The subject of the present doctoral dissertation is people who, as a result of a traumatic event caused by an injury, development of a disease or medical treatment, acquired a disability. The paper examines the period following a traumatic event. Using case studies of biographical interviews with individuals, I highlight their struggles with the obstacles within themselves and the environmental barriers they face during this period, as well as their dealing with opportunities on their path of recovery, in which initially most people feel helpless, experiencing hopelessness and sometimes also desperation. In our culture, we do not have built-in alternative patterns of behaviour and coping for dealing with such circumstances, as we do for some other types of problems or diseases. When a person becomes ill, he or she temporarily takes on the role of a patient, which brings with it also increased understanding and tolerance from the environment. When a person recovers, treatment of him or her, his or hers rights and obligations are restored to the way they were before one got ill. However, when a person acquires a disability and therewith a permanent diagnostic category, he or she also acquires a permanent and irreversible role of a person with a disability (a formal status of a disabled person or a chronic patient), which also includes an expected and particular treatment from the environment. The aim of the dissertation is not only to seek solutions in the change of the organisation and behaviour of the environment, but also in changing the paradigm or fundamental understanding of the recovery period. To this end, I am using the life course theory as a basic interpretive framework to explore the recovery process of people who are left with a permanent acquired disability following a traumatic event.
The life course theory allows exploration of how relationships, common life transitions, social changes and characteristics of people with whom a person lives and the environment in which a person lives shape his or her life and life course before and after a traumatic event. In exploring disability, the theory takes into account the fact that many conditions and contexts are already established before the disability occurs (in the period between childhood and the time of the traumatic event). These conditions, contexts and experiences determine how the traumatic event and other disability-related life events, as well as all resulting consequences, will integrate into the existing complexity of life and the new identity of the individual as well as his or her social group (family, partnership, living community). In this process, interactions and responses do not necessarily develop in clear, sequential phases, but rather in a fluid and dynamic networked way and in direct interaction with social factors (the culture and socio-economic situation) and environmental aspects (e.g. universal services and equal opportunities) throughout the entire lifetime. Such a complex networked intertwining of elements co-creates different paths of recovery and therefore results in different degrees of acquired disability during the recovery, where not only the degree of physical disability and the disability itself play a role, but also, or especially, the context in which this process takes place.
My study shows that factors related to the recovery following a traumatic event resulting in a permanent disability occur in three main areas, namely (1) the attitude of the environment toward the individual (the context of the person in recovery), (2) health and rehabilitation (forms of help and self-help) and (3) post-traumatic stress and growth (the relationships and neurocognitive processes of the individual). In terms of the attitude of the environment toward the individual, three groups of factors emerge: (1) structural forms of organisations (the structure and construction of social milieu in which help professionals work), (2) people's implicit schemes (the paradigms, concepts, models, mental constructs, social definitions, definitions of people with acquired disabilities) and (3) social care, health care and other social policies (legislation and regulations defining the forms of help and work of organisations and the conceptual and paradigmatic forms of work and the work methods and procedures). In the health and formal rehabilitation category, the factors concerned are (1) professional help, (2) help of significant others and (3) self-initiative and care of one's health. This area concerns the impact of the treatment from professionals, significant others and oneself on the individual. In the category of post-traumatic growth, the experiences of interviewees show five domains of factors related to the recovery process, which, in line with the post-traumatic growth concept, I termed the appreciation of life, personal strength, new possibilities, relating to others and existential and spiritual change. These concern the effects that result from experiencing a traumatic event and the consequences brought about by this event. Interviewees did not experience the traumatic event and its consequences only in a negative, but also a positive way, and they described post-traumatic growth as a development and acquisition of new skills in response to the traumatic event and its consequences. While the traditional theoretical concept of trauma focuses mostly on pathology and the treatment thereof, the experiences of interviewees show that traumatic experiences can be followed by useful adaptations and that through the process of traumatic stress or life transition, a person develops new personality traits, new values, new basic life patterns and a different lifestyle that raises the level of the person's quality of life. Usually, new abilities are developed in the domain of cognition, emotions, functioning in relationships, and often different spiritual and existential values emerge.
The main goal of the doctoral thesis was to gain insight into a life transition, in our case the process of recovery, and to investigate in more detail the factors influencing this process. Through the combination of analysis of relevant literature and gathered empirical data, and application of professional and first-person experiences related to the recovery process, and based on the results of the research, I developed a model of recovery and post-traumatic growth following an acquired disability. The model captures the networked interconnectedness of different factors influencing the course of recovery. It shows multidimensional context, such as parallel processes in different life lines or areas, and temporal processes in different life periods that affect the course of recovery. Parallel processes include interactions as well as independent processes within an individual life area (family or institution, schooling or work, friends, interests, one's body, personality). Temporal processes are synchronous influences (activities and the structure from the present) and diachronic influences (activities and the structure from the past) that affect the recovery process at any moment. The model also includes a turning point (traumatic event), which redirects the life course (“nothing will ever be the way it used to be”). Using the model, various possibilities for transforming a traumatic experience can be elucidated, such as experiential learning and resilience (which learned and the memory of a traumatic event), mental disorders and psychosomatic illnesses or post-traumatic growth.
In my dissertation, I endeavoured to use theories and concepts that have allowed me to gain comprehensive insight into the recovery process and the world of the person in this process during my research, and that will provide this insight also in practice. I am proposing holistic thinking as a transdisciplinary approach, which I hope, the abovementioned model of recovery and post-traumatic growth following an acquired disability will make possible. I propose that this model be used as a common mental framework in the treatment of persons, regardless of the scientific field or profession offering help to people in the period of recovery. In order to provide quality assistance in integrating the person's identity and empowerment for greater autonomy and independence, a person in recovery should be viewed as a whole or holistically, and should be cooperated with by a transdisciplinary team, even though, or precisely because the individual expert operates only on his or her own micro level or specialisation. This would restore humanity to the person and humanness to science.
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