Chronic Fatigue Syndrome (CFS) is a contested condition that generates scepticism and occupies a marginalised position within medical and social contexts. The thesis examines the illness experiences, and specifically the experiences of self, for people affected with CFS. Using qualitative inquiry, a substantive theory related to the process of self-renewal and adaptation associated with CFS is explicated. The theory encompasses the trajectory of CFS from onset to chronicity, and in exceptional instances, recovery. Illness narratives were derived from in-depth, semi-structured interviews of 19 adults, including 16 people affected with, and 3 people recovered from, CFS. Data was coded and analysed using a grounded theory approach. Analysis generated two parallel narratives that defined the illness experience of CFS: the narrative of the illness biographies and the narrative of self, specifically the struggling and diminished self seeking renewal. The illness biographies encompassed the stories of symptoms and their explanations, the encounters that ensued and their contentious milieu. The narrative of self was the primary narrative. It articulated the negative consequences to self and personhood associated with CFS, named the Violation of Self, and the consequent efforts of participants to decrease the struggle and violation by use of the Guardian Response and the Reconstructing Response. The Guardian Response provided protection and self-reclamation. The Reconstructing Response fostered self-renewal and meaning. The two narratives were bridged by the threats of CFS. That is, the illness biographies were accompanied by threats of disruption related to chronic illness, and by threats of invalidation that arose from CFS as a contested condition. In turn, these threats provided the catalyst to the violation and responses as described in the narrative of self. Under different conditions the relative strengths of violation, guardianship or reconstruction fluctuated, and it was these fluctuations that presented the participants with the ongoing struggle of CFS.

Chronic Fatigue Syndrome (CFS) is a contested condition that generates scepticism and occupies a marginalised position within medical and social contexts. The thesis examines the illness experiences, and specifically the experiences of self, for people affected with CFS. Using qualitative inquiry, a substantive theory related to the process of self-renewal and adaptation associated with CFS is explicated. The theory encompasses the trajectory of CFS from onset to chronicity, and in exceptional instances, recovery. Illness narratives were derived from in-depth, semi-structured interviews of 19 adults, including 16 people affected with, and 3 people recovered from, CFS. Data was coded and analysed using a grounded theory approach. Analysis generated two parallel narratives that defined the illness experience of CFS: the narrative of the illness biographies and the narrative of self, specifically the struggling and diminished self seeking renewal. The illness biographies encompassed the stories of symptoms and their explanations, the encounters that ensued and their contentious milieu. The narrative of self was the primary narrative. It articulated the negative consequences to self and personhood associated with CFS, named the Violation of Self, and the consequent efforts of participants to decrease the struggle and violation by use of the Guardian Response and the Reconstructing Response. The Guardian Response provided protection and self-reclamation. The Reconstructing Response fostered self-renewal and meaning. The two narratives were bridged by the threats of CFS. That is, the illness biographies were accompanied by threats of disruption related to chronic illness, and by threats of invalidation that arose from CFS as a contested condition. In turn, these threats provided the catalyst to the violation and responses as described in the narrative of self. Under different conditions the relative strengths of violation, guardianship or reconstruction fluctuated, and it was these fluctuations that presented the participants with the ongoing struggle of CFS.

O objetivo deste estudo foi descrever e analisar os processos de subjetivação inscritos na constituição da experiência de si da/o enfermeira/o, nas práticas assistenciais de um cenário de trabalho exemplar – a Unidade de Terapia Intensiva; submetendo-os ao olhar foucaultiano sobre os regimes de verdade, através do qual pretendeu-se interrogar as condições nas quais a/o enfermeira/o problematiza o que ela/e é. Nos processos de subjetivação, buscamos indagar das tecnologias do eu - jogos de verdade através dos quais a/o enfermeira/o se dá a pensar seu próprio ser, quando se percebe, se reconhece, se julga como tal. O referencial teórico utilizado foi de Michel Foucault, complementado por estudos de Jorge Larrosa sobre os dispositivos de produção e mediação da experiência de si. O local de pesquisa foi a Unidade de Tratamento Intensivo do Hospital Universitário Júlio Muller da rede pública de serviços do Sistema Único de Saúde do município de Cuiabá e o grupo pesquisado foi formado prioritariamente por enfermeiras/os que aí exerciam atividades de assistência em saúde, pois uma vez que as tecnologias do eu constituem dispositivos de reflexividade, nos interessou a experiência de si mesmo da/o enfermeira/o; entretanto, sempre considerando que outros trabalhadores participam desta construção. Os instrumentos técnicos utilizados buscaram apreender as práticas assistenciais em sua materialidade discursiva e não discursiva, buscando selecionar casos e registros exemplares, assim como casos dissonantes destas práticas. A análise dos dados se deu pela construção de diversas grades de pesquisa, produto do olhar sob a materialidade das práticas, das relações de poder entre os sujeitos, das relações do sujeito consigo mesmo, pois a constituição da experiência de si da/o enfermeira/o - como experiência historicamente singular; relaciona campos de discurso, campos de poder e processos de subjetivação. Os dispositivos de produção e mediação da experiência de ser enfermeira/o mostram sua materialidade nas práticas diárias de leitura e de intervenção sobre o corpo/máquina na UTI nos mecanismos nos quais se desenvolveram (e se desenvolvem) competências em torno da objetividade do corpo da clínica e se produziu (e ainda se produz) a experiência de ser, a(o) enfermeira(o), a extensão do olho e do braço médico; nos mecanismos nos quais se apreendeu (e se apreende cotidianamente) a linguagem clínica e se produziu (e ainda se produz) a experiência de ser, a(o) enfermeira(o), um sujeito do discurso Clínico; e também nos mecanismos nos quais se marcou (e se marca) o lugar de cada um, e se produziu (e se produz diariamente) a experiência do lugar de si mesmo, a(o) enfermeira(o), em relação aos outros agentes das práticas na UTI. Nestes mecanismos, segue-se produzindo um olhar profissional, como olhar mais Clínico que Cuidativo; e uma atuação profissional orientada pela Clínica. Na complexidade desta experiência, e de forma contingente a estes dispositivos e mecanismos, está a indagação das possibilidades de governo de si da/o enfermeira/o nos atuais cenários do trabalho / This study aimed describing and analyzing the processes of subjectivity inscribed in the constitution of the nurse’s experience of the self, in the assistance practices of an exemplar work scenery – the Unity of Intensive Therapy; submitting them to a Foucault’s look about the truth regimes, through which the study intended to examine the conditions in which the nurse asks herself/himself what she/he is. In the processes of subjectivity, we try to question the technologies of the self – truth games through which the nurse reflects upon herself/himself, when she/he realizes herself/himself, recognizes herself/himself, judges herself/himself as one. It was used the theoretical referential of Michel Foucault, complemented by studies of Jorge Larrosa about the apparatus of production and mediation of the experience of the self. This research took place at the Unity of Intensive Therapy of the Julio Muller University Hospital, that is a Public Institution of the Unique Health System in Cuiabá. The researched group was constituted, mainly, of nurses who worked with health assistance activities at this University Hospital, once the technologies of the self constitute apparatus of reflexivity, we got interested by the nurse’s experience of the self; however, always considering that other workers participate of this construction. The technical instruments used in this study tried to capture the assistance practices in theirs material discursive sense and also in theirs material not discursive sense, trying to select exemplar cases and registers, as well as discordant cases of these practices. The data analysis was done through the construction of several research boards, which were a result of the look given to the materiality of the practices, of the subject’s power relation, of the subject’s relation with herself/himself, once the constitution of the nurse’s experience of the self – as experience historically singular - relates speech camps, power camps and processes of subjectivity. The production and mediation apparatus of the experience of being nurse show their materiality in the daily practices of reading and intervention upon the body/machine in the UIT in the mechanisms in which they developed (and still develop) competences around the objectivity of the clinic staff and produced (and still produce) the experience of being, the nurse, the extension of the doctor’s eyes and arms; in the mechanisms in which it was captured (and is daily captured) the clinical language and it was produced (and is still produced) the experience of being, the nurse, a subject of the clinical speech; and also in the mechanisms in which it was marked (and is still marked) the place of each one, and it was produced (and is daily produced) the experience of place of herself/himself, the nurse, in relation to the other agents of the practices in the UIT. In these mechanisms, it is observed a production of a professional look, as a look that prefers the clinic instead of the care; and a professional actuation oriented by the clinic. In the complexity of this experience, and in a contingent form to these apparatus and mechanisms, it is the interrogation of the possibilities of the nurse’s Govern of the self in the current work sceneries.

O objetivo deste estudo foi descrever e analisar os processos de subjetivação inscritos na constituição da experiência de si da/o enfermeira/o, nas práticas assistenciais de um cenário de trabalho exemplar – a Unidade de Terapia Intensiva; submetendo-os ao olhar foucaultiano sobre os regimes de verdade, através do qual pretendeu-se interrogar as condições nas quais a/o enfermeira/o problematiza o que ela/e é. Nos processos de subjetivação, buscamos indagar das tecnologias do eu - jogos de verdade através dos quais a/o enfermeira/o se dá a pensar seu próprio ser, quando se percebe, se reconhece, se julga como tal. O referencial teórico utilizado foi de Michel Foucault, complementado por estudos de Jorge Larrosa sobre os dispositivos de produção e mediação da experiência de si. O local de pesquisa foi a Unidade de Tratamento Intensivo do Hospital Universitário Júlio Muller da rede pública de serviços do Sistema Único de Saúde do município de Cuiabá e o grupo pesquisado foi formado prioritariamente por enfermeiras/os que aí exerciam atividades de assistência em saúde, pois uma vez que as tecnologias do eu constituem dispositivos de reflexividade, nos interessou a experiência de si mesmo da/o enfermeira/o; entretanto, sempre considerando que outros trabalhadores participam desta construção. Os instrumentos técnicos utilizados buscaram apreender as práticas assistenciais em sua materialidade discursiva e não discursiva, buscando selecionar casos e registros exemplares, assim como casos dissonantes destas práticas. A análise dos dados se deu pela construção de diversas grades de pesquisa, produto do olhar sob a materialidade das práticas, das relações de poder entre os sujeitos, das relações do sujeito consigo mesmo, pois a constituição da experiência de si da/o enfermeira/o - como experiência historicamente singular; relaciona campos de discurso, campos de poder e processos de subjetivação. Os dispositivos de produção e mediação da experiência de ser enfermeira/o mostram sua materialidade nas práticas diárias de leitura e de intervenção sobre o corpo/máquina na UTI nos mecanismos nos quais se desenvolveram (e se desenvolvem) competências em torno da objetividade do corpo da clínica e se produziu (e ainda se produz) a experiência de ser, a(o) enfermeira(o), a extensão do olho e do braço médico; nos mecanismos nos quais se apreendeu (e se apreende cotidianamente) a linguagem clínica e se produziu (e ainda se produz) a experiência de ser, a(o) enfermeira(o), um sujeito do discurso Clínico; e também nos mecanismos nos quais se marcou (e se marca) o lugar de cada um, e se produziu (e se produz diariamente) a experiência do lugar de si mesmo, a(o) enfermeira(o), em relação aos outros agentes das práticas na UTI. Nestes mecanismos, segue-se produzindo um olhar profissional, como olhar mais Clínico que Cuidativo; e uma atuação profissional orientada pela Clínica. Na complexidade desta experiência, e de forma contingente a estes dispositivos e mecanismos, está a indagação das possibilidades de governo de si da/o enfermeira/o nos atuais cenários do trabalho / This study aimed describing and analyzing the processes of subjectivity inscribed in the constitution of the nurse’s experience of the self, in the assistance practices of an exemplar work scenery – the Unity of Intensive Therapy; submitting them to a Foucault’s look about the truth regimes, through which the study intended to examine the conditions in which the nurse asks herself/himself what she/he is. In the processes of subjectivity, we try to question the technologies of the self – truth games through which the nurse reflects upon herself/himself, when she/he realizes herself/himself, recognizes herself/himself, judges herself/himself as one. It was used the theoretical referential of Michel Foucault, complemented by studies of Jorge Larrosa about the apparatus of production and mediation of the experience of the self. This research took place at the Unity of Intensive Therapy of the Julio Muller University Hospital, that is a Public Institution of the Unique Health System in Cuiabá. The researched group was constituted, mainly, of nurses who worked with health assistance activities at this University Hospital, once the technologies of the self constitute apparatus of reflexivity, we got interested by the nurse’s experience of the self; however, always considering that other workers participate of this construction. The technical instruments used in this study tried to capture the assistance practices in theirs material discursive sense and also in theirs material not discursive sense, trying to select exemplar cases and registers, as well as discordant cases of these practices. The data analysis was done through the construction of several research boards, which were a result of the look given to the materiality of the practices, of the subject’s power relation, of the subject’s relation with herself/himself, once the constitution of the nurse’s experience of the self – as experience historically singular - relates speech camps, power camps and processes of subjectivity. The production and mediation apparatus of the experience of being nurse show their materiality in the daily practices of reading and intervention upon the body/machine in the UIT in the mechanisms in which they developed (and still develop) competences around the objectivity of the clinic staff and produced (and still produce) the experience of being, the nurse, the extension of the doctor’s eyes and arms; in the mechanisms in which it was captured (and is daily captured) the clinical language and it was produced (and is still produced) the experience of being, the nurse, a subject of the clinical speech; and also in the mechanisms in which it was marked (and is still marked) the place of each one, and it was produced (and is daily produced) the experience of place of herself/himself, the nurse, in relation to the other agents of the practices in the UIT. In these mechanisms, it is observed a production of a professional look, as a look that prefers the clinic instead of the care; and a professional actuation oriented by the clinic. In the complexity of this experience, and in a contingent form to these apparatus and mechanisms, it is the interrogation of the possibilities of the nurse’s Govern of the self in the current work sceneries.

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