Coping And Self-Reliance

As identified earlier, moods and thrownness disturb individual interpretation of being-in-the-world. Heidegger ( 1 962) also uses the expressionfor-the-sake-ofto describe the degree to which that self-interpretation is disturbed by phenomena. The ability to solve and cope with complex problems draws on the involvement of being-in-the-world, not as a disinterested spectator, but as one bound into the for-the-sake-of-being-with-others-in-the-world (Dreyfus, 1 99 1 ; Heidegger,

1 962). In other words, in afor-the-sake-ofmode, Da-sein understands self in terms of the world and others in the world. This understanding of the world is revealed when the research participants explained why they coped.

You just do it, it is part of like going to work you know. You 've got to do it, you just do it . . . You manage, you manage, you have to manage. It is something [that you have to do], and I have done that all my life (Queenie, p. l , & p.6).

In coping because they had to cope they were resolving the potentiality-for­ being-in-the-world. In talking about the potentiality-for-being that they could fore-see, the research participants described circumspection of the situations and

actionsfor-the-sake-oftheir spouse that moulded being-in-the-world. The world

of those whose spouse was temporarily hospitalised in the non-local tertiary centre did not contain the presence-at-hand of their spouse's health, or the spouse in the role that was traditional to that household. Therefore, temporising the

situation required Da-sein to consider the for-the-sake of, which resulted in self­

determination of the possibilities for the potentiality-for-being. Because, in this instance the research participants were aware that the situation was temporary, they did cope.

All the research participants responded that having a sense of positive outcomes sustained them, and in fact it is apparent that having a sense of hope was the most vital factor in supporting their spouse during this time of out-of-town

hospitalisation. Although there were times when the research participants were uncertain of the future themselves, they believed that the positive outlook they adopted in front of their spouse sustained their own ability to cope. Being aware

of their own coping reserves not only gave themselves confidence, but also assisted their spouse to maintain confidence, which in turn led to hardiness. The ability to maintain hardiness correlates with an individual's appraisal of the situation (DiBartolo & Soeken, 2003), and has a positive effect on quality of life, while hopelessness has a detrimental effect (Northouse et aI., 2003). As one research participant summarised:

But, you just cope ... At the time you just don 't think about it. You just go on and on and on and on. But when it 's over and you are back to some normality it kind of hits you then. And you think, "how have I coped? " But you know. I think you do. You find some inner strength . . . and you just do it. I don 't know . . . But you keep everything together then after, it

kind of hits you. You start to think of all the things that could have happened. But at the time you don 't. Like, you just carry on and do the best that you can I guess. And you try and be strong for the person that is sick . . . And you just find an inner strength and carry on. Battle it out. But it is definitely not easy. I certainly would not like to go through that again (Victoria, p.6/7).

All research participants now believe it is vital to the family well-being that they move forward. Most of the research participants found that they were sustained by looking towards a positive future during the time of non-local tertiary hospitalisation, something that their spouses were not so positive about.

However, as identified in the following extract from one research participant, in moving forward, the research participants were aware that the dis-ease remains in the background of daily life as it has now become:

But there are an ever-increasing number of days when you don 't think about it, [this illness] but there is always something that brings you back to it, every so often . . . And I don 't think that that will ever change now . .. (Edward, p. l l ) .

6.7 Chapter Review.

Couples adjusted to being-in-the-world of having their spouse hospitalised out­ of-town because they held on to the knowledge that it was a temporary

arrangement. They had already found their world had changed as a result of their spouse having dis-ease. However, during the times that the spouse was

hospitalised in the non-local tertiary centre, and they were with them, there were long hours of loneliness which the research participant filled by walking around the park, or doing whatever domestic chores they could. Those who stayed at

home found the evenings long and lonely, and once the children were in bed, and the house was quiet, the participants worried about their spouses and the future.

Worrying about the immediate future also resulted in the research participants wanting to maintain a watch over their spouses. The research participants felt that their watch was required because, while the spouses were the centre of the research participants' worlds, they were not the centre of the world of the health professionals. If the supporting spouse did not maintain watch, no-one would. The research participants reported that maintaining watch, and 'being there' was hard work, resulting in the spouses wondering if anyone was concerned for their personal well-being. All energies seemed to be focussed on the sick spouse, leaving little energy to focus on self, or the requirements of juggling home and family.

Despite feeling that they had no energy to focus on personal needs, the research participants contended that they coped; they coped because they had to cope. Although they all expressed that they coped during this time, they did not want to add to the spouse's stress, and needed to find other sources from which to draw on their own strength. In addition, the state of thrownness for the research participants was managed by an ability to generate a sense of coping with life­ world activities. Coping meant that the research participants could 'be there' with their spouses during these turbulent times.

The next chapter focuses on the challenges that the research participants had to being there with their spouses. Some of these challenges are generated by bureaucracy, and by the health professionals who treat patients in tertiary centres, especially those for whom the tertiary centre is not in the region of residence.

CHAPTER SEVEN

BEING-WITH AND BEING-WITHOUT-OTHERS.

7.1 Introduction.

This chapter, the last in the presentation of the findings, examines the times when the research participants felt that they were alone in the world. They may have been with their spouse during the time of out-of-town hospitalisation, but they were surrounded by unfamiliarity and because the health professionals did not recognise the impact that the non-local hospitalisation had on the participants and their spouses. Like other times when the research participants were affected by the out-of-town hospitalisation, the disruption to their interpretive frameworks occurred at times when the research participants felt that 'others' were not listening to either them or their spouse. Further times that 'others' made the research participants uncomfortable within the world occurred when the health professionals did not focus specifically on the spouse, or individualise the spouse's care. This treatment with indifference occurred prior to receiving the diagnosis, and during the time that they were in the out-of-town centre. There were times too when the research participants felt that their spouse's

understanding and needs was removed from the research participants' understanding of the situation resulting in the participants being-alone-in-the­ world.

Throughout this chapter I focus on the time that the research participants felt isolated, especially during the times that the spouse was in hospital out-of-town. During this time, the sick spouses were in a hospital environment, and although the nursing staff and other health professionals were there, the research

participants perceived that the health professionals did not use processed to

facilitate understanding of the hospital world. While the health professionals were familiar and at home in this world, the spouses were surrounded by the unfamiliar, and until the research participant and the spouse were transferred home there was no familiarity with any surroundings.

7.2 'The They' Of Solicitude.

No-one exists in the world alone. As outlined in Chapter Three people exist in the world and give little thought to understanding living. During analysis of the

interviews, it became apparent that the research participants talked about 'they say'. For example ... "they kept telling us that it was [the infection], but they never

did grow anything. But that 's what they said it was " (Winifred, p. l ). Or, as another research participant's spouse said, "I had at least eight Giardia tests over that two-year period. They all kept coming back negative . . . They treated me for it with all the tablets . . . but I didn 't have it " (Melanie, p. l ). Furthermore, the research participants were perturbed that the health professionals did not pay full attention to the information presented by the spouse or the research participant. The health professionals were the experts; therefore 'they' gave answers to explain the symptoms. Because they were the experts, the health professionals did not have to justify their actions to the spouses or research participants, even if their actions were incorrect:

You know, you go to a doctor and you say ''I'm crook and there is something wrong with me " and they just don 't seem to be interested.

Well in her case they did not seem to be interested, and as she said, it was six years before they actually really did something, and that is a long time. I do think that if people go back with the same problem time and time again, I think it should be looked into (Yoland, p. l ).

In these instances the research participants were reliant on the health

professionals' expertise to treat the disease symptoms; sometimes, as identified, for diseases that the spouses didn't have. Heidegger's phenomenological stance

stressed that being-with-others means that we allow ourselves to become

overwhelmed by 'the they', suppressing our individuality. We are 'thrown' into the world and situations of living with others, so we understand the 'that-it-is' of existence (Dreyfus, 1 99 1 ; Heidegger, 1 962; Leonard, 1 994). In other words we are already situated in the world in which we interpret the ways of speaking and

conducting ourselves. Our reactions to situations that do not concern Da-sein are

reflections of the degree of our falling into 'their' way of thinking (Heidegger, 1 962; Leonard, 1 994). In contrast, situations that cause us to question societal

norms raise awareness of Da-sein 's fallen state (Dreyfus, 1 99 1 ; Heidegger, 1 962).

In the above examples, 'the they' became apparent as the research participants became aware of different interpretive understandings of the world. The research participants and their spouses were reliant on medical expertise to make the diagnosis, but they also felt their spouse's awareness of their own health status was being disregarded. Although Heidegger (1 962) reminded us that in order to

fully understand we need to thrust "aside our interpretative tendencies, which keep thrusting them-selves upon us" (p. 96), findings of this research are that the health professionals overlooked the information that was presented. As the following extract demonstrates the research participants were disturbed that their life-worlds appeared different from the health professionals' interpretations:

He [the GP] was not taking any particular interest or hadn 't

researched the history ofhis [my spouse's]family. And that was on file, on computer for him [the GP] to view. And anybody should have

said, "perhaps we had better do a little more investigation into this ". And he chose to ignore that. [My husband's apparent health status] was deceiving, but you [Others] don 't know what 's going on. You should never take appearances for granted (Zoe, p. 1 7) .

What are the interpretations that the research participants made from the health professionals' reactions? Are they interpreting that as everyday people, they are not the experts, therefore they cannot 'know'? Are the health professionals reliant on technology for diagnosis and symptom management, and if there is no

physiological evidence, the symptoms do not exist? Are the frustrations

expressed by both the spouses and the research participants a result of reliance on the health professionals' medical knowledge, and disappointment if the health professionals don't interpret the lay person's actual symptoms?

It became apparent during analysis of the narratives that society has expectations about the specialist knowledge and associated roles and responsibilities of health professionals. When the health professionals did not do what the research participant expected should be done, individual, rather than general society expectations, had not been fulfilled. Because the dissatisfaction was not

something that was talked about with others, the research participants felt isolated thinking this way. When the health professionals viewed the dis-ease with

unconcerned circumspection, because they 'knew' the expected dis-ease outcomes, the research participants perceived that concern and solicitude were missing, and resulted in the research participants' perceptions of being-alone.

Situations when health specialists did not use expert knowledge added to the sense of being-alone and to the couple's concern. Alice used an example to illustrate this:

didn 't pick it up . . . And now when you look at it, I mean the surgeons in [the centre], and our GP just can 't believe whoever read that scan didn 't pick it up (Alice, p.2).

Not only were the research participants reliant on the health professionals' expertise, 'others' moulded the research participants' response to any dissatisfaction with the health professional's actions. In everyday living, Da­ sein 's interpretations are grounded in its existence of being-in-the-world with

others. Others in the world are encountered in an "unconcerned,

uncircumspective tarrying alongside" existence (Heidegger, 1 962, p. 1 56). Our ordinary existence is inauthentic, falling into the way of the public, or 'the they'. Being-alone is not related to the number of people surrounding us, but to the relationship between interpreting self and others. Even in situations when no­ one else is visible, others influence the potentiality-for-being (Heidegger, 1 962). However, 'their' way also influences the way in which Da-sein views others. If a person were not immersed in 'their' way, it would be impossible for that person to foresee any possibilities (Cooper, 1 996). It became apparent from this current study that 'others' did not fulfil the research participants' expectations by not being focussed on the information at hand. I call this time Being­ without-others. By this expression I mean a time when the research participants felt isolated from familiar being-in-the-world interpretive frameworks.

Society had given the medical experts 'their' role. However, because 'they' were not listening to the research participants, the research participants were ' thrown' from being-in-the-world and those who surrounded them. The research

participants did not feel they had the mandate to criticise the health professionals, because their criticism was challenging the 'their' expectations. For example, Alice had been warned that the resources in the tertiary centre were too great to challenge. Warren was going to require additional treatment in the future, and Alice was fearful of the unspoken, but real threats to his continued treatment if she did complain.

Our GP said that there are going to have to be a lot of questions answered about this. And . . . yeah, but I don 't think anything will be done. But you feel like, I actually feel like writing a letter, because I know who it is. Because if she had noticed it, it would have been quite a simple operation . . . [But] I don 't think anything will happen.

Because [the tertiary centre] told us, that it is probably not worth it,

and . . .! don 't really know how you start. I don 't know (Alice, p.7).

Like all the other Beings described in the previous two chapters, Being-without­ others occurred both before the out-of-town hospitalisation as well as during the time that the spouse was hospitalised.