Stroke and self-identity among people of advanced older age:A biographical approach

摘要

Stroke is one of the leading causes of adult disability, but little is known about the meanings of stroke for survivors of advanced older age. This thesis examines the experience and meaning of stroke in relation to the self-identity of people aged 75 and over based on a biographical-narrative approach. It draws on both Gidden’s (1991) conceptualisation of self-identity as a set of reflexive biographical narratives and Goffman’s (1959) notion of identity as constructed in everyday social interaction. Individual and joint biographical-narrative interviews were conducted with 27 stroke survivors and 13 spouses, aged 75 and over. Three forms of analysis were employed, to examine both narrative content and narrative style, namely thematic analysis, analysis of interaction in joint interviews and linguistic methods involving comparative key word analysis. Thematic analysis demonstrated the significance of an individual’s whole biography for meanings assigned to stroke and processes of narrative reconstruction with other overarching themes and aspects of self-identity identified as employment, loneliness and bereavement; and housing and community. Underlying these themes were self-presentations as hardworking, honest and financially self-sufficient, thus resisting dominant negative discourses associated with old age and ill health. Analysis of interaction and language in couple interviews led to the identification of three types of relationship that shaped the meaning of stroke. ‘United couples’ pulled together and emphasised their accommodation of the stroke and normality as a couple, despite often considerable disability, and was strongly underpinned by a collaborative narrative style; ‘Positive caring relationships’, described self-reliant couples who took pride in how they managed, and ‘Frustrated carers’ emphasised the difficulties of caring and hardships experienced and were characterised by a conflictual narrative style. These data extend notions of how illness is ‘lived’ and demonstrate how biography and marital relationships can mediate the experience of chronic illness and its impact on identity.