The mechanisms and processes of connection: developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives.

BACKGROUND: Mental health recovery narratives are a core component of recovery-oriented interventions such as peer support and anti-stigma campaigns. A substantial number of recorded recovery narratives are now publicly available online in different modalities and in published books. Whilst the benefits of telling one's story have been investigated, much less is known about how recorded narratives of differing modalities impact on recipients. A previous qualitative study identified connection to the narrator and/or to events in the narrative to be a core mechanism of change. The factors that influence how individuals connect with a recorded narrative are unknown. The aim of the current study was to characterise the immediate effects of receiving recovery narratives presented in a range of modalities (text, video and audio), by establishing the mechanisms of connection and the processes by which connection leads to outcomes. METHOD: A study involving 40 mental health service users in England was conducted. Participants were presented with up to 10 randomly-selected recovery narratives and were interviewed on the immediate impact of each narrative. Thematic analysis was used to identify the mechanisms of connection and how connection leads to outcome. RESULTS: Receiving a recovery narrative led participants to reflect upon their own experiences or those of others, which then led to connection through three mechanisms: comparing oneself with the narrative and narrator; learning about other's experiences; and experiencing empathy. These mechanisms led to outcomes through three processes: the identification of change (through attending to narrative structure); the interpretation of change (through attending to narrative content); and the internalisation of interpretations. CONCLUSIONS: This is the first study to identify mechanisms and processes of connection with recorded recovery narratives. The empirically-based causal chain model developed in this study describes the immediate effects on recipients. This model can inform selection of narratives for use in interventions, and be used to support peer support workers in recounting their own recovery narratives in ways which are maximally beneficial to others.

Structural developmental psychology and health promotion in the third age.

In response to the ever-increasing longevity in Western societies, old age has been divided into two different periods, labelled the third and fourth age. Where the third age, with its onset at retirement, mostly involves positive aspects of growing old, the fourth age involves functional decline and increased morbidity. This article focuses on the entry to the third age and its potential for health promotion initiatives. Well-being is an important factor to emphasize in such health promotion, and this article views the lifestyle of third agers as essential for their well-being. The structural developmental theory of Robert Kegan delineates how a person's way of knowing develops throughout the life course. This theory is an untapped and salient perspective for health promotion initiatives in the third age. This article outlines Kegan's approach as a tool for developing psychologically spacious health promotion, and suggests future directions for research on the topic.

When everyday life becomes a storm on the horizon: families' experiences of good mental health while hiking in nature.

Hiking in nature is often presented as a yearning for lost harmony premised on an alleged divide between nature as authentically healthy and society as polluted. This paper's aim is to question this strict divide and the strong belief in nature as having an innate health-providing effect, the biophilia hypothesis, by examining what Norwegian families with young children experience when walking in the forest. Twenty-four conversations with families during a hiking trip in the forest were recorded, and the data were analysed with Giorgi's descriptive phenomenological research method. The paper introduces the general descriptive meaning structure of the phenomenon 'family-hiking with young children'. It shows that a hiking trip clears space for the family in their everyday lives which is largely dominated by relations with non-family members at both work and leisure. The families experience that they actively generate a different existence with a sense of here-and-now presences that can strengthen core family relations and also provide the opportunity to pass down experiences that can be recollected and realized by future generations. This experience is complex and constituted by social practices, which indicate that the biophilia hypothesis seems to be an insufficient explanation of why families go hiking in nature. Nature rather represents a peaceful background that allows for the perpetuation of the family as a social institution and the recreation of cohesion in everyday life.

The quest for choice and the need for relational care in mental health work.

Since the revolutionary mood of the 1960s, patient-centered mental health care and a research emphasis on service users as experts by experience have emerged hand in hand with a view of service users as consumers. What happens to knowledge derived from firsthand experience when mental health users become experts and actively choose care? What kind of perspective do service users pursue on psychological distress? These are important questions in a field where psychiatric expertise on mental illness is socially structured and constrained as an intra-personal disturbance of the mind. We argue that experience experts have lost a coherent perspective on care and health. We illustrate this by rationally reconstructing how the interpersonal view of mental health first gained and then lost coherence between the conception of mental health, the practice of mental health care, and the user experience. Harry Stack Sullivan's interpersonal theory was a paradigm case for such coherence. The inclusion of mental health consumers as 'experts by experience' in the mental health field took place at the cost of Sullivan's coherent interpersonal theory. Service users who interact side by side with medical experts as experience experts are constrained by the evidence-based imperative and consumerism. Service users are caught up in a race among experts to gain knowledge about mental problems from a third-person perspective instead of from first-person experience. To make a contribution service users have more to gain from a research approach that appreciates that they are persons among persons rather than experts among experts.

Studying narrative-in-action in women with chronic rheumatic conditions.

In this article we aim to sculpt a possible methodology for studying how a good everyday life comes about when living with chronic rheumatic conditions (CRC). Our "how" focus acknowledges a woman with CRC as one member of a diverse population, whereby we question the biomedically based view that she differs from the population. The more frequently asked "what" question colors study designs and results in categories and characteristics regarding what she is able to do and what adaptations she has made in everyday life as a consequence of her disease. Adopting a narrative approach, we ask how a good everyday life comes about, and illustrate this with ethnographic material of the everyday activities of women living with CRC. We conceptualize narrative as embedded in the process of enacting activities. Furthermore, we highlight hermeneutical interpretative processes of how meaning works in the stream of everyday action.

Education is a private matter: Clinical midwives' experiences of being part-time master's students in midwifery.

When the master's degree in midwifery was introduced in Norway, clinical midwives with a professional diploma soon requested the possibility to upgrade their education to a master's degree. In 2014, a part-time master's program worth 40 ECTS credits was introduced at a Norwegian university. In this study, we aimed to explore clinical midwives' experiences of how taking a part-time master's program in midwifery was received at their workplace. We employed a qualitative research design and an explorative descriptive approach. A convenience sample consisting of 47 clinical midwifes with varying seniority was recruited in 2016 and 2017, and five focus group interviews were conducted at the end of the study programs. Systematic text condensation was used to analyze the data, generating three themes. The first concerns the midwives' experiences of learning new tools to advance their profession. Secondly, they expressed hope for support, but found that education was a private matter. Finally, they experienced that financial support depended on goodwill from their employers. The study demonstrates that a master's degree in midwifery can be instrumental to strengthen clinical practice, but also points towards the need to update and strengthen management and leadership to facilitate and implement new knowledge.

New mothers' struggles to love their child. An interpretative synthesis of qualitative studies.

PURPOSE: New mothers may question the nature of their motherly love after the birth. Most mothers find that feelings of affection come within a week from birth. However, some mothers are still struggling with this after many months. Many studies place strong emphasis on the importance of maternal affection for the development of the child. Few studies look into mothers' experiences when maternal affection or love remains a struggle. Method:We present an interpretative synthesis based on a systematic analysis of five qualitative studies that report findings related to mothers' stated inability to exhibit maternal affection. Result:In answer to our question "what characterizes the experiences of women who struggle with, or are unable to exhibit, maternal affection after birth", we identified the uncertainty involved in imagining the unborn child, birth and maternal future, birth as a disillusionment, and the ensuing process of decreasing agency and increasing alienation. Especially a traumatic birth may lead to disillusionment. Conclusion: Health care workers and research can support a mother's positive resolution of her struggle by promoting realistic and more open expectations for maternal affection as well as her sense of agency and ownership during birth and the early mother-child relationship.

The lived experience of well-being in retirement: A phenomenological study.

This phenomenological study aimed to identify and describe the general meaning structure of the experience of well-being after retirement. We interviewed nine retirees about their lived experiences with well-being and analysed the data with Giorgi's descriptive phenomenological method. The general meaning structure described well-being in retirement as a phenomenon that interweaves four constituents: (1) an awareness of and gratitude for a healthy and functioning body, (2) a new experience of time presenting possibilities for action, (3) a heightened sense of agency, and (4) being-in-place in relationships. We discuss these findings in relation to relevant literature of successful aging, the perception of time, eudaimonic and hedonic well-being and generativity. Our findings contribute to the field by comprehensibly describing the phenomenon of well-being as it is experienced by retirees, which we conclude to be a valuable contribution for initiatives promoting well-being in retirement.

A case study of a mother's intertwining experiences with incest and postpartum depression.

The association between childhood sexual abuse (CSA) and major depression disorder (MDD) gives reason to suspect that many mothers with postpartum depression (PPD) have a history of CSA. However, few studies have investigated how CSA and PPD are related. In this case study we explore how the experience of incest intertwines with the experience of postpartum depression. We focus on participant subject "Nina," who has experienced both. We interviewed her three times and we analysed the interviews with Giorgi's phenomenological descriptive method to arrive at a contextualised meaning structure. Nina's intruding fantasies of men who abuse her children merge with her recollections of her own incest experiences. She may succeed in forcing these fantasies out of her consciousness, but they still alter her perceptions, thoughts, and emotions. She feels overwhelmed and succumbs to sadness, while she also is drawn towards information about CSA, which in turn feeds her fantasies. The psychodynamic concepts of repetition compulsion, transference, and projection may provide some explanation of Nina's actions, thoughts, and emotions through her past experiences. With our phenomenological stance, we aim to acknowledge Nina's descriptions of her everyday life here and now. With reference to Husserl, Heidegger, Merleau-Ponty, and Minkowski, we show that Nina's past is not a dated memory; rather it determines the structure of her consciousness that constitutes her past as her true present and future. Incest dominates Nina's world, and her possibilities for action are restricted by this perceived world. Any suspension of action implies anguish, and she resolves this by incest-structured action that in turn feeds and colours her expectations. Thus anxiety and depression are intertwined in the structure of this experience.