Twenty five severely head injured patients from two specialist neurological rehabilitation centres were interviewed on average seven months post-injury. Changes in self-concept were investigated through the completion of scales of anxiety and depression, an attitude questionnaire relating to physical disability and semantic differential ratings of Present Self, Past (pre-morbid) Self, Future Self, a Typical Person and a Typical Head Injured Person. Psychological distress in terms of anxiety and depressions was common. Patients viewed themselves as having changed substantially as a result of their head injury on a wide range of constructs, yet confidently anticipated a return to Past (pre-morbid) Self within a year, even though Past Self was rated more positively overall than a Typical Person. While differing dramatically from Past Self, Present Self was rated more positively in some respects than the concept of a Typical Head Injured Person, which was perceived as markedly different from that of a Typical Person. Whilst unrealistic expectations may initially serve to protect the profoundly disabled individual and even motivate him towards recovery, in the long run they are more likely to hamper rehabilitation and adjustment. Effective intervention calls for awareness of the patient's own perspective as well as the relatives' reactions to the overt disabilities.