The Impact of Gender, Employment and Class on Perceptions of Chronic Pain
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The Impact of Gender, Employment and Class on Perceptions of Chronic Pain: An Ecological Perspective A dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of Doctor of Education in the Counseling Program of the School of Human Services College of Education, Criminal Justice, and Human Services by Corinne Wehby Bridges Committee Chair: Ellen Cook Abstract This research explored the lived experiences of working class, unemployed men who experienced chronic pain and their meaning making process. Using qualitative in-depth phenomenological interviewing this research examined how employment, class and gender affected perceptions of life for clients who are unable to work due to a chronic pain condition. Previous literature related to the chronic pain experience suggested that multiple variables should be addressed in counseling for healing to take place. Six unemployed working class men with chronic pain participated in two ninety minute in-depth interviews. As relevant themes emerged, data were analyzed through an ecological lens in order to conceptualize the intricate contextual and persona; factors interacting in these men’s lives, subjective differences in how life with chronic pain is experienced, and the characteristics and life challenges faced by those experiencing chronic pain. This research can assist counselors and clients in the development of strategies to change client attitudes and/or behaviors by understanding how men may perceive and experience their lives in the context of chronic pain. ii Copyright 2013 Corinne Wehby Bridges iii Dedicated to my children Christopher Kelly, Edward, Virginia, & Gabriel iv Acknowledgements I would like to thank my chair, Dr. Ellen Cook and my committee members Dr. Laura Nabors and Dr. Vicki Stieha for their support and guidance throughout this process. Dr. Stieha is responsible for my introduction to the world of qualitative research; her knowledge and expertise proved invaluable to my understanding of the chosen methodology. A special thanks to Dr. Nabors for her unwavering commitment to student success, without which I might not have achieved my doctoral goals. I am forever grateful to have been afforded the opportunity to work with Dr. Ellen Cook, whose expertise in the Ecological Perspective, gender and chronic pain is awe inspiring. Ellen, thank you for stimulating and engaging in academic discussion, encouraging me to move beyond my comfort zone, pushing me to be a better writer and scholar and most importantly, for providing me with a new mantra when I truly needed it. I would also like to thank Michael T. Farrell, PhD. & Associates as well as ForPsych for allowing me to utilize their patient population for recruitment purposes. Specifically, Dr. Stephen Halmi of MTF & Associates and Dr. Christopher Ward of ForPsych, thank you for all of your efforts on my behalf. I would like to pay tribute to the six brave men who were willing to commit themselves to this project. Thank you for sharing and trusting me with your very personal experiences; you were open and honest and I am grateful. I am honored to have worked with you and truly believe this project will lead to greater acceptance, understanding and advocacy. I want to express my utmost appreciation for my mother in-law, Vickie Bridges, for caring for me as she would one of her own. I will always be grateful for your thoughtfulness, consideration and willingness to help in any way possible. Thank you! v To my parents, whose love and support is endless, thank you for helping make this dream a reality (and I’m not just talking about the babysitting). You gave me the courage to know that I could see this through. Mom, thank you so much for our daily talks and your encouragement throughout this process. They strengthened my resolve and truly meant the world to me. Pop, thank you for always telling me just how smart you think I am. This constant refrain instilled a belief in me that enabled me to undertake this doctoral adventure despite my learning disability and any obstacles that presented themselves along the way. I love you both. Finally, to my husband Christopher, my biggest fan, who believes I can achieve anything, and constantly shows me that I am truly loved. You supported me (and our family) through the addition of not one but two doctoral babies in a three year period, allowed me to talk incessantly about my work, share ideas and ask for advice (even if I didn’t always take it) and were always willing to give me time. I am forever grateful for your understanding of this process and of me. I look forward to our next great adventure and of course, for the ability to refer to ourselves as “Drs. Bridges”. Thank you, I couldn’t love you more. vi Table of Contents Abstract ii Dedication iv Acknowledgements v Chapter 1: Introduction 1 Statement of the Problem 3 Purpose of the Study 4 Significance of the Study 4 Assumptions 5 Methodology 5 Definitions 6 Chapter 2: Scholarly Review of the Literature 9 Chronic Pain 9 Overview of the Ecological Perspective 11 Behavior is Personal and Contextual 14 Behavior is Interactional 14 Behavior is Meaningful 15 Ecological Counseling 16 Gender and Men’s Pain Experience 17 Socioeconomic Status, Work, and the Pain Experience 20 Summary 23 vii Chapter 3: Methodology 25 Research Methods 25 Research Design 26 Recruitment Sites and Procedures 28 Analytical Processes 32 Positionality 35 Validity 36 Chapter 4: Results 38 BPI Responses and Demographics: Adam 39 Adam 40 BPI Responses and Demographics: Barty 59 Barty 60 BPI Responses and Demographics: Carl 78 Carl 79 BPI Responses and Demographics: Dave 103 Dave 104 BPI Responses and Demographics: Eddie 126 Eddie 127 BPI Responses and Demographics: Frank 144 Frank 145 Summary 160 Chapter 5: Discussion 162 Summary of the Study 162 viii Research Findings 164 Personal Interactions within Context 164 Work 165 General activity 166 Mood 167 Relations with others 169 Sociocultural identity and power 170 Gender as an Interactional Cultural Factor 171 Class 171 Education and employment 173 Pain is Meaningful 174 Being a man 175 Spirituality and hope for the future 180 Grief 183 Dimensions of patient status 186 Perceptions of ability to cope 189 Implications for Counseling 191 Scope of the Study 194 Limitations and Implications for Future Research 194 Conclusions 196 ix Chapter 1: Introduction Chronic pain is an international phenomenon that affects millions of people. At some point in one’s life, every human being experiences pain. The initial response is to do what is needed to alleviate pain. Children fall and seek comfort in their mother’s kiss. This act alone may alleviate their pain. Some extreme pain is tolerated because of its purpose, such as childbirth or the discomfort of athletic training. However, it is the very nature of chronic pain to have no set duration, a fact so unnatural to the human experience. Literature on pain supports the concept that it is universal, diverse and multidimensional (Lee, Chronister, & Bishop, 2008). Pain can be classified as acute, lasting no longer than three months, or chronic, which extends beyond the expected tissue healing time of three months (Burns, 2010). It does not differentiate between race or religious preference, socioeconomic status, age, gender or education (Davidhizar & Giger, 2004; Green, Ndao-Brumblay, Nagrant, Baker, & Rothman, 2004; Nayak, Shiflett, Eshun, & Levine, 2000; Saastamoinen, Leino-Arjas, Laaksonen, &Lahelma, 2005; Schlesinger, 1996). Men, women and children alike can all experience chronic pain from a variety of causes. It can stem from diseases or illnesses, including, but not limited to arthritis, fibromyalgia, multiple sclerosis and cancer (Arnold, Bradley, & McCarberg, 2010; de Wit et al., 2001; Khan & Pallant, 2007). It can be brought on by injury: a car accident, a sport, a work related injury, even surgery and has no set duration (Burns, 2010). Despite the fact that chronic pain is one of the most common reasons people seek medical attention, it is difficult to treat and there is no specific treatment that will guarantee relief (Davidhizar & Giger, 2004; Hardt, Jacobsen, & Goldberg, 2008). In addition, the intensity of chronic pain typically has a waxing and waning course; thus it is never completely “out of mind” and often lingers, which can be draining (Higgins, 2005; Shea & McDonald, 2011). 1 When people experience chronic physical pain they can become susceptible to mental anguish or pain, which can lead to depressed mood and feelings of anxiousness (Burns, 2010; Hardt et al., 2008; Lame, Peters, Vlaeyen, Kleef, & Patijn, 2004). People experiencing chronic pain are likely to develop depression, anxiety, or both (Burns, 2010; Campbell & Cramb, 2008; Green et al., 2004; Karlin, Creech, Grimes, Clark, Meagher, & Morey, 2005). People can begin to feel helpless about improving their physical condition and hopeless to change their circumstances (Campbell & Cramb, 2008; Haythornwaite, Menefee, Heinberg, & Clark, 1998). These states of mind, in turn, can lead to fear, frustration, instability, and anger which changes lives and lifestyles (Fernandez & Turk, 1995; Lame et al., 2004). Chronic pain carries with it a stigma. Unlike acute pain, chronic pain cannot be “fixed.” It is often difficult to pinpoint causal factors of the pain and to measure pain intensity, leaving physicians to rely solely on client self-report (Jackson, 2005). This changes the very nature of the doctor/patient relationship. Clients seek help from medical experts in order to get better; practitioners rely on medical instruments to assess health issues and promote healing. When this socially accepted interaction cannot lead to a mutually satisfying resolution, both patient and practitioner can become frustrated. “Relations between pain patients and health care deliverers are considered the worst in medicine. In fact, pain patients can provoke an intense hostility in caregivers, often the result of a relationship that has seriously deteriorated” (Jackson, 2005, p.