ACR ABSTRACT - Changing shoes: metaphorical descriptions of RA and identity

[Guest guest]

Changing Shoes: Metaphorical Descriptions of Rheumatoid Arthritis and Identity.

L Backman, PhD, OT©1,Anne Townsend, PhD2, C Li, BSc

(PT) MSc PhD3. 1Occupational Science & Therapy, University of British

Columbia, Vancouver, BC,2W. Maurice Young Centre for Applied Ethics,

University of British Columbia,3Physical Therapy, University of

British Columbia, Vancouver, BC

Background: People lead storied lives and narrative inquiry makes

sense of human experience through analyzing stories told. Personal

accounts of episodes and events include narrative/rhetorical devices,

like metaphors, which help us understand how individuals interpret and

apply meaning to their experiences. These interpretations are central

to their sense of self and may influence how people engage in future

activities and collaborate with health care providers. This study

explored how descriptions of emotional and physical adjustments to

living with rheumatoid arthritis (RA) serve as metaphors for the

impact of RA on identity.

Method: A secondary analysis of two qualitative studies was undertaken

using a narrative approach. Study one explored the impact of RA on the

role of mother in 12 women; study two explored the help-seeking

process in 37 women diagnosed with RA in the year prior to

recruitment. During the original data analysis for both studies,

narrative devices were observed in descriptions of daily life

experiences that had been disrupted by RA, and this prompted the

present analysis. All 49 transcripts were reviewed and metaphorical

descriptions of how RA experiences shaped sense of self or identity

were extracted. Representative metaphors were then written by research

team members, supported by verbatim passages from transcripts, and

revised until consensus was achieved by the team as a whole.

Results: A number of metaphors illustrate the process of adapting to

RA, characterized by adjustments to daily routines from the most basic

of self care to participation in valued life roles. A powerful example

is “changing shoes” or “no more shoes.” This metaphor arises from

descriptions of actual events where women could no longer wear the

shoes that reflected their style, preference, or life roles.

Underlying the seemingly superficial loss of favored shoes was a loss

of self – a professional self, a country-club self, a stylish self.

“Changing shoes” then becomes a metaphor for a shift in identity from

a healthy person to one living with chronic illness and the new work

that entails. The things women did to accommodate arthritis, either on

their own or on the advice of a health professional, are shown through

narrative analysis to represent emotional and physical adaptation to

everyday activities that are meaningful to each individual. Metaphors

were also observed to exemplify key concepts specific to identity in

current occupational therapy and rehabilitation theories that are

intended to inform practice and clinical reasoning.

Conclusion: Metaphor was used to interpret stories of women living

with RA. In the example presented here, changing shoes represents not

only a physical adjustment to accommodate pain and apply joint

protection principles, but also part of an internal process of

reshaping identity. Appreciating how small changes carry greater

meaning with regard to one's identity may foster more effective

patient-provider communication and client-centered practice.

Abstract 1321

Tuesday, November 9, 2010, 9:00 am

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Not an MD

[Guest guest]

Wow! Cool article ! Although it's really more like changing your whole

blinkin' uniform than just shoes-- LOL.

Gentle Hugs-- in SC

--- On Sat, 11/13/10, <Rheumatoid.Arthritis.Support@...>

wrote: