‘Getting back to normal?’

By Sarah Earthy

Look for a card for someone who is ill or has had an operation and the likelihood is that the message on the front will read ‘Get well soon’, perhaps followed by ‘Wishing you a speedy recovery’ inside. A stereotypical accompanying image might be a cartoon of a patient, probably male, sitting propped up in a hospital bed covered in spots or with a leg in plaster. Many of us have known situations when such a sentiment, let alone picture, is obviously inappropriate such as when the recipient is unlikely to recover or to recover completely. But in other circumstances, however serious the illness or health event might be, the wish and hope remain the same; for a quick and full recovery, a speedy return to normal for all concerned. The notion of ‘convalescence’ – variously defined as a period or necessary period of gradual return to or recovery of health and strength following illness or hospital treatment – was once integral to the experience of illness and provision of care but has now largely disappeared from everyday speech and from formal provision of healthcare in the UK.

For sociologists these observations raise interesting questions about cultural understandings and expectations surrounding the period following a non-trivial health event such as acute physical illness or injury. The assumption seems to be that recovery is, or at least should be, linear and relatively unproblematic. Yet narrative accounts of illness – both autobiographical and the accounts of participants in qualitative research interviews – suggest that the aftermath of illness or other health event may be complex, involving emotional and psychological as well as physical recovery. Some sixty years ago, the functionalist Talcott Parsons presented the conceptual model of the Sick Role as a way of understanding the societal management of sickness. At the time his work was well received but was subject to sustained criticism from the late 1960s onwards as functionalism in general came under fire. His work has been viewed more favourably again recently. Within Parsons’ model of the Sick Role and from subsequent research exploring help-seeking behaviour, patients’ experiences of illness and hospital care and the study of diagnosis, medical sociologists have identified complex social processes involved in a person with symptoms becoming a ‘patient’. In contrast, much less attention has been paid, empirically or conceptually, to how people cease to be patients and the ways in which individuals’ expectations and experiences of recovery may vary in the context of different types of health event or an array of social factors such as age, life stage, gender, ethnicity, employment status, socio-economic circumstances, domestic situation, cultural capital and social connections and resources.

The research project ‘Getting Back to Normal?’ Patients’ Experiences and Expectations Following Major Illness or Injury aims to address some of these gaps. The project team are from the Centre for Research in Primary and Community Care at the University of Hertfordshire (Professor Hilary Thomas and Elaine McNeilly) and the Department of Sociology at the University of Surrey (Dr Sarah Earthy and Jude Sleney). We are assisted by an advisory group comprising of patient representatives, health professionals, experts in patient support and health policy, and medical sociologists. The study is funded by the Economic and Social Research Council (reference (ES/K006037/1) and we are about halfway through the analysis.

The question mark after ‘normal’ in the title is deliberate. It reflects the complexity of the lived experience which may include ups and downs, uncertainty whether things will ever return to how they were prior to the illness or injury even if treatment has been judged successful, and the effects of a drawn out period of recovery in creating a new version of ‘normal’ for the individual and those close to them.

The method we are using is secondary analysis, using thematic and narrative approaches, of 165 qualitative interviews from four datasets. Three of the datasets cover situations of serious illness. These situations are heart attack, diverse types of leukaemia and a critical state of health that required admission to intensive care. The interview data for these conditions come from the archive of the Health Experiences Research Group (HERG) based in the Department of Primary Care at Oxford University. The interviews were originally carried out to provide information for http://www.healthtalkonline.org – a fantastic website drawing on more than 2,000 people’s experiences of over 60 health-related conditions and illnesses. The fourth dataset we are analysing for the ‘Getting Back to Normal?’ project comes from the UK Burden of Injury Study. One of the reasons we are keen to include experiences of serious injury (defined as having involved at least one night in hospital) is that there has been much less sociological study of injury compared with illness and we are interested in exploring how the nature of the health event influences expectations and experiences of recovery. Amongst the 165 people interviewed in the four datasets, we have a fairly good representation of people of different ages, life stages, gender, socio-economic circumstances and domestic situations. Some people were interviewed within a year of the event occurring (‘the event’ being the heart attack or injury taking place or a more diffuse stage of diagnosis or hospital admission). Other people were interviewed some or many years later and their accounts provide a longer term perspective on what happened, what recovery meant and involved at the time, and what has happened since.

So will we come up with a range of different/ ‘better’ straplines for cards to replace ‘Get well soon’? Probably not. But we hope to bring a sociological gaze to a hitherto under-researched area of illness and injury with implications for health policy and practice as well as academic study.



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