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'Discovering' Chronic Illness: Using Grounded Theory

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'Discovering' Chronic Illness: Using Grounded Theory 5~. .Scl. rfzd. Vol. 30. No. I I. pp. 1161-l 172. 1990 0277-953619053.00 + 0.00 Pnnted in Grca! Bntaln. ,411rights resrned Copyright i” 1990Pergamon Press plc ‘DISCOVERING’ CHRONIC ILLNESS: USING GROUNDED THEORY _ KATHY CHARMAZ Sonoma State University, Rohnert Park, CA 94928, U.S.A. Abstract-This paper focuses on using the grounded theory method to study social psychological themes which cut across diverse chronic illnesses. The grounded theory method is presented as a method having both phenomenoiogical and positivistic roots, which leads to confusion and misinterpretations of the method. A social constructionist version and application of grounded theory are introduced after brief overviews of the method and of the debates it has engendered are provided. Next, phases in developing concepts and theoretical frameworks through using the grounded theory approach are discussed. These phases include: (I) developing and refining the research and data collection questions, (2) raising terms to concepts. (3) asking more conceptual questions on a generic level and (4) making further discoveries and clarifying concepts through writing and rewriting. Throughout the discussion, examples and illustrations are derived from two recent papers, ‘Disclosing Illness’ and ‘Struggling for a Self: Identity Levels of the Chronically III’. Last, the merits of the method for theoretical development are discussed. ISTRODUCTION the meanings that people ascribe to their situations [8-l I]. These meanings derive from shared inter- The grounded theory method provides a set of useful actions, which turn on the pivotal role of language. research strategies for studying the experience of The symbolic interactionist assumption of the chronic illness [I-5]. This paper focuses on using the indeterminancy of action rests on the human capacity grounded theory method for studying people with to objectify self and to ascribe meanings to self like a wide range of chronic illnesses to address how any other object. Such a perspective can lead to an chronicity affects ill people’s self-concepts. Through- overly rationalized view of the individual which out the paper, ways of using grounded theory to a phenomenological perspective helps to correct. develop social constructionist analyses are explored. Because phenomenology means studying the objects As used here, the term social constructionist means: of consciousness, it fosters studying emotions [ 12, 131. (I) III people’s creation of taken-for-granted inter- Both symbolic interactionism and phenomenology actions, emotions, definitions, ideas, and knowledge lead the researcher to look closely at the research about illness and about self and (2) Researchers’ participants’ interpretations of their actions and sociological constructions which they develop, in situations. Marxist theory can then provide tools for turn, by studying chronically ill people’s construc- linking subjective consciousness and choice to larger tions. social structures. Moreover, Marxist theory brings a Chronically ill people, like most everyone, experi- critical posture to examining the data. ence their constructions as reality; their constructions For the type of social constructionist view taken are neither convenient fabrications nor idiosyncratic here, the assumptions underlying these theoretical inventions. Rather, ill people’s constructions reflect perspectives and the questions flowing from them are their understandings of their experiences as well as perhaps, more significant for the resulting grounded the diverse situations in which they have them [6]. theory analyses then are specific concepts inherent Further. their friends and family often support within each theoretical perspective. Symbolic inter- their constructions even when these constructions actionists assume that as thinking, acting, creative challenge or contradict those of medical profession- individuals, human beings respond to the actions of als, and even when ill people cannot make their others after interpreting these others’ intent and constructions credible or negotiable. Grounded action. A symbolic interactionist perspective leads theory analyses can then provide physicians with one to look at self and meaning as processes. alternative understandings of patients’ beliefs and Phenomenologists assume that subjective reality may actions than those readily available in clinical take varied forms. This perspective fosters the re- settings. Subsequently, physicians may use these searcher’s study of the multiple dimensions and understandings to improve communications with realities of a person’s lived experience. Marxists patients and to act on problems which patients define. assume that individual psychology is both shaped and Like Foucault’s [7] argument about the conditions constrained by social structure. Thus, a Marxist giving rise to discursive practices, this constructionist perspective fosters asking critical questions about view acknowledges that outcomes result from social how society impinges upon the individual and how interactions, negotiations and power. However, individuals reproduce dominant ideas within society. my application of grounded theory derives from a In keeping with Berger and Luckman [14], such a symbolic interactionist perspective tempered by constructionist view assumes an emergent reality Marxism and phenomenology. Symbolic inter- fundamentally shaped by social interaction. Hence, a actionism assumes that human action depends upon constructionist approach offers an open-ended and 1161 1162 KATHY CHARMAZ flexible means of studying both fluid interactive pro- researcher’s approach to data collection and analysis. cesses and more stable social structures [15]. Rather In comparison, more traditional logical-deductive than directly applying concepts such as Mead’s “I”, approaches explicitly derive hypotheses from pre- “me”, and “generalized other”, or Schutz’ “typi- existing theories, which fundamentally structure both fication” or “multiple realities”, these concepts were the data collection and analysis toward verification of used to sensitize me to look for themes and issues refutation of these hypotheses (and therefore, the within the data [16]. theories from which they were derived). Grounded Themes were addressed which cut across diverse theorists affirm. check. and refine their developing chronic illnesses such as multiple sclerosis, diabetes, ideas, but they do not limit themselves to pre- circulatory disease, renal failure, and cancer. These conceived hypotheses nor do they follow the pre- cross-cutting themes initially included self-esteem, scribed canons of traditional random sampling continuity and change of self concept, and relation- required for statistical verification. ships between time and identity. After gathering and Grounded theory also differs from other qualita- studying more data, my focus also explicitly included tive approaches. Most qualitative approaches stress emotions and the self, information-control about self collecting copious amounts of data before delving and illness, meanings of chronic illness, and ways of into the analysis; researchers using such approaches living with it. often complete their major analytic work long Different chronic illnesses give rise to variations after they have left the field. In contrast, grounded and complexity in conceptual development of the theorists use their emerging theoretical categories to crosscutting themes. For example, some chronic ill- shape the data collection while in the field as well as nesses resulted in periodic, progressive, or permanent to structure the analytic processes of coding, memo- visible disabilities; other disabilities remained invisi- making, integrating and writing the developing ble. The kinds of situations posed by such differences theory [20-231. The ‘groundedness’ of this approach were studied as well as how ill people thought and fundamentally results from these researchers’ com- felt about them, and what effects visible disability mitment to analyze what they actually observe in the made when studying relations between self, emotions, field or in their data. If they find recurrent themes or information, and time. issues in the data, then they need to follow up on My social constructionist version of using the them, which can, and often, does lead grounded grounded theory method to study illness makes use of theorists in unanticipated directions. For example, four different phases in developing concepts and while a graduate student, I conducted a study of theoretical frameworks: (1) creating and refining the caring for ill and dying elders in working-class research and data collection questions, (2) raising families [24]. An unexpected theme emerged about terms of concepts, (3) asking more conceptual ques- the role coroner’s deputies played in notifying tions on a generic level, and (4) making further families about the death of their relative. Checking discoveries and clarifying concepts through writing out that theme led me to further comparative re- and rewriting. In this paper, I shall illustrate each search with coroner’s deputies in different settings phase and will draw my examples a@ discussion of about their strategies for announcing death [25]. substantive work mainly from two recent papers, Grounded theorists begin with general research ‘Disclosing Illness’ [ 171, an examination of ill people’s questions rather than tightly framed pre-conceived constructions about what, when, and how to tell hypotheses. If, perchance, those research
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