Trr svetlana's course 011

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Power Point program used in the Social Construction of Disability and Health Course at University of Calgary; Friday August 26, 2011. Presented by Val Lougheed.

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Trr svetlana's course 011

  1. 1. Val Lougheed Northern Lights Canada Social Construction of Disability and Health Trauma, Rehab and Recovery ~ Keep Your Fork ~ 1-800-361-4642 * www.northernlightscanada.ca * vlougheed@northernlightscanada.ca
  2. 2. “ You don’t want your impairments to define you – you want them to inform you.” (Hanita Dagan, personal communication, 2005)
  3. 3. <ul><li>www.slideshare.net/vlougheed </li></ul>#NLCAN www.northernlightscanada.ca/about/about-val-lougheed/be-still
  4. 4. Agenda <ul><li>Beginning … </li></ul><ul><li>Middle … </li></ul><ul><li>End … </li></ul>
  5. 5. Social Construction of Disability and Health <ul><li>What does it mean to recover? </li></ul><ul><li>What lens(es) does Val see recovery through? </li></ul><ul><li>What aspects of recovery are potential social problems? </li></ul><ul><li>How do I use a narrative in a research study of a specific social problem? </li></ul>
  6. 6. The Truth “ The truth about anything is an acquired meaning based on personal experiences, and the telling of those experiences.” (Gergen, 1999)
  7. 7. Rated PG-113 People Strongly Cautioned! May contain bad language, brief nudity, sexual overtones, and drug usage.
  8. 8. Beginning My Story
  9. 12. Sept. 9, 2003 - morning
  10. 13. Sept. 9 – p.m.
  11. 14. Sept. 15 2003 – Jan. 19 2004 Journey Back to Life
  12. 19. Research
  13. 21. Researcher’s Position Paradigm <ul><li>Interpretive/Constructivist </li></ul>Ontology <ul><li>multiple realities </li></ul><ul><li>socially constructed </li></ul><ul><li>time and context dependent </li></ul>Epistemology <ul><li>research is an ongoing, interactive process </li></ul><ul><li>confirmability and rigor vs. objectivity </li></ul>Approach to Research <ul><ul><li>Qualitative </li></ul></ul><ul><ul><li>Grounded </li></ul></ul><ul><li>insights and hypotheses emerge from the data </li></ul><ul><li>evidence illustrated by characteristic examples from the data </li></ul><ul><li>inductive </li></ul>(Glaser and Strauss, 1967; Mertens, 1998)
  14. 22. Research Methodology Narrative Inquiry <ul><li>the “story” provides a window into lived experience and its meanings </li></ul><ul><li>phenomenological </li></ul>Data Analysis Method <ul><ul><li>Open Coding </li></ul></ul><ul><ul><li>“ opens” up the data so meaning can be discovered </li></ul></ul>Findings Must Be … <ul><li>practical </li></ul><ul><li>useful for patients/clients and practitioners </li></ul><ul><li>a foundation for further research </li></ul>(my own requirements) (White and Epston, 1990: van Manen, 1998) (Mertens, 1998; Strauss, 1988; Glaser and Strauss, 1967)
  15. 23. Open Coding <ul><li>a method to organize “mountains of raw data”, and then locate the themes and patterns in the data. </li></ul><ul><li>(Neuman, 1997, p. 422) </li></ul>
  16. 24. Open Coding Analysis <ul><li>Print narrative with a three-inch margin on the right-hand side of each page. </li></ul><ul><li>Divide the narrative into discreet phases, as determined by what was happening at the time. </li></ul><ul><li>Determine the general topic of each phase and then imagine what insights are embedded in that topic; make notes in the three-inch margin. </li></ul><ul><li>Create a time line of the narrative, phase-by-phase, with associated critical events and insights. </li></ul>
  17. 25. Open Coding Analysis (cont’d.) <ul><li>Make a list of all of the insights embedded in the entire narrative (data), using the time line. </li></ul><ul><li>Synthesize the data by grouping similar insights together, in order to develop a number of topical categories. </li></ul><ul><li>Determine the dominant theme of each topical category and title it thus. </li></ul><ul><li>Write about each dominant theme, using examples from the narrative (and references from literature, if you must) as informative evidence . </li></ul>
  18. 26. Dominant Themes <ul><li>Narcotic Pain Killers </li></ul><ul><li>ABI </li></ul><ul><li>Pain </li></ul><ul><li>Trauma </li></ul><ul><li>Depression </li></ul><ul><li>Methods of Helping </li></ul><ul><ul><li>Return to Work </li></ul></ul><ul><ul><li>Life </li></ul></ul>
  19. 27. Foundation for Understanding Experience
  20. 28. Body-Mind Connection Psychoimmunoendocrine Network <ul><li>The nervous, endocrine, and immune systems are functionally integrated – the brain is only one part of this non-hierarchical network </li></ul><ul><li>Memories, emotions, behaviours and physiology are all connected at the molecular level </li></ul><ul><li>(Candace Pert, 1997, p. 171 – 179) </li></ul>
  21. 29. The Truth “ The truth about anything is an acquired meaning based on personal experiences, and the telling of those experiences.” (Gergen, 1999)
  22. 30. Understanding Life Through the Lenses of Social Construction <ul><li>The Inclusion Lense: </li></ul><ul><ul><ul><li>journalists, economists, demographers </li></ul></ul></ul><ul><ul><ul><li>life – social and economic factors </li></ul></ul></ul><ul><li>The Health Lense: </li></ul><ul><ul><ul><li>physicians, psychologists, scientists </li></ul></ul></ul><ul><ul><ul><li>life – cause, cures, care resources, control measures </li></ul></ul></ul>
  23. 31. Understanding Life Through the Lenses of Social Construction <ul><li>The Meaning Lense: </li></ul><ul><ul><ul><li>speakers, singers, artists, authors </li></ul></ul></ul><ul><ul><ul><li>life – patterns of thinking and cultural expressions </li></ul></ul></ul><ul><li>The Coping Lense: </li></ul><ul><ul><ul><li>counsellors, wellness experts, self-help authors </li></ul></ul></ul><ul><ul><ul><li>life – coming to terms with personal experience. </li></ul></ul></ul><ul><li>(Marlett, 2001, personal communication) </li></ul>
  24. 32. February 2004 – Present Starting Point
  25. 33. Identity Disintegration and The Re-organization of Self March 2004
  26. 34. “ In the aftermath of traumatic life events … [the] sense of self has been shattered.” (Herman, 1992, p. 61) “ An existential crisis …” (Hanita Dagan, personal communication, 2005)
  27. 35. Sliding Down the Slope (Dalhousie, March 2005) Early 1900’s Oxycodone ™ developed in Germany 1995 Purdue Pharmacy (USA) launches OxyContin ™ – controlled-release formula 1996 Approved in Canada 2002 OxyContin ™ earns Purdue more than $1 billion U.S. 2003 OxyContin ™ is one of Canada’s 3 most-prescribed narcotic painkillers Nov. 2003 – Oct. 2004 783,762 prescriptions for OxyContin ™ dispensed in Canada
  28. 36. Sliding Down the Slope
  29. 38. A Foothold <ul><li>Mild – moderate ABI </li></ul><ul><li>Depressed (dysphoria) </li></ul><ul><li>Working memory problems </li></ul><ul><li>Hiding pain </li></ul>1 st Neuropsychological Assessment June 2004 -- Results
  30. 39. ABI – Measuring Loss “ Pre-morbid intelligence is a crucial variable …” Subjective Report – difficulty retrieving words and communicating ideas Objective Report – above-average performance on neuropsychological measures (Prigatano, 1999, p. 59)
  31. 40. Losing My Grip My IWRP August 2004
  32. 42. Rescued in the Valley of Despair Head Injury Program Oct. – Dec. 2004
  33. 44. HIP Oct to Nov – Full-time December – Part-time
  34. 45. GO TO WORK
  35. 46. GRTW – The Plan Jan. 3 – Feb. 7, 2005 (5 weeks)
  36. 47. GRTW – The Reality
  37. 48. GRTW – The Reality
  38. 49. GRTW – The Reality Narrative Therapy
  39. 50. GRTW – The Reality
  40. 51. GRTW – The Reality
  41. 52. GRTW – The Reality
  42. 53. GRTW – The Reality
  43. 54. GRTW – The Reality
  44. 55. GRTW – The Reality
  45. 56. Rescue Attempts <ul><li>Case Manager </li></ul><ul><li>Job Coach </li></ul><ul><li>Colleagues/Friends/ Psychologist </li></ul>
  46. 57. Sliding Back Down Into The Abyss <ul><li>Non-compliance </li></ul><ul><li>Malingering </li></ul><ul><li>Trying too hard </li></ul><ul><li>Not trying hard enough </li></ul>2 nd Neuropsychological Assessment May 2005 -- Edmonton
  47. 58. Test Results <ul><li>Mild to Moderate ABI </li></ul><ul><li>Pain? </li></ul><ul><li>Depression? </li></ul><ul><li>Motivation? </li></ul><ul><li>“ a high flyer” </li></ul><ul><li>“ phobic avoidance” </li></ul><ul><li>Future plans – “live off dividends” [from company] </li></ul>
  48. 59. Lesson ASSUMPTIONS REVEAL BIAS
  49. 60. <ul><li>Mild – moderate ABI </li></ul><ul><li>Good prognosis </li></ul><ul><li>Post-Traumatic amnesia </li></ul><ul><li>Pain? </li></ul><ul><li>Depression? </li></ul><ul><li>“ Adjustment Disorder with Anxiety and Depressed Mood” </li></ul>3rd Neuropsychological Assessment August 2005 -- Calgary
  50. 61. Symptom Overlap (co-morbidity) (Michael Sullivan, Centre for Research on Pain and Disability, McGill University, September, 2006) Pain, Trauma, Depression, ABI
  51. 63. Oct. 3 – Dec. 11
  52. 65. Pain Research 1600’s – Rene Descartes (philosopher)
  53. 66. Pain Research 1950’s – Wilder Penfield (brain surgeon)
  54. 68. Pain Research Patrick Wall (physiologist) Ronald Melzack (psychologist)
  55. 69. Pain Research <ul><li>Gate Control Theory </li></ul><ul><li>Acute and chronic pain </li></ul><ul><li>Pain sensation travels up the central nervous system to the brain through a “gate” </li></ul><ul><li>“ Gate” – triggered by cell changes – sends descending messages that alter sensory input </li></ul><ul><li>Pain isn’t pain until it reaches the brain </li></ul><ul><li>Emotions, context, etc. affect pain sensations </li></ul><ul><li>Pain is a negotiable, individual experience </li></ul><ul><li>Pain centres in the brain – they just keep moving around </li></ul><ul><li>(Jackson, 2002, p. 21) </li></ul>
  56. 71. Pain – The Future SCN9A (Globe and Mail, March 24, 2007) Glia Cells (Scientific American, November, 2009) Poppy Genes (U of Calgary -- Calgary Sun, March 15, 2010)
  57. 76. <ul><li>Regulates survival functions, emotional expression and processing of memories. </li></ul><ul><li>(Rothschild, 2000) </li></ul><ul><li>Amygdala - attaches emotional tags to memories </li></ul><ul><li>(Dr. Suffield, personal communication, 2004) </li></ul><ul><li>Hippocampus - controls the laying down of new memories </li></ul><ul><li>(Ramachandran & Blakeslee, 1998, p. 15) </li></ul><ul><li>Hypothalamus – controls the outward expression of emotions </li></ul><ul><li>(Ramachandran & Blakeslee, 1998, p. 177) </li></ul>Trauma Research Limbic System
  58. 77. “ In every encounter, basic trust is in question.” ( Herman, 1992, p. 92) “ Survivors feel unsafe in their bodies – and in any relationship with other people.” (Herman, 1992, p. 160) Rehab & Recovery
  59. 78. DISSO CIA TION Trauma Research
  60. 79. Flight
  61. 80. Fight
  62. 81. Freeze
  63. 82. <ul><li>“ Survival Central” </li></ul><ul><li>(Rothschild, 2000, p. 46) </li></ul><ul><li>Amygdala - Implicit memory </li></ul><ul><ul><li>storage of emotions and sensory reactions </li></ul></ul><ul><li>(Rothschild, 2000, p. 20) </li></ul><ul><li>Hippocampus – Explicit memory </li></ul><ul><ul><li>creates memories of actual sequence of events </li></ul></ul><ul><li>(Rothschild, 2000, p. 28) </li></ul>Trauma Research Limbic System and Memory
  64. 83. <ul><li>Stress Hormones </li></ul><ul><li>Amygdala - Implicit memory </li></ul><ul><ul><li>storage of emotions and sensory reactions </li></ul></ul><ul><li>(Rothschild, 2000, p. 20) </li></ul><ul><li>Hippocampus – Explicit memory </li></ul><ul><ul><li>creates memories of actual sequence of events </li></ul></ul><ul><li>(Gunnar & Barr, 1998) </li></ul>Trauma Research Limbic System Under Threat
  65. 85. Trauma Personal Experience <ul><li>Dissociation & Cocoon = Safety </li></ul><ul><li>System on High Alert Always = Survival </li></ul><ul><li>World is black & white = Trust </li></ul>Trust (Safety) = Love No Trust (Life Threatening) = Hate
  66. 86. Trauma Personal Experience <ul><li>Listen to me </li></ul><ul><li>Understand me </li></ul><ul><li>Respect me </li></ul><ul><li>Are competent </li></ul>I trust (love, feel safe with, will try hard for) practitioners who:
  67. 89. “… depression [caused by trauma] is not the same as ordinary depression.” ( Herman, 1992, p. 118) Depression
  68. 90. “ Emotions are not in the head – they are in every cell in the body.” (Pert (1995), in Bolen, 1996, p. 7) Pscyhoimmunoendocrine Network
  69. 93. <ul><li>Affects more than IQ …. </li></ul><ul><li>We are sensitive to changes in higher cerebral functioning </li></ul><ul><li>Very important to a person’s sense of self </li></ul><ul><li>Touches core … of a person’s self-esteem </li></ul><ul><li>(Prigatano, 1999, p. 58) </li></ul>ABI
  70. 94. Back to Wilder Penfield – 1950’s ABI Localizationist
  71. 95. Paul Bach-y-Rita – 1934 – 2006 Scientist and Rehab Doctor Neuroplasticity - 1969
  72. 96. Michael Merzenich Neuroplastician Neuroplasticity
  73. 97. Harnessing the Power
  74. 101. “ The words and attitudes of others … are potent. They help or hex healing and recovery.” “ Expectations are powerful.” (Bolen, 1996, p. 94) “ Cortisol shuts down immune cells’ responses…” (Sternberg, 2001, p. 112). Body-Mind Connection
  75. 102. <ul><li>Hypothalamus </li></ul><ul><li>Peptides </li></ul><ul><li>Receptors </li></ul><ul><li>Biochemical Events </li></ul>
  76. 104. Quantum Connection <ul><li>The Living Matrix -- 1995 </li></ul><ul><li>A type of energy exists that has previously gone unnoticed. </li></ul><ul><li>Cells/DNA influence matter through this form of energy. </li></ul><ul><li>DNA Phantom effect. Braden, 2007, p. 45 </li></ul>
  77. 105. “ Loss of identity can evoke a personal crisis, creating a need for change.” (Ornelas, in Smith & Johnson (Eds), 1997, p. 172) The Re-Organization of Self Identity Research
  78. 106. Scaling the Canyon
  79. 107. Sept., 2005 Waskesiu
  80. 112. Breast Cancer Reconstructive Surgery March 2006
  81. 113. Convocation M.Ed. -- June 2006
  82. 114. Back in “a” Saddle September 2007 <ul><li>Officially change role/ title </li></ul><ul><li>Re-organize NL </li></ul><ul><li>Work part-time </li></ul>
  83. 116. Social Construction of Disability and Health Resilience <ul><li>Ability to return to original form after being bent (bounce back) </li></ul><ul><li>Thriving in constant change, ability to be: </li></ul><ul><ul><ul><li>Flexible </li></ul></ul></ul><ul><ul><ul><li>Creative </li></ul></ul></ul><ul><ul><ul><li>Adaptable </li></ul></ul></ul><ul><ul><ul><li>Learn from experience </li></ul></ul></ul><ul><li>http://www.resiliencycenter.com/articles/5levels.shtml </li></ul>
  84. 117. Social Construction of Disability and Health Rehabilitation (habiter – to live inside) “ Rehabilitation is the learning to live inside not only one’s body, however it is after an injury or illness, but inside one’s very being.” (Kabat-Zinn, in Meili, 2003, p. 241)
  85. 118. Social Construction of Disability and Health Recovery (Crombez, October, 2003) Curing Focus on the illness/ impairment [outside] Healing Focus on the person [inside]
  86. 119. Be Still
  87. 120. Social Construction of Disability and Health <ul><li>What does it mean to recover? </li></ul><ul><li>What lens(es) does Val see recovery through? </li></ul><ul><li>What aspects of recovery are potential social problems? </li></ul><ul><li>How do I use a narrative in a research study of a specific social problem? </li></ul>
  88. 121. Keep Your Fork
  89. 122. <ul><li>Northern Lights Canada is a person-centred organization committed to providing innovative, responsive links to real work. </li></ul><ul><li>We offer 4 major divisions of service: </li></ul><ul><ul><li>Vocational Rehabilitation Services </li></ul></ul><ul><ul><li>Employment Services </li></ul></ul><ul><ul><li>Employer Services </li></ul></ul><ul><ul><li>Corporate Training </li></ul></ul><ul><li>For more information, please contact us: </li></ul><ul><li>1-800-361-4642 </li></ul><ul><li>www.northernlightscanada.ca </li></ul>
  90. 123. Voc Rehab Canada (VRCAN) is a national consortium of experienced regional vocational rehabilitation companies. VRCAN provides customers with single-point access to VR services anywhere they are needed in Canada, whether on an individual service or contract basis. Member companies include: For more information, please feel free to contact us at 1-800-361-4642 Argus Management Consultants, Inc. Sandra Preeper & Associates Advantage Rehabilitation Consultants Ltd. Rehabilitation Alternatives Limited / Vocational Alternatives Software OPTIMA Rehabilitation CVE Inc. Northern Lights Canada Occupational Rehabilitation Group of Canada (ORGOC) Western Rehabilitation Specialists Inc. Diversified Rehabilitation Group Genesis Rehabilitation Ltd. Rehabilitation Focus
  91. 125. Social Construction of Disability and Health <ul><li>What does it mean to recover? </li></ul><ul><li>What lens(es) does Val see recovery through? </li></ul><ul><li>What aspects of recovery are potential social problems? </li></ul><ul><li>How do I use a narrative in a research study of a specific social problem? </li></ul>
  92. 126. Social Construction of Disability and Health <ul><li>What does it mean to recover? </li></ul><ul><li>After listening to Val’s story, what do you think it means to recover? </li></ul><ul><li>What specific parts of Val’s story reveal the meaning of recovery? </li></ul>
  93. 127. Social Construction of Disability and Health <ul><li>2. What lens(es) does Val see recovery through? </li></ul><ul><li>What specific sub-stories reveal the lens(es) that Val sees her experience through? </li></ul><ul><ul><ul><li>► what is the origin of such lenses? </li></ul></ul></ul><ul><li>What lens do you see recovery through? </li></ul><ul><ul><ul><li>► What is the origin of your lens? </li></ul></ul></ul><ul><li>► How does this shape your understanding of recovery? </li></ul>
  94. 128. Social Construction of Disability and Health <ul><li>3. What aspects of recovery (in Val’s story) are potential social problems? </li></ul><ul><li>What is a social problem? </li></ul><ul><li>What are the specific social problems that Val encountered? </li></ul><ul><li>Do you think a lot of people encounter such problems? </li></ul><ul><li>Any solutions? </li></ul>
  95. 129. Social Construction of Disability and Health <ul><li>4. How do I use a narrative in a research study of a specific social problem? </li></ul><ul><li>What is the exact social problem I am investigating? </li></ul><ul><li>What do I look for in a narrative to help me understand what my social problem means to people? </li></ul><ul><li>How do I organize the data in the story in order to use it for research? </li></ul><ul><li>How do I ensure that my research is rigorous? </li></ul>
  96. 130. Social Construction of Disability and Health <ul><li>Rigor in Research </li></ul><ul><li>The quality of being believable or trustworthy (Free Online Dictionary) </li></ul><ul><li>“ adherence to principles and procedures, methods and techniques that minimize bias and error in collection, anaysis, interpretation and reporting of data” (Ogawa and Malen (1991) in Mertens (1998), p. 49) </li></ul><ul><li>Higher order thinking and real world application (Academic Leadership, The Online Journal, Vol 9, Issue 2, Spring 2011) </li></ul>

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