Storying meaning in hospice patient biographies : a thesis submitted to Massey University of Palmerston North in partial fulfilment of the requirements for the degree of Masters of Arts and Psychology

Abstract

The importance of meaning in life has been emphasised in the writings of many existentialists. Furthermore, serious repercussions have been associated with loss of meaning. Postulated life-enhancing qualities of discovering meaning in life make this an especially critical issue for the dying. A sense of meaning in late-stage disease is an important focus for therapeutic exchange. A notable method which has been shown to facilitate this is the production of a life story (Lewis. 1989). Narrative is a natural instrument which facilitates expression of personal meaning. Engaging in storying life clarifies meaning of experience by affording closure (Lashley, 1993). The present study employed narrative inquiry, a subset of qualitative research designs, to examine hospice patient biographies (N=7) to determine how the process of constructing a biographical account facing death contributes to meaning formation. It has been argued that approaching death disrupts one's personal narrative resulting in loss of meaning. This activity is said to compel reconstruction of one's story in order to restore meaning in life. Lichter. Mooney and Boyd (1993) argued that recounting experiences enables individuals to resolve unfinished business, an important element for promoting closure, which engenders meaning. Two methods of analysis were adopted: analysis of narrative and storying meaning. Analysis of narrative was based on Polkinghorne's (1995) methods of narrative configuration. Storying meaning was carried out as a means of making sense and showing the significance of thoughts and actions in the context of an unfolding plot. With analysis of narrative a variety of inquiries were undertaken. This included examining the biographies for narrative typologies. Given the importance of goals in meaning formation, we focused on the plot structure before and after illness to establish the influence this experience had upon goal direction. Narrative devices which contribute to meaning formation were also explored. This included: roles, epiphany, closure, and metaphor. These features were examined for patterns, themes, and regularities across biographies. Considering the detrimental impact death anxiety has upon meaning construction, inquiry also focuscd on this concept and its association with selected narrative devices. With storying meaning, knowledge about a particular situation is produced. In this study we concentrated on how meaning is constructed through storying a life facing death. This encompassed searching for processes of meaning-making within the biographies. Analysis of narrative revealed goal-focused progressive narratives. Storying lives in this coherent fashion enabled meaning to be constructed. Narrative devices assisted in production of a coherent stoty which promoted closure to storied life Adoption of these devices also positively reframcd the narrator's viewpoint toward this experience, which enabled individuals to make sense of events and happenings in the story. Surprisingly, death anxiety assumed a peripheral concern; it did not feature as a critical issue in meaning construction within these accounts. Storying meaning revealed processes of meaning-making in these stoned accounts. Unfolding of these stories revealed meaningful lives interrupted by adversity, which were then overcome. Prior to the disruption these accounts were replete with sources of personal meaning. Disruption ensued with evidence of loss of meaning. Restoring meaning involved reconstructing one's personal narrative. Analysis revealed evidence of processes of meaning- making within these stories. Methods of meaning formation included: making sense of illness, changing the life scheme, changing one's perception of the event, and methods of self- transcendence. Similar processes have been established in other studies examining meaning construction. These processes were found to promote closure in storied accounts, an important element which facilitates meaning. This finding supports Lichter and associates' (1993) argument regarding the value of narrative, particularly for those facing death where meaning in life has been lost. Results indicated individuals construct meaning by reconstructing personal narratives in order to make sense of these experiences and integrate these into their storied lives. As Williams (1984) argued it is in this activity of reconstructing one's personal life narrative that illness and its consequences arc ascribcd meaning in the context of one's life. The value of narrative for those approaching death and those experiencing serious loss is emphasised