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Between death as escape and the dream of life: Psychosocial dimensions of health in young menliving with substance abuse and suicidal behaviour
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Mellom døden som befrielse og drømmen om liv. : Helsens psykososiale dimensjoner hos yngre menn med rusavhengighet og selvmord (Norwegian)
Abstract [en]

Substance abuse and suicidal behaviour are major challenges to public health. These phenomena are mainly studied by quantitative designs. This qualitative thesis aims at gaining a deeper understanding of substance abuse and suicidal behaviour, as experienced by young men in different types of treatment. By describing, exploring and interpreting lived experiences, in this thesis I try to give a more nuanced language of both substance abuse and suicidal behaviour, also in young migrating men. I also focus on the system of services related to the prevention and follow-up of life-threatening overdoses by describing and exploring how this phenomenon is experienced by individuals and professionals in Oslo. By researching the lived experiences of substance abuse and suicidal behaviour, combined with researching the phenomenon of life-threatening overdoses, a deeper insight is gained and this can be an important source to both prevention and health promotion for the group in question. The first three papers are based on descriptive, explorative and interpretative studies. How meaning is constructed is the core research question. In the fourth study I describe and explore life-threatening overdoses as a contemporary phenomenon in its context. The research questions are on a descriptive level. In the first three papers, the research object is the personal narratives from in-depth interviews, which are analysed using a phenomenological hermeneutic method. The case study is composed of data collected from different sources, and analysed by triangulation. The main finding in the first paper is that substance abuse and suicidal behaviour can be understood as goal-oriented, communicative and meaning-making activities about the individuals’ balance between death as an escape from pain and the hope of a life. In the second study, metaphorical expressions about a shifting sense of self is understood as balancing being an agent or a victim. In migrating young men these phenomena are interpreted as goal-oriented, communicative and meanig-making activities about existing in a maze that is perceived as closed. The findings of the case study show that different forms of life-threatening overdoses in Oslo are experienced in a state of existential and material stress. A wish of follow-up might not be expressed by the individual. Due to structural problems, such as lack of goals, professionals do not prevent such events in a planned way, nor do they cooperate between different levels. Professionals decide what is good quality in prevention and follow-up of life-threatening overdoses

Abstract [no]

Rusavhengighet og selvmordsadferd representerer store folkehelseproblemer. Disse fenomenene er hovedsakelig studert med kvantitative design. Målet med denne kvalitative avhandlingen er å få dypere kunnskap om rusavhengighet og selvmordsadferd slik fenomenene er opplevd av yngre menn i ulike typer behandling. Gjennom å beskrive, undersøke og tolke levde opplevelser forsøker avhandlingen å få fram en mer nyansert forståelse av, og språk om, både rusavhengighet og selvmordsadferd, også hos yngre menn med migrasjonserfaring. Avhandlingen fokuserer systemnivået gjennom å beskrive og undersøke hvordan livstruende overdoser oppleves og erfares som levde erfaringer og som yrkesutfordring i Oslo. Et omverdensperspektiv, kombinert med en dypere forståelse og et rikere språk kan være viktige bidrag til forebyggende og helsefremmende tiltak. Det første, andre og tredje arbeidet i avhandlingen er beskrivende, undersøkende og tolkende studier som fokuser yngre menns levde erfaringer med rusavhengighet og selvmordsadferd. Hvordan mening konstrueres er det sentrale forskningsspørsmålet. Det fjerde arbeidet, case studien, undersøker livstruende overdoser i en nå-tidig kontekst, og forskningsspørsmålene er beskrivende. I de første tre arbeidene er forskningsobjektet personlige narrativer samlet gjennom åpne dybdeintervjuer, og som er tolket ved bruk av en fenomenologisk hermeneutisk analyse. I case studien er data fra ulike kilder analysert ved hjelp av triangulering. Hovedfunnet i den første studien er at rusavhengighet og selvmordsadferd kan forstås som måltettede, kommunikative og meningsfulle handlinger om personens balanse mellom døden som befrielse fra smerte og håpet om et bedre liv. I den andre studien kommer metaforiske beskrivelser av en skiftende opplevelse av seg selv i prosessene knyttet til både rusavhengighet og selvmordsadferd tydelig fram. Dette kan forstås som å balansere en selvopplevelse mellom aktør og offer. I den tredje studien kan rusavhengighet og selvmordsadferd hos migrerte menn forstås som målrettede, kommunikative og meningsfulle handlinger om personens opplevelse av å eksistere i en stengt labyrint. Funnene i case studien tyder på at livstruende overdoser i Oslo erfares i eksistensielt stressfulle omstendigheter. Et personlig ønske om oppfølging gis ikke alltid eksplisitt. Strukturelle problemer medfører at profesjonelle arbeider med livstruende overdoser uten overordnete mål og uten samordnet planlegging. Profesjonelle bestemmer derfor selv hva som er god kvalitet når det gjelder forebygging og oppfølging av livstruende overdoser

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2008. , 112 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2008:7
Keyword [en]
Public health science, health, substance abuse, suicidal behaviour, men, migration, qualitative methods, phenomenological hermeneutics, case study, health care services.
Keyword [no]
Folkehelsevitenskap, helse, rusavhengighet, selvmordsadferd, menn, migrasjon, kvalitativ metode, fenomenologisk hermeneutisk analyse, case study, helsetjeneste
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3654ISBN: 978-91-85721-49-8 (print)OAI: oai:DiVA.org:norden-3654DiVA: diva2:785198
Public defence
2008-12-17, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2015-02-02Bibliographically approved
List of papers
1. Metaphors of a shifting sense of self in men recovering from substance abuse and suicidal behavior.
Open this publication in new window or tab >>Metaphors of a shifting sense of self in men recovering from substance abuse and suicidal behavior.
2008 (English)In: Journal of Psychosocial Nursing and Mental Health Services, ISSN 0279-3695, E-ISSN 1938-2413, Vol. 46, no 4, 35-41 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this descriptive study was to explore and interpret men's experience of sense of self within the context of recovery from substance abuse and suicidal behavior. A secondary analysis of data from a previous study of four young Norwegian men revealed how a shifting sense of self was constructed through the use of metaphors. The analysis identified three themes related to the participants' sense of self: The Meaning of Being Isolated, The Meaning of Being Close to the Point of No Return, and The Meaning of Still Being on the Edge. By acknowledging metaphorical expressions as a source of important knowledge, this study reflects on how mental health professionals can use metaphors in the recovery process. As part of the' treatment alliance and therapeutic communication, we suggest that metaphors may aid the assessment of suicidal ideation, promote a sense of a more active self, and signal acceptance and recognition of subjectivity.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3649 (URN)18478807 (PubMedID)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
2. Young men's experiences of living with substance abuse and suicidal behaviour: Between death as an escape from pain and the hope of a life
Open this publication in new window or tab >>Young men's experiences of living with substance abuse and suicidal behaviour: Between death as an escape from pain and the hope of a life
2007 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 4, 246-259 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to illuminate the experiences of suicidal behaviour in young Norwegian men with long-term substance abuse and to interpret their narratives with regard to meaning. Data were collected using open-ended, in-depth interviews. A phenomenological hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the perceived sense of pain and hope in the participants. In the structural analysis, three themes were identified: (1) the meaning of relating, (2) the meaning of reflecting and (3) the meaning of acting. A comprehensive understanding of data indicated that the meaning of living with suicidal behaviour could be understood as a movement between different positions of wanting death as an escape from pain and hope for a better life. Our conclusion is that suicidal behaviour in men with substance abuse is a communicative activity about the individual's lived experience of pain and hope. How the participants experienced and constructed masculinity influenced the suicidal behaviour. To reduce pain and create hope by being seen and confirmed in social relationships, and being helped to verbalize existential thoughts and openly discuss possible solutions, are of importance.

Keyword
Public health, substance abuse, suicidal behaviour, men, hermeneutics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3648 (URN)10.1080/17482620701547008 (DOI)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved
3. Living in a maze: Health, well-being and coping in young non-western men in Scandinavia experiencing substance abuse and suicidal behaviour
Open this publication in new window or tab >>Living in a maze: Health, well-being and coping in young non-western men in Scandinavia experiencing substance abuse and suicidal behaviour
2008 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 4, no 1, 4-16 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to illuminate and interpret the lived experiences of emigration, substance abuse and suicidal behaviour in young non-western men in Scandinavia. The research questions were formulated as: (1) How is meaning constructed in the narratives? (2) What impact do these experiences have on health, well-being and coping? Data were collected using open-ended in-depth interviews. A phenomenological-hermeneutic approach, inspired by the philosophy of Ricoeur, was used to analyse the data. The naïve reading involved awareness of the participants’ perceived sense of insecurity in life. The structural analysis identified three themes: (1) the meaning of getting in a tight spot, (2) the meaning of being in a fog and (3) the meaning of the burning bed. A comprehensive understanding of the data was formulated as “living in a maze”. Ill health involved having a sense of liminality, which impaired one's possibilities to define and re-define goals. Substance abuse and suicidal behaviour were explicit expressions of not being well, when living in a maze that was perceived as closed. Both problem-focused and emotion-focused coping were used by the participants. These provided the motivation for substance abuse and suicidal behaviour.

Keyword
Public health, emigration, substance abuse, suicidal behaviour, hermeneutics, men
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3651 (URN)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved

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