Trr svetlana's course 011

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 …


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 RealityNarrative Therapy

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

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


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


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

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


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?



• 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?


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?



• 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?


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)

Trr svetlana's course 011

Education

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