Is Ricoeur's Notion of Narrative Identity Useful in Understanding Recovery in Drug Addicts?

Health(care) in the Crisis: Reflections in Science and Society on Opioid Addiction

Opioid abuse and misuse have led to an epidemic which is currently spreading worldwide. Since the number of opioid overdoses is still increasing, it is becoming obvious that current rather unsystematic approaches to tackle this health problem are not effective. This review suggests that fighting the opioid epidemic requires a structured public health approach. Therefore, it is important to consider not only scientific and biomedical perspectives, but societal implications and the lived experience of groups at risk as well. Hence, this review evaluates the risk factors associated with opioid overdoses and investigates the rates of chronic opioid misuse, particularly in the context of chronic pain as well as post-surgery treatments, as the entrance of opioids in people's lives. Linking pharmaceutical biology to narrative analysis is essential to understand the modulations of the usual themes of addiction and abuse present in the opioid crisis. This paper shows that patient narratives can be an important resource in understanding the complexity of opioid abuse and addiction. In particular, the relationship between chronic pain and social inequality must be considered. The main goal of this review is to demonstrate how a deeper transdisciplinary-enriched understanding can lead to more precise strategies of prevention or treatment of opioid abuse.

"I Was Raised in Addiction": Constructions of the Self and the Other in Discourses of Addiction and Recovery

The aim of this article is to address how conceptualizations of addiction shape the lived experiences of people who use drugs (PWUDs) during the current opioid epidemic. Using a discourse analytic approach, we examine interview transcripts from 27 PWUDs in rural Appalachian Ohio. We investigate the ways in which participants talk about their substance use, what these linguistic choices reveal about their conceptions of self and other PWUDs, and how participants' discursive caches might be constrained by or defined within broader social discourses. We highlight three subject positions enacted by participants during the interviews: addict as victim of circumstance, addict as good Samaritan, and addict as motivated for change. We argue participants leverage these positions to contrast themselves with a reified addict-other whose identity carries socially ascribed characteristics of being blameworthy, immoral, callous, and complicit. We implicate these processes in the perpetuation of intragroup stigma and discuss implications for intervention.

Indagación narrativa y calidad de vida en mujeres con artritis reumatoide

Introducción. La artritis reumatoide (AR) es una enfermedad que afecta la capacidad laboral y la calidad de vida; su prevalencia es mayor en mujeres entre la tercera y la cuarta década. Para comprender cómo los pacientes con AR perciben su calidad de vida, es necesario considerar sus experiencias y los significados que dan a su condición de enfermo crónico, además este proceso permite obtener información relevante para implementar estrategias que contribuyan a solucionar sus necesidades y mejorar su calidad de vida.Objetivo. Describir las percepciones de mujeres con AR sobre su calidad de vida.Materiales y métodos. Estudio descriptivo cualitativo realizado en una muestra de 36 mujeres diagnosticadas con AR a quienes se les realizaron entrevistas a profundidad. Los datos fueron organizados mediante el programa AtlasTI; la indagación narrativa y el análisis interpretativo fueron realizados de acuerdo con lo propuesto por Ricoeur y Benner, respectivamente.Resultados. La indagación narrativa de los relatos de las participantes les permitió describir su calidad de vida como un estado de bienestar a pesar de que esta se ve afectada por la enfermedad. En el análisis de las narrativas se evidenció que la necesidad de protección y seguridad social es un fenómeno producto de las múltiples dificultades que las personas con AR afrontan en el actual sistema de salud de Colombia.Conclusión. Los resultados reportados en este estudio pueden considerarse como un aporte para la humanización de la prestación de los servicios de salud, puesto que permitirán a los profesionales de la salud reflexionar sobre cómo abordar la calidad de vida desde un enfoque psicosocial y humanístico.

Rehabilitation From Addiction and Chronic Illnesses: A Comparative Analysis of the Narratives of Hungarian Patients

BACKGROUND

In Hungary the psychological care provided during the rehabilitation of patients with chronic illnesses is insufficient. Patients with addiction, on the other hand, appear to make more use of psychological services. Narratives of patients recovering from addiction and patients with various chronic illnesses were examined in order to gain a better understanding of psychological phenomena during rehabilitation.

METHODS

Semi-structured interviews were carried out. Narrative and thematic analysis was used in order to determine the structure and characteristics of patients' narratives.

RESULTS

The narratives of patients recovering from addiction were found to be more structured and uniform; they identified with their illness and played an active role in their recovery. Patients with a chronic illness mainly recounted passive events and physical difficulties. Stigmatization was mentioned by both groups.

IMPLICATIONS FOR PRACTICE

The level of stigmatization experienced by patients with a chronic illness may be one of the reasons why they use healthcare services more frequently than patients with an addiction. The authors believe that teaching patients to provide good narratives about suffering from and recovering from chronic illnesses may aid them in the rehabilitation process. An adaptive mixture of different illnesses and addiction narratives might be beneficial in the recovery process of various patient groups.

Voices of Temporary Sobriety - A Diary Study of an Alcohol-Free Month in Hungary

Background: Temporary abstinence from alcohol as a challenge could support self-knowledge, self-care, and health consciousness in several ways. Objectives: The present study explored Dry November participants' personal experiences and coping strategies during a one-month abstinence period. The research is embedded in the Hungarian context of drinking habits, culture, society, and alcohol policy. Methods: This qualitative study comprised the thematic analysis of 23 participants' diaries, reported twice a week for 30 days (in November 2017), to identify and understand the common experiences of temporary sobriety. Results: Three main themes emerged from the analysis: challenge, community, and relationship toward alcohol and abstinence. Results showed that there are no categorical differences between successful and non-successful participants. Conclusions: The present research demonstrated that during the challenge, rather than simply saying 'no' to alcohol, participants utilized other refusal strategies to avoid social confrontation.

The Quest for Meaning Around Self-Injurious and Suicidal Acts: A Qualitative Study Among Adolescent Girls

Introduction: Suicide and non-suicidal self-injury (NSSI) are major problems in adolescent psychiatry and share numerous clinical characteristics. The principal objective of this study is to describe the subjective experience of adolescent girls and young women who present NSSI and/or suicidal behaviors and to determine the common aspects and the specificities of each experience. Method: This exploratory study is based on a procedure that is qualitative, phenomenological, and inductive. The data were collected from two semi-structured interviews each of 18 girls and young women aged 12-21 years, who were receiving care from a psychiatrist specializing in adolescents and who at least once had harmed themselves by NSSI or attempted suicide, or both. The thematic data analysis was performed by applying the methods of interpretative phenomenological analysis. Results: The results are described around four superordinate themes: relationships with the self, with others/otherness, with the body, and with death; they are then subdivided into 13 themes. Several themes appeared common to both types of behavior, especially the relational dimension of self-harming acts. The process of separation-individuation seems complex for these youth. Conclusion: The results underline the relational aspects of the self-harming behavior (NSSI or suicidal) among adolescent girls. These aspects also appear to be expressed in the family sphere, the social sphere, in contact with peers, and also at a societal level when the community no longer addresses adolescents' difficulties. When the process of subjectification does not appear to reach completion, self-aggressive behavior is seen as an ultimate attempt to regain a feeling of autonomy.

Phenomenologic analysis of healthcare worker perceptions of intensive care unit diaries

Introduction

Studies have reported associations between diaries kept for intensive care unit (ICU) patients and long-term quality-of-life and psychological outcomes in patients and their relatives. Little was known about perceptions of healthcare workers reading and writing in the diaries. We investigated healthcare worker perceptions the better to understand their opinions and responses to reading and writing in the diaries.

Methods

We used a phenomenologic approach to conduct a qualitative study of 36 semistructured interviews in a medical-surgical ICU in a 460-bed tertiary hospital.

Results

Two domains of perception were assessed: reading and writing in the diaries. These two domains led to four main themes in the ICU workers' perceptions: suffering of the families; using the diary as a source of information for families but also as generating difficulties in writing bad news; determining the optimal interpersonal distance with the patient and relatives; and using the diary as a tool for constructing a narrative of the patient's ICU stay.

Conclusions

The ICU workers thought that the diary was beneficial in communicating the suffering of families while providing comfort and helping to build the patient's ICU narrative. They reported strong emotions related to the diaries and a perception of intruding into the patients' and families' privacy when reading the diaries. Fear of strong emotional investment may adversely affect the ability of ICU workers to perform their duties optimally. ICU workers are in favor of ICU diaries, but activation by the diaries of emotions among younger ICU workers may require specific support.

The experience of addiction as told by the addicted: incorporating biological understandings into self-story

How do the addicted view addiction against the framework of formal theories that attempt to explain the condition? In this empirical paper, we report on the lived experience of addiction based on 63 semi-structured, open-ended interviews with individuals in treatment for alcohol and nicotine abuse at five sites in Minnesota. Using qualitative analysis, we identified four themes that provide insights into understanding how people who are addicted view their addiction, with particular emphasis on the biological model. More than half of our sample articulated a biological understanding of addiction as a disease. Themes did not cluster by addictive substance used; however, biological understandings of addiction did cluster by treatment center. Biological understandings have the potential to become dominant narratives of addiction in the current era. Though the desire for a "unified theory" of addiction seems curiously seductive to scholars, it lacks utility. Conceptual "disarray" may actually reflect a more accurate representation of the illness as told by those who live with it. For practitioners in the field of addiction, we suggest the practice of narrative medicine with its ethic of negative capability as a useful approach for interpreting and relating to diverse experiences of disease and illness.

Qualitative research using photo-elicitation to explore the role of food in family relationships among obese adolescents

Obesity in adolescence is a major public health issue. Family relationships have an important role, whether in the onset of the condition, its maintenance, or the way in which the problem is approached. Food and family relationships are two major elements in therapeutic care. The subject of the present study is the investigation of the place of food within family relationships among obese adolescents, so as to tailor care strategies. Twelve semi-structured interviews were conducted among adolescents presenting obesity and their parents. The investigation was qualitative, and used photo-elicitation. A photograph produced by the subject is used as the basis for narrative, and the verbal material obtained is analysed using Interpretative Phenomenological Analysis. The results can be categorised along two axes. The first describes the place of food in the one-to-one parent-child relationship; the second describes the organisation of the family group. This study evidenced two possible lines of approach in understanding the place of food in these families. There are major interrelations between food and relationships within the family, so that implications for therapy can be drawn: taking account of bonding between parent and child, and therapeutic orientation towards family functioning rather than towards individual eating patterns.

Incomprehensibility in the narratives of individuals with a diagnosis of schizophrenia

The fact that individuals with a diagnosis of schizophrenia have difficulties in terms of ordering and communicating their life stories is well known, and undoubtedly these dysfunctions are linked to the experience of alienation and isolation. In this article we contribute to the debate by studying life narratives of ten patients with a diagnosis of paranoid schizophrenia living in care homes in Andalusia, Spain. Patients were selected through meetings held with the directors of the care homes and data obtained from narrative, semistructured interviews. Thematic self-positioning and structure analysis identified four types of clearly distinctive narratives: delusive episodes with invasive voices, delusive episodes with no invasive voices, absence of delusive episodes or invasive voices and domination of self-position as patient, and complexity and articulation of self-positions.

Studying narrative-in-action in women with chronic rheumatic conditions

In this article we aim to sculpt a possible methodology for studying how a good everyday life comes about when living with chronic rheumatic conditions (CRC). Our "how" focus acknowledges a woman with CRC as one member of a diverse population, whereby we question the biomedically based view that she differs from the population. The more frequently asked "what" question colors study designs and results in categories and characteristics regarding what she is able to do and what adaptations she has made in everyday life as a consequence of her disease. Adopting a narrative approach, we ask how a good everyday life comes about, and illustrate this with ethnographic material of the everyday activities of women living with CRC. We conceptualize narrative as embedded in the process of enacting activities. Furthermore, we highlight hermeneutical interpretative processes of how meaning works in the stream of everyday action.