‘So many women suffer in silence’: a thematic analysis of women’s written accounts of coping with endometriosis

Abstract

Objective: To understand women’s experiences of coping with endometriosis, and impact on their lives.

Design: Women accessed an online questionnaire through a U.K.-based endometriosis charity website.

Methods: Thirty-four women, aged 22–56 years, with self-reported medically-diagnosed endometriosis, 30 of whom were White, responded to open-ended questions, analysed using inductive thematic analysis.

Results: Participants spoke about their lives being a constant struggle, where they tried to maintain their personal and working lives whilst dealing with long-term pain. Women had to ‘battle’ for an accurate diagnosis, and had limited faith in health professionals. Coping strategies included avoidance of social events to conserve energy (self-pacing), and avoiding taking painkillers to retain alertness. Women did not feel able to be honest with family and friends about their symptoms, and felt socially isolated and misunderstood.

Conclusions: Implications for health professionals are discussed, including the need for earlier diagnosis and taking women’s symptoms more seriously at referral; understanding the need to conserve energy in the context of long-term pain; that not taking pain medication may be an active choice to retain alertness; and that avoiding being honest with friends and family and subsequent feelings of isolation may be common experiences relevant to designing treatment programmes.     

‘QUIS CUSTODIET?’: WHO HAS ULTIMATE RESPONSIBILITY FOR CONFIDENTIALITY IN MENTAL HEALTH SERVICES?

Confidentiality is a complex and engaging subject. One of the questions I would ask the reader to consider is whether ‘absolute’ confidentiality can truly exist within the analytic relationship and whether it is worth asking the same question in relation to psychotherapy as it is practised within the NHS. Is the position of absolute confidence a noble aspiration or could it be regarded as a rather inflexible stance whose advocates occupy an arrogant and even omnipotent position? This last question deliberately invokes a false dichotomy and I would argue that the clinical reality of working with patients continually dispels the myth that ‘absolute’ confidentiality can exist within the analytic relationship. If we can accept this position, then the stage is set for a potentially more fruitful, if complex, debate about where the line of disclosure lies for individual cases. It would seem timely, in view of the recent publication of the Royal College of Psychiatrists' report Good Psychiatric Practice: Confidentiality & Information Sharing (2006 Royal College of Psychiatrists. 2006. Good Psychiatric Practice: Confidentiality & Information Sharing, London: Royal College of Psychiatrists. Council Report CR133 [Google Scholar]), to reflect upon how the ‘contract’ of confidentiality is drawn up in the apparently dyadic relationship of analytic therapy as practised in the private sector and to consider the particular conflicts and threats to patient confidence posed by the multidisciplinary and highly transparent ways of working that have evolved within modern NHS mental health services.     

Do chimpanzees (Pan troglodytes) and 2-year-old children (Homo sapiens) understand double invisible displacement?

Chimpanzees (Pan troglodytes) and young children (Homo sapiens) have difficulty with double invisible displacements in which an object is hidden in two nonadjacent boxes in a linear array. Experiment 1 eliminated the possibility that chimpanzees' previous poor performance was due to the hiding direction of the displacement device. As in Call (2001), subjects failed double nonadjacent displacements, showing a tendency to select adjacent boxes. In Experiments 2 and 3, chimpanzees and 24-month-old children were tested on a new adaptation of the task in which four hiding boxes were presented in a diamond-shaped array on a vertical plane. Both species performed above chance on double invisible displacements using this format, suggesting that previous poor performance was due to a response bias or inhibition problem rather than a fundamental limitation in representational capacity.