Legacy of betrayal: A grounded theory of becoming demoralized from the perspective of women who have been depressed.

Abstract

AbstractSeven previously depressed women were interviewed about their understanding of how they had become depressed. The grounded theory method was used analyze the interview transcripts and develop a theory that reflected their understanding. The core theme was labeled Becoming Demoralized. The women had depressive episodes when they became demoralized by Betrayed: Being Abused, Being Disrespected, and Being Left. These betrayals often resulted in feelings of being Left Out Of The World, feeling Nobody Cares About Me, which also contributed demoralization. The experience of being demoralized involved believing one is Not Worthy Of Love, There Is I Can Do To Change Things, and Nothing Is Ever Going To Get Better. Some women were demoralized in childhood, and then further demoralized by later, often similar, Betrayals, A few women did not become demoralized until they were Betrayed as adults. The self-perpetuating nature of demoralization can result in chronic or recurrent depression.Most theories of depression do not specifically address the causes of depression in women or the higher prevalence of depression in women than men (see Nolen-Hoeksema, 1990 for review). The lack of attention gender differences in research has been described as sexism of omission (Collier, 1982, p.4). To remedy this lacuna in knowledge about depression in women, it has been argued that theoretical explanations should germinate from women's experiences and understanding (Stoppard, 1997). Otherwise, theorizing will continue be divorced from the perceptions of those who have actually experienced depression. Moreover, without an exclusive focus on women, androcentric models, which use men's experience as the normative standard, remain unshaken, and only a partial and distorted view of women is possible (Harding, 1987). The goal of this study was develop a theoretical understanding that inherently reflected the views of women who had been depressed. As DuBois (1983), a feminist researcher, has stated: to address women's lives and experiences in their own terms, create theory grounded in the actual experience and language of women, is the central agenda for feminist social science and scholarship (p. 108).Much of the recent research on depression in women utilizes qualitative methods (for example, Jack, 1991) and is reflective of the growing influence of social constructionism (see Berger & Luckman, 1966) on depression research. For example, this epistemology is reflected in the critique by Wiener and Marcus (1994) of the meaningfulness of the diagnosis of a syndrome of depressive symptoms (Diagnostic and Statistical Manual of Mental Disorders-IV, American Psychiatric Association, 1994). They have criticized the traditional diagnostic category of depression because of its ... imprecision, inconsistencies, ambiguity, overgeneralization, and contradictions . and because it subsumes very different psychosocial transactions. They advocate the replacement of symptom based diagnoses with transactional taxonomies that focus on the meaning of behaviour.A focus on the socially constructed meaning of depression has been undertaken in recent research. For example, Lewis (1995) explored, using qualitative methods, how male and female participants subjectively experienced depression, how they arrived at and understood the label of depression, and how they made sense of their experiences. Additionally, in Speaking of Sadness, Karp (1996) described the identity-altering process that male and female participants experienced as they came see themselves as depressed and continued theorize about themselves and how they became depressed. Whereas these studies did not specifically address gender, Schreiber's (1996) grounded theory study focused on women's experience and examined participants' process of recovery from depression. This process, labeled (Re)Defining My Self, involved a woman's search for personal identity within her social environment. …