Restructuring illness meaning through the clinical encounter: a process of disruption and coherence

This study explores restructuring of illness meaning among ten Turkish-born women, assessed as somatizing, encountering caregivers imposing a "psychological language" for understanding distress. Participants were referred from local health care services in Western Stockholm, Sweden. Data were collected between 1997 and 2001 from 37 interviews with ten women. Data were analyzed using a qualitative method with a grounded theory approach to construct an understanding of meaning making from an emic perspective. Participants' restructuring included loss of earlier meanings given to illness, shifts in expressions and healing strategies, and a push toward giving illness and suffering a psychological or psychiatric meaning. Restructuring had in many ways been a disruptive and complicated experience. In their everyday context participants were engaged in bridging gaps between different perspectives of looking upon their illness. They had poor support from their social context in creating coherence between frames of meaning. On the basis of the results the author suggests that Antonovsky's concept of sense of coherence (SOC) may have relevance to the process of restructuring illness meaning, and that constructing coherence between experience, expression, past, and new meanings given to illness may be significant for patients' recovery. For clinical care, results indicate that restructuring should be done so as not to impose too alien a reordering of the disruptive experiences of illness. With regard to further research, results indicate the importance of gaining insight into how individuals and social and cultural groups make sense of their interaction with caregivers and local health care services.