New world, new rules: life narratives and changes in self-concept in the first year after stroke

Abstract

Within rehabilitation research recovery from a stroke has been defined by health
professionals as the improvement in the physical ability and task-related skills of an individual. The negative psychological consequences of a stroke for both individuals and their families have been recognised for several years, but are poorly understood. Within this thesis an alternative approach has been used to explore psychological consequences following a stroke. The focus of study has been the change in identity of individuals and their spouses, rather than the ability of an individual to carry out tasks.

Ten consecutive couples were included following one partner's admission to hospital following a stroke. Separate narrative life history interviews were carried out with the stroke respondent and their spouse in hospital, and at six months and at one year after hospital discharge. Data collection and analysis was based on an interpretative phenomenological approach. A second concurrent study was carried out including 38 stroke respondents who were admitted to hospital following a stroke. While in hospital they were asked to complete a questionnaire including indices of physical ability, task-orientated ability, mood and self-concept. The questionnaire was administered again at six months and one year following discharge. Multivariate statistical procedures were carried out to describe the associations between the variables assessed.

All respondents reported that they had experienced a fundamental change in their lives. They continued to report this fundamental change up to the final interview at one year, apart from one couple, where the stroke partner had made a complete physical recovery. The issue which appeared to dominate the stroke respondent's first year post-stroke was a split between their body and their physical and social self They could not maintain their prior identity within the capabilities of their new body. The spouses reported that they became totally responsible for not only their own lives but also the life of their partner. The issues of body-self split and total responsibility appeared to be hidden from others,making the situation of the respondents more challenging. Younger spouses reported more difficulty than older spouses in integrating the stroke into their life situation. Issues facing the respondents also varied depending on their own life histories and life goals. Within the quantitative analysis the mood of the stroke respondents was not highly correlated with physical ability or task-oriented improvement. Perceived difference between past and present self-concept was correlated to anxiety and depression at all assessment times even when the other indictors were taken into account.

Exploration of identity change appears to be a useful framework for exploring the
psychological consequences of a stroke.

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