of this early return, she gains a sense of cognitive strength through reorienting her own existential commitments through the trauma as a deep connection to her work and students.

As we have alluded to, compared to the other participants in this study (especially Roger), Philip was able to commit himself to a new sense of purpose with

*Social Support, Identity, and Meaning: A Phenomenological Analysis of Post-Concussion… DOI: http://dx.doi.org/10.5772/intechopen.95541*

relative ease in the midst of experiencing PCS after the TBI that ended his career. He describes how he was able to establish a new purpose on the team after realizing his contributions on the field were no longer possible:

*P: I would say so because obviously I'm not contributing on the field and it's tough for me to be like a coach and not try to overstep some boundaries here and there. At times I just felt like I was letting people down and I know I did not actually quit but it kind of felt that feeling of being like a quitter for the first time in my life.*

*I: Did you feel that way?*

*P: I did. At first it was really hard to kind of get over that fact that I had to stop because of my health but it was like was I kind of quitting almost?*

*I: Were you able to find any ways to make contributions? Or anything that you felt was a contribution to the team? During those few weeks and months as you are going through this and you are not on the field, you are not playing, you are watching from the sidelines, was there anything you could've done there or is there anything that you did do during that time that made you feel like hey I am contributing something here to the team?*

*P: Yeah, definitely. I helped. I went to every practice and helped out at all of those. So, I still felt that I was a part of the team even though I wasn't playing, you know? I got to go to all of the games.*

*I: And you did feel like you were able to hold up with all of this work for the team?*

*P: Yeah, I was able to chart plays for the defense and contribute as much as possible but I think not actually physically contributing to a win or loss kind of made me feel a little down on myself.*

Despite his inability to contribute to his team's success on the field, P3 is offered the opportunity to take up a pseudo-coaching and staff-support role for the team. Through this, he is able to bring some of his on the ground knowledge to his coaching staff while also offering an extra set of eyes and hands to the day-to-day work of practice and game day operations. Yet, he still expresses initial lament about not being able to physically contribute on the field to his team's efforts. P3 continues, explaining how he was able to establish a new sense of purpose and meaning through support from his coaches:

*P: Yeah, I definitely felt supported. Even after the second concussion, I would always just talk to (Head Coach) on a Sunday. We'd talk about the game. He'd always ask me about my perspective. He would always ask me too, kind of like how the team was feeling. So, I was almost like the inside scoop for the coaching staff. Kind of the emotions of the team throughout the season.*

*I: Are you grateful for that, looking back? That you were kind of able to act like this liaison between the players and coaches?*

*P: Yeah I would say so. For him to trust my opinion and he asked me, "Alright, what do you think we need to do differently?" I think that was good too just to have him be supportive of my voice on the team.*

*I: Did you still feel like you had some value and worth to the team by doing things like this?*

*P: Yeah I would say so. Definitely towards the end of the season, it got easier and easier that I wasn't playing and contributing, I think that obviously helped too just having my small role on the team.*

*I: I know it's hypothetical but if you did not have that what do you think it would be like? What do you think the season would have been like?*

*P: I think it would have been a lot harder. To be officially away from everything, that would have made it a lot lot tougher. And my parents said oh maybe you should just take some time off and not go to all of the practices and not go to the games but I felt it helped for me to actually still be a part of the team. Because all of the guys in my senior class are my best friends for life. I know that's a relationship that I'm going to continue. Not being there with them in this final season of ours and how much we have gone through as a team and how many different coaches we have had, we are the first senior class of Coach Chesney obviously we have been through a lot, and if I wasn't able to be there with them, it obviously would have been a lot harder for me.*

P3 expresses, without equivocation, that the support of his coaching staff and the opportunity to reorient his identity and role on the team in the aftermath of a career ending TBI created a space for him to feel a novel sense of purpose for his life after football. His ability to take a role on the team and embrace these new behaviors, mindsets, and opportunities made him feel connected to his teammates and improved his sense of psychosocial wellbeing. This role allows him to feel that he is making a contribution to the team despite his inability to play. Ultimately, he does not stay stuck in a rigid sense of identity in the aftermath of the TBI. These new routines and behaviors are well within his acumen and ability after the TBI and build a sense of confidence and a novel concept of identity in his relationship to football. His embrace of this novel role is a new existential commitment that opens space for a reexamined life after football. This effort is aligned with both the amelioration of his symptoms and the increase in his psychosocial sense of wellbeing after the trauma.
