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"...for a "successful" treatment/therapy to occur, doesn't the individual have to realize that they need the treatment?" I think that is a good point. I know that lots of the guys at the rehab I worked at didn't seem to think that they needed to do X Y or Z, and in some cases I couldn't disagree with them.

I like the notion that arose about being "brain altered". If our brains are changing--via endogenous processes (hormones, for example), via everyday experience, via pharmacological therapy, or via psychotherapy, and so forth--everyone is brain altered (at every moment even).

Defining a problem... I think that as long as we're looking at what is impaired in a praticular person, we have to keep in mind that it is relative to the outside environment, ie culture. I don't want to say that individuals with brain damaged shouldn't be taught about their deficits--I think it's important for a person to understand what they can and cannot do, so they can then develop new ways to do whatever.