Obesity and Diabetes: the Enemies Within

Scholarships & Prizes Office. University of Sydne

Therapeutic Narrative Illness Writing and the Quest for Healing

This thesis examines how narratives of illness become therapeutic narratives. The method is to engage closely with (mainly Australian) texts - literary accounts of illness - in order to identify key elements that effect a healing function (healing is distinguished from cure). Textual analysis is placed in the frame of medical information about the relevant conditions, and theoretical perspectives that provide a cultural and historical setting for illness writing. Bio-medical discourse foregrounds the clinical process of diagnosis, investigation and treatment and relegates the personal meanings of illness to secondary place. The thesis explores ways in which the patient's account provides an alternative discourse that supplements - and at times challenges - the medical discourse. Illness foregrounds the body, and illness narratives confront the reality of embodied experience. Illness that is chronic or incurable, ageing, physical and mental decline, and the inescapable prospect of death confront the patient with the need to find meaning in experience. Narratives of illness may serve as ventilation, diversion or escape for the patient. They may provide practical help, information and consolation to family and carers, and others who suffer with the condition. These are valuable functions, but I argue that illness writing may embody more powerful therapeutic elements that transform and give meaning to the illness as part of the individual's life story. Key therapeutic functions identified are perversity, empowerment and transformation. Healing can begin with the empowerment of telling one's story. Illness stories may challenge the stigma and the subordination associated with disease. They can affirm a sense of belonging and community where illness intersects with other forms of marginalization. Powerful illness narratives are often characterised by perversity, overturning the assumptions of dominant cultural discourses - including those that place authority with the medical practitioner and demand acquiescence from the patient. The most powerful therapeutic narratives transform the story of illness into a new story

Responses to chest pain: a qualitative study

Previous research has suggested the existence of socio-economic and gender variation in uptake of hospital cardiology services but it is not known at which stage of the care pathway these variations arise.This thesis aims to address this gap in the literature by exploring the perceptions of an behaviour in response to chest pain of men and women living in two socio-economically contrasting areas of Glasgow. It has 3 objectives: to describe respondents' perceptions of and actions in response to chest pain; to ascertain whether there are differences in perceptions and behaviour associated with socio-economic status or gender; and, to relate any observed differences to the known variations in uptake of cardiology services.Respondents' interpretations of chest pain were related to their perceived vulnerability to heart disease and their previous illness experience. Their decisions of whether to present to a general practitioner were influenced by the quality of previous encounters with doctors and by their lay care and self-care. Women generally felt less vulnerable to heart disease than men, and often believed that their health problems were secondary to those of family members. These factors led women to report a reluctance to present with chest pain. Compared with more affluent people, those from the deprived area generally felt more vulnerable to heart disease but the perception that they were to blame for their ill-health often led to reluctance to present with chest pain. Differences in perceptions and behaviour might partly explain gender inequities in access to hospital cardiology services but socio-economic inequities in uptake of services have proved more difficult to explain