Illness-related Experiences Research Articles

Medical traumatic stress in cystic fibrosis: A qualitative analysis

BackgroundPeople living with cystic fibrosis (PwCF) face a lifetime of potentially traumatic illness-related experiences that can lead to posttraumatic stress symptoms. Existing criteria for this type of posttraumatic stress, called medical traumatic stress (MTS), may not fully capture the CF experience. In this study we aimed to explore: 1) illness-related experiences perceived as traumatic in the setting of CF, 2) perceived MTS symptoms in PwCF, and 3) perceived health-related functional impairments from MTS. MethodsInformed by our aims, we developed and piloted guides for semi-structured interviews and focus groups with PwCF, family members of PwCF, and CF medical providers. We then conducted a series of interviews and focus groups. The qualitative analytical process followed Deterding and Waters’ three stages of flexible coding for in-depth interviews, generating key themes and sub-themes in each domain of study inquiry. ResultsWe recruited 51 participants, including 24 PwCF, 7 family members of PwCF, and 20 CF care team members. Illness-related experiences perceived as traumatic were often characterized by themes of loss of agency, threats of bodily harm, and shifts in identity. Prominent MTS symptoms included shame, survivor guilt, burden guilt, germaphobia, and symptom panic. Health-related themes of functional impairments perceived to result from MTS included poor adherence and strained relationships between providers and patients/families. ConclusionsThis is the first study to explore the specific experiences of MTS in PwCF. It highlights the need for screening that includes these specific exposure types and symptoms, which may be mitigatable with medical trauma-focused interventions.

Posttraumatic growth in psychosis: Symptoms, meaning, and coping

IntroductionResearch suggested that psychosis and mental illness-related experiences can be extremely traumatic, and that psychosis could theoretically also lead to posttraumatic growth (Mazor et al., 2019; PTG). The promotion of PTG may contribute to the treatment of people who experienced massive traumas such as people with severe mental illness (SMI). Psychotic symptoms are a common feature of SMI, and individuals who have experienced psychosis are also more likely to have been exposed to trauma and are more vulnerable to developing posttraumatic symptomatology (Ng et al., 2021). Negative symptoms such as amotivation could also contribute to the traumatic experiencing of psychosis (Mazor et al., 2016). Amotivation is specifically relevant to the possible traumatic sequelae of psychosis (Mueser et al., 2010). Alongside the adverse consequences of psychopathological symptoms is the unique outcome of coping with adversity (Tedeschi & Calhoun, 1995)- PTG. Two important factors that contribute to PTG is coping self-efficacy (CSE), and meaning making (Mazor et al., 2018). We investigated the possibility of PTG in individuals with SMI, through the mediating effect of CSE and meaning making.ObjectivesRecent research has shown high rates of exposure to trauma among people with SMI, and that psychosis and mental illness-related experiences can be extremely traumatic. While some develop PTSD, it has been noted that some may also experience PTG. However, few studies have examined PTG in this population.Methods121 participants were recruited from community mental health centers and administered trauma and psychiatric questionnaires. Study protocol was approved by the University of Haifa ethics board.ResultsHigh levels of traumatic exposure were found in the sample. Furthermore, we found that people who endured psychosis can experience PTG, which was mediated by meaning making (MLQ) and CSE. Psychotic symptoms were found to be a major obstacle for PTG, whereas negative symptoms were found to have the potential to lead to PTG when mediated by meaning making and CSE.Mediation analyses for the dimensions of PANSS, MLQ total, CSE total, and PTGI total (N=121)Dependent Variable (DV)Independent variable (IV)MediatorIV to mediatorB (SE)Mediator to DVB (SE)Mediation effectB (SE)Z PTGI totalPANSSPositive symptoms totalMLQ total-0.46(0.26)0.99***(0.10)-0.46(0.27)1.71CSE total-2.08(0.89)0.28***(0.03)-0.58(0.28)PANSSNegative symptoms totalMLQ total-0.64***(.17)0.93***(0.11)-0.60(0.17)3.62***-2.06***(0.58)0.26***(0.03)-0.53(0.17)3.13**PANSSGeneral psychopathology totalMLQ total-0.64***(.12)0.96***(0.11)-0.61(0.13)4.77***-2.32***(0.43)0.27***(0.03)-0.62(0.15)4.08***Note.**p<.01***p<.001ConclusionsThe portrayed research provided preliminary evidence for the potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis.Disclosure of InterestNone Declared

Patient Competence for Coping with Disease - A Qualitative Analysis in Women with Breast and Gynaecological Cancer

The study explores challenges, competencies, and helpful support in coping with the disease of patients with breast cancer and gynaecological cancer and how patient competence as an interaction of these factors might be promoted. Semi-structured interviews were conducted with 19 patients in acute care, 20 patients undergoing rehabilitation, and 16 participants in a self-help group and evaluated using qualitative content analysis. The challenges are summarised in the main categories - diagnosis processing, treatment/recurrence fears, illness processing and adaptation, worries about relatives, reactions of the social environment, and worries about the workplace. The named personal competencies in dealing with these challenges were assigned to the following main categories: cognition-related coping, action-related coping, self-regulation illness processing, obtaining and accepting support, self-determined communication of the illness, identifying and applying helpful strategies, illness-related experience, favourable life circumstances, openness to offers of help. Helpful emotional, informational or instrumental support is perceived by relatives, friends, animals, colleagues/employers, treatment providers, rehabilitation, fellow patients, self-help, and counselling facilities. The women describe a variety of competencies, which corresponds to a needs-oriented, self-directed coping process. The individuality and complexity of the interaction of the components of patient competence underline the relevance of patient-oriented care. Empowerment and an active patient role are necessary to promote their coping skills according to their needs. Support from practitioners or the private environment can reduce challenges or promote competencies and application.

A qualitative synthesis of drawing-based research on the illness-related experiences of children living with physical health problems.

The strengths of drawing-based approaches for encouraging children's participation in health research and facilitating communication with them have been increasingly acknowledged in the medical literature. However, there is a lack of methodological discussion on drawing-based approaches suitable for researching children living with physical health problems. The present study systematically reviewed qualitative research using drawing-based approaches on the experiences of children living with physical health problems and summarised how the approaches were used as well. We identified 54 studies from five databases. The characteristics of qualitative methods and drawing-based approaches were analysed. To obtain an overall understanding of the illness-related experiences of these children, qualitative data generated from the included studies were synthesised using the thematic synthesis approach. This systematic review highlights the appropriateness and accuracy of the use of drawings-based approaches in health research with children on their illness-related experiences, fostering inclusive participation and engagement of young generations.

P.16 Parental illness intrusiveness, parental well-being and youth well-being in families confronted with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disorder characterized by progressive muscular weakness. It has a large impact on the daily life of patients and parents, yet research on parental well-being remains scarce. This study explored specific difficulties in parents’ everyday lives and associations with parental and patient well-being. Parental illness intrusiveness (a parent's perception that the illness of the child interferes with one's personal life) was examined. Associations between parental illness intrusiveness, parental depressive symptoms, patient depressive symptoms and patient characteristics were explored. The sample included 23 parents (74% mothers, Mage=47.3) of patients with DMD (age 12-22, Mage=16.65). Parents completed questionnaires on illness intrusiveness (Illness Intrusiveness Scale), depressive symptoms (CES-D), and overall quality of life (VAS-scale). Patients reported on their own depressive symptoms (CES-D). The Activlim assessed physical functioning. Mothers reported more illness intrusiveness than fathers [42.78 (SD=18.58) versus 23.00 (SD=3.16); F(1,21)=6.54, p=.018]. A substantial subset of parents (39.1%) and youth (39.1%) met cut-off criteria of 16 or more on CES-D which reflects an increased risk for depressive disorders. Parental depressive symptoms correlated negatively with their overall quality of life (r=-.79, p<.001), and positively with parental illness intrusiveness (r=.45, p=.030). Patient depressive symptoms did not correlate significantly with parent depressive symptoms (r=.30, p=.161) or illness intrusiveness (r=.11, p=.612). Patient age was not related to parental illness intrusiveness and parent or patient depressive symptoms. Although preliminary, these findings illustrate the significant burden that parents of boys with DMD can experience and the importance of assessing parental illness-related experiences. However, larger samples focusing on both mothers and fathers are needed in future work. Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disorder characterized by progressive muscular weakness. It has a large impact on the daily life of patients and parents, yet research on parental well-being remains scarce. This study explored specific difficulties in parents’ everyday lives and associations with parental and patient well-being. Parental illness intrusiveness (a parent's perception that the illness of the child interferes with one's personal life) was examined. Associations between parental illness intrusiveness, parental depressive symptoms, patient depressive symptoms and patient characteristics were explored. The sample included 23 parents (74% mothers, Mage=47.3) of patients with DMD (age 12-22, Mage=16.65). Parents completed questionnaires on illness intrusiveness (Illness Intrusiveness Scale), depressive symptoms (CES-D), and overall quality of life (VAS-scale). Patients reported on their own depressive symptoms (CES-D). The Activlim assessed physical functioning. Mothers reported more illness intrusiveness than fathers [42.78 (SD=18.58) versus 23.00 (SD=3.16); F(1,21)=6.54, p=.018]. A substantial subset of parents (39.1%) and youth (39.1%) met cut-off criteria of 16 or more on CES-D which reflects an increased risk for depressive disorders. Parental depressive symptoms correlated negatively with their overall quality of life (r=-.79, p<.001), and positively with parental illness intrusiveness (r=.45, p=.030). Patient depressive symptoms did not correlate significantly with parent depressive symptoms (r=.30, p=.161) or illness intrusiveness (r=.11, p=.612). Patient age was not related to parental illness intrusiveness and parent or patient depressive symptoms. Although preliminary, these findings illustrate the significant burden that parents of boys with DMD can experience and the importance of assessing parental illness-related experiences. However, larger samples focusing on both mothers and fathers are needed in future work.

Testing a Model of Disclosure, Perceived Support Quality, and Well-Being in the College Student Mental Illness Context: A Weekly Diary Study

ABSTRACT Prominent disclosure models elucidate decisions to disclose health information, yet explanations for disclosure consequences remain underdeveloped. Drawing on Chaudoir and Fisher’s disclosure process model, this study aims to advance understandings of how disclosure to a parent contributes to well-being for college students with mental illness. We tested a mediational model in which, at the within-person level, perceived support quality explains the association between on-going disclosure of mental illness-related experiences and well-being. Participants were 163 college students who self-identified as having mental illness and who completed six consecutive, weekly surveys. A multilevel analysis showed that increases in disclosures of mental illness-related experiences, relative to participants’ mean level, were associated with enhanced well-being via perceptions of higher quality support, above and beyond between-person differences. This study contributes to the literature by offering an explanation for the effects of disclosure on well-being and underscores the importance of capturing disclosures over time.

Worries and Benefit Finding in Cancer Survivors and Parents: A Longitudinal Study

The interplay and longitudinal associations between positive and negative illness-related experiences in childhood cancer survivors and their families remain unclear. Therefore, benefit finding, cancer-related worries, depressive symptoms, and life satisfaction were prospectively investigated in childhood cancer survivors and parents. Directionality of effects and interactions between benefit finding and cancer-related worries in predicting general well-being were examined. Childhood cancer survivors (n = 125 at T1; aged 14-25), mothers (n = 133 at T1), and fathers (n = 91 at T1) completed two annual questionnaires on benefit finding, cancer-related worries, depressive symptoms, and life satisfaction. Cross-lagged panel analyses including benefit finding, cancer-related worries, their interaction, and depressive symptoms or life satisfaction were conducted in survivors, mothers, and fathers. Relatively high stability coefficients were found for all study variables. In survivors, cancer-related worries predicted relative increases in depressive symptoms and benefit finding over time. Benefit finding predicted relative increases in life satisfaction over time and buffered negative effects of cancer-related worries on life satisfaction. In mothers and fathers, positive correlated change at T2 (the correlation between residuals at T2) indicated that relative change in benefit finding over time was positively related to relative change in cancer-related worries. Benefit finding was related both to positive well-being and negative illness experiences, which calls for more research to unravel the different functions of benefit finding over time. Clinicians should be encouraged to attend to positive illness experiences along with more negative ones to obtain a more nuanced view on the illness experiences of survivors and their families.

271: Loss of control, shifts in illness identity, and perceived vulnerability underlie traumatic illness–related experiences in patients with cystic fibrosis

271: Loss of control, shifts in illness identity, and perceived vulnerability underlie traumatic illness–related experiences in patients with cystic fibrosis

"My Life in the Hospital": Narratives of Children With a Medical Condition.

Pediatric hospitalization is a common experience that may increase children's sense of isolation and impinge on their social-emotional wellbeing. Educators and medical practitioners could minimize these negative effects of hospitalization if they were able to listen to the voices of the children and, therefore, better meet their needs. This qualitative study provides an overview of how children with a medical condition actively construct and organize their thoughts and feelings about illness, life in hospital, and relationships. We extrapolated from a collection of children's narratives from a previous more comprehensive study (consisting of 379 narratives from children in 29 public hospitals across Italy, age range 3-14 years). Narratives grouped under the headings "Me and my illness" or "Me and the others" were selected and analyzed using interpretative phenomenological analysis (IPA) to identify the richness and complexity of children's experience. Results showed that children's description of their illness was affected both by cognitive and social factors. For children, the concept of feeling ill or well is not linked only to the fact that they are in hospital for a medical condition; rather, it is influenced by their ability to form relationships with others, play, be active, and feel alive within the hospital environment. Listening to narratives can deepen our understanding of children's illness-related experiences and how they make sense of their situation. A set of practice implications are presented to help health professionals and educators to improve their listening capabilities and better prevent adverse pediatric hospitalization outcomes.

The Elusive Understanding of Lyme Disease in Non-Endemic Geographic Areas: An Exploratory Survey of Patients With Chronic Symptoms in Texas.

This study was designed to determine the quality of life, diagnostic, and illness-related experiences of patients who self-report a diagnosis with Lyme disease (LD) and/or who are experiencing chronic illness in Texas, a state considered non-endemic for tick-borne illness. This exploratory study found that self-reported LD respondents have multisystem health problems that result in very poor quality of life. Lyme disease respondents experience multiple and severe symptoms, particularly flu-like illness, extreme fatigue, back and neck pain, and anxiety and depression. These symptoms were present at similar levels among all LD respondents, whether their diagnosis was clinical or serological. For all LD respondents, this study points to quality of life experiences that are powerfully negative. Practitioners and disease surveillance experts may consider LD when multisystem symptoms are severe, other etiologies are ruled out, and quality of life is threatened.

Posttraumatic growth in psychosis: Challenges to the assumptive world.

Research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic and may lead to significant symptomatology. Indeed, overwhelming traumatic experiences may shatter people's core beliefs about themselves, the world, and others. However, coping with adversity may also foster a unique outcome; namely posttraumatic growth (PTG). The experience of PTG is contingent on people's ability to reexamine their core beliefs after trauma. Little is known about whether and how such core-belief reexamination is related to PTG among people with SMI and psychosis, specifically people who experience positive, negative, and general psychopathological symptoms (PANSS). For the purpose of this study, 121 participants were recruited from community mental health rehabilitation centers and administered trauma- and psychiatry-oriented questionnaires. In addition to high levels of traumatic exposure, we observed that people with SMI can experience PTG, which is mediated by reexamination of core beliefs, contingent on low levels of illness-related psychopathological symptoms. The ability to challenge one's world assumptions and reestablish a functional set of assumptions is critical to the development of PTG. In light of the high levels of posttraumatic comorbidity found in this population, psychiatric facilities should place greater emphasis on treating the traumatic aspects of SMI and on teaching and practicing effective strategies to reevaluate life after trauma. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

'The Future is Probably Now': Understanding of illness, uncertainty and end-of-life discussions in older adults with heart failure and family caregivers.

BackgroundEarlier end‐of‐life communication is critical for people with heart failure given the uncertainty and high‐risk of mortality in illness. Despite this, end‐of‐life communication is uncommon in heart failure. Left unaddressed, lack of end‐of‐life discussions can lead to discordant care at the end of life.ObjectiveThis study explores patients' and caregivers’ understanding of illness, experiences of uncertainty, and perceptions of end‐of‐life discussions in advanced illness.DesignInterpretive descriptive qualitative study of older adults with heart failure and family caregivers. Fourteen semi‐structured interviews were conducted with 19 participants in Ontario, Canada. Interviews were transcribed verbatim and content analysis was used to analyse the data.Main resultsUnderstanding of illness was shaped by participants’ illness‐related experiences (e.g. symptoms, hospitalizations and self‐care routines) and the ability to adapt to challenges of illness. Participants were knowledgeable of heart failure management, and yet, were limited in their understanding of the consequences of illness. Participants adapted to the challenges of illness which appeared to influence their perception of overall health. Uncertainty reflected participants’ inability to connect manifestations of heart failure as part of the progression of illness towards the end of life. Most participants had not engaged in prior end‐of‐life discussions.ConclusionDetailed knowledge of heart failure management does not necessarily translate to an understanding of the consequences of illness. The ability to adapt to illness‐related challenges may delay older adults and family caregivers from engaging in end‐of‐life discussions. Future research is needed to examine the impact of addressing the consequences of illness in facilitating earlier end‐of‐life communication.

Post-traumatic growth in mental health recovery: qualitative study of narratives.

ObjectivesPost-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.DesignQualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.SettingEngland.ParticipantsParticipants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.ResultsComponents of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.ConclusionsPost-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.Trial registration number ISRCTN11152837

Experiences of People with Epilepsy during Art Therapy

Research background. Epilepsy is not only a central nervous system or brain disorder. It is a biological, psychological and social condition (Scambler, 2010). Children with epilepsy have a higher risk of having psychological disorders such as depression, anxiety and attention defcit disorders. The application of art therapy for people with epilepsy helps to express and understand feelings more effectively (Shore, 2014). Unfortunately, there is a lack of research that analyses the experience of epilepsy patients in art therapy. The aim of this article is to reveal and describe experiences of epileptic people during art therapy. Research questions: What experiences of epilepsy patients predominate in the collected thematic analysis data? What formal elements of drawing reflect the participants’ experiences? How does thematic analysis data relate to the data of formal elements analysis of drawings? Methods. Qualitative study in which the participants of the study were subjected to group art therapy. The data was analysed by the thematic method and the analysis of formal elements of the drawings. Results. The analysis of the verbal data revealed the individual themes of the study participants’ experiences. After drawing analysis formal elements were found that expressed the participants’ experiences. Conclusions. 1. Experiences dominating in thematic analysis are loneliness and confnement during difcult moments, as well as constant tension and internal confusion. 2. The experiences of research participants are reflected in these repeated formal elements of drawing: the use of confnes and framing, the use of black and red collars, fgurative and abstract depictions, the chaotic nature of the composition, the lack of concreteness in shapes, expressiveness, and incompleteness. 3. The thematic and formal drawing element analyses complement each other. Drawings that convey the illness-related experiences include confnes, framing, and black colour in the main elements of the composition. Drawing that reflects unpleasant feelings and experiences uses abstract depiction, chaotic compositions, the lack of concreteness in shapes, expressiveness and incompleteness.Keywords: epilepsy, art therapy, psychosocial risks.

Posttraumatic growth among people with serious mental illness, psychosis and posttraumatic stress symptoms

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop posttraumatic symptomatology related to these experiences, some appear to experience posttraumatic growth (PTG). Little is known, however, about PTG as a possible outcome among people who experienced psychosis as well as posttraumatic stress symptoms (PTSS). For further understanding of the relationship between PTSS and PTG among people with SMI who experienced psychosis, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. Results revealed that while high levels of traumatic exposure were common, most participants experienced some level of PTG which was contingent upon meaning making and coping self-efficacy. In addition, posttraumatic avoidance symptoms were found to be a major obstacle to PTG. The range of effect sizes for significant results ranged from η2=0.037 to η2=0.144. These findings provide preliminary evidence for the potential role of meaning making and coping self-efficacy as mediators of PTG in clinical, highly traumatized populations of people with SMI and psychosis. Implications of these findings for future research and clinical practice are discussed.

Adaptation to inflammatory rheumatic disease: Do illness representations predict patients' physical functioning over time? A complex relationship.

Patients with an inflammatory rheumatic disease (IRD), are often faced with significant limitations in physical functioning. Illness representations are a key-factor of their illness-related experience. Our aim was to examine (a) whether illness representations can predict or only reflect IRD patients' physical functioning over time, and (b) the specific pathways through which representations and physical functioning at baseline are associated with representations and functioning at follow-up. Patients with rheumatoid arthritis (N=54) or systemic lupus erythematosus (N=58) participated in the two phases of the study, 1year apart. According to the results, illness representations were rather predicted by physical functioning than the other way around. At the same time, illness representations at baseline and at follow-up seemed to form a chain that mediated the relation between physical functioning at baseline and 1year later. These findings may help us better delineate the interplay between the ways patients understand their condition and adaptation to illness.

Posttraumatic Growth in Psychosis.

Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI). In addition, studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop full blown PTSD related to these experiences, it has been noted that some may also experience posttraumatic growth (PTG). However, few studies have examined PTG as a possible outcome in people who have experienced psychosis. To further understand the relationships between psychosis and PTG, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. High levels of traumatic exposure were found in the sample. Regarding our main focus of study, we observed that people who endured psychosis can experience PTG, and that PTG is mediated by meaning making and coping self-efficacy (CSE) appraisal. Psychotic symptoms were found to be a major obstacle to meaning making, CSE, and PTG, whereas negative symptoms were found to be significantly related to PTG when mediated by meaning making and CSE. The current research provides preliminary evidence for potential role of meaning making and CSE as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis. This may have both research as well as clinical practice relevance for the field of psychiatric rehabilitation.

Rhetorics of the Visual: Graphic Medicine, Comics and its Affordances

Affordances, in the context of comics, connote to the general attributes of the medium such as temporality, spatiality, gestures, tone / handwriting and economy. Although comics evinces a dynamic relationship among these elements, it is possible to delineate functional and rhetorical role of these affordances on a conceptual and technical level. Taking these cues, the paper after briefly reviewing the definition and scope of graphic medicine aims to demonstrate the functional and rhetorical role of the aforementioned affordances in communicating illness and illness related experiences. Among other issues this article also seeks to address the following: how do comics engage in the visual and verbal translation of the experiences of chronic illness? how do affordances of comics facilitate the readers’ haptic experience of an author’s subjective trauma? Despite its juvenile legacy, comics capacitates graphic medicine to represent physical and emotional aspects of narrating subjective illness experiences within the medium. The paper concludes that comics is a uniquely suited communicative medium as it diagrams the interiority of illness experience, and, in the process, evolves itself as a locus of tacit knowledge through its translation and mediation of emotional truths and affective states altered by illness.

How the Illness Management and Recovery Program Enhanced Recovery of Persons With Schizophrenia and Other Psychotic Disorders: A Qualitative Study

This study aims to describe how the Illness Management and Recovery program enhanced recovery of persons with schizophrenia and other psychotic disorders from their own perspective. Participants valued learning how to divide huge goals into attainable steps, how to recognize and prevent a relapse by managing symptoms, practicing skills, and talking openly about illness related experience. They learned from the exchange with peers and from the information in the IMR textbook. Nurses should have continuous attention and reinforcement for progress on goals, skills practice and exchange of peer information. A peer-support specialist can contribute to keep this focus.

Robert Schumann in Endenich: The Diagnosis and Course of His Illness and His Illness-Related Experiences

Robert Schumann in Endenich: The Diagnosis and Course of His Illness and His Illness-Related Experiences