From chaos to new life: Ritual enactment in the passage from illness to health

Illness irreversibly alters our lives and our relationships. More than a physical or psychological experience, the passage of illness is an existential crisis that is potentially transformative for an individual and his or her loved ones. It is through ritual enactment that we can most fully experience the transformative potential of illness. Rituals are common during illness, but are underutilized for the critically-important reintegration period following acute illness, when personal, interpersonal, and communal healing must occur. Pastoral counselors and others who comfort and counsel the sick and their loved ones should encourage religious and secular ritual enactment to ease this passage.     

Impact of chronic illness: Differing perspectives of younger and older women

Abstract

The purpose of this study was to examine the life experiences of six women with chronic illness who represent three differing life stages. The participants included two women who were in young adulthood, two who were between the ages of 40 and 60, and two women in their late 70s. The women were all diagnosed with multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, osteoporosis, or a combination of these disorders. They were interviewed concerning the impact illness has had on their lives, the manner in which chronic illness has altered their self-perceptions, and the ways in which they have come to make meaning from the event. While the women had achieved varying levels of acceptance of their illness, it appeared that the ability to cope was dependent on numerous factors across several life circumstances. Distinctions were made regarding ability to either adjust to the illness or use the experience as a catalyst for personal growth.     

Examining adversarial growth in illness: The factor structure of the silver lining questionnaire (SLQ-38)

The Silver Lining Questionnaire (SLQ-38) is purported to measure 10 aspects of adversarial growth in illness. To date however, no empirical evidence exists to support this claim. Hence the aim of this study was to investigate the factor structure of the SLQ-38 in a sample of 560 individuals with multiple sclerosis (MS), cancer, cardiac, and renal disease. The results demonstrate that 24 SLQ-38 items can be factored into five subscales: improved personal relationships, greater appreciation for life, positive influence on others, personal inner strength and changes in life philosophy, all of which are in accordance with the literature on adversarial growth. Individuals with MS experienced lower adversarial growth compared to other illness groups. Gender, age and time since diagnosis were unrelated to adversarial growth in illness. The utility of the revised SLQ-38 is discussed along with suggestions for future research on the convergent and divergent validity of this revised instrument.     

The Gentleman Vanishes: Dementia,Caretaking and the Life of the Mind

This essay recounts the author’s journey with her father during his prolonged decline due to dementia. The experience pushed her to break out of the confines of conventional scholarly research in her academic field of architectural history to a multi-disciplinary consideration of nineteenth-century environmental, sensory and horticultural therapies for the mentally ill. During her father’s illness, she discovered the tangible therapeutic benefits of momentary engagements with his environment through his five senses and through the emotional filter of poetry. This reorientation to sensory and poetic experience had a beneficial impact on the caretaker as well.     

The physical activity experiences of men with serious mental illness: Three short stories

ObjectivesAlthough a considerable amount of research has explored the effects of physical activity on mental health, the voices of people with mental illness have been largely excluded from published reports. Through this study we aim to foreground service users’ voices in order to shed light on the personal and subjective nature of the relationship between physical activity and serious mental illness (SMI).MethodsAn interpretive case study approach was used to explore in depth the physical activity experiences of three men with SMI. Creative analytic practice was used to write three creative non-fictions which, as first-person narratives, foreground the participants’ voices.ResultsWe present three short stories in an effort to communicate participants’ personal and subjective experiences of physical activity in an accessible, engaging, and evocative manner. We hope to: (i) provide potentially motivating physical activity success stories for others who live with SMI; (ii) increase awareness among mental health professionals of the possibilities of physical activity; and (iii) provide an empathetic understanding of possibilities and problems of living with SMI which may help challenge the stigma surrounding mental illness.ConclusionsFor us, the stories communicate the diversity and difference inherent in the ways men with SMI experience physical activity. We reflect on how the short story form allows these differences to be preserved and respected. We resist making further interpretations of the stories preferring instead to encourage the reader to form her or his own conclusions.     

Cancer Patients' Illness Experiences During a Group Intervention

The study used secondary data analysis to explore cancer patients' illness experiences during a listening group intervention. Participants were 12 patients (age range 22 to 62 years in age; males = 4; females = 8). Data were analysed using qualitative content analysis. Analysis of the data yielded twelve prevalent themes namely, support, perspectives and experiences in medical context, perspectives on life and death, emotional experiences, religiosity, role of knowledge and information pertaining to cancer, finances, concern for others, loss, desire for survival, humour, and physical symptoms. A framework suggesting possible moderating factors that could influence cancer patients' illness experiences and outcomes are proposed. The results of the study emphasise how stressful and complex living with cancer can be. However, many cancer patients developed alternative perspectives on life which also seem to bring about personal growth. It is suggested that further research regarding the development of a survivorship care programme within the South African context be undertaken.     

Couples coping with cancer: Research issues and recent findings

The diagnosis of cancer in one partner can impose numerous changes for both the individual diagnosed with cancer and his or her healthy spouse. In this article, the literature on spouse social support in the context of cancer is reviewed. The importance of understanding support given and received within a close relationship using an interactional, contextual perspective is emphasized. Examining support-related interactions and understanding the personal characteristics that determine the type and amount of support that providers give and the kind of support individuals prefer, and investigating why significant others respond in supportive or critical ways is important. In addition, the study of support interactions must be placed in the both in the context of a marriage and in the context of a catastrophic life event such as cancer. A longitudinal study of patients with gastrointestinal cancer and their healthy partners was undertaken to examine these issues, and the design of this study is described. General problems conducting research with couples undergoing a severe life stressor as well as specific problems our research group has encountered while setting up a research program in the cancer setting are reviewed.     

Overcoming the Shame of Cancer

The author describes the silencing and dehumanizing effects of being diagnosed with cancer. This experience evolved from a sense of being totally stunned, to being flooded with shame, and finally to be able to reenter an experience of subjectivity through the support of his family, friends, and community. He describes his personal struggle to disclose having cancer to his patients and supervises and the incredible beneficial effects of disclosure and being virtually and actually held and cared for. The author describes from Relational, Kleinian, and Lacanian perspectives his understanding of the effects of self-disclosure in reestablishing the capacity for symbolization and the ability to create personal meaning.     

Call of the Wild

Freud described "wild analysis" as an undisciplined version of psychoanalysis; but the new Penguin series of Freud's writings collects many of his papers under the title Wild Analysis, challenging the differentiation. This paper traces wild elements at the core of psychoanalytic thought, crediting Groddeck, Ferenczi, and Winnicott for bringing them to the open. The image of the wild analyst can serve us as the image of the deeply involved, personally motivated analyst, whose work is intense and emotionally risky. This is the opposite of the "civilized" analyst who uses well-defined existing paths, takes no personal risks, and therefore stays at an emotional distance from his/her patients. Every analyst's capacity to develop a unique analytic self, based on his/her genuine life experience and worldview, is endangered if stepping out of line is slandered as "wild analysis" or as insanity. The relevance of these issues for contemporary psychoanalytic thought and education is demonstrated.     

The role of positive thinking in social perceptions of cancer outcomes

Pressure for 'positive thinking' (PT; i.e., focusing on positive thoughts/suppressing negative thoughts to 'fight' cancer) burdens cancer patients facing health deterioration. It was determined whether PT exposure enhanced effort, control and responsibility attributions assigned to an individual for his/her cancer trajectory. Within an online blog a hypothetical same-gender person describes a personal cancer experience. 482 participants were assigned to one of six experimental conditions in which we manipulated PT exposure (blogger learns about 'power of PT' but does not try it, blogger tries PT, control/no PT) and cancer outcome (successful/unsuccessful treatment). A 3?×?2?×?2 multivariate analysis of covariance (with personal cancer experience covariates) tested PT exposure?×?cancer outcome?×?gender effects on attributions for the blogger's cancer outcome. Results indicate that PT exposure enhanced effort and responsibility attributions assigned to individuals for their cancer outcomes and that responsibility attributions differed as a function of gender. Findings suggest that exposure to the idea of PT may lead to cancer patients being perceived as culpable if they do not recover from the disease.     

“It Is Not Wit,It Is Truth:” Transcending the Narrative Bounds of Professional and Personal Identity in Life and in Art

Taking inspiration from the film Wit (2001), adapted from Margaret Edson’s (1999) Pulitzer Prize-winning play, this article explores the particularities of witnessing a cinematic cancer narrative juxtaposed with the author’s own cancer narrative. The analysis reveals the tenuous line between death and dying, illness and wellness, life and living and the resulting identities shaped in the process of understanding both from a personal and professional lens. By framing these representations of illness experience within the narrative constructions of drama, time, metaphor and morality, the personal stories of intellectual knowledge converging with intimate and embodied knowing are revealed.     

骨科疾病诊治中的临床思维

医学哲学是对医学科学成就总的概括,并以此为基础探讨生命活动和病程的一般规律,研究医学科学的思维方式,直至疾病预防、诊断治疗。同时研究辩证规律和范畴在医学科学中的表现,从而指导骨科医师解决在骨科疾病诊治中遇到的诸多问题,并有助于形成正确的临床思维。结合临床工作体会,探讨医学哲学在骨科疾病诊治临床思维中的应用。     

Life Experience Is Not a Disease or Why Medicalizing Madness Is Counterproductive to Recovery

Abstract

The author draws on her personal experience as the family member of an individual with mental illness, on her anthropological research and on that of others to argue that medicalizing madness can be counterproductive to recovery. The medical model is sometimes used in a way that strips away the meaning of the illness experience. Analogies drawn to diseases do not help the understanding of mental illness. Psychiatry is a social practice embedded in a social milieu and that renders it less than objective. It is useful to recognize that the experiences called symptoms have meaning and may have positive and pleasurable aspects.     

The role of positive thinking in social perceptions of cancer outcomes

Pressure for ‘positive thinking’ (PT; i.e. focusing on positive thoughts/suppressing negative thoughts to ‘fight’ cancer) burdens cancer patients facing health deterioration. It was determined whether PT exposure enhanced effort, control and responsibility attributions assigned to an individual for his/her cancer trajectory. Within an online blog a hypothetical same-gender person describes a personal cancer experience. 482 participants were assigned to one of six experimental conditions in which we manipulated PT exposure (blogger learns about ‘power of PT’ but does not try it, blogger tries PT, control/no PT) and cancer outcome (successful/unsuccessful treatment). A 3?×?2?×?2 multivariate analysis of covariance (with personal cancer experience covariates) tested PT exposure?×?cancer outcome?×?gender effects on attributions for the blogger's cancer outcome. Results indicate that PT exposure enhanced effort and responsibility attributions assigned to individuals for their cancer outcomes and that responsibility attributions differed as a function of gender. Findings suggest that exposure to the idea of PT may lead to cancer patients being perceived as culpable if they do not recover from the disease.     

The structure of adversarial growth in a sample of cancer patients 8 years post-diagnosis: a revision of the SLQ-38

Stressful and traumatic events may trigger positive life changes, so-called adversarial growth. Despite growing interest in this topic, the structure and dimensionality of this concept has not been established. Recently, empirical reviews have suggested that the factors underlying this construct are highly related. Currently, the use of confirmatory factor analysis to test this hypothesis is advocated. Using data from cancer patients (n = 206), this study investigated the dimensionality of a Dutch translated version of the Silver Lining Questionnaire (SLQ-38). A 16-item SLQ (SLQ-16), with three subscales or first-order factors (enhanced personal relationships, changes in life philosophy and changes within the self) loading on a second-order general adversarial growth factor, was a good fitting model. In conclusion, the SLQ-16 may prove useful in the assessment of adversarial growth following illness.     

Predictors of posttraumatic growth following bone marrow transplantation for cancer.

There is growing recognition that the experience of cancer can have a positive as well as a negative psychological impact. This longitudinal study sought to identify predictors of posttraumatic growth among cancer patients (N=72) undergoing bone marrow transplantation. Greater posttraumatic growth in the posttransplant period was related to younger age; less education; greater use of positive reinterpretation, problem solving, and seeking alternative rewards as coping strategies in the pretransplant period; more stressful appraisal of aspects of the transplant experience; and more negatively biased recall of pretransplant levels of psychological distress. Findings partially support J. A. Schaefer and R. H. Moos's (1992) model of life crises and personal growth and also suggest that temporal self-comparisons contribute to the experience of posttraumatic growth.