Reconnecting with Life: Reconnecting with Self, Others and Time A grounded theory study of recovering from mental health problems in an Irish context A thesis submitted by Yulia Kartalova-O’Doherty, M.A., M.Sc. for a Ph.D. in psychosocial health at the School of Nursing, Dublin City University First supervisor Professor Chris Stevenson, School of Nursing, DCU Second supervisor Professor Agnes Higgins, School of Nursing and Midwifery, TCD January 2010 I hereby certify that this material, which I now submit for the assessment on the programme of study leading to the award of Doctor of Philosophy in psychosocial health is entirely my own work, that I have exercised reasonable care to ensure that the work is original, and does not to the best of my knowledge breach any law of copyright, and has not been taken from the work of others save and to the extent that such work has been cited and acknowledged within the text of my work. Signed :_________________(Candidate) ID No.:_______________ Date:___________ 2 Contents List of Tables and Figures.......................................................................................................... 6 Abstract........................................................................................................................................ 7 Acknowledgements ..................................................................................................................... 8 1. Introduction and Background ......................................................................................... 10 1.1 Scoping and shaping of the current study ........................................................................ 10 1.2 Policy background to the study......................................................................................... 14 1.3 The four models of recovery............................................................................................. 14 1.3.1 The biomedical model of mental illness and recovery............................................... 15 1.3.2 The rehabilitation model of mental illness and recovery........................................... 18 1.3.3 The empowerment model of recovery ........................................................................ 19 1.3.4 The psychological model of recovery......................................................................... 20 1.4 Consumer-defined concepts and processes of recovery.................................................. 21 1.5 The Irish policy context of mental illness and recovery.................................................... 24 1.6 Rationale to the study....................................................................................................... 26 1.7 Study aim and objectives .................................................................................................. 27 2. Methodology ...................................................................................................................... 28 2.1 Philosophical underpinnings behind the selection of methodology ................................ 28 2.2 Critical realism................................................................................................................... 30 2.3 Critical realism and grounded theory ............................................................................... 33 2.4 Conceptualisation procedures in grounded theory.......................................................... 34 2.5 Study design...................................................................................................................... 36 2.6 Ethical issues and considerations ..................................................................................... 37 2.7 Stages of theoretical sampling, interviewing and analysis ............................................... 38 2.7.1 First stage of theoretical sampling, interviewing and data analysis ......................... 38 2.7.2 Second stage of theoretical sampling, interviewing and data analysis...................... 42 2.7.3 Third stage of theoretical sampling, interviewing and conceptualising .................... 45 2.8 The use of literature in the study...................................................................................... 48 2.9 The use of technology in the study................................................................................... 50 2.10 Balancing subjectivity with objective spirit..................................................................... 51 3 2.11 Criteria to assure quality in grounded theory................................................................. 52 3. Findings and Theory......................................................................................................... 55 3.1 Overview of socio-demographic and other characteristics of the sample....................... 55 3.2 From disconnection to reconnection................................................................................ 59 3.3 Core category: reconnecting with life............................................................................... 63 3.4 The three subcategories of the core category: reconnecting with self, others and time 65 3.4.1 Reconnecting with self ............................................................................................... 65 3.4.2 Reconnecting self with others .................................................................................... 68 3.4.3 Reconnecting self, others and time............................................................................. 69 3.5 Interactive multidimensional processes of reconnecting self, others and time............... 71 3.5.1 Getting back to oneself: getting back to ‘here and now’ ........................................... 72 3.5. 2 Hope, will, and way: giving up, or fighting? ............................................................ 74 3.5.3 Experiencing meaningful connection with others..................................................... 80 3.5.4 Coming to terms with the past.................................................................................... 85 3.5.5 Fighting to reconnect with life: designing and executing one’s own recovery.......... 89 3.5.6 Synchronising self with others in time and giving back............................................. 93 3.5.7 Futurising and moving on: making active choices in life .......................................... 97 3.5.8 Turning bad days into good days............................................................................... 99 3.6 Summary of theory ......................................................................................................... 105 4. Discussion of theory ........................................................................................................ 107 4.1 Relevance of the current theoretical framework to previous research and mental health practice ................................................................................................................................. 107 4.2 From disconnection to reconnection.............................................................................. 109 4.3 What is life? .................................................................................................................... 110 4.4 Reconnecting with self.................................................................................................... 111 4.4.1 Giving up and fighting for recovery......................................................................... 111 4.4.2 Intrinsic motivation and self-determination............................................................. 113 4.4.3 Conation as fighting spirit in psychology ................................................................ 116 4.4.4 Embodiment: bodily intentionality........................................................................... 117 4.5 Reconnecting self with others ........................................................................................ 120 4.5.1 Meaningful connection: acceptance, validation and empathy................................. 120 4.5.2 Giving back to others: altruism ............................................................................... 123 4 4.5.3 Reconnecting self, others and something bigger: spirituality.................................. 124 4.5.4 Role of positive and constructive feedback in development of self-esteem and self- confidence ......................................................................................................................... 126 4.5.5 The role of humour in reconnecting self and others ................................................ 126 4.5.5 Environment: positive and negative energy............................................................. 127 4.6 Reconnecting self, others and time ................................................................................ 129 4.6.1 Good days, bad days: interruption versus immersion ............................................. 130 4.6.2 Reconnecting past and future in the living present.................................................. 131 4.6.3 Coming to terms with the past.................................................................................. 132 4.6.4 Futurising: turning bad days into good days........................................................... 132 4.6.5 Synchronising self, others and time ......................................................................... 134 4.7 Reconnecting with life through