Thesis advisor: Sharlene N. Hesse-Biber / Sociocultural theorists of eating disorders recurrently investigate anorexia nervosa (AN) through a macro lens of inequality, underscoring thinness as a social construction of beauty and form of cultural capital. Conversely, other scholars attest that focus on AN as a manifestation of idealized body image may, instead, function as a red herring in illness understanding. Taken together, it becomes unclear how to best advance AN research and treatment practices when etiology is uncertain. While researchers largely depend on eating disorder professionals to elucidate AN healing complexities, as an alternative, I utilized a feminist epistemological approach to inquiry in centering individuals with personal AN experience, as another type of AN expert, from whom there is much for researchers to learn. With recognition of health and illness as both private and social experiences, I sought to understand how individuals experience AN and recovery in their everyday lives. I conducted 25 in-depth interviews (article one) and 150 open-ended surveys (articles two, three, and four) with individuals who identified as having had experience with AN. I explored: 1) how respondents understand AN and recovery, and 2) what respondents most want researchers to know about AN and recovery. My aim was not to explain why AN happens, as much as to phenomenologically explore how. In article one, I focused on how individuals experience AN and recovery in everyday self-presentation. A central implication is that AN and recovery can be recognized as interactional accomplishments that are un/successfully “done.” Thus, while conventional portrayals of AN often depict a person with AN looking into a mirror and seeing a distorted perception of their own body, respondents demonstrated how they relied on the interpretations of others to inform their impressions. In article two, I investigated how respondents evaluate weight as a metric of AN recovery. Respondents portrayed weight as a weak criterion, underscoring how it is a physical measure for a mental illness. Yet, respondents simultaneously stressed how weight matters for recovery, given low weight is requisite for support. In effect, respondents pivoted emphasis from weight as a catalyst for AN, to weight as an obstacle to recovery. In article three, respondents articulated how others’ expectations for healing did not always resonate with personal experience. This disjuncture led to treatment strategies that were often incompatible with respondents’ recovery realities. While a single definition of recovery may be useful to researchers, it may paradoxically present disempowering effects for individuals with AN, constituting or exacerbating iatrogenic harm. In article four, respondents further illuminated juxtapositions between clinical and personal definitions of AN healing. Notably, respondents positioned the development of positive relationships with others as among the most efficacious ways to heal. In addition, respondents advocated for recovery criteria that centered personal agency for more individualized and integrative AN healing. Collectively, the article themes overlapped, with AN manifesting as: an identity, role, entity, experience, and status. Ultimately, some respondents felt they had fully recovered from AN. However, most respondents, regardless of illness status, spoke about others’ misunderstandings of AN, which, from their perspectives, collaborated to fashion a masquerade of recovery that immobilized healing. The voices of respondents in the dissertation are profound, as they expose how the validity and legitimacy of their illness experience, as uncertain and negotiable, become the definition of the AN situation. Consequently, AN history remains a composite of social constructions that continually reposition questions of cause, meaning, and blame. The answers to these inquiries,which mold into illness etiologies, shape academic, clinical, conventional, personal, and professional responses. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

The diagnosis of Alzheimer's disease (AD) is stressful for both patients and their family caregivers (FCG). As the disease progresses, the patient's memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. This research examines the impact of the subjective burden with the objective stressors on FCG's depression and to determines which psychosocial resources can be used to either mediate or moderate this relationship. I examine the baseline data that was collected from 670 family caregivers of Alzheimer's patients in the Resources for Enhancing Alzheimer's Caregiver Health (REACH) II clinical trial (REACH II), 2001-2004. The measurements used in the current study are caregivers' background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Three research questions will be investigated in this study: (1) How do the caregivers' background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs'depressive symptoms? (3) How do psychosocial resources mediate and or moderate the relationship between the primary stressors and FCGs'depression experiences? / Master of Science / The diagnosis of Alzheimer’s disease (AD) is stressful for both patients and their family caregivers (FCG). In 2018, an estimated 5.7 million Americans have been diagnosed with Alzheimer’s disease (Alzheimer’s Association 2018). As the disease progresses, the patient’s memory, functioning status, and behavioral problems get worse, and the needs of the patient that must be addressed by family caregivers increase dramatically. As Aneshensel, Carol S., Leonard I. Pearlin, Joseph T. Mullan, Steven H. Zarit, and Carol J. Whitlatch (1995) noted in their book Profiles in Caregiving: The Unexpected Career, the role of caregiving is generally an ‘unexpected job’ for FCGs (Aneshensel et al. 1995). Based on Pearlin’s stress process model (SPM), the primary goal of my thesis is to compare the impact of the subjective burden of caregiving with that of objective stressors on FCG’s depression, and to determine whether psychosocial resources can either mediate or moderate this relationship. Objective stressors refer to the AD patient’s memory and behavior problems, his or her cognitive impairment, self-care activities, and functional status. Subjective burden is the FCG’s emotional response to objective stressors. Objective stressors and subjective burden are associated with each other, and they are primary stressors in the SPM. Psychosocial resources include FCG’s religious coping, their positive experiences of caregiving, their social networks and whether they were satisfied with social support that they received from others. The present study is important for two reasons. First, rather than focusing on subjective burden alone, the model examined how objective stressors (i.e. burden) influence mental health through their impact on subjective burden. Second, previous influential studies of the stressors of caregiving either did not include the moderating effects of psychosocial resources (Pearlin et al., 1999), or included a limited number of resources and found that they did not play a significant role in how caregiving stress influences caregivers mental health (Aneshensel et al. 1995). In my thesis, I will explore both of the mediating and moderating effects of four types of psychosocial resources. I examine the baseline data that was collected from 670 family caregivers of Alzheimer’s patients from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) II clinical trial (REACH II), 2001–2004 (Schulz, Burgio, and Stevens 2006). The study participants target on FCGs who are vulnerable to the caregiving stressors. The purpose of the baseline data was to describe the AD patients’ cognitive impairment and behavior problems at the initial stage of the REACH II study, the demands caused by the impairments imposed upon FCGs, the psychosocial resources adopted by FCGs to relieve the caregiving stress, and the consequences of the primary stressors on FCGs’ daily lives. I will explore three research questions in the current study: (1) How do the caregivers’ background and context factors affect FCGs experiences of objective stressors and subjective burden during the caregiving process? (2) What is the relationship between the objective stressors and subjective burdens, and what impact, if any, do they have on FCGs’ depressive symptoms? (3) How do psychosocial resources mediate or moderate the relationship between the primary stressors and FCGs’ depression experiences? The measurements used in the current study are caregivers’ background and context factors, objective stressors, subjective burden, psychosocial resources, and symptoms of depression. Data analysis is primarily based on multiple linear regression. I will also use the post-hoc probing methods to specifically test the significance of the moderating test. There are four key findings in the present study. First, caregivers’ background and context factors have some significant associations with objective stressors and subjective burden, but overall, their impact is minimal. Second, subjective burden has a stronger impact on depressive symptoms than all of the objective stressors do. Third, subjective burden undermines all four psychosocial resources tested in the current study. Fourth, the mediating and moderating effects of psychosocial resources have a negligible impact in the caregiving stress process. Surprisingly, the effect of subjective burden on depressive symptoms among FCGs remained largely unchanged after all psychosocial resources were included in the model as mediators and moderators. In the mediational test, the effects of subjective burden on depression decreased by only 14 percent after all psychosocial resources were taken into account. Likewise, each of these psychosocial resources had only a negligible effect on moderating the impacts of stressors. The study suggests that unless there is a full understanding of the effects of these stressors on caregivers’ well-being, any interventions or preventive actions will be of limited utility. Future research should pay more attention to exploring the relationships between the subjective burden and objective stressors, and examining their different impacts on FCGs’ depression experience. Additionally, the fact that none of the psychosocial resources have a buffering effect in the caregiving process suggests that there is little in the lives of caregivers that mitigates the deleterious effects of caregiving stress on Alzheimer’s caregivers. Policymakers and mental health providers should consider the stress of caregiving, as reflected in both its objective and subjective aspects, as a major risk factor in the lives of those who care for family members with Alzheimer’s disease. Those factors may play a causal role in caregivers’ mental disorders and suicidal ideation.

This study explored community music therapy as a psychosocial resource for persons living with HIV/AIDS at a clinic in Tshwane, South Africa. The role of community music therapy and its implications in South Africa were addressed as a second aim. A review of the literature on HIV/AIDS suggested that Sub-Saharan Africa has the most reported cases of HIV/AIDS and that persons living with HIV/AIDS may experience a lack of psychosocial resources. These psychosocial resources included inter- and intrapersonal attributes, positive mood and feelings of well-being. The data emerged from transcription of audio and video excerpts of community music therapy sessions, which included live music making and informal interviews during sessions at an HIV/AIDS clinic. These excerpts were transcribed as thick descriptions, coded and categorized to answer the research questions. The four categories were discussed as themes and supported community music therapy as a psychosocial resource for persons living with HIV/AIDS. In the broader South African context, community music therapy is a viable, inexpensive and valuable approach to re-establish community and facilitate psychosocial resources for persons living with HIV/AIDS. / Mini Dissertation (MMus)--University of Pretoria, 2009. / gm2014 / Music / Unrestricted

Aim: The overall aim of this thesis was to illuminate, describe, and promote understanding of women’s experiences of prolonged labour. The thesis compromises four studies. Methods: Paper I describes a case-referent study that recruited women (n = 255) giving singleton live birth to their first child by spontaneous labour after more than 37 completed weeks’ pregnancy. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships, and childhood experiences. Paper II presented a cross-sectional study of 644 women who had been expecting their first child. Participants were asked to complete a questionnaire measuring psychosocial resources (social network and support), work-related psychosocial factors, control of daily life, and health characteristics. Papers III and IV presented interviews performed with 10 women, who, following prolonged labour, had given singleton live birth to their first children. Results: The risk of a negative birth experience was increased for women following prolonged labour. Both women experiencing prolonged and normal labours perceived the support given by their partners and midwives during labour to be very important, and felt pain relief to be a key issue. The suffering experienced during labour was more likely to mark the women for life if the labour was prolonged than if the experience of giving birth was positive and labour was normal. Both women, including those who had and those who had not experienced prolonged labour reported a high level of psychosocial resources, support, and sense of wellbeing in early pregnancy. The difficulties of prolonged labour were interpreted as an experience of being caught up in pain and fear: the women described how they had felt exhausted, powerless, and out of control. They described their dependency on others, and said that the caregiver’s decision to assist with the delivery was experienced as being relieved from pain. Prolonged labour could be understood as an experience of suddenly falling ill or of finding oneself in a life-threatening condition associated with an overwhelming fear of losing oneself and the child. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like “fumbling in the dark”. Women had experienced bodily fatigue accompanied by feelings of illness and detachment from the child. Meeting the child when in this condition entailed a struggle to become a mother. The negativity connected with prolonged labour and a struggle for motherhood may be comparable to the experience of illness and recovery. In spite of these experiences, reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged their interaction and relationship with the child, and contributed to their adaptation to motherhood. Conclusion: Women experiencing prolonged labour require advanced medical and obstetric care, which may limit their ability to participate in making decisions about their care. They have a special need for extra support and encouragement, as well as increased nursing and midwifery care during delivery.

Les recherches actuelles sur la résilience s’intéressent à l’intervention psychoéducative sur les facteurs de risque, en vue de passer d’une résilience naturelle à une résilience assistée : nous considérons la promotion des pratiques de résilience comme un facteur de développement des capacités psychologiques des enfants. Dans ce sens, le milieu scolaire peut constituer un espace d’interactions sociales et avec le soutien de la famille favoriser l’émergence de ressources socio-affectives, cognitives et conatives. Comment les pratiques scolaires peuvent-elles promouvoir la résilience ? Pour répondre à cette question, nous avons travaillé auprès d’un échantillon de 119 enfants à haut risque fréquentant des écoles défavorisées du Pérou. Notre approche méthodologique a pris en compte la perception qu’ont les enseignants et les élèves du climat social scolaire, en particulier des relations entre élèves, des relations entre enseignants, des relations entre élèves et enseignants, de l’organisation, de l’établissement des règles, et du développement d’activités périscolaires. En outre, nous avons identifié les besoins psychosociaux des élèves sur la base de leurs déclarations. Ces analyses nous ont apporté des éléments de réponse qui nous servent à proposer des pratiques psychoéducatives de résilience.Les pratiques psychoéducatives sont réparties en quatre catégories : la salle de classe et l’école, l’école et la famille, les parents et l’enfant, et les besoins psychosociaux de l’enfant/élève. / The research on resilience has focused mainly on psycho educational intervention on risk factors in children. Studying not only "natural resilience" but how "assisted resilience" helps children deal with trauma. This change of strategy suggests that promoting practices of resilience may be a means of developing psychological skills of resilience into children. To that respect, the schools’ social environment, with the help of the family, can be used as a place of interaction that promotes the emergence of social, emotional, cognitive and volitional skills whitin the students. The key question of this study is how schools can include practices that enhance the development of resilience skills into children? To answer this question, we used a sample of 119 high-risk children attending disadvantaged Peruvian schools. Our methodology takes into account the teachers’ and students’ perceptions of the school’s social climate, in particular the relationship among students, among teachers, and between students and teachers, the school’s organization, the establishment of rules, and the development of extracurricular activities. The study also includes the students’ thoughts about their psychosocial needs. The analysis of these elements provides a basis to suggest psychoeducational practices to promote resilience. These psychoeducational practices come into four categories: practices related to the classroom and the school, to the school and the family, to the parents and their children, and to the psychosocial needs of the child/student.

Cette thèse explore les processus soutenant l’action des encadrants en santé au travail. Nous avons utilisé nos terrains d’interventions professionnels auprès d’encadrants d’équipes pour questionner les processus soutenant l’action des encadrants en santé au travail. Une première étude questionne les impasses de la notion de risques psychosociaux pour envisager l’action des encadrants en santé au travail. Puis, une deuxième étude a permis d’interroger l’opérationnalité du concept psychologique du métier et sa dynamique par la discussion du travail avant de tester différents espaces de discussion lors d’une recherche action dans un Etablissement d’Hébergement pour Personnes Agées Dépendantes (EHPAD). L’analyse des résultats de cette troisième étude a fait émerger les résistances à la discussion. Celle-ci nécessite un apprentissage individuel, collectif et organisationnel à la discussion du travail auprès des encadrants, des équipes et des acteurs impliqués en santé au travail (direction, professionnels en santé au travail, partenaires sociaux). Sur la base de ces résultats, nous définissons les conditions que les espaces de discussion, animés par les encadrants, doivent réunir pour développer la santé des équipes. / This thesis explores the processes supporting the action of managers and supervisors on occupational health. We used our experiences of professional interventions with team supervisors to question this issue. A first study questions the impasses of the concept of psychosocial risks to consider the action of managers on occupational health of the team members. Then, a second study investigates the operational concept of the psychological dynamics of the job related to discussion about work. For the third study, we test different management devices through discussion using a research-action methodology in an establishment for elderly dependents (EHPAD). Analysis of the results of this third study brings out the resistance to discussion. This requires individual learning, collective and organizational work for discussion with supervisors, teams and stakeholders involved in health at work (management, health professionals at work, social partners). Based on these results, we define the requirements for discussion spaces and the role of supervisors in order to develop psychological health of team members.