trr svetlana's course 011
DESCRIPTION
Power Point program used in the Social Construction of Disability and Health Course at University of Calgary; Friday August 26, 2011. Presented by Val Lougheed.TRANSCRIPT
Val LougheedNorthern Lights Canada
Social Construction of Disability and Health
Trauma, Rehab and Recovery
~ Keep Your Fork ~
1-800-361-4642 * www.northernlightscanada.ca * [email protected]
“You don’t want your impairments to define you – you want them to inform you.”
(Hanita Dagan, personal communication, 2005)
www.slideshare.net/vlougheed
#NLCAN
www.northernlightscanada.ca/about/about-
val-lougheed/be-still
Agenda
•Beginning …
•Middle …
•End …
Social Construction of Disability and Health
1. What does it mean to recover?
2. What lens(es) does Val see recovery through?
3. What aspects of recovery are potential social problems?
4. How do I use a narrative in a research study of a specific social problem?
“The truth about anything is an acquired meaning based on personal experiences, and the telling of those experiences.”
(Gergen, 1999)
The Truth
Rated PG-113
People Strongly Cautioned!
May contain bad language, brief nudity, sexual overtones, and drug usage.
Beginning
My Story
Sept. 9, 2003 - morning
Sept. 9 – p.m.
Sept. 15 2003 – Jan. 19 2004
Journey Back to Life
Research
Researcher’s Position
Paradigm
• Interpretive/ConstructivistOntology
• multiple realities• socially constructed• time and context dependent
Epistemology• research is an ongoing, interactive process• confirmability and rigor vs. objectivity
Approach to Research• Qualitative• Grounded
o insights and hypotheses emerge from the datao evidence illustrated by characteristic examples from
the datao inductive (Glaser and Strauss, 1967; Mertens, 1998)
Research Methodology
Narrative Inquiry
• the “story” provides a window into lived experience and its meanings
• phenomenological
Data Analysis Method•Open Coding•“opens” up the data so meaning can be discovered
Findings Must Be …
• practical• useful for patients/clients and practitioners• a foundation for further research
(my own requirements)
(White and Epston, 1990: van Manen, 1998)
(Mertens, 1998; Strauss, 1988; Glaser and Strauss, 1967)
• a method to organize “mountains of raw data”, and then locate the themes and patterns in the data.
(Neuman, 1997, p. 422)
Open Coding
Open Coding Analysis
1. Print narrative with a three-inch margin on the right-hand side of each page.
2. Divide the narrative into discreet phases, as determined by what was happening at the time.
3. Determine the general topic of each phase and then imagine what insights are embedded in that topic; make notes in the three-inch margin.
4. Create a time line of the narrative, phase-by-phase, with associated critical events and insights.
Open Coding Analysis (cont’d.)
5. Make a list of all of the insights embedded in the entire narrative (data), using the time line.
6. Synthesize the data by grouping similar insights together, in order to develop a number of topical categories.
7. Determine the dominant theme of each topical category and title it thus.
8. Write about each dominant theme, using examples from the narrative (and references from literature, if you must) as informative evidence .
Dominant Themes
• Narcotic Pain Killers
• ABI
• Pain
• Trauma
• Depression
• Methods of Helping• Return to Work
• Life
Foundation for Understanding
Experience
Body-Mind Connection
Psychoimmunoendocrine Network
The nervous, endocrine, and immune systems are functionally integrated – the brain is only one part of this non-hierarchical network Memories, emotions, behaviours and physiology are all connected at the molecular level
(Candace Pert, 1997, p. 171 – 179)
“The truth about anything is an acquired meaning based on personal experiences, and the telling of those experiences.”
(Gergen, 1999)
The Truth
The Inclusion Lense:• journalists, economists, demographers
• life – social and economic factors
Understanding Life Through the Lenses of Social Construction
The Health Lense:• physicians, psychologists, scientists
• life – cause, cures, care resources, control measures
The Meaning Lense:• speakers, singers, artists, authors
• life – patterns of thinking and cultural expressions
Understanding Life Through the Lenses of Social Construction
The Coping Lense:• counsellors, wellness experts, self-help authors
• life – coming to terms with personal experience.
(Marlett, 2001, personal communication)
February 2004 – Present
Starting Point
Identity Disintegration
and
The Re-organization of Self
March 2004
“In the aftermath of traumatic life events … [the] sense of self has been shattered.”
(Herman, 1992, p. 61)
“An existential crisis …”
(Hanita Dagan, personal communication, 2005)
Sliding Down the Slope
Early 1900’s Oxycodone™ developed in Germany
1995 Purdue Pharmacy (USA) launches OxyContin™ – controlled-release formula
1996 Approved in Canada
2002 OxyContin™ earns Purdue more than $1 billion U.S.
2003 OxyContin™ is one of Canada’s 3 most-prescribed narcotic painkillers
Nov. 2003 – Oct. 2004
783,762 prescriptions for OxyContin™ dispensed in Canada
(Dalhousie, March 2005)
Sliding Down the Slope
A Foothold
• Mild – moderate ABI
• Depressed (dysphoria)
• Working memory problems
• Hiding pain
1st Neuropsychological Assessment
June 2004 -- Results
ABI – Measuring Loss
“Pre-morbid intelligence is a crucial variable …”
Subjective Report – difficulty retrieving words and communicating ideas
Objective Report – above-average performance on neuropsychological measures
(Prigatano, 1999, p. 59)
Losing My Grip
My IWRPAugust 2004
Rescued in the Valley of Despair
Head Injury ProgramOct. – Dec. 2004
HIPOct to Nov – Full-time
December – Part-time
GO TO WORK
GRTW – The Plan
Jan. 3 – Feb. 7, 2005
(5 weeks)
GRTW – The Reality
GRTW – The Reality
GRTW – The RealityNarrative Therapy
GRTW – The Reality
GRTW – The Reality
GRTW – The Reality
GRTW – The Reality
GRTW – The Reality
GRTW – The Reality
Rescue Attempts
• Case Manager
• Job Coach
• Colleagues/Friends/ Psychologist
Sliding Back Down Into The Abyss
• Non-compliance
• Malingering
• Trying too hard
• Not trying hard enough
2nd Neuropsychological Assessment
May 2005 -- Edmonton
Test Results• Mild to Moderate ABI
• Pain?
• Depression?
• Motivation?
• “a high flyer”
• “phobic avoidance”
• Future plans – “live off dividends” [from company]
Lesson
ASSUMPTIONS
REVEAL BIAS
• Mild – moderate ABI
• Good prognosis
• Post-Traumatic amnesia
• Pain?
• Depression?
• “Adjustment Disorder with Anxiety and Depressed Mood”
3rd Neuropsychological Assessment
August 2005 -- Calgary
Symptom Overlap
(co-morbidity)
(Michael Sullivan, Centre for Research on Pain and
Disability, McGill University, September, 2006)
Pain, Trauma, Depression, ABI
Oct. 3 – Dec. 11
Pain Research
1600’s – Rene Descartes (philosopher)
Pain Research
1950’s – Wilder Penfield (brain surgeon)
Pain Research
Patrick Wall (physiologist)Ronald Melzack (psychologist)
Pain ResearchGate Control Theory
• Acute and chronic pain
• Pain sensation travels up the central nervous system to the brain through a “gate”
• “Gate” – triggered by cell changes – sends descending messages that alter sensory input
• Pain isn’t pain until it reaches the brain
• Emotions, context, etc. affect pain sensations
• Pain is a negotiable, individual experience
• Pain centres in the brain – they just keep moving around
(Jackson, 2002, p. 21)
Pain – The Future
SCN9A(Globe and Mail, March 24, 2007)
Glia Cells(Scientific American, November, 2009)
Poppy Genes(U of Calgary -- Calgary Sun, March 15,
2010)
Regulates survival functions, emotional expression and processing of memories.
(Rothschild, 2000)
• Amygdala - attaches emotional tags to memories
(Dr. Suffield, personal communication, 2004)
• Hippocampus - controls the laying down of new memories(Ramachandran & Blakeslee, 1998, p. 15)
• Hypothalamus – controls the outward expression of emotions
(Ramachandran & Blakeslee, 1998, p. 177)
Trauma ResearchLimbic System
“In every encounter, basic trust is in question.” ( Herman, 1992, p. 92)
“Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160)
Rehab & Recovery
DISSOCIA
TION
Trauma Research
Flight
Fight
Freeze
“Survival Central”(Rothschild, 2000, p. 46)
•Amygdala - Implicit memory• storage of emotions and sensory
reactions (Rothschild, 2000, p. 20)
•Hippocampus – Explicit memory• creates memories of actual sequence
of events(Rothschild, 2000, p. 28)
Trauma ResearchLimbic System and Memory
Stress Hormones
•Amygdala - Implicit memory• storage of emotions and sensory
reactions (Rothschild, 2000, p. 20)
•Hippocampus – Explicit memory• creates memories of actual sequence
of events(Gunnar & Barr, 1998)
Trauma ResearchLimbic System Under Threat
TraumaPersonal Experience
• Dissociation & Cocoon = Safety
• System on High Alert Always = Survival
• World is black & white = Trust
Trust (Safety) = Love
No Trust (Life Threatening) = Hate
TraumaPersonal Experience
• Listen to me
• Understand me
• Respect me
• Are competent
I trust (love, feel safe with, will try hard for) practitioners who:
“… depression [caused by trauma] is not the same as ordinary depression.”
( Herman, 1992, p. 118)
Depression
“Emotions are not in the head – they are in every cell in the body.”
(Pert (1995), in Bolen, 1996, p. 7)
Pscyhoimmunoendocrine Network
Affects more than IQ ….
• We are sensitive to changes in higher cerebral functioning
• Very important to a person’s sense of self
• Touches core … of a person’s self-esteem
(Prigatano, 1999, p. 58)
ABI
Back to Wilder Penfield – 1950’s
ABI
Localizationist
Paul Bach-y-Rita – 1934 – 2006
Scientist and Rehab Doctor
Neuroplasticity - 1969
Michael Merzenich
Neuroplastician
Neuroplasticity
Harnessing the Power
“The words and attitudes of others … are potent. They help or hex healing and recovery.”
“ Expectations are powerful.” (Bolen, 1996, p. 94)
“Cortisol shuts down immune cells’ responses…”
(Sternberg, 2001, p. 112).
Body-Mind Connection
•Hypothalamus
•Peptides
•Receptors
•Biochemical Events
Quantum Connection
The Living Matrix -- 1995• A type of energy exists that has previously gone unnoticed.
• Cells/DNA influence matter through this form of energy.
• DNA Phantom effect. Braden, 2007, p. 45
“Loss of identity can evoke a personal crisis, creating a need for change.”
(Ornelas, in Smith & Johnson (Eds), 1997, p. 172)
The Re-Organization of Self
Identity Research
Scaling the Canyon
Sept., 2005
Waskesiu
Breast Cancer Reconstructive Surgery
March 2006
Convocation M.Ed. -- June 2006
Back in “a” SaddleSeptember 2007
• Officially change role/ title
• Re-organize NL
• Work part-time
Social Construction of Disability and Health
Resilience Ability to return to original form after
being bent (bounce back)
Thriving in constant change, ability to be:
• Flexible
• Creative
• Adaptable
• Learn from experiencehttp://www.resiliencycenter.com/articles/5levels.shtml
Social Construction of Disability and Health
Rehabilitation (habiter – to live inside)
“Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.”
(Kabat-Zinn, in Meili, 2003, p. 241)
Social Construction of Disability and
Health
Recovery
Curing Focus on the illness/ impairment [outside]
Healing Focus on the person [inside] (Crombez, October, 2003)
Be Still
Social Construction of Disability and Health
1. What does it mean to recover?
2. What lens(es) does Val see recovery through?
3. What aspects of recovery are potential social problems?
4. How do I use a narrative in a research study of a specific social problem?
Keep Your Fork
Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work.
We offer 4 major divisions of service: • Vocational Rehabilitation Services • Employment Services • Employer Services• Corporate Training
For more information, please contact us: 1-800-361-4642
www.northernlightscanada.ca
Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis.
Member companies include:Argus Management Consultants,
Inc. Sandra Preeper & Associates
Advantage Rehabilitation Consultants Ltd.
Rehabilitation Alternatives Limited / Vocational Alternatives Software
OPTIMA Rehabilitation CVE Inc.
Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC)
Western Rehabilitation Specialists Inc.
Diversified Rehabilitation Group
Genesis Rehabilitation Ltd. Rehabilitation FocusFor more information, please feel free to contact us at 1-800-361-
4642
Social Construction of Disability and Health
1. What does it mean to recover?
2. What lens(es) does Val see recovery through?
3. What aspects of recovery are potential social problems?
4. How do I use a narrative in a research study of a specific social problem?
Social Construction of Disability and Health
1.What does it mean to recover?
• After listening to Val’s story, what do you think it means to recover?
• What specific parts of Val’s story reveal the meaning of recovery?
Social Construction of Disability and Health
2. What lens(es) does Val see recovery through?
• What specific sub-stories reveal the lens(es) that Val sees her experience through?
► what is the origin of such lenses?
• What lens do you see recovery through?
► What is the origin of your lens?
► How does this shape your understanding of recovery?
Social Construction of Disability and Health
3. What aspects of recovery (in Val’s story) are potential social problems?
• What is a social problem?
• What are the specific social problems that Val encountered?
• Do you think a lot of people encounter such problems?
• Any solutions?
Social Construction of Disability and Health
4. How do I use a narrative in a research study of a specific social problem?
• What is the exact social problem I am investigating?
• What do I look for in a narrative to help me understand what my social problem means to people?
• How do I organize the data in the story in order to use it for research?
• How do I ensure that my research is rigorous?
Social Construction of Disability and Health
Rigor in Research
• The quality of being believable or trustworthy (Free Online Dictionary)
• “adherence to principles and procedures, methods and techniques that minimize bias and error in collection, anaysis, interpretation and reporting of data” (Ogawa and Malen (1991) in Mertens (1998), p. 49)
• Higher order thinking and real world application (Academic Leadership, The Online Journal, Vol 9, Issue 2, Spring 2011)