Douglas Ezzy

Illness narratives: time, hope and HIV

Life threatening illness, such as HIV/AIDS, also threaten peoples sense of identity and taken-for-granted assumptions about the temporal framing of their lives. In response, people often experience transformations in values, spirituality and life priorities. Drawing on a combined quantitative and qualitative study of people living with HIV/AIDS in Australia, three different narratives that people use to make sense of their illness experience are identified: linear restitution narratives, linear chaotic narratives and polyphonic narratives. Linear illness narratives colonise the future, assuming that the future can be controlled through human action. They emphasise a faith in medical science, tend to be secular and self-centred and assume the end of life to be in the distant future. Hope is focused on concrete outcomes such as improved health or material possessions. Linear narratives can be either restitutive or chaotic. Restitutive linear narratives anticipate a life that will mirror the narrative. Chaotic linear narratives anticipate a life that will fail to meet the linear ideal resulting in despair and depression. In contrast, polyphonic illness narratives are oriented toward the present, emphasising the unpredictability of the future. These narratives tend to include spiritual experiences, a communally oriented value system, and to recount increased self-understanding and the gaining of new insights as a consequence of their illness. Hope in polyphonic narratives is more abstract and focused on a celebration of mystery, surprise and creativity.

Unemployment and mental health: A critical review

Existing theoretical explanations of the mental health consequences of unemployment are outlined, critically reviewed and an alternative theory proposed. Theories reviewed include the rehabilitation approach, the stages model, Jahodas functional model, Warrs vitamin model and Fryers agency critique. A discussion of the effects of moderating variables--including the quality of work, work commitment and age--is used to assess the usefulness of these theoretical explanations. Most theories are found to deal inadequately with the temporal aspects of unemployment, the relationship between subjective experience and objective location and the complexity of the effects of moderating variables. In response to these inadequacies and in contrast to the predominant empiricist, psychological orientation, a middle range theory is proposed informed by a sociological perspective. The proposed theory conceptualises unemployment as a type of status passage and suggests an explanation of changes in mental health derived from identity theory.

Qualitative Interviewing as an Embodied Emotional Performance.

The article argues that the emotional framing of interviews plays a major role in shaping the content of interviews. Drawing on the psychoanalytic theory of Jessica Benjamin and Luce Irigaray, the article describes how interviews can be experienced as either conquest or communion. Qualitative researchers typically focus on the cognitively articulated aspects of the interview and elide the significance of their own and the interviewee’s, emotions. A reanalysis of two previous qualitative interview studies is used to illustrate the difference between interviews experienced as conquest or communion. The article argues that all interviews are emotional and embodied performances and that good interviewing is facilitated by a reflexive awareness of, and engagement with, the emotional, embodied, and performed dimensions of the interview.

Poverty, disease progression and employment among people living with HIV/AIDS in Australia

A national survey of 925 people living with HIV/AIDS (PLWHA) in Australia is used to examine the relationship between disease progression, employment status, poverty and economic hardship. While disease progression has some impact on economic hardship, employment status is found to be the strongest determinant of both poverty and economic hardship. The most commonly cited reasons for leaving work were psychosocial (71%), with declining health cited by half of respondents. It is therefore argued that psychosocial issues are at least as important as changes in health in causing unemployment and therefore poverty and economic hardship among PLWHA in Australia.

Lived Experience and Interpretation in Narrative Theory: Experiences of Living with HIV/AIDS

Narrative analysis builds on the strengths of qualitative research by examining the construction of meaning and symbolic systems in a framework that is explicitly temporal and that links research in the humanities with that in the social sciences. Qualitative methodologies often assume reported data accurately reflects the realities of lived experience. On the other hand some research drawing on cultural studies argues that the “facts” of a persons life are irrelevant. This paper argues for a middle way based on narrative theory that explores the interaction of “objective” events and their “subjective” interpretation. Further, narrative analysis enables exploration of the temporal structure of peoples experiences focusing on both how a persons memories of the past and anticipations of the future influence their understanding and actions in the present. These points are developed drawing on the theory and methodology of both Symbolic Interactionism and Paul Ricoeurs Hermeneutics. The experiences of people living with HIV/AIDS are used to illustrate and explicate the usefulness of narrative analysis.

Employment, accommodation, finances and combination therapy: the social consequences of living with HIV/AIDS in Australia

The research reported here is of a study of the psychosocial impact of living with HIV/AIDS in Australia focusing on employment, accommodation and income in the environment of new treatments for HIV/AIDS. Many people experience profound changes to their lifestyle as a result of living with HIV/AIDS. In addition to detrimental changes in their health, many people experience major changes in their employment, accommodation, finances and relationships. The research highlights the significance of psychosocial factors along with changes in physical health in shaping PLWHAs (People Living with HIV/AIDS) changes in employment and accommodations. The new treatments now available for HIV/AIDS are further transforming peoples attitudes, with many PLWHA considering returning to employment.

Are qualitative methods misunderstood

Qualitative research methods are increasingly utilised by health researchers. Along with this the criteria for assessing the quality of qualitative research are changing from a natural science model to an interpretative social science model. This is a product of the realisation by health researchers that qualitative methods utilise a different epistemology to statistical methods. I demonstrate that a recent article in the Australian and New Zealand Journal of Public Health draws on a now outdated natural science methodology of assessing bias in focus groups. Drawing on interpretativist social science theory and recent work in the British Medical Journal I argue for the importance of examining the social contexts through which qualitative data is produced.

Antiretroviral uptake in Australia: medical, attitudinal and cultural correlates:

The objective of this study was to describe the medical, attitudinal and cultural correlates of antiretroviral uptake amongst people living with HIV/AIDS (PLWHA) in Australia. Stratified purposive sampling produced a sample of 925 PLWHA, which represents 8.3% of the current population of PLWHA in Australia. Respondents completed a self-administered questionnaire which revealed that 78% of respondents were using antiretroviral drugs for HIV/AIDS. Logistic regression revealed that PLWHA were more likely to use antiretroviral drugs if they had more favourable attitudes toward antiretroviral drugs, if they had been diagnosed with an AIDS-defining illness, and if they had ever had a CD4/T-cell count below 400 copies/ml blood. Women were less likely than men to use antiretroviral drugs, and logistic regression revealed different predictors of antiretroviral drug use amongst men and women. Given the importance of attitudes toward antiretroviral drugs, it is likely that if the current confidence in antiretroviral drugs were to change, this would be reflected in an equally rapid cessation of treatment amongst many PLWHA.

White Witches and Black Magic: Ethics and Consumerism in Contemporary Witchcraft

What is white Witchcraft and how is it different to black magic? The books and practices of the purveyors of white Witchcraft are examined alongside other popular Witches oriented toward consumerism. White Witchcraft is also compared to traditional Witchcraft. I argue that white Witchcraft is a marketing label for a type of Witchcraft consistent with consumer Capitalism. White Witchcraft emphasises growth and success eliding the understanding of loss, death, and the dark that is found in traditional Witchcraft. White Witchcraft also celebrates individual pleasure and instrumental self-gratification at the expense of locating individuals in ecological and human networks of relationships. Consumer-oriented Witchcraft has popularised and facilitated the growth of Witchcraft, but consumer capitalism has also shaped Witchcraft to be consistent with consumer values and ethics. The purveyors of white Witchcraft do not challenge or question the goals and values of consumer capitalism, but explicitly celebrate them. The mass media and consumerism are central sites of ethical struggle for contemporary Witches.

New Age Witchcraft? Popular spell books and the re-enchantment of everyday life

Witchcraft is entering mainstream culture through movies, magazines, websites, novels, and spell books. This paper examines a small number of popular spell books to investigate the effects of popularisation on the beliefs and practices of Witchcraft. I interrogate the debate about Witchcrafts relationship to the New Age to identify characteristics that might be present in a popularised Witchcraft. The characteristics include: the self-ethic, a this-worldly orientation, holism, evolutionary development and ephemeral participation. I argue that popularised Witchcraft has some New Age characteristics, but that other interesting trends include the re-enchantment of everyday life and the sacralisation of the sensuous through love spells, body confidence spells, and material prosperity spells. Spell books provide a technology of the self for young women. I argue that the paraphernalia of New Age Witchcraft are a site in which central contemporary identity issues are contested.