Jennifer Poole

Beyond Recovery: Colonization, Health and Healing for Indigenous People in Canada

How do we limit our focus to mental health when Indigenous teaching demands a much wider lens? How do we respond to mental health recovery when Indigenous experience speaks to a very different approach to healing, and how can we take up the health of Indigenous people in Canada without a discussion of identity and colonization? We cannot, for the mental health and recovery of Indigenous people in Canada have always been tied to history, identity, politics, language and dislocation. Thus, in this paper, our aim is to make clear that history, highlight the impacts of colonization and expound on Indigenous healing practices taking place in Toronto. Based on findings from a local research project, we argue these healing practices go beyond limited notions of recovery and practice, offering profound and practical ways to address the physical, emotional, spiritual and mental health of Indigenous peoples.

Troubling dimensions of heart transplantation

Heart transplantation is now the accepted therapy for end-stage heart failure that is resistant to medical treatment. Families of deceased donors routinely are urged to view the heart as a “gift of life” that will enable the donor to live on by extending and sustaining the life of a stranger. In contrast, heart recipients are encouraged to view the organ mechanistically—as a new pump that was rendered a spare, reusable part when a generous stranger died. Psychosocial and psychoanalytic research, anecdotal evidence and first-person accounts indicate that after transplant, many recipients experience unexpected changes or distress that cannot be understood adequately using biomedical explanatory models alone. In this paper it is argued that phenomenological philosophy offers a promising way to frame an ongoing empirical study that asks recipients to reflect on what it is like to incorporate the heart of another person. Merleau-Ponty and others have posited that any change to the body inevitably transforms the self. Hence, it is argued in this paper that replacing failing hearts with functioning hearts from deceased persons must be considered much more than a complex technical procedure. Acknowledging the disturbances to embodiment and personal identity associated with transplantation may explain adverse outcomes that heretofore have been inexplicable. Ultimately, a phenomenological understanding could lead to improvements in the consent process, preoperative teaching and follow-up care.

One Story at a Time Narrative Therapy, Older Adults, and Addictions

Various factors including social isolation and financial worries put older adults at risk for addictions. Indeed, older adults are the largest consumers of medication, and alcohol consumption is rising. Yet interventions are limited and problems often go unreported. Unearthing “problem” stories in people’s lives (i.e., “the addiction story”) and retelling them in more empowering ways, narrative therapy offers a viable therapeutic alternative, and research on narrative therapy has proven encouraging. However, little is known about narrative therapy with older adults and with addictions. Seeking to address these gaps, an ethnographic study was conducted in Toronto, Canada, with a group of older adults receiving narrative therapy for addictions. Findings suggest that the therapy was “helpful” and participants were able to reduce or halt their substance misuse. Most important, aspects of narrative therapy such as storytelling may be particularly well suited to older adults, offering powerful possibilities for applied gerontology.

Qualitative interviews vs standardized self-report questionnaires in assessing quality of life in heart transplant recipients.

Quality of life (QoL) studies in heart transplant recipients (HTRs) using validated, quantitative, self-report questionnaires have reported poor QoL in approximately 20% of patients. This consecutive mixed methods study compared self-report questionnaires, the Medical Outcomes Study 36-item Short Form Health Survey (MOS SF-36) and the Atkinson Life Satisfaction Scale, with phenomenologically informed audiovisual (AV) qualitative interview data in 27 medically stable HTRs (70% male; age 53 ± 13.77 years; time since transplant 4.06 ± 2.42 years). Self-report questionnaire data reported poor QoL and more distress compared with previous studies and normative population samples; in contrast, 52% of HTRs displayed pervasive distress according to visual methodology. Using qualitative methods to assess QoL yields information that would otherwise remain unobserved by the exclusive use of quantitative QOL questionnaires.

The Obligation to Say ‘Thank you’: Heart Transplant Recipients’ Experience of Writing to the Donor Family

Transplant recipients are encouraged to write anonymous thank‐you letters to the donor family. We prospectively explored heart transplant recipients’ embodied responses to the ‘obligation’ to write a thank‐you letter using audio/video‐taped open‐ended interviews (N = 27). Fifteen of the 19 participants, who wrote letters to the donor family, expressed or visually revealed significant distress about issues such as the obligation to write anonymously and the inadequacy of the ‘thank‐you’. Writing the thank‐you letter is not a neutral experience for heart transplant recipients. Rethinking the obligatory practice regarding the thank‐you letter and developing the necessary support for the recipient through this process is necessary.

Mad Students in the Social Work Classroom? Notes From the Beginnings of an Inquiry

In this article, we introduce a pilot project at a Canadian school of social work, a project that asked whether this expressly anti-oppressive school was really open to Mad students (or those with mental health issues). Using principles of community-based participatory research, we interviewed eight students who identified as having had experiences with mental health issues and asked them to speak about their experiences in the classroom. Working with the data, we co-voiced next steps for pedagogy, research, and action around madness and social work.

Narrative Therapy, Older Adults, and Group Work?: Practice, Research, and Recommendations

In this article, the authors report on a qualitative study that explored the use of narrative therapy with a diverse group of older adults dealing with mental health and substance misuse issues. Narrative therapy supports individuals to critically assess their lives and develop alternative and empowering life stories that aim to keep the problem in its place. Although the literature suggests this is a promising intervention for individuals, there is a lack of research on narrative therapy and group work. Aiming to address this gap, the authors developed and researched a narrative therapy group for older adults coping with mental health and substance misuse issues in Toronto, Canada. Taking an ethnographic approach, field notes and interviews provided rich data on how, when, and for whom, such a group could be beneficial. Findings contribute to the literature on group work, older adults, and narrative therapy.

Heart transplants: Identity disruption, bodily integrity and interconnectedness

Of heart transplant recipients, 30 per cent report ongoing or episodic emotional issues post-transplant, which are not attributable to medications or pathophysiological changes. To this end, our team theorized that cardiac transplantation introduces pressing new questions about how patients incorporate a transplanted heart into their sense of self and how this impacts their identity. The work of Merleau-Ponty provided the theoretical underpinning for this project as it rationalizes how corporeal changes affect one’s self and offer an innovative framework to access these complex aspects of living with a transplanted heart. We used visual methodology and recorded 25 semi-structured interviews videographically. Both visual and verbal data were analyzed at the same time in an iterative process. The most common theme was that participants expressed a disruption to their own identity and bodily integrity. Additionally, participants reported interconnectedness with the donor, even when the transplanted heart was perceived as an intruder or stranger. Finally, transplant recipients were very vivid in their descriptions and speculation of how they imagined the donor. Receiving an anonymous donor organ from a stranger often leaves the recipient with questions about who they themselves are now. Our study provides a nuanced understanding of heart transplant recipients’ embodied experiences of self and identity. Insights gained are valuable to educate transplant professionals to develop new supportive interventions both pre- and post-transplant, and to improve the process of informed consent. Ultimately, such insights could be used to enable heart transplant recipients to incorporate the graft optimally over time, easing distress and improving recovery.

Grief and loss for patients before and after heart transplant

OBJECTIVES The purpose of the study was to examine the loss and grief experiences of patients waiting for and living with new hearts. BACKGROUND There is much scholarship on loss and grief. Less attention has been paid to these issues in clinical transplantation, and even less on the patient experience. METHODS Part of a qualitative inquiry oriented to the work of Merleau-Ponty, a secondary analysis was carried out on audiovisual data from interviews with thirty participants. RESULTS Patients experience loss and three forms of grief. Pre-transplant patients waiting for transplant experience loss and anticipatory grief related to their own death and the future death of their donor. Transplanted patients experience long-lasting complicated grief with respect to the donor and disenfranchised grief which may not be sanctioned. CONCLUSIONS Loss as well as anticipatory, complicated and disenfranchised grief may have been inadvertently disregarded or downplayed. More research and attention is needed.

Messy entanglements: research assemblages in heart transplantation discourses and practices

The paper engages with a variety of data around a supposedly single biomedical event, that of heart transplantation. In conventional discourse, organ transplantation constitutes an unproblematised form of spare part surgery in which failing biological components are replaced by more efficient and enduring ones, but once that simple picture is complicated by employing a radically interdisciplinary approach, any biomedical certainty is profoundly disrupted. Our aim, as a cross-sectorial partnership, has been to explore the complexities of heart transplantation by explicitly entangling research from the arts, biosciences and humanities without privileging any one discourse. It has been no easy enterprise yet it has been highly productive of new insights. We draw on our own ongoing funded research with both heart donor families and recipients to explore our different perceptions of what constitutes data and to demonstrate how the dynamic entangling of multiple data produces a constitutive assemblage of elements in which no one can claim priority. Our claim is that the use of such research assemblages and the collaborations that we bring to our project breaks through disciplinary silos to enable a fuller comprehension of the significance and experience of heart transplantation in both theory and practice.