Målfrid Råheim

Lived Experience of Chronic Pain and Fibromyalgia: Women's Stories From Daily Life:

The hermeneutic-phenomenological study presented in this article is grounded in a lifeworld perspective. The authors aimed at rich descriptions of womens lived experience of chronic pain and fibromyalgia. They conducted individual life-form interviews with 12 women with fibromyalgia. On the basis of the womens stories, three typologies were developed: at the will of the treacherous body—powerlessness; struggling to escape the treacherous body— ambivalence; and caring for the treacherous body—coping. The lived experience described in the typologies were further interpreted according to the existentials: lived body, lived time and space, and lived relations. The womens stories point to a world experienced as fundamentally changed by a body in chronic pain, describing a struggle in which they feel that their existence is at stake.

‘‘My quality of life is worse compared to my earlier life’’ Living with chronic problems after weight loss surgery

Weight loss surgery is commonly regarded as improving individuals’ health and social life, and resulting in a happier and more active life for those defined as “morbidly obese.” However, some researchers have started to doubt whether these positive outcomes apply to everyone and this article explores this doubt further. More specifically, we focus on the experiences of women whose life situation became worse after weight loss surgery. The material draws on qualitative interviews of five Norwegian women undergoing the irreversible gastric bypass procedure. Our findings illustrate that the women lived seemingly “normal” lives prior to the surgery with few signs of illness. Worries about future illness as well as social stigma because of their body shape motivated them to undergo weight loss surgery. After the surgery, however, their situation was profoundly changed and their lives were dramatically restricted. Chronic pain, loss of energy, as well as feelings of shame and failure for having these problems not only limited their social lives but it also made them less physically active. In addition, they had difficulties taking care of their children, and functioning satisfactorily at work. Accordingly, the women gradually felt more “disabled,” regarding themselves as “outsiders” whose problems needed to be kept private. The results highlight some “subtle” consequences of weight loss surgery, particularly the shame and stigma experienced by those whose lives became dramatically worse. Living in a society where negative impacts of weight loss surgery are more or less neglected in research as well as in the public debate the women seemed to suffer in silence. Their problems were clearly present and felt in the body but not talked about and shared with others.

Totally Changed, Yet Still the Same: Patients’ Lived Experiences 5 Years Beyond Bariatric Surgery

Bariatric surgery provides sustainable weight loss and increased quality of life for most, but not all patients. To increase the knowledge of this complex patient group and their needs during follow-up, we aimed to describe the essential meaning of bariatric surgery patients’ long-term experiences by using a phenomenological lifeworld approach. Eight patients were interviewed between 5 and 7 years after bariatric surgery. Life after bariatric surgery was described as living with tension, ambivalence, and reinforced attention toward one’s own body. The tension was related to embodied change and altered relations to the social world. The patients express an ongoing demand for control of health-related habits and practices, and to not lose control over the body again. Surgical weight loss and improved physical function do not necessarily mean changed health-related habits and practices in the long term. Experiencing weight regain is connected with emotional stress, shame, and self-contempt.

Barriers against returning to work – as perceived by disability pensioners with back pain: A focus group based qualitative study

Purpose. The aim of this study was to explore the issue of perceived barriers for returning to work, based on the experiences and beliefs in a group of disability pensioners with back pain. Method. Focus groups were used to interview 12 women and five men, aged 38 – 56, who participated in a larger project aiming to help disability pensioners back to work. Results. The barriers appearing were related to earlier negative experiences, poor self-judgement of work ability and low self-esteem, lack of support from social security authorities and unsuitable economic arrangements. The pensioners also suggested alternative solutions for making a possible return to work. Conclusions. Our study provides insight into the perceived barriers of returning to work and might be useful in future efforts aiming to help disability pensioners back to work.

Self-perception as embodied knowledge – changing processes for patients with chronic pain

The studys purpose was to explore change and perception of change related to patients with chronic back and/or neck pain through treatment courses of Norwegian psychomotor physiotherapy. A multiple case synthesis of nine cases, nine patients and five physiotherapists, was based on in-depth interviews and repeated video-recordings. Patients wrote reflective notes. In order to study changing processes within and over sessions a two-step procedure was applied: identifying main changing patterns, and identifying patient groups concerning similarities and varieties of main changing patterns. Five changing patterns were identified: (i) to move restricted and non-restricted; (ii) to breathe restricted and non-restricted; (iii) to reflect in a non-exploring and exploring way; (iv) to not transfer and transfer experience from treatment to daily life; and (v) to be detached from and to be in touch with the body. Two patient groups were identified: the limited and the considerable change groups. The process of self-perception seemed to be integrated in all the changing patterns, and to be a basis for reducing pain, and changing movement, breath and expression within and outside therapy. Self-perception appeared as a process of varying acts and self-knowledge. Merleau-Pontys phenomenological perspective of perception may add to the understanding of change.

Men in the women’s world of hereditary breast and ovarian cancer—a systematic review

Little is known about men seeking genetic counseling for hereditary breast and ovarian cancer (HBOC). We review the sparse literature on men attending such genetic consultations. Two main themes are identified: the women’s influence on the genetic counseling process, and the psychological impact on men. The women in the HBOC families have an influence on the men’s decision to request genetic testing, and they take the leading role in communicating genetic information. With respect to psychological impact, the men suffer from grief and fear of developing cancer, and they seem to use avoidance as a coping strategy. Carrier males experience feelings of guilt because they might have passed on a mutation to their children. Non-carriers experience test-related stress if their siblings tested positive. Mutation status may have an impact on reproductive issues. These findings are discussed in light of gender issues and literature concerning men’s health behavior. Further studies are needed to provide optimal care for men seeking genetic counseling for hereditary breast and ovarian cancer.

The ambivalence of losing weight after bariatric surgery

This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the womens experiences, a meaning structure-the ambivalence of losing weight after obesity surgery-was identified across the womens processes of change. This consisted of five core themes: movement and activity-freedom but new demands and old restraints; eating habits and digestion-the complexity of change; appearance-smaller, but looser; social relations-stability and change; and being oneself-vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the womens experiences, a meaning structure—the ambivalence of losing weight after obesity surgery—was identified across the womens processes of change. This consisted of five core themes: movement and activity—freedom but new demands and old restraints; eating habits and digestion—the complexity of change; appearance—smaller, but looser; social relations—stability and change; and being oneself—vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.This study is grounded in a phenomenological lifeworld perspective. It aims at providing rich descriptions of lived experience of the process of losing weight after obesity surgery. Two women participated in in-depth interviews four times each during the first postoperative year. Based on the womens experiences, a meaning structure-the ambivalence of losing weight after obesity surgery-was identified across the womens processes of change. This consisted of five core themes: movement and activity-freedom but new demands and old restraints; eating habits and digestion-the complexity of change; appearance-smaller, but looser; social relations-stability and change; and being oneself-vulnerability and self-assurance. These core themes changed over time in terms of dominance. The experience of ambivalence is discussed according to a phenomenological perspective of the body as lived experience.

Dis-appearance and dys-appearance anew: living with excess skin and intestinal changes following weight loss surgery.

The aim of this article is to explore bodily changes following weight loss surgery. Our empirical material is based on individual interviews with 22 Norwegian women. To further analyze their experiences, we build primarily on the phenomenologist Drew Leder`s distinction between bodily dis-appearance and dys-appearance. Additionally, our analysis is inspired by Simone de Beauvoir, Merleau-Ponty and Julia Kristeva. Although these scholars have not directed their attention to obesity operations, they occupy a prime framework for shedding light on different dimensions of bodily change. In doing so, we were able to identify two main themes: The felt “inner” body versus the visible “surface” body and the “old” body versus the “new” body. In different, though interconnected ways, these main themes encompass tensions between changes the women experienced as contributing to a more “normal” and active life, feeling more accepted, and changes that generated ambivalence. In particular, their skin became increasingly problematic because it did not “shrink” like the rest of the body. On the contrary, it became looser and looser. Moreover, badsmelling folds of skin that wobbled, sweated and chafed at the smallest movement, aprons of fat hanging in front of their stomachs, batwing arms, thick flabby thighs and sagging breasts were described as a huge contrast to the positive response they received to their changed body shape when they were out and about with their clothes on. At the same time, they expressed ambivalence with regards to removing the excess skin by means of plastic surgery. Through their own and other women`s experiences they learned removing the excess skin by means of surgery could be a double-edged sword. By illuminating the experiences of the ones undergoing such changes our article offers new insight in a scholarly debate predominated by medical research documenting the positive outcomes of weight loss surgery.

Life changed existentially: a qualitative study of experiences at 6-8 months after mild stroke.

Abstract Purpose: To explore experiences of mild-stroke survivors in the context of early supported discharge. The meanings patients attributed to activities and participation in the home recovery process were our main interest. Methods: Eight participants (45–80 years) from a randomised controlled study were selected for this sub-study. This purposive sample had received rehabilitation in their homes in the post-stroke acute phase of recovery as part of the larger study. Extensive interview data were analysed using an interpretive strategy and systematic text condensation. Coping theory was included in later stages of analysis. Findings: The mild-stroke survivors’ stories revealed that life had changed profoundly. Differences and similarities in experienced changes were related to: self-perceived health, the body, practical activities, taking part in society, and self-perception. The findings showed the ways in which life changed for mild-stroke survivors, experienced challenges, and survivors’ thoughts about the future. Conclusions: Mild-stroke rehabilitation should focus more strongly on basic concerns related to self-perceived health, self-perception, and body, since these dimensions seem to complicate daily activities and close relationships. Professionals should also be aware of patients who experience an uncertain situation and unresolved rehabilitation needs, which still can be present 6–8 months after the stroke. Implications for Rehabilitation When living with mild stroke, entrance to practical and social activities seemed founded on the patients’ perception of the body and self as comprehensible or not. Comprehending their own changed body and sense of self seem to be a long-term process when living with mild stroke. It is suggested that long-term follow-up be incorporated in home rehabilitation service, also in the context of early supported discharge. This may contribute to help patient cope more optimally with activities and participation of importance to them.

Stigmatization and Male Identity: Norwegian Males’ Experience after Identification as BRCA1/2 Mutation Carriers

In families with hereditary breast and ovarian cancer, there is limited knowledge about the reactions of BRCA1/2 mutation positive males. In the present qualitative study, fifteen BRCA1/2 mutation positive men in Norway participated in two successive, in-depth interviews. Seven female partners participated in the second interview. The men reported strong emotional reactions to their positive test results, and they expressed a desire to keep the genetic information private. They considered discussing their test results or health related information with other males as difficult, and they perceived females as their sources of social and emotional support. Interestingly, the second interview revealed important information not communicated during the first interview. The findings of this study contribute to the discussion of whether men who test positive for a BRCA1/2 mutation should receive tailored genetic counseling sessions. Health care providers should be aware of psychological vulnerability in these men, likely stemming from fewer emotional supports in their social networks.