Human occupation in the context of chronic poverty and psychiatric disability

Duncan, Madeleine (Stellenbosch : University of Stellenbosch, 2009-12)

Thesis

ABSTRACT: This study, within the fields of occupational therapy and occupational science, describes the occupations of isiXhosa-speaking individuals with longstanding histories of mental illness living in chronic poverty. Occupation refers to the daily tasks and purposeful activities which, in occupying people’s time, establish the patterns of their lives and give expression to their roles, identity, interests and abilities. The aim of this study was to describe how poor households and persons with psychiatric disability living in those households coped with their circumstances and how they viewed, orchestrated, drew meaning from and attributed purpose to the everyday things they did, in particular the self-identified, primary income generating occupation of the disabled person. The research questions elicited information about the genesis, characteristics, meanings and functions of occupation, in particular those occupations performed by the disabled member that contributed to the survival of the household. Using case study methodology, the research involved prolonged engagement with five households living in a peri-urban, informal settlement on the outskirts of Cape Town, South Africa. Qualitative data about occupation was derived through demographic screening, multiple interviews with key informants in each household, participant observation and focus group discussion. In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake,1995) were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). In addition, discussions were held with mental health professionals familiar with the context and the Xhosa culture. Four forms of data analysis and interpretation (Kavale, 1996; Stake, 1995) were applied were applied to develop substantive case studies: condensation (identification of major organising ideas); categorisation (thematic categorical aggregation); patterning (narrative structuring) and generalisation (naturalistic interpretation). Thematic descriptions of the basics of occupation are used to illustrate the various ways participants negotiated the challenges of life at the margins of society through the ordinary things they did everyday. Cross case analysis provided insights into the financial and social costs of mental illness as well as the strategies, embedded in occupation, adopted by participants in dealing with their circumstances. The central thesis of this dissertation is that psychiatrically disabled people, as economic actors functioning in complex structural, social and occupational matrices, contribute in paradoxical ways to the survival of their households. While their illness behaviour may increase the vulnerability of the household from time to time, they nevertheless facilitate its functioning either as providers of a disability grant; as contributors of additional labour or as productive income generating agents. The individual, the social and the structural are co-constituted in what poor and disabled people are able to do everyday. The less resources that are available in the occupational form, the more effort is needed to perform occupations and the more reliance is placed on the informal relational economy. Relative mastery of constrained circumstances occurred by optimising the goodness of fit between occupational form and occupational performance through adaptive capacity, an under-recognised form of agency in the context of chronic poverty. Looking beyond the obscuring façade of psychiatric disability at the ordinary things people did everyday revealed their capacity to strategise practically and attitudinally in support of the household’s survival. The study heightens awareness of human experiences that have been overlooked in the occupational science and occupational therapy literature, in particular how the basics of occupation operate in resource constrained environments. This contribution to knowledge about human occupation will inform mental health occupational therapy practice and community based psychiatric services concerned with the inclusion of disabled people in promoting social development.

OPSOMMING: Hierdie studie val binne die gebied van arbeidsterapie en ‘occupational science’. Dit beskryf die ‘occupations’ van Xhosa-sprekende individue met ‘n geskiedenis van geestesongesteldheid wat in kroniese armoede in informele nedersettings aan die buitewyke van Kaapstad, Suid-Afrika woon. ‘Occupation’ verwys na die daaglikse take en doelgerigte aktiwiteite wat mense se tyd in beslag neem; die patrone en ritmes van hul lewens bevestig en wat uitdrukking gee aan hul verskeie rolle, identiteit, belangstellings en vermoëns. Die doel van die studie was om inligting te verkry oor die oorsprong, eienskappe, betekenis en funksies van ’occupation’ in die konteks van armoede en veral met betrekking tot die psigiatries gestremde lid se belewenis en bydrae tot die huishouding se oorlewing deur sy of haar self-geidentifiseerde, primêre winsgewende ‘occupation’. Verlengde verbintenis met vyf huishoudings en sleutel informante as gevalstudies het die verkryging van kwalitatiewe data oor ‘occupation’ deur onderhoude, waarneming en fokusgroepe moontlik gemaak. Onderhoude met geestesgesondheidspesialiste vertroud met die konteks en die Xhosakultuur is ook gevoer. Vier tipes data-analise en interpretasie (Kavale, 1996; Stake, 1995) is toegepas om die ontwikkeling van substantiewe gevallestudies moontlik te maak: kondensasie (identifisering en organisasie van belangrike idees); kategorisering (tematiese sorteering van eenhede van betekenis); motief (narratiewe strukturering) en veralgemening (naturalistiese interpretasie). Kruisgevalanalise is toegepas om inligting oor die finansiële en sosiale kostes van ‘n psigiatriese stoornis in die konteks van armoede te bekom asook die ‘occupational’ strategieë waarvan informante in die hantering van hul omstandighede gebruik gemaak het. Die slotsom van hierdie verhandeling is dat psigiatries gestremde persone wat in die konteks van kroniese armoede ‘n bestaan probeer voer, op paradoksale maniere ‘n bydrae tot die voortbestaan van hul huishoudings lewer. Terwyl hulle siektegedrag die kwesbaarheid van die huishouding van tyd tot tyd laat toeneem, maak hulle nieteenstaande die oorlewing van die huishouding moontlik deur ‘n kombinasie van die volgende bydraes: die verskaffing van bykomende arbeid; die beskikbaarstelling van ‘n ongeskiktheidstoelaag en die produktiewe uitvoering van winsgewende ‘occupations’ in die sogenaamde ‘tweede’ of informele ekonomie. Die individuele, die sosiale en die strukturele is aan mekaar verbonde en beinvloed sodanig wat arm en gestremde mense daagliks in staat is om te doen. Hoe minder materiele komponente en hulpbronne in die ‘occupational form’ beskikbaar is, hoe groter is die inspanning wat benodig word om ‘occupation’ uit te voer en hoe meer afhanklik word die gestremde persoon op die informele sosiale ekonomie. Die teenoorgestelde is ook waar. Die kapasiteit vir aanpasbaarheid, ‘n miskende vorm van agentskap in die konteks van kroniese armoede, maak die bemeestering van beperkte omstandighede moontlik. Die kapasiteit vir aanpasbaarheid is geleë in die vermoë om strategies, prakties en sielkundig te funksioneer. Die studie vergroot die bewustheid van menslike ervarings wat oor die hoof gesien is in die arbeidsterapie en ‘occupational science’ literatuur, veral hoe die basiese beginsels van ‘occupation’ funksioneer in omgewings wat gekenmerk word deur deprivasie en beperkte materiële besittings. Hierdie bydrae tot kennis oor ‘occupation’ sal arbeidsterapiepraktyk en gemeenskaps-gebaseerde psigiatriese dienste toelig asook die insluiting van psigiatries gestremde persone in maatskaplike ontwikkeling bevorder.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/1120
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