Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

ObjectivesIt has been suggested that mental illness threatens identity and sense of self when one's personal story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy, therefore, is to allow individuals to re-story their life in a more positive way which facilitates the reconstruction of a meaningful identity and sense of self. This research explores the ways in which involvement in sport and exercise may play a part in this process.DesignQualitative analysis of narrative.MethodWe used an interpretive approach which included semi-structured interviews and participant observation with 11 men with serious mental illness to gather stories of participants’ sport and exercise experiences. We conducted an analysis of narrative to explore the more general narrative types which were evident in participants’ accounts.FindingsWe identified three narrative types underlying participants’ talk about sport and exercise: (a) an action narrative about “going places and doing stuff”; (b) an achievement narrative about accomplishment through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined with opportunities to talk about those experiences. We note that these narrative types differ significantly from—and may be considered alternatives to—dominant illness narratives.ConclusionThis study provides an alternative perspective on how sport and exercise can help men with serious mental illness by providing the narrative resources which enabled participants to re-story aspects of their lives through creating and sharing personal stories through which they rebuilt or maintained a positive sense of self and identity.     

From pleasure and pride to the fear of decline: Exploring the emotions in older women's physical activity narratives

ObjectivesThe purpose of this study was to explore the emotion narratives in older women's ageing body and physical activity-related stories.MethodThe study was informed by narrative inquiry. We conducted two semi-structured interviews with 21 women aged 65 to 94 and asked them about their physical activity engagement, and body perceptions, experiences, and management strategies. Using thematic narrative analysis, we analysed the content of participants’ stories pertaining to physical activity, the core patterns within them, and considered the cultural context in which they were embedded.ResultsEmotion narratives of anxiety/fear, shame, guilt, pride, and pleasure permeated the women's stories. Participants feared physical and cognitive decline, and engaged in physical activity to stave off the ageing process. Body-related shame and guilt transected their stories; they were frustrated by their inabilities to engage in certain activities and with their move away from the healthy and physically fit cultural ideal. To negotiate this body-related anxiety/fear, shame, and guilt, the women drew attention to their accomplishments in the physical domain with pride, reinforcing their efforts to take personal responsibility for their health. Participants were also physically active for pleasure, gaining satisfaction from the social connections and mindfulness derived from being active, and through their participation in challenging yet rewarding activities.ConclusionsThe findings are novel as they highlight the importance of cultural age and body norms coupled with complex emotional experiences in shaping later life physical activity experiences, and draw attention to the usefulness of stories to explore emotions in the physical domain.     

Auditory and visual hallucinations in a sample of severely mentally ill Puerto Rican women: an examination of the cultural context

The content, interpretation, and structure of hallucinations experienced by individuals with severe mental illness are influenced by the culture of the individuals who experience them. We analyzed the content of visual and auditory hallucinations of 53 Puerto Rican women in northeastern Ohio with a diagnosis of a severe mental illness (SMI) who were participating in a study of HIV risk among Hispanic women with SMI. Compared to non-hallucinators, hallucinators had lower global assessment of functioning scores and greater suicidality. Hallucinations reflected three themes: religious themes, command hallucinations, and unidentifiable voices. Hallucinators’ subjective experience of their hallucinations ranged from a sense of security to significant distress. Participants developed a wide range of strategies to deal with threatening hallucinations. Provider response to individuals’ experience appeared to impact the quality of the patient–provider relationship. We recommend the inclusion of religious history in the initial assessment of individuals. This will assist the provider in making an accurate diagnosis, distinguishing between religious beliefs and those that reflect underlying pathology, and in increasing the level of cultural competence of the care provided. Religious and spiritual beliefs that provide a source of hope and strength for the patient can be utilized to expand and enhance the patient's coping strategies.     

Disability,inclusive adventurous training and adapted sport: Two soldiers' stories of involvement

ObjectivesTo generate insights into the personal meaning and value of an inclusive adventurous training and adapted sport course for military personnel who have experienced physical disability as a result of injuries sustained during active service.DesignNarrative storytelling approach based on collaboratively written creative nonfictions.MethodFirst-person stories were constructed with two male soldiers on the basis of informal interviews and conversations across five days of a residential adventure training and sport course.ResultsThe stories portray the personal benefits, meaning, and value of adventurous training and sport by illuminating each individual's experiences since injury/trauma, his experiences while on the course, and how these interact to shape psychological wellbeing and future life horizons. They reveal a complex interplay between physical, psychological, and social disability among some military personnel.ConclusionsThe story as analysis expands current understanding of the psychological effects of physical activity for injured military personnel through: (i) providing an alternative analytical approach; (ii) revealing subjectivities, personal meaning, and biographical connections to generate a holistic understanding of the individual; (iii) preserving the complexity and ambiguity that characterize lived experience to support plural understandings; (iv) sharing an embodied representation as an ethical act of witnessing another's life. We suggest these kinds of understandings are necessary for physical activity practitioners who wish to support military personnel who have sustained a disability.     

Experiences of surgery readiness assessments in British Columbia

Abstract

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard.

Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate.

Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia.

Results: We developed three main themes to capture participants’ narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps.

Discussion: These narratives demonstrate how much variation exists among people’s experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.     

“The ripples are big”: Storying the impact of doping in sport beyond the sanctioned athlete

ObjectiveThe purpose of this paper was to extend current doping research efforts by shifting the focus away from a doping-user perspective to examine the experiences of elite athletes that have been personally affected by other athletes' doping behaviours.DesignThis research works within the interpretive paradigm, adopting relativist ontology and transactional/subjectivist epistemology.MethodConversational interviews were conducted with ‘competitive’ (N = 2) and ‘retired’ (N = 2) elite Track and Field athletes from multiple countries. In order to communicate the findings in a way that captures the complexity of the issue, whilst also appealing to the athletes this issue affects, creative non-fiction stories were used to present the findings.ResultsTwo stories were created; one incorporating the ‘competitive’ athletes' experiences and one presenting the ‘retired’ athletes' accounts. The stories detail financial, emotional, and relational implications stemming from others' use of performance enhancing drugs. Critically, the impact is not ephemeral; the retired athletes detailed the long-term implications of their experiences. Meanwhile, the competitive athletes suggest that given the current state of sport, they regularly have to defend their status as ‘clean athletes’. Thus, the ripples of doping in sport appear to be far reaching and enduring.ConclusionsIncorporating a novel mode of knowledge production within the doping literature, the stories presented here demonstrate elite athletes' candid accounts of being impacted by others’ doping behaviours in sport. This study also emphasises the value of adopting novel and creative approaches to data collection and representation within the field of doping research.     

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.     

Engagement with meditation as a positive health trajectory: Divergent narratives of progress in male meditators

Objective: Studying personal narratives can generate understanding of how people experience physical and mental illness. However, few studies have explored narratives of engagement in health positive behaviours, with none focusing on men specifically. Thus, we sought to examine men’s experiences of their efforts to engage in and maintain healthy behaviours, focusing on meditation as an example of such behaviour.

Design: We recruited 30 male meditators, using principles of maximum variation sampling, and conducted two in-depth interviews with each, separated by a year. Main outcome measures: We sought to elicit men’s narratives of their experiences of trying to maintain a meditation practice.

Results: We identified an overall theme of a ‘positive health trajectory,’ in particular, making ‘progress’ through meditation. Under this were six main accounts. Only two articulated a ‘positive’ message about progress: Climbing a hierarchy of practitioners, and progress catalysed in other areas of life. The other four reflected the difficulties around progress: Progress being undermined by illness; disappointment with progress; progress ‘forgotten’ (superseded by other concerns); and progress re-conceptualised due to other priorities.

Conclusion: Men’s narratives reveal the way they experience and construct their engagement with meditation – as an example of health behaviour – in terms of progress.     

Investigating real-time physical activity behavior using ecological momentary assessment: Effects of mental fatigue and benefit-cost valuations

BackgroundCurrent research investigating the relationship between mental fatigue and physical activity behaviors relies on laboratory-based, experimental studies which lack ecological validity.ObjectiveThis study used ecological momentary assessment (EMA) to assess feelings of mental fatigue and subjective evaluations (benefits and costs) as predictors of moderate-to-vigorous intensity physical activity in the everyday lives of young adults.MethodsOne hundred participants (n = 22 males, n = 78 females, M_age = 20.60 years, 70% meeting or exceeding physical activity guidelines) responded to digital survey prompts up to four times a day and wore an accelerometer for seven consecutive days. Moderate-to-vigorous intensity physical activity in the 180-min time window following each survey prompt was recorded. Data from the 28 survey-moderate-to-vigorous intensity physical activity epochs were analyzed using multilevel mixed-effects linear modelling.ResultsHigher levels of mental fatigue than one’s average level were associated with engaging in fewer moderate-to-vigorous intensity physical activity minutes (p = .004) and lower benefit vs. cost scores (p = .001). Higher benefit vs. cost scores than one’s average level were associated with engaging in more minutes of moderate-to-vigorous intensity physical activity (p < .001).ConclusionsResults are the first to demonstrate outside the lab, that mental fatigue experienced in everyday life may amplify the perceived costs of moderate-to-vigorous intensity physical activity, with both factors playing a potential role in moderate-to-vigorous intensity physical activity decision-making. Future research may apply insights gained from this study in design and testing of real-time interventions promoting moderate-to-vigorous intensity physical activity.     

A ‘new life’ story or ‘delaying the inevitable’? Exploring older people's narratives during exercise uptake

ObjectivesThe purpose of this study was to examine narratives of ageing in a clinical population embarking on a physical activity/exercise programme, exploring if and how their narratives changed throughout their experiences.DesignThe study employed a longitudinal narrative approach.MethodParticipants were six sedentary individuals aged between 78 and 89 years who were enrolled on an exercise programme for older adults. During the course of the 32-week programme participants took part in multiple interviews focused on their attitudes towards physical activity and their physical self-perceptions and identity. A structural narrative analysis was used to focus on the progression of the plot outlined in each participant's story.ResultsOur results suggested the emergence of two comparative narratives, with each demonstrated in the stories told by three participants. The first narrative is one of decelerated decline, in which the exercise programme is assimilated or fitted into the existing life narrative, but little is made of the personal meaning of being active. In the second narrative, participation in exercise prompted participants to re-story their ageing narratives, changing from initially accepting the decline they associated with an ageing body, to the prospect of gaining some control. While this increased sense of control may intuitively seem positive, participants initially described a number of existential challenges and dilemmas as well as their resolution of these.ConclusionParticipants' emergent stories highlighted that while older adults may perceive exercise positively, their existing narratives of decline may be resistant to change. Where changes do occur, it is important for health professionals to recognize the associated difficulties with gaining increased responsibility for health.     

Being the Shadow: Witnessing Schizophrenia

This essay discusses Susan Smiley’s documentary film, Out of the Shadow (2004), and Tina Kotulski’s memoir, Saving Millie: A Daughter’s Story of Surviving Her Mother’s Schizophrenia, as filmic and narrative treatments of their mother’s schizophrenia. Mildred Smiley, and her diagnosis of and treatment for schizophrenia, is at the center of both her daughters’ treatments of mental illness, and in these texts, all three become witnesses to the multiple experiences of mental illness and the multiple events of psychiatric power. As I will argue, these two texts are treatments of schizophrenia that both see and don’t see Mildred Smiley’s experience of mental illness. Through these texts, we—viewer and reader—are asked to look again, or to look for the first time, at mental illness, and we are positioned as having the agency to look or look away. As we look and try to make sense of what we see (and don’t see), we too participate in the production of mental illness as a category of analysis.     

Making space: Spirituality and mental health

This paper was the Mary Hemingway Rees Memorial Lecture, delivered at the XXIst World Assembly for Mental Health, Vancouver, Canada, 2001. The author had recently completed a period of appointment as the New Zealand Commissioner for Mental Health. In this lecture, the author puts in a moving plea - as a survivior of mental illness - for considering both spirituality and mental health in terms of the experience of the self. She talks about the value of communication particularly by sharing experiences via personal stories. The author goes on to contrast communication and control, and to emphasize the importance of making space in order to accept our own and others' imperfections and vulnerabilities. Attention is drawn to the work of Baruk (1978, 1998, 1999, 2000). She also discusses the way in which mental illness can lead to spiritual progress, and ultimately to mental health. The original version of the talk contained further pictorial illustrations; for technical reasons it would be difficult to reproduce all of them here in the journal. Most of the illustrative material consisted of photographs by the author, including the two photographs that are reproduced in this paper.     

“You have to be mental to jump off a board any way”: Elite divers' conceptualizations and perceptions of mental health

ObjectivesMental health research in elite sport focuses predominantly on mental illness prevalence rates and help-seeking behaviours. Diving has been identified as a sport that generates particular challenges for maintaining mental health, yet has received scant attention from researchers. Therefore, purpose this paper explores what mental health and mental health related behaviours mean for a group of young, elite athletes as conditioned by their peculiar social context as elite athletes.MethodSemi-structured interviews were conducted with purposely sampled eight elite divers aged between 14 and 24 years with between 5 and 16 years of diving experience who have competed in international level diving competitions including Olympic, Common Wealth and World Cup competitions. Interviews were recorded, transcribed verbatim, and analyzed using inductive thematic analysis.ResultsAnalysis identified mental health literacy, experiences of mental health, risk factors, and opportunities for support as themes. Mental health generated negative connotations for participants attributable to knowledge development occurring through personal and vicarious experience of mental illness. Limited knowledge of symptoms of mental illnesses was evident. Participants identified a range of risk-factors inherent in their sport performance and culture revealing a performative and gendered dimension to mental health.ConclusionsOur results indicate the need to recognize the performative nature of mental health for elite divers and therefore social and cultural influences alongside biophysical. Greater efforts need to be made to help improve the overall mental health literacy of elite divers so they may be able to seek the support and treatment they need.     

Sources of autonomy support,subjective vitality and physical activity behaviour associated with participation in a lunchtime walking intervention for physically inactive adults

ObjectivesBased on Basic Needs Theory (BNT: Deci & Ryan, 1985), this study examined longitudinal relationships between autonomy support from two sources, psychological need satisfaction, subjective vitality and self-reported physical activity during a walking intervention for physically inactive adults. We proposed that autonomy support provided via a walk leader and the overall programme would independently predict change in subjective vitality and physical activity from baseline to week 16 (post-intervention) and at four month follow-up. Further, we proposed that direct relationships among sources of autonomy support and outcomes would be mediated by autonomy, relatedness, and competence need satisfaction.DesignA longitudinal examination.MethodsParticipants (N = 69; n = 63 females, n = 6 males) from a 16-week walking programme completed a multi-section questionnaire measuring the aforementioned variables at three time points, including a four month post-intervention follow-up.ResultsBoth hypotheses were partly supported. Autonomy support from the walk leader positively predicted changes in subjective vitality from baseline to week 16 and in physical activity from baseline to follow-up. Autonomy support from the programme positively predicted changes in subjective vitality from baseline to week 16. Finally, autonomy gained from the walk leader mediated the relationship between autonomy support and subjective vitality, and between perceived autonomy support and physical activity.ConclusionsFindings indicate that autonomy support from both a walk leader and wider programme can predict psychological need satisfaction, subjective vitality and physical activity. Clinicians and researchers implementing future walking interventions may increase physical activity and subjective vitality by facilitating psychological need satisfaction through autonomy support from both sources.     

Narrating the other: Self-other agreement of affective qualities and manifest events among personal life stories and the vicarious life stories provided by informants

Life stories are psychosocial constructions of one’s past, present, and future. Vicarious stories are mental representations of others’ life stories. Across two studies, we examined self-other agreement among features of participants’ personal and vicarious stories and whether agreement corresponded with relationship closeness. Agreement was quantified via the affective qualities and manifest events of key scenes. Targets’ personal and informants’ vicarious stories demonstrated agreement in tone, but not in redemption or contamination (Study 1). The manifest events within informants’ vicarious scenes corresponded with participants’ personal life stories 25% of the time, and this agreement increased with greater relationship closeness (Study 2). Our findings support the notion that an understanding of the important events in someone’s life may facilitate interpersonal closeness.     

The transnational experience of sport psychology practitioners from training to practice

ObjectiveDespite a growing body of literature examining the migratory experiences of athletes, limited attention has been paid to the migratory experience of sport psychology practitioners (SPPs). This study explores SPPs’ experiences of transnational migration; specifically, for those who expatriated to receive their training and repatriated to begin their professional careers.DesignAdhering to consensual qualitative research methodology, we conducted a qualitative study using semi-structured interviews.MethodsFollowing criterion-based sampling, we interviewed six female and four male SPPs who worked in academic (n = 3), applied (n = 3), and governmental (n = 4) environments. We used an analytical procedure encompassing concurrent deductive and inductive processes.ResultsParticipants described their motivations for expatriation and repatriation. They shared the challenges and benefits they faced throughout their transnational experience, recognizing the value that this experience brought to their lives. In most cases, SPPs shared how their training abroad became a professional advantage, once repatriated. They also described how the process of repatriation was more challenging than expected due to personal and professional difficulties.ConclusionsParticipants highlighted the positive influence that their transnational experience had in their personal and professional lives. Their transnational experience helped them grow personally and professionally, and provided them with professional advantages. However, our participants’ stories also highlighted systematic barriers that professional organizations could address to facilitate the transnational experience of practitioners, which would subsequently enhance the cultural growth of the field. Recommendations for professionals engaging in similar transnational experiences are discussed.     

Positive and negative affect and well-being in cardiac patients and their spouses: the mediating role of illness representations

Objective: The aim of this study was to examine whether illness representations of control and consequences mediate the relation of cardiac patients’ affect to well-being. A further aim was to examine this indirect relationship at a dyadic level (i.e. patient and spouse). Design and main outcome measures: One hundred and four patients with a cardiovascular disease and their spouses participated in the study. Positive and negative affect was assessed at baseline; illness representations were assessed 2 months later, and physical and psychological well-being 4 months later. Results: Illness representations generally mediated the impact of patients’ and spouses’ affect on well-being, while several actor and partner effects were found. However, it was only positive affect that was indirectly related to well-being, while the representations of personal and treatment control chiefly acted as mediators. The effects were stronger for patients than spouses, as well as for physical well-being. Conclusion: The results underline the strong connection between illness-related self-regulation and the overall person/environment interaction as depicted by affect. They also indicate the need to integrate theories on adaptation to illness, with models describing adaptation of couples to stressful conditions, and specific theories about the role of emotion in adaptation to illness.     

Utility of Popular Stories to relieve Distress: Perspectives of Adult Listeners

The present study explores the differential utility of 'Popular stories' to relieve distress as perceived by persons with chronic physical illness and mental illness and also to examine the differential utility of various themes of stories. Each of the sample group consisting of persons with HIV+, Cancer, Depression spectrum disorders, Anxiety spectrum disorders, and also persons without any specific illness (N?=?125) was presented with a set of 40 stories of eight different themes. They were asked to rate the utility of each story to relieve distress. Qualitative observations during the process were also noted down. Persons with chronic physical illness, especially those with HIV+, have given the highest rating to the usefulness of stories for relieving distress vis-à-vis persons with mental illness, especially Anxiety group. Stories with the theme 'Goal Direction and Prioritization' were perceived most useful for relieving distress whereas the theme 'Relativity/Count your blessings' has been perceived as the least useful for relieving distress. The findings of the present study would be useful in selection of stories to be used in a psychotherapeutic set-up and further investigation.     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.