Discussion and closing the circle

Introduction

In this study hermeneutic phenomenology has been used to understand the phenomenon of PA and QoL in people with psychosis. The four main themes

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which emerged were discussed alongside the four existentials of the lifeworld (van Manen, 1990).

Figure 5.5 Existential interpretation of the phenomenon of PA and QoL in people with psychosis

Each of the eight participants provided me with a different insight into PA. I interviewed the first two of these participants on the same morning in a room in a day centre which they both attended. I approached these interviews with anticipation and hope. I felt a little anxious that I would not receive rich information from the participants or that the interviews would be stilted and awkward. This preconception was prejudiced discussions I had had with other researchers who had carried out interviews with people with psychosis about PA.

However, my nerves derived from preconceived thoughts were unfounded, I talked with these first two participants for just under an hour each and in both cases they appeared to talk openly and honestly about their experiences of PA and their experiences of psychosis, rarely detracting from the focus of the interview. This situation followed for a further four of the participants and there were only two interviews where I felt that at times the conversation stilted and the participants did not seem to have much to discuss with respect to the phenomenon. Nevertheless, this was interesting in itself and from what they did say, it came across to me that PA did not play such an important role for them in

Cocooned in a web of lethargy and tangled thoughts:

Embodiment

Experiencing a snapshot of reality:

Spatiality Being

normal:

Relationality Dance as if no-one is watching:

Temporality

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their lives as it did for other participants. Throughout the interviews I could see potential themes to guide the analysis developing and during the final interview which was with Ann I found myself thinking ‘Ann is describing very similar aspects of the experience to a number of the other participants’. Often I felt it was her words that encapsulated some of the themes that had been developing in my thoughts throughout this interview process.

5.5.1 Parallel and distinctive findings

Although the themes were organised in a way which distinguished the existential givens into distinct themes, there were a number of overlapping qualities.

Especially, it seemed that embodiment can help to uncover the essential meaning of the phenomenon in all of the themes. How these themes weave in and out of each other and their place in the whole will now be described with respect to the literature which has explored similar aspects of the phenomenon.

Embodiment: cocooned in a web of lethargy and tangled thoughts

Embodiment was used to describe the struggle the participants faced to be active. It was found that the body was often prevented from being active because it is enshrouded in a web of lethargy and tangled thoughts. Lethargy was associated with symptoms of the illness, side-effects of the medication and the environment where the participant inhabited. Avolition is the term used when describing a lack of motivation in psychiatric discourse. It is one of the negative symptoms of psychosis according to the definition as outlined by DSM-IV and ICD-10. Avolition may therefore be viewed by mental health professionals as part of a person’s psychosis. It occurred to me that if professionals view it as part of the SU’s illness, SUs may also view it as part of their illness and therefore both professionals and SUs may not believe that they can be active because of their illness. It becomes a self-fulfilling prophecy, reinforcing a culture of limited PA for people with psychosis.

In other literature, work has been carried out which identifies barriers to PA in people with serious mental illness (SMI). McDevitt et al (2006) carried out focus groups in people with psychosis and found that barriers to PA are: mental illness symptoms, medications, weight gain from medications, safety concerns and fear

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of discrimination. A recurring theme in the literature is how participants perceive that their medication and their illness are what prevent them from being active (Roberts & Bailey, 2011; Hodgson, 2011).

None of the above studies had undertaken a phenomenological analysis upon the phenomenon and had often been specifically investigating what the barriers were to PA in a population of people with either psychosis or SMI. Study two differed as the focus was on a person’s experiences of PA and through phenomenological analysis it became clear that there are a multitude of embodied reasons which prevented the participants from being active. Equally, through the methodology implemented in the current study, it emerged that the same factors that prevented people from being active actually drove them to be active. This study also adds insight into the role of embodiment as it was highlighted that the struggle to be active is inherent in a perceived mind-body dualism by the participants. They perceived that when they were ill, their mind was separate from their body, their body was ignored. However, the medication made people focus on their body which appeared to be separate from self.

Because their mind and body were perceived as separate they were in a struggle to connect to the world as though they were not seen as a whole person.

However, it was this focus on the lack of action from the body that induced participants to be active.

Upon consideration of the whole, it was viewed that this is an essential theme to the phenomenon of PA and QoL in people with psychosis. This struggle to be active was inherent in the PA experiences of the participants. It outlined how their illness, it’s associated symptoms, medication and the environment all play a part in the participants QoL. Without PA, their life was viewed as stagnant, one that participants described being incredibly frustrated with, one which suggests a poor QoL. It was this stagnation that drove people to be active, it was their choice. If they chose to be active they were choosing to fight to improve their QoL. The participants were active players in their recovery. However, a positive experience of PA could be prevented if the perceived tangled thoughts were too great.

199 Spatiality: experiencing a snapshot of reality

The existential of spatiality enlightened a discussion of how the routine of PA, including preparation and the actual act of PA aids people escape ‘the pit of dung’ and break into the perceived ‘real world’. PA also appeared to help prevent people from falling backwards into undesired places. Different environments presented different experiences, but frequently being outside was described alongside feeling real. However, this depended on the participant, for some being outside undertaking PA was like breaking free from an oppression, however for others undertaking PA outside augments the feeling of oppression because of the fear associated with being outside. Darker et al (2007) found that people found walking more enjoyable if surrounded by nature. This was similar to the finding in the current study, but this was not the case for all participants and it depended on the nature of their perceived symptoms.

Other research has outlined that the characteristics of the facility where PA takes place is important (Raine et al, 2002). For instance PA was found to be more appealing if it was not in a facility associated with mental health services. This did not emerge in the current study. However, most of the PA undertaken was not at facilities associated with mental health services but was either at local sports centres, in their home or outside close to their home. Some of these activities were provided by mental health services and a discussion around mainstream and mental health services was discussed further in relationality.

Overall it emerged that for PA to be beneficial and to prevent a return to ‘the pit of dung’ the individual needed to feel safe and comfortable in their environment.

From the extensive literature searches which I have carried out I have not identified any other studies which have found that PA alters the perception of space in people with psychosis. For me, this is an essential consideration for QoL. When people perceived themselves to be in ‘the pit of dung’ their QoL was severely affected. They were often physically and mentally confined to a small space unable to do anything. PA appeared to be beneficial when the participants were on their way out of the ‘pit’, but may still be enshrouded in the web of lethargy and tangled thoughts. The use of the body in a meaningful way