Cultural pathways to psychosis care: Patient and caregiver narratives from Puebla, Mexico

The current study used the McGill Illness Narrative Interview (MINI) to explore patients' (n = 6) and caregivers' (n = 3) narratives about how they identified and sought care for psychosis. Participants were recruited from an outpatient clinic at the Hospital Psiquiátrico Dr. Rafael Serrano, a public psychiatric hospital in Puebla, Mexico. All participants consented to complete semi-structured interviews in Spanish. Thematic analyses were used to inductively identify common themes in participants' narratives. The results indicated that during the initial symptom onset, most participants noticed the presence of hallucinations but did not seek help for this hallmark symptom. Participants described seeking care only when they or their ill relative exhibited escalating aggressive behaviors or physical symptoms that were interpreted as common medical problems. As participants became connected to specialty mental health services, they began to develop a conceptualization of psychosis as a disorder of aggression. For some participants, this conceptualization of psychosis as an illness of aggression contributed to their ambivalence about the diagnosis. These results can be understood using a cultural scripts framework, which suggests that cultural norms are influenced by collective understandings of normalcy and valorization of behaviors. Implications for community campaigns are discussed.

In Darkness We Meet: Annie Ernaux's Account of Care and Dementia

The complexities surrounding aging, dementia, and care are timely and urgent issues that transcend beyond institutional boundaries, evincing a critical debate on later life across disciplines. In recent decades, there has been a significant rise in literary and cultural representations of dementia and care narratives, which offer valuable insights into the intricate paradigms of living and growing older with this condition. In her memoir I Remain in Darkness (1999), the Nobel Prize winning author Annie Ernaux provides a candid account of her mother's journey through dementia, from its onset to the gradual decline. Ernaux sincerely explores the nuances of dementia and caregiving within both the familial and institutional context, and sheds light on the complex and uneasy relationship between a mother and a daughter. Through the act of witnessing, she embarks on a path of healing, which allows her to confront her past wounds and better navigate the challenges that lie ahead. Ernaux's harrowing account of her mother's dementia and aging is both a confessional piece of writing and a narrative therapy, which reveals the challenges of aging, illness, and unresolved family tensions. Her work illuminates the interconnectedness between the past, present, and future, and shows that illness narratives can act as a catalyst for transformative change, identity formation, and self-reflection. However, Ernaux's confessional memoir also troubles the ethics of life writing and identity issues, and seems to perpetuate the pathologizing medical gaze through the exposure of her mother's vulnerability and intimacy in the face of dementia and care.

As if I was a spacecraft returning to Earth's atmosphere. Expanding insights into illness narratives and childhood cancer through evocative autoethnography

Today, a majority of children diagnosed with cancer are expected to grow up and live-hopefully until old age. Still, knowledge of the lived experience of childhood cancer survivors is sparse. In pursuit of knowledge expansion, by combining my intersecting roles as an academic, educational counselor, and childhood cancer survivor, I approach my personal illness narrative. By means of evocative autoethnography, I write intentionally vulnerably about my experiences and make them available for consideration. I explore my narrative through archives, artifacts, memories of the past, and conversations evoked in the present. I re-visit the cultural landscape of a southern Norwegian girl growing up in the 00s with cancer. Through this, my illness narrative presents as positioned, tangled, and interwoven with a developmental trajectory. Specific educational experiences seem to linger, and many are related to being absent from or re-entering school after the onset of illness. To grasp the intersecting and conflicting experiences of being very ill while also young, I suggest Erik Erikson's moratorium as a key concept. To complement Arthur Frank's illness narratives of restitution, chaos, and quest, I establish the moratorium narrative. As a fresh resource, the moratorium narrative underlines the need to make sensitive our academic community's gaze on illness trajectories unfolding in formative phases and illness narratives defined by growing up. By providing a point of recognition that prompts elaboration, this could also provide the young and very ill with a much-needed narrative space of opportunity, of which more narratives are invited and insisted upon.

Listening to Cancer Patients' Narratives During Residency: A Pilot Study on a Communication Skills' Workshop Involving Patients-Partners

The field of cancer care still lacks best practices in communication. Few postgraduate training programs offer formal training to develop such skills. The patient partnership has been used in medical education to increase the sensitivity of the subjective experiences of patients. In our Canadian center, residents and patient-partners participated in an educational workshop on communication focusing on patient's narrative. The aim of this pilot qualitative study was to explore the experiences of participants in the workshop. Using theoretical sampling, we recruited 6 residents and 6 patient-partners. Semi-structured interviews were conducted and transcribed. A thematic analysis was performed. From analysis, 4 themes emerged: (1) lack of communication skills training; (2) barriers to effective communication in cancer care; (3) the empathy of patient-partners towards the communication challenges faced by residents; and (4) the participants' reactions to the workshop. Based on our findings, our communication skills workshop centered on narrative medicine and involving patient-partners appears feasible. Future research could study its pedagogical value and the optimal learning environment required.

"There Are Many of Us": Online Testimonies From "Pill Victims" as a New Form of Health Activism

The French pill scare is usually presented as a "media debate" triggered by the case of Marion Larat, a young woman who suffered a stroke attributed to the pill she was taking. This article intends to focus on a practice that preceded, accompanied, and followed this health scare: the publication of online testimonies of thrombotic reactions posted on the website of the French Association of Victims of Pulmonary Embolism and Stroke Associated with Hormonal Contraception (Avep). Through a discourse analysis, we intend to analyze these online public self-reports as an activist practice aimed at criticizing the dominant medical discourse on contraception. Four discursive frames emerged: unpreparedness of women and doctors, denial of blame and search for the cause, breaking the silence and building solidarity, and collective action. The first two frames concern the process women put in place to obtain the right to speak about and criticize a medical practice. The right to speak is achieved through a concise narrative style focusing on facts, bodily manifestations, and risk factors. The second pair refers to the formation of pill victims as subjects with an ambivalent status and ephemeral agency. The testimonies build what we call "lone solidarity", that is, the creation of a social bond and action around a common experience of witnessing medical injustice that develops without any exchange between members. This proves to be inclusive and viral, but at the same time fiercely anti-representational with respect to political struggles or social identification.

Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants-the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

The challenges and necessity of situating 'illness narratives' in recovery and mental health treatment

In mental health services, recovery constitutes a guiding principle that is endorsed in professional medical guidelines and has become central to mental health policies across the world. However, for many clinicians, it can be a challenge to effectively embed recovery concepts into professionally directed treatment of disease without distortion, and ostensibly away from what matters to those who use the services. We discuss the evolving and multifaceted concept of 'recovery', including illness narratives to frame our discussion. We demonstrate how integration between a person-directed management of illness and a professionally directed treatment of disease can converge, resulting in positive outcomes for people with mental illness.

Witchcraft and Cancer in the Narrative of a Portuguese Woman

An 83-year-old Portuguese cancer survivor and amputee structures her illness narrative around the etiology of an upper limb's sarcoma, pointing to witchcraft as the root of her malignancy, through a prayer spoken by a neighbor. This is not a self-explanatory claim, since she must have the ability to blend the principles of a naturalistic thought - disrupted cells - with the supernatural, but with such a logical robustness that it can make sense to her and to others, convincingly grasping, containing and defining the ontological intricacy and interconnectedness of the multiple elements shaping her experience of bewitchment and illness.

"I felt like I was left on my own": A mixed-methods analysis of maternal experiences of cesarean birth and mental distress in the United States

BACKGROUND

Postpartum depression (PPD) is the most common complication of childbearing. Understanding potential contributors, such as cesarean deliveries, is essential to improving maternal mental health. This study investigated the relationship between unplanned versus planned cesarean birth and postpartum depressive symptoms.

METHODS

We employed a sequential, mixed-methods approach wherein the Edinburgh Postnatal Depression Scale (EPDS) was first administered to participants who had experienced a cesarean birth within the previous 12 months. EPDS scores among those in the unplanned vs. planned cesarean groups were compared by means of SPSS. Twenty-five participants with EPDS scores >8 were then interviewed to provide subjective measures of maternal well-being. Interview data were subjected to thematic qualitative analysis using a modified grounded theory approach.

RESULTS

The average EPDS score from 120 participants with unplanned cesareans was 10.7 ± 6.4, with 68.5% scoring >8. The average EPDS score from 93 participants with planned cesarean births was 8.96 ± 5.7, with 52.7% scoring >8. The difference in mean score was statistically significant (P < 0.05). Interview findings revealed several important themes including: support, medical interaction, stress, recovery, breastfeeding, and sleep. In several cases, participants were not properly screened, or screening tool responses were ignored. Numerous participants reported medical interactions where they felt ignored by practitioners, including one interviewee who stated, "I got my tubes tied because it was so traumatizing that I never wanted to give birth again."

DISCUSSION

Findings suggest that unplanned cesareans have a higher incidence and severity of postpartum depressive symptoms. Interview analyses highlight important areas for improvement and concern about the current state of postpartum mental health care and physician-guided supports in this US sample.

Speaking Shame and Laughing It Off: Using Humorous Narrative to Conquer the Shame of Anorectal Illness

Patients with anorectal illness (AI) must deal with shame from social stigma and difficulties in the medical context. Recovering from shame is a challenge. Applying shame resilience theory (SRT) to the Chinese health care setting, this study explores how patients with AI develop resilience to shame using humor to facilitate the narrative's five functions. The method is a thematic narrative analysis of 60 stories from a Chinese online community. Four main themes were identified: understanding shame events, normalizing them, shifting priorities, and transforming shame into pride. Storytellers can use humor to externalize shame, reflect on their concealment and avoidance, eliminate the shame associated with making health decisions, re-establish shameless identities, achieve positive agency, and build illness communities through "aligning moments" with their audiences and subverting hierarchies of normality and abnormality.

What was lost, missing, sought and hoped for: Qualitatively exploring medical crowdfunding campaign narratives for Lyme disease

Lyme disease remains a contested illness in Canada, thereby making the diagnostic and treatment journeys difficult for some people. One outcome of this is that increasing numbers of people are turning to medical crowdfunding to support access to alternative therapies, non-local health care providers and assist with managing the costs of everyday life. In this analysis, we qualitatively explore the narratives shared in Canadians' crowdfunding campaigns to support Lyme disease treatment or diagnosis to identify whether or not any common elements shared in these narratives exist, and if so, what they are. We identified 238 campaigns for inclusion from three prominent crowdfunding platforms. Thematic analysis of the campaign narratives shows four consistent themes shared in these campaigns: what is lost (e.g. bodily ability), what is missing (e.g. local care options), what is sought (e.g. funds to cover treatment abroad) and what is hoped for (e.g. return to wellbeing). These themes demonstrate the highly personal and emotional nature of medical crowdfunding, particularly in the context of a contested illness that may lead some to question the legitimacy of one's financial need. This analysis contributes valuable new insights to the nascent scholarship on medical crowdfunding, and particularly to our understanding of how people communicate about their health and bodily needs on this public platform. It also identifies important directions for future research, including the potential for crowdfunding narratives to be used for advocacy.

Thematic content of video narratives in patients and survivors of adolescent cancer

OBJECTIVE

Modern day adolescents and young adults (AYAs) connect with their peers via a number of increasingly novel ways, many of which involve social media. These online relationships are often translated offline to increase one's social standing and quality of in-person relationships. However, when an AYA is diagnosed with a chronic medical condition, like cancer, in-person relationships with peers become difficult and the online component of socialization is all that is left. Video testimonials are a way that some AYAs have chosen to reach out to their peers; however, little is known about what AYAs are saying in these videos and how they are using them to connect with peers on a more intimate level.

METHODS

This study examined the content of video testimonials of n = 25 AYA cancer patients and survivors. Transcripts of videos were coded by a team of researchers to identify themes and overall tone.

RESULTS

Results suggested that films focused on struggles AYAs faced during their cancer journeys with a number of themes emerging; additionally, a hopeful tone was seen around the overall impact that cancer had on the patient's life.

CONCLUSIONS

It may be the case that video testimonials are an effective way to allow AYA patients with a cancer history to explore their thoughts about their illness experience and fill an important social gap not available to them as they undergo treatment.

Examining cancer survivorship trajectories: Exploring the intersection between qualitative illness narratives and quantitative screening instruments

OBJECTIVE

This article examines the associations of quantitatively refined trajectories of adjustment to cancer survivorship determined by previously published qualitative narrative analysis.

METHOD

Patients completed measures of cancer-related worry (Cancer Related Worries Scale), depression (Patient Health Questionnaire-9), posttraumatic growth (Benefit Finding Scale), and open-ended survey questions 6, 12, and 18 months postdiagnosis of head and neck, esophageal, gastric, or colorectal cancer. Previously published narrative analysis revealed five distinct survivorship "paths," which were combined into four paths in the present article: Moving On, Seeing the World Differently, Taking One Day at a Time, and Never the Same. To determine the association of qualitatively determined paths with quantitatively assessed adjustment (i.e., Cancer Related Worries Scale, Patient Health Questionnaire-9, Benefit Finding Scale), we used linear multilevel modeling to regress the adjustment variables on time, path, the time-by-path interaction, and relevant covariates (age, stage, cancer site, ethnicity, and Deyo score).

RESULTS

There was a significant main effect of path on cancer worry, depression, and posttraumatic growth (p < 0.02 for all). Patients in the Moving On group reported consistently low worry, depression, and growth compared to the other groups. Patients in the Seeing the World Differently and Taking One Day at a Time paths both reported moderate worry and depression; but those in the Seeing the World Differently path reported the highest posttraumatic growth, whereas patients in the Taking One Day at a Time path reported little growth. Finally, patients in the Never the Same path reported the highest worry and depression but lowest posttraumatic growth.Significance of resultsThis longitudinal study reinforces the notion that cancer survivorship is not a one-size-fits-all experience nor a dichotomized experience of "distress" or "no distress." Additionally, this hypothesis-generating study suggests future directions for potential self-report measures to help clinicians identify cancer survivors' trajectory to develop a more patient-centered survivorship care plan.

Illness and femininity in Hilary Mantel's Giving Up the Ghost (2003)

This paper offers a reading of Hilary Mantel's memoir, Giving Up The Ghost (2003). The interest of the memoir derives from the fact that it provides an exceptionally rich picture of the impact of family life on a child's attitudes towards her own body. Mantel presents her bodily experiences as primitive, often unconscious, perceptions of the relationships within her family of origin. When she discovers new things about those relationships, she must register the change through her body in some way. Drawing on a range of concepts taken from psychoanalytic psychosomatics, I suggest that at the heart of the memoir is the author's bafflement at the repeated and uncanny irruption of a conflict between her body as a somewhat autonomous signifying entity and the psychological strength she seeks and often finds through identifications with family members. I argue that this conflict overlapped with her acceptance of a female gender identity. The sustained nature of this conflict prevented her from establishing a metric of what I will call 'psychosomatic normality', with disastrous consequences when she began to suffer the symptoms of acute endometriosis. The memoir also shows the power of early life in determining how diseases are experienced subjectively, over time.

Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach

BACKGROUND

Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions.

METHODS

Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories.

RESULTS

Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning.

CONCLUSIONS

'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made.

Colleen's story: reflections on the concept of "patient and family centered care"

As a patient who has also been a family caregiver, I would like to offer my reflections on the concept of "patient and family centered care." How is it defined from a patient perspective? Why is it important? In what circumstances is it evident? And where is it lacking? I would like to leave the reader with a list of relatively small but, in my experience, powerful things that health care workers can do today to improve the patient and family experience.

Bipolar disorder: idioms of susceptibility and disease and the role of 'genes' in illness explanations

This qualitative study explores (1) how members of the Dutch Association for People with Bipolar Disorder explain the affliction of bipolar disorder; (2) the relationship between genetic, environmental and personal factors in these explanations and (3) the relationship between illness explanations, self-management and identity. A total of 40 participants took part in seven different focus group discussions. The results demonstrate that there are two different explanatory idioms, each one centred around an opposing concept, that is, susceptibility and disease. Individuals who construct explanations around the concept of 'disease' attach more importance to 'genes and chemicals' than to environmental components in the onset of the disorder, whereas individuals adhering to the central concept of 'susceptibility' tend to do this much less. Compared with individuals using the 'susceptibility' idiom, those who use a 'disease' idiom tend to observe fewer possibilities for self-management and are less inclined to construct normalcy through a quest for personal growth. Stories of suffering seem more integral to the 'disease' idiom than to the 'susceptibility' idiom. The 'disease' idiom seems less integrated in a contemporary surveillance psychiatric discourse than the 'susceptibility' idiom; however, both vocabularies can offer normative constraints.

Giving an account of one's pain in the anthropological interview

In this paper, I analyze the illness stories narrated by a mother and her 13-year-old son as part of an ethnographic study of child chronic pain sufferers and their families. In examining some of the moral, relational and communicative challenges of giving an account of one's pain, I focus on what is left out of some accounts of illness and suffering and explore some possible reasons for these elisions. Drawing on recent work by Judith Butler (Giving an Account of Oneself, 2005), I investigate how the pragmatic context of interviews can introduce a form of symbolic violence to narrative accounts. Specifically, I use the term "genre of complaint" to highlight how anthropological research interviews in biomedical settings invoke certain typified forms of suffering that call for the rectification of perceived injustices. Interview narratives articulated in the genre of complaint privilege specific types of pain and suffering and cast others into the background. Giving an account of one's pain is thus a strategic and selective process, creating interruptions and silences as much as moments of clarity. Therefore, I argue that medical anthropologists ought to attend more closely to the institutional structures and relations that shape the production of illness narratives in interview encounters.