Resilience in people with spinal cord injury: a narrative approach

This PhD thesis explores the phenomenon of resilience in people with spinal cord injury (SCI). The purpose of this research is to understand how resilience is experienced and given meaning in people with SCI, as well how resilience is fostered, how it impacts upon health and well-being, and how it can be managed to achieve maximum benefits with regard to health and well-being. It is the first in depth narrative investigation of resilience in people with SCI. Using both life story interviews and the process of timelining, participants stories were collected. Following this they were then analysed using dialogical narrative analysis (Frank, 2010, 2012). This enabled participants stories to be examined with regard to their effects on resilience and health and well-being. The analysis shows that firstly, due to the intangible nature of resilience, participants had trouble in articulating exactly what resilience meant to them. Instead, resilience was shown through participants stories which could be grouped into four different narrative types: loss, adaptation, posttraumatic growth (PTG), and life-as-normal. Together, these narrative types constructed resilience, and as such, resilience in people with SCI has four facets or faces , like a four-sided dice. The process of resilience in people with SCI worked by participants drawing upon the different narrative types at different times depending upon the demands being placed upon them. The loss narrative was drawn upon immediately following injury, and was concerned with the narration of the physical, psychological and social losses participants incurred following SCI. The loss narrative fostered resilience by enabling participants to talk about their losses, enabling participants to survive the hardest time of their lives. The second narrative type was the adaptation narrative. This narrative type focussed upon rehabilitation in both the spinal unit and in the community. This narrative type built resilience via progression through rehabilitation towards a quality of life comparable to pre-injury levels. The PTG narrative was concerned with the ways in which participants had developed following SCI and built resilience by shifting the focus onto the positives to come out of participants experiences of SCI. The life-as-normal narrative was used by two participants across their entire life story and enabled participants to continue with their lives with minimal disruption. It built resilience by placing disability in the background and therefore making it unimportant. This thesis then concludes with the empirical, theoretical, methodological and practical implications arising from this research. The potential for resilience to help improve the health and well-being of people with SCI is discussed, as well as the ways in which resilience can have a maximum benefit on health and well-being of people with SCI