The concept of self in the context of crisis: a study of families of the severely brain-injured.

Patients in coma and a persistent vegetative state (PVS) lack cognitive ability, but may survive for prolonged periods. They present their family members with complex and difficult questions with respect to their treatment and care ranging from the type of technical support they should receive to the nature of adjustments in daily life to accommodate new circumstances and needs. Such decisions are often made in the face of considerable socio-economic and moral constraints with little if any medical guidance and no firm cultural guidelines. Based on a continuing study of families of patients in coma and PVS living in the greater New York area and using the case-study method, this paper argues that such patients and their families find themselves in socially ambiguous and isolated positions which can best be described through the anthropological concept of liminality. Further, it is hypothesized that decisions concerning these patients will in part reflect the way in which family members define the concept of self.