När smärtan blir en del av livet : Livsomställning vid kronisk sjukdom och funktionshinder

Sammanfattning: The aim of this thesis is to study the life-changing processes necessary when a person is faced with the demands caused by chronic illness or disability. As subjects for the study, women with chronic pain (fibromyalgi and myofascial pain syndrome), were chosen. Eighteen women active in working life were interviewed on two occasions, with an interval of two months. The women have been living with their pain for various periods of time and had reached different points in their life adjustment process. Their life stories have shown how they reason in order to create meaning and coherence in the new life conditions imposed by the pain. The result is summed up in the Life Adjustment Model, which is described in three stages. The model reflects a biographical perspective, i.e. the changing relationship to the past, the present, and the future. Stage I is the period when the self image is seen as threatened and is defended, among other things, by denying the problems. Getting a medical explanation for the state of pain becomes very important in order to proceed with the adjustment work. In Stage II, the pain as a chronic condition has been acknowledged, and the emotional process becomes obvious. Coping strategies are activated. Later in this stage, the self- confidence is restored and strategies are developed to manage to live with the pain. In Stage III, the coping strategies which have been tried in order to handle the psychological stress caused by the pain are stabilised, and they turn into routine adaptation. A maintenance work is developed, which becomes a companion in life in order to tackle and integrate the pain. By thus regarding life adjustment as a long-term process, the meaning of living with one's illness or disability is made clear. It should not be regarded as a finished event. Instead it will become a potential stress factor for the rest of the life. Since these women are active workers, the importance of the rehabilitation situation for the life adjustment process is given special attention in the study. One conclusion is that a holistic rehabilitation (the personal working through process, medical and vocational measures) must be taken into account and co- ordinated in order to make it possible for the life adjustment to proceed.

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