Firfnsffiv'. Ferguson, Outside Member Schcgl of Child and Youth Care)
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A (J C i, iJ T l:’ fj»ivin9 Voice to Women's Experience of Depression ;u l Ty Q r .g r Ai'j u a rr .^ritoiFiS by Mary Louise Reilly .. B.A., Carleton University, 1984 d e a n B .Ed., University of Ottawa, 1985 M.Ed., University of Ottawa, 1987 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Decree of DOCTOR OF PHILOSOPHY in the Department of Psychological Foundations in Education We accept this dissertation as conforming to the ureauired standard --------- --------------- ^ ---- 7 ----------------- -j j r-^ C^T- * Dr) Vance Feavy, Supervisor (Department or Psychological Founijiatirdhs in Education) John 0. Anderson, Departmental Member (Department of Psychological Foundations in Education) Dr. Alan R. Drengson, Cmtside Member _ (Department of Philosophy) firfnSffiv'. Ferguson, Outside Member Schcgl of Child and Youth Care) -------------1--------------------- j— * = * * ----------------------------------- 1------------------------------------------------- =----------------- Dr. Mary Baird Carlsen, External Examiner © MARY LOUISE REILLY, 1993 University of Victoria All rights reserved. Dissertation may not bs reproduced in whole or in part, by photocopying or otner means, without the permission of the author. ii Supervisors Dr. R. Vance Peavy ABSTRACT The purpose of this research was to gain understanding of women's experience of depression using a phenomenological-hermeneutic approach. Data was obtained from psychotherapy sessions with seven women who were diagnosed as clinically depressed. The sessions were raidiotaped and then transcribed. The transcripts were analyzed using Van Manen's approach. Several interesting themes emerged from these transcripts: (a) living environment, (b) experience of time, (c) intimate relationships, (d) the body out of balance, (e) language, (f) medication, (g) symptoms, (h) distortions of thought, (i) telling the story, (j) from victim to survivor, and (k) coping strategies. The results of this research indicate that women have a knowledge airi understanding of depression that is a valuable resource for clinicians and researchers studying depression. iii Examiners: —y LS ---- «" Dr. R. VanceJ6zv Peavy, Supeprist (Department of Psychological^ oundations) Drx John 0, Anderson, Departmental Member department of Psychological Foundations) Dr. Alan R. Drengson, Outsine Member (Department of Philosophy) Dr. Roy Vi. Fe/gi^pn,. C. Outside Member (Departmentnent of dhlld and Youth Care) Dr. Mary Ba/ird Carlsen, External Examiner iv TABLE OF CONTENTS A b s t r a c t ..................................................ii Table of Contents ....................................... iv List of F i g u r e s ........................................ vii Acknowledgements .................................... viii Dedication................................................ix CHAPTER ONE INTRODUCTION............ 1 The Question ................... ................... 1 General Characteristics of Depression ........... 5 Research Method .................................... 6 Participants ...................................... 7 Psychotherapist as Researcher ................... 9 Giving Voice to Women's Experience ................ 10 CHAPTER TWO REVIEW OF LITERATURE ON WOMEN AND DEPRESSION .......... 14 Definition and Diagnostic Criteria ................... 14 Definition........................................... 15 Phenomenological Characteristics ................... 16 Associated Symptoms and Effects ................... 18 Cognitive ana Emotional Aspects ................. 20 Measurement Instruments .......................... 20 Classification ...................................... 21 Diagnostic Signs and Symptoms .... ........... 23 Epidemiology of Depression in Women ................ 24 History and Aetiology ............................ 29 T r e a t m e n t ...................................... 43 Psychodynamic Therapy ............................. 44 Cognitive-Behavioural Therapy ................... 46 Social Learning Therapy .......................... 47 Interpersonal Therapy ............................. 47 Family and Marital Therapy ........................ 48 Group Therapy ....................................... 50 Phototherapy ........................................ 51 Somatic Forms of Therapy ........................... 52 P r o g n o s i s ........................................... 56 CHAPTER THREE REVIEW OF RESEARCH ON DEPRESSION IN WOMEN ............ 58 Research Methods ...................................... 58 Comparative Treatment Strategy ..................... 58 Case S t u d y ........................................... 61 V Longitudinal and Cross-Sectional study ........... 63 Experimental Study ................................ 63 Analysis of Research Findings ..................... 66 Cognitive-Behavioural Studies ................... 67 Family Therapy .................................... 71 Developmental Studies ............................ 72 Life Events ......................................... 75 Work R o l e s ...................................... 80 Longitudinal Studies . 82 Other Therapeutic Variables ..................... 84 Group Therapy ....................................... 86 C on c l u s i o n ..................... 87 CHAPTER FOUR METHOD .................................................... 90 P r o c e d u r e ............................................. 90 Data Analysis ......................................... 91 Lived Experience....................................101 Personal Experience .............................. 104 Etymological Sources .............................. 104 Idiomatic Phrases ..................................105 Use of Metaphor .................................... 106 Descriptions from Art, Literature, and Poetry . 107 Thematic Analysis ................................ 109 Writing and Rewriting ............................ 110 Conclusion ........................................ Ill CHAPTER FIVE FINDINGS AND DISCUSSION .............................. 112 Reflections on 'Transcribing the Tapes . ............ 112 Researcher's Experience of Depression ........... 114 Profiles of the W o m e n ................................116 P a t .................................................117 E u r e k a ...............................................118 A r i a n a ...............................................120 N a o m i ...............................................121 C a r o l i n e .........* ................................. 121 L y n n e ...............................................123 F r a n c i s c a .......................................... 123 Phenomenological Themes ............................ 125 Living Environment ................................ 128 Experience of T i m e ............................. , . 133 Intimate Relationships ............................ 138 The Body Out of B a l a n c e ........................... 154 L a n g u a g e ............................................ 162 M e d i c a t i o n ........ 168 S y m p t o m s ............................................ 171 Distortions of Thought ........................ ..181 Telling the S t o r y ..................................183 From victim to Survivor ..................... 189 Coping Strategies ................................ 200 vi CHAPTER SIX CONCLUSIONS ............................................ 206 Themes in S u m m a r y ....................... 208 Intimate Relationships............... ............ 209 Living Environment ................................ 211 Experience of T i m e ................... * ............ 212 The Body Out of B a l a n c e ........................... 214 L a n g u a g e ............ ............................. 215 Medication.......................................... 216 S y m p t o m s ............................................ 218 Distortions of Thought ............................ 219 Telling the S t o r y ................................ 220 From Victim to Survivor ........................... 221 Coping Strategies ................................ 222 Final Words from the Women .... 223 Future Research .................................... 227 Implications for Clinicians ........................ 228 Investigating the Meaning of Symptoms.............. 229 Social and Emotional Support ..................... 229 Productive Depression ................................ 232 References ...................................... 234 App e n d i c e s .............................................. 261 Appendix A: Group Rules ............................ 262 Aopendix B: Contract for Group Participants .... 263 Appendix C: Transcript of Session 1 ............ 264 vii LIST OF FIGURES Figure 1: Phenomenological Themes 127 viii ACKNOWLEDGEMENTS I wish to thank Dr. R. Vance teavy for his understanding, patience, and support. I feel privileged to have had this great man as my supervisor. I also wish to thank my committee members, Dr. Alan R. Drengson, Dr. Roy V. Ferguson, and Dr. John 0. Anderson for their helpful comments and guidance. I am indebted to the seven women who participated in this study. Their courage and integrity were inspirational. Finally, I wish to thank ray mother for her strength and wisdom. i x DEDICATION This dissertation is dedicated to my husband, Mark, for his love and patience, and for his assistance in editing the manuscript, and to my son, Mark, who taught me as I raised him. INTRODUCTION The Question Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self—