Emerging conversations within oncology have drawn more attention to cancer among young adults (ages 18-45). Recent research has illuminated many of the psychosocial difficulties young adults face as they go through the many trials and tribulations of chronic illness. However, a subject still understudied, much is unclear about the personal as well as the cultural implications of being diagnosed during this period of time. In a book of cancer stories, performer and young adult cancer patient Kairol Rosenthal (2009) expressed her frustration with what she saw as “stereotypes” promulgated by the limited public discourses that exist on the subject (p. 7). She sought to counterbalance these representations with stories capturing the “complexities of our real daily lives” (p. 7). Indeed, in oncological discourses young adults tend to be cast in oversimplified terms, based upon cultural expectations about what young adulthood should be and pressures to conform to those standards. Intersecting with dominant discourses within narrative identity development, two imperatives are placed upon young adults’ stories: integration of different life experiences and selves into a coherent narrative and developing a sense of self-authorship in the direction of one’s life. What seems to be lost in these imperatives within the existing research is what is at stake for individual lives (a phenomenological perspective) and how those stakes are negotiated or contested with hegemonic trajectories of life (a critical perspective). Receptive to Rosenthal’s critique of dominant discourses around cancer and young adulthood, the purpose of this thesis was to explore the complexity and diversity of young adults living with cancer. More specifically, I intended to interrogate some of their existential and biographical challenges as expressed in their narratives of cancer, as well as their engagements with ideological constructions of young adulthood, namely, the expectations of narrative coherence and self-authorship. This research marked a departure from most studies on the subject in its qualitative methodology (i.e., narrative analysis) and in its explicit evaluation of the effects of cultural discourses on young adults’ attempts to make meaning. More generally, this research shows the importance of language—in discourses, narratives, and metaphors—in constructing and communicating illness experiences. For this project, I gathered a mix of written and oral narratives (through semi-structured interviews) from 21 participants from across Canada. The foci of analyses were on what could be called narrative ‘moments of meaning’ and ‘moments of being,’ that is, situated expressions of how they made sense of their worlds and themselves. Many of these were critical moments in the sense of questioning and resisting dominant discourses of cancer and young adulthood. Their moments of meaning often expressed negotiation of personal desires and innovative intentions with familiar cultural narratives or “prototypical plots” (Good, 1994)—including stories of battling cancer, embarking on a life journey, nearing recovery, encountering unpredictability and mystery, and living with chaos. These moments of meaning served an array of purposes well beyond the expected function of constructing a coherent narrative. When telling of identity disruptions and the liminality of cancer, participants produced both more orderly moments of being (e.g., survivor, patient, or warrior identities) and more liminal moments of non-being (e.g., victim, phoenix, or trickster identities). Self-authorship seemed to be present among the former, while the latter expressed less control and certainty of being—which was not always seen as a problem. These moments of being and non-being were collaborated and contested within the intersubjective spaces of their clinical relationships, local worlds, and cancer patient communities. More specific to their age group, their moments of being and non-being often related to what may be understood as developmental identities, including the ‘traditional milestones’ such as individual autonomy, family (i.e., marriage and parenthood), and vocation (i.e., getting an education and building a career). In their struggles they sometimes reaffirmed these cultural ideals toward identity integration and other times resisted them as “normalizing ideologies” (Becker, 1997) of young adulthood. As part of these larger negotiations of meaning and being, the participants expressed struggles to understand the moral significance of their illnesses. Confronted with what may be called “causal ontologies” of suffering (Shweder, 1997), they spoke of different etiological models of cancer’s origins as well as reconciliatory models for living with cancer in the future. Their narratives sometimes led toward “remoralization” (Kleinman, 1988)—couching experiences of suffering in terms of a moral order (narrative coherence) and personal responsibility (self-authorship)—and sometimes led away from it, depending on whether they believed their illnesses originated from events in their personal and social lives. Overall, the participants in this study communicated complex and potentially chronic existential challenges. In many ways their narratives resisted dominant representations of young adults with cancer—and of cancer patients in general—suggesting that such representations need to be rethought. Their critical moments of meaning and being may serve as counternarratives to the stereotypes of concern to Rosenthal and many other cancer patients. Specifically, their narratives revealed the merits and limits of the ideological construction of young adulthood as a time of narrative coherence and self-authorship. This study has important implications for future health research and psychosocial support in the field of oncology; building upon a “narrative medicine” (Charon, 2006), sensitivity to how language is used among young adult cancer patients may lead toward more inclusive clinical practices.

This thesis focuses on the experiences of Vietnamese immigrants and refugees in accessing health care services in Saskatoon. Within Canada, terms such as immigrant and refugee are assigned to reflect the differing circumstances that “newcomers,” i.e. foreign-born residents, arrive under, who are typically classified as either temporary or permanent residents (Gushulak et al. 2011). Research has suggested that newcomers to Canada from non-European countries tend to under-utilize health services (Curtis and MacMinn 2008; Luu, Leung and Nash 2009; O’Mahony and Donnelly 2007; Whitley, Kirmayer and Groleau 2006), while language and cultural differences are cited as barriers to health care (Asanin and Wilson 2008; Gushulak et al. 2011; Kirmayer et al. 1996). Qualitative health research regarding Vietnamese immigrants and refugees in Saskatchewan is currently lacking. The purpose of this study was to elicit a deeper understanding of experiences in accessing health care services through open-ended interviews. A total of 14 interviews were conducted regarding the health care experiences of members of the Vietnamese community in Saskatoon. The aim was to examine the possible socio-cultural determinants affecting the experiences of this study’s participants, to explore whether or not these determinants resulted in health care under-utilization, and to determine areas for future research, particularly, in working to resolve barriers to care for immigrant and refugee groups. Participants iterated the challenges that newcomers face in accessing health care, such as language, cultural, geographical, and socio-economic differences, as identified within the literature. However, the most elaborate responses given by the Vietnamese-born participants in this study were built around references to Vietnam (their country of origin). In particular, they described their experiences in Saskatoon through comparisons of health care and larger socio-economic circumstances in Vietnam. While participants described both positive and negative experiences, the consensus was that health care is generally better in Canada than in Vietnam. This thesis illustrates the value of examining the participants’ descriptions of Vietnam in understanding their experiences with health care in Saskatoon. These findings contribute to a contextual understanding of the socio-cultural determinants affecting the experiences of immigrants and refugees. I follow previous research studies to suggest that the cross-cultural contexts of health and illness need to be continually explored in health research regarding immigrants and refugees.

Thesis advisor: Jane Flanagan / Background: Over the past decade, increasing numbers of emerging adults, defined as ages 18 to 22, have journeyed to the United States (US) from Guatemala, Honduras and El Salvador. Upon arrival to the US, many experience inequities in health and healthcare access. The inequities are shaped by US political practices and choices attributed to broad structural and systemic-level barriers within planetary, social, economic and necropolitical forces. Applying a critical framework of antiracism, anti-oppression and anticolonialism, nurses and other healthcare providers must seek to understand the health patterning and life experiences of emerging adult im/migrants from Guatemala, Honduras, and El Salvador so that their health and healthcare needs may be supported. Approach: This qualitative research project aimed to explore health patterning of emerging adult immigrants from Guatemala, Honduras, and El Salvador using the nursing specific research praxis of Health as Expanding Consciousness (HEC). The second aim explored themes across the group. Critical posthuman, feminist, and new materialist assumptions also informed the approach to the study. Between June 2021 to November 2022 thirteen emerging adult participants from Guatemala and Honduras were interviewed twice. Enrollment occurred through community-based recruitment and snowball sampling methods. Each person’s individual story was explored using the HEC praxis method. Results: Participants’ stories uncovered unique profiles with situated, context-specific individual health patterning. Four themes were identified across stories using the qualitative analytic method of Sort and Sift, Think and Shift: Family is Fundamental, The Journey Holds Meaning, Opportunities Exist Amidst Constraints, and Movement and Art are Healing. Conclusions: The discussion section reviews main implications for building critical nursing praxis; understanding intersections of health, nursing care and human mobility; advancing nursing policy for people excluded from care; advancing research using HEC praxis as a caring act of accompaniment; and transforming nursing education for social justice and radical possibility. Im/migration and asylum-seeking were viewed as fundamental human rights including critically advancing the right to health and safety for people in mobility contexts. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

At the Ottawa Hospital in Ontario, Canada, clinicians use full body immersion virtual reality to treat a variety of health conditions, including: traumatic brain injuries, post- traumatic stress disorder, acquired brain injuries, complex regional pain syndrome, spinal cord injuries, Guillain-Barré syndrome, and lower limb amputations. The system is shared between military and civilian patient populations. Viewed by clinicians and the system’s designers as a value neutral medical technology, clinical virtual reality’s sights, sounds, movements, and smells reveal cultural assumptions about universal patient experiences. In this dissertation I draw from reflexive feminist research methodologies, visual anthropology and sensory ethnography in a hospital to centre the body in current debates about digital accessibility in the 21st Century. 40 in-depth interviews with practitioners and patients, 210 clinical observations, and film and photography ground research participant experiences in day-to-day understandings of virtual reality at the hospital. In this dissertation I address an ongoing absence of the body as a site of analytical attention in anthropological studies of virtual reality. While much literature in the social sciences situates virtual reality as a ‘post-human’ technology, I argue that virtual reality treatments are always experienced, resisted and interpreted through diverse body schemata. Furthermore, virtual reality cannot be decoupled from the sensitivities, socialities and politics of particular bodies in particular places and times. The Ottawa Hospital’s Computer Assisted Rehabilitation Environment (CAREN) system features a digitally enhanced walk-in chamber, treadmills on hydraulic pistons, surround sound audio, advanced graphics and user feedback utilizing force plates and a dynamic infrared motion capture system. The CAREN system utilizes hardware and software reliant on specific assumptions about human bodies. For example, these assumptions are echoed in depictions of race, gender, class, and indigeneity. Patients using virtual reality technologies can experience more than one disability or health condition at a time, further disrupting the idea of universal user experiences. As clinicians and patients confront the limitations of body normativity in the CAREN system’s interface design, they improvise, resist, and experience virtual reality in ways that defy design agendas, ultimately shaping patient treatments and unique paths to healing and health. / Graduate