ABSTRACT
Major personality changes can result from brain damage and dementia. We look at what happens when the known other is irretrievably altered by brain incident, forcing a paradigm shift in our relatedness. We cannot know the altered other without holding on to our previous experience of them, yet if we hold on too tightly, we cannot fully know the present, altered person. The challenge is to find new ways of living with the presence of history, not as a haunting presence, but as an essential and constitutive element in our present experience of the other. In the face of the many discontinuities, our struggle is to retain continuity and allegiance with the person we knew and with whom we had a shared world. In so doing, we can forge creative ways to relate to the altered other. “Knowing” is a complicated psychic function that includes not only the “realistic” aspects of the other as we perceive them now, but also the unconscious, ongoing knowing of the other as we have always known them. Two cases illustrate this psychic struggle. Finally, we confront the paradox of both knowing and not knowing the other at the same time. An attitude of loosely holding in our mind the other, as we knew them, while allowing for coming to know the altered other is the best we can do. To come to “know” an altered other is to allow for changes in our internal self and object relations so that we might know them more expansively as they were to us, as they currently are to us and also, importantly, what they might have been for us.
