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100112120 Qualitative Portfolio. Mathew Mark Aspey
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Theoretical Critique.
Critically Evaluate the use of
Qualitative Methods in Health
Psychology Research.
Word Count = 1,495 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
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Theoretical Critique.
Critically Evaluate the use of Qualitative Methods in Health Psychology
Research.
Qualitative researchers suggest that in order to fully analyse and
explain behaviour: figures and statistics simply don’t examine behaviour in
enough detail to achieve these goals. The concern of qualitative research is
therefore, meaning, as researchers are interested in how people make sense
of the world and more importantly how they react to situations Bannister,
Burman, Parker, Taylor & Tindall, 1994).
This is particularly important with regards to health psychology,
particularly with regards to chronic illnesses, as it is often the case that patient
experiences differ from case to case. Therefore a much more individual
approach is required in order to fully understand what is like, for the
individual, to experience these conditions.
Unlike quantitative research, which uses statistics to examine the
incidence of a an event in order to establish population norms, qualitative
research delves much deeper by attempting to gain greater understanding of
an event by exploring it within its contextual setting. Finch (1986) suggested,
“Qualitative research is taken to encompass techniques which are not
statistically based, but are especially suited to small-scale analysis, and in
which the researcher gets to know the social world being studied at first hand”
In the case of quantitative research, there is a heavy emphasis on
using statistics and manipulating variables in order to predict behaviour. The
point of qualitative research, however, is to disregard the shackles of
preconceived variables and attempt to describe and explain events, which
occur naturally within the participant’s own environment.
Psychologists in favour of quantitative research may argue that
qualitative research takes “insufficient account of the need for scientific
replication of data” (Morgan, 1996). That is to say that qualitative research
does not adhere to the criteria, which must always be met when conducting
‘scientific research’. The main focus of this argument rests on the lack of
reliability found qualitative research; whereas quantitative researchers can
100112120 Qualitative Portfolio. Mathew Mark Aspey
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settle disagreements over data by looking at the objectivity provided by
statistics, qualitative researchers, however, to produce the same
interpretations of subjective ‘opinions’ expressed within their data (Morgan,
1998).
Qualitative researchers, on the other hand, suggest that ‘objective
reality’, as proposed by Morgan (1996), is unattainable. They suggest that
qualitative research provides understanding of the human mind, whilst taking
into account the changeability of the social world (Cooper and Stevenson,
1998). Furthermore, Burt and Oaksford (1999) suggested that the ‘scientific
methods’ of quantitative research tend to focus on areas where “theories can
be can be built, tested and applied”. Quantitative research, therefore, ignores
areas that are not easily grafted to objective methods. Qualitative research
provides a much more tangible method of investigating such areas.
There are many advantages to using qualitative research with regards
to Health Psychology. Qualitative research brings much insight into the field
as it enables researchers to gain understanding of health issues that in most
cases are highly specific to the individual. Quantitative research approaches
health research as though all sufferers of respective illnesses share the same
experiences with may be predicted and manipulated. Qualitative research
shows that this is often not the case, the symptoms of illnesses may be
largely generalisable across patient populations, but it is often the case that
people’s interpretation and understanding of their symptoms can vary greatly.
Qualitative research provides patients with a platform on which to voice their
experiences so that greater understanding may be gained.
With regards to healthy behaviours, there have been many models
developed in order to predict the likelihood that people will engage in specific
behaviours, such as the Theory of Planned Behaviour. The success of these
models can be measured statistically using quantitative research. Qualitative
methods investigate behaviour in great detail, with the use of subjective
information, in order to gain the individual’s perspective and attitudes, which
can often be the driving force in most behaviour. This can therefore be used
to help researchers investigate why some models may be more successful at
predicting healthy behaviours than others within different health settings.
100112120 Qualitative Portfolio. Mathew Mark Aspey
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The data gained from qualitative research is highly rich in detail and
topics may often come out of the research that the researcher may not have
thought of. Therefore the use of qualitative methods may be used in order to
explore health issues in greater detail and perhaps identify new avenues of
research, which may enhance our understanding further.
With regards to debilitating illnesses, it may be the case that an elderly
person who is house bound, will experience very different emotional and
psychological responses than a much younger person, who may have bills to
pay and a family to provide for. Quantitative research may find it difficult to
account for this, particularly in cases where illnesses, such as Parkinson’s
Disease (PD), where the vast majority of sufferers are elderly. The individual
nature of qualitative research takes into account the context in which
behaviour is occurring, in order to account for these issues of under-
representation within research.
In spite of these many advantages to the use of qualitative methods,
there are still many quantitative psychologists who remain sceptical about its
validity as a robust methodology. This is mostly due to the many drawbacks
relating to conducting qualitative research.
Qualitative research can often be extremely time consuming,
particularly with regards to research that employs interview methodologies,
whereby data must be transcribed and subsequently analysed. As a result of
this, they can also prove to be rather expensive to administer due to the
extensive labour that must be implemented on the part of the researcher,
whom may often require a research assistant in order to share in the process
of transcription.
Qualitative research often proves to be rather difficult to replicate, this
is largely due to the fact that it deals with highly personal and individual
experiences that they may become difficult to apply to other participants who
may have different experiences with the same illness. This is a common
phenomenon with degenerative diseases such as PD whereby one patient
may experience tremors along with bradykinesia and muscle rigidity, another
patient may experience bradykinesia and muscle rigidity but have absolutely
no experience of the tremors. This will inevitably make it difficult to make
100112120 Qualitative Portfolio. Mathew Mark Aspey
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assertions towards all PD patients based upon the testimony of a few
individual’s.
Due to the intensity of the information being gathered, along with the
aforementioned constraints upon time and resources, it is much more
practical to conduct qualitative research using very small sample sizes. This
makes it extremely problematic when attempting to generalise the findings to
a population based upon individual accounts.
With regards to the methods in which qualitative data is collected, it is
commonly upheld that researcher biases are built-in and therefore are often
unavoidable in many cases. Qualitative research can often become a
collaborative effort between the researcher and participant. In order to gain
the most detailed information possible, researchers may ask questions that
may steer the conversation towards certain points that the researcher is trying
to investigate in greater detail.
It is important, for the advancement of qualitative research, that all
research conducted in this area is conducted in the correct, robust manner.
Lincoln and Guba (1985) suggested four main criteria for producing valid
qualitative research: Credibility (accurate representations of the participant’s
perspective), Transferability (producing findings that are not only specific to
the context in which they are found), Dependability (reliability, taking into
account contextual changes) and Confirmability (minimising researcher bias
in the interpretation of data). Looking at these criteria, it is clear that there is
great importance on qualitative research representing it’s participants in an
accurate manner as inaccurate representations could then lead to us having
an inaccurate understanding of the subject. This could potentially be harmful
to the reputation of qualitative research.
Silverman (1993) stated that “… methods and methodologies aren’t
true or false, good or bad, rather they are more or less useful dependent upon
the aim of the research.” This suggests that there is air of futility in trying to
argue for one method being better than the other, it is therefore much more
beneficial to select the research method that would provide the most useful
information with regards to the research aims.
To conclude, in many cases it may be beneficial to collaborate the use
of qualitative and quantitative measures in a symbiotic relationship in order to
100112120 Qualitative Portfolio. Mathew Mark Aspey
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attain maximum information about behaviour, as each method is appropriate
to different phases of research. In support of this, Nicholson (1995) stated that
when qualitative research is conducted well it is “as scientific as quantitative
psychology” and that employing the use of both techniques in their respective
settings, “is more likely to enhance understanding of the issues being
investigated than hinder them”.
These differing methods of research may help guide one another in
delving much deeper into health issues, quantitative data may be used in
order to map out specific questions which may be tackled in greater depth
using qualitative data and likewise, qualitative research may be employed in
order to produce pilot data, which may then guide qualitative data collection.
Word Count = 1,495 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
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References.
 Bannister, P., Burman, E., Parker, I., Taylor, M. & Tindall, C. (1994).
Qualitative Methods in Psychology: A Research Guide. Buckingham,
Open University Press.
 Burt, K. & Oaksford, M. (1999). Qualitative methods: Beyond beliefs
and desires. The Psychologist, 12, 332-335.
 Cooper, N. & Stevenson, C. (1998). Qualitative research: ‘New
science’ and psychology. The Psychologist, 11, 484-485.
 Finch, J. (1986). Research and Policy: The Uses of Qualitative
Methods in Social and Educational Research. Falmer Press. 1986.
 Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Newbury Park,
CA: Sage Publication
 Morgan, M. J. (1996). Qualitative research: A package deal? The
Psychologist, 9, 31-32.
 Morgan, M. J. (1998). Qualitative research: Science or pseudo-
science? The Psychologist, 11, 481-483; (& the Postscript, p. 488)
 Nicholson, P. (1995). Qualitative research, psychology and mental
health: analysing subjectivity. Journal of Mental Health, 4, 337-345.
 Silverman, D. (1993). Interpreting Qualitative Data. Methods for
Analyzing Talk Text and Interaction. Sage. London. 1993.
100112120 Qualitative Portfolio. Mathew Mark Aspey
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Completed Analysis.
“The Gift that Keeps on Taking”: A
Young Man’s Experience of Being
Diagnosed with Young Onset
Parkinson’s Disease whilst Living in
the public Spotlight.
Word count = 2,441 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
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“The Gift that Keeps on Taking”: A Young Man’s Experience of Being
Diagnosed with Young Onset Parkinson’s Disease whilst Living in the
public Spotlight.
Method: -
Data Collection: -
An extract was used from the book, ‘Lucky Man: A Memoir’ by Michael
J. Fox; in which he describes his experiences with Young Onset Parkinson’s
Disease (YOPD), from dealing with the initial diagnosis through to living with
the disease and having to adapt to it’s symptoms.
Participant: -
At the beginning of the extract, Michael is a thirty-one year old
Hollywood actor at the height of his movie career. He has a wife and an infant
son and a promising future ahead of him until he is diagnosed with
Parkinson’s Disease. The extract chronicles his journey from the initial
diagnosis, through periods of denial, anger, depression and escapism, to the
point where he is beginning to accept his condition and deal with it
constructively. As the extract is taken from the participant’s autobiography,
which has been published for the purpose of public viewing, it is not
necessary to protect anonymity throughout this analysis.
Procedure: -
An extract from pages 140 – 181 was analysed using Interpretative
Phenomenological Analysis (Smith, 1996a, 1999). The extract was read and
re-read numerous times in order to gain an in-depth understanding of the
writer’s account. The process used was identical to that used by Bramley and
Eatough (2004). During this process, the researcher made notes of any points
they found interesting and produced their own interpretation of what was
being said and picked out relevant quotations from the text in order to
highlight these interpretations. These quotes were then coded invivo, using
examples from the text e.g. quotes that related to solitude were coded under
the heading ‘Solitude’. These were then listed and grouped together in order
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to produce Sub-ordinate Themes; these are clusters of quotes, which may
share a common theme, e.g. quotations that shared commonalities were
clustered in order to form sub-ordinate themes such as solitude and self-
loathing. These sub-ordinate themes were then listed and grouped together
further in order to create Super-ordinate Themes, which are clusters of
themes, which may share a similar topic of interest, e.g. the sub-ordinate
themes; ‘Solitude’ and ‘Self-loathing’ are clustered in order to form the super-
ordinate theme; ‘Isolation’. A master table was produced in order to show the
link between quotations and themes within their designated sections (as
shown in Table 1).
Findings: -
Table 1: Quotations and their emerging themes throughout the extract: -
Super-
ordinate
Themes
Sub-ordinate
Themes
Quotations Page Line
1. Denial 1. Avoidance 1. “colossal mistake” 141 9
2. “reasons to disqualify myself” 141 27
3. “hadn’t (…) surrendered my denial” 147 16
4. “defy the odds (…) magically
disappearing”
147 20
5. “threw myself into a maniacal fitness
regime”
153 9
6. “(…) plotted ways to busy myself (…)” 163 19
7. “don’t I pay someone to take care of this” 167 16
8. “if I cant fix it, I don’t even want to talk
about it”
179 32
2. Alcoholism 1. “when I was drunk, it was all a little easier
to ignore”
156 35
2. “(…) ally in my struggle (…) yet another
adversary”
160 14
2. Distress 1. Fear 1. “I was losing my franchise” 146 24
2. “exasperation, frustration and fear were
my only companions”
147 27
3. “was I really ready for life without
anesthesia?
161 26
4. “fear-based agenda” 162 32
5. “afraid to leave my artificial womb” 170 8
6. “a little boy who’d rather die than admit
how scared he was”
175 5
7. “my anxiety was liquid” 176 2
100112120 Qualitative Portfolio. Mathew Mark Aspey
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8. “would you love me if you knew I’m afraid
(…) about the future?”
180 21
2. Career
worries
1. “PD was going to rob me (…) as an actor” 153 24
3. Anger 1. “pissed off at the guy (…) fate was mine” 141 21
2. “acceptance didn’t come without flashes
of anger and pain”
177 31
3. “I would punch (…) until I raised bruises” 177 33
4. “no one was to blame (…) project that
onto everyone else”
180 27
3. Isolation 1. Solitude 1. “drinking was now about isolation and self
medication”
155 18
2. “the distance that my behaviour was
opening (…) frightened me “
156 26
3. “you don’t understand” 156 31
4. “I was still isolating myself (…) turmoil that
I could not comprehend”
163 11
5. “our deepening emotional distance” 163 16
6. “no, I’ll get through this on my own” 168 33
7. “the bath tub became my refuge, my
hiding place”
169 24
8. “I sure as hell didn’t want company” 170 25
9. “bad enough I had allowed PD to own me,
(…) I had made them slaves to it as well”
180 3
2. Guilt 1. “I put a lot of pressure on a four year old
(…)”
171 24
3. Self
Loathing
1. “disappoint my family and myself” 170 9
2. “”does she still love me?” and if she did,
“how is that possible?””
171 18
4. Hiding
Parkinson’s
Disease
1. “keep anyone else from noticing” 150 9
2. “the good news was, now I could hide it” 150 27
3. “even as I was growing sicker, (…)
healthier than ever”
153 33
4. Labelling
as PD
Sufferer
1. Labelled As
Parkinson’s
Sufferer
1. “forever be locked into a prognosis” 146 5
2. “my most trying personal experience
reduced to a common laundry list (…)”
146 13
2. Identifying
Other
Sufferers
1. “I observed what seemed like millions of
people with symptoms (…)”
142 14
2. “I tried to remember (…) might have been
affected”
143 7
5. Positive
Steps
1. Taking
Control
1. PD’s brutal assumption of authority (…)
still have sovereignty”
160 23
100112120 Qualitative Portfolio. Mathew Mark Aspey
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2. “I did, indeed, need help and was ready to
accept it”
161 22
3. “thankfully, something deed inside would
not allow me to quit”
174 31
4. “I didn’t have to hide in the bath tub
anymore”
177 8
5. “claim my Parkinson’s diagnosis” 177 30
6. “it came down to showing up for my life
(…)”
181 7
2. Finding
Direction
1. “(…) accounting of where I was in my life
(…)”
164 9
2. “I could find some peace, or (…) where to
turn next”
171 3
3. “getting results” 176 17
4. “I made a commitment to it” 176 32
5. “scheduled an appointment myself” 178 3
6. “beginning to accept my diagnosis” 181 3
3. Finding
Peace
1. “the only reward I sought was relief” 174 23
2. “(…) freed me up to live the rest of my
life”
177 2
3. “rediscovering the shower” 177 11
4. information helped chip away at my
uncertainty and sense of isolation”
178 29
6. Support 1. Support
Network
1. “she, along with an ever-widening circle of
friends (…) live a life without alcohol”
162 1
2. “no red flags warning me that my trust
had been misplaced”
176 25
3. “Sam’s going to love being a big brother” 181 17
2. Asking For
Help
1. “I have a drinking problem (…) if you
know somebody I could talk to (…)”
161 9
2. “I just couldn’t handle this by myself any
more”
172 3
3. Vulnerability 1. “this time I didn’t have a clue where to
start”
174 26
2. “find myself this beaten down and
vulnerable”
174 29
3. “little boy who’d rather die than admit how
scared he was”
175 5
4. “defenceless, as if all my skin had been
peeled away”
176 6
Analysis: -
The following analysis explores Michael’s personal experience of
Parkinson’s Disease (PD), via the in-depth exploration of one of the six super-
ordinate themes that emerged. This is theme of ‘Distress’. This theme
illustrates his emotional state throughout the period immediately following his
diagnosis and incorporates sub-ordinate themes such as ‘Fear’, Career
Worries’ and ‘Anger’.
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Distress: -
Fear: -
When first presented with the news that he has PD, Michael’s first
reaction is fear. When faced with serious illnesses that will inevitably change
their lives, people often go through what is generally considered a textbook
process of coming to terms with their condition. In order to describe this
process, Kübler-Ross (1969) developed a definitive model, ‘The Grief Cycle’,
consisting of five stages: Denial/ Isolation, Anger, Bargaining, Depression and
finally Acceptance. It suggests that when faced with a period of intense grief,
people go through these stages before arriving at the acceptance stage. This
is illustrated throughout the extract. During the period after being diagnosed,
he often reports feeling afraid as he struggles to cope with the implications of
being diagnosed with PD. On page 147, line 27, he says: -
“exasperation, frustration and fear were my only
companions in those early days”
Describing these feelings as his ‘only companions’ suggests that there
is a sense of feeling alone here. In these early days, he has little
understanding of PD or what to expect as it progresses. He rationalises that if
he didn’t fully understand what was happening to him, then how could he
expect anyone else to. At this stage, it appears as though he has resigned
himself to the fact that this is his problem and his alone, which he must deal
with himself. Martinez-Martin (1998) suggested that the frustrations caused by
PD are heavy burdens for both the patient and their family to bear.
Up until this point, Michael enjoyed a fairly active lifestyle. At the time
of his diagnosis, he is a high profile actor in his early thirties with a wife and
young son to take care of. It may be due to this situation that he reports his
fears towards the prospect of not being able to perform the tasks that he is
used to performing, both in his family life and his professional life. With
regards to his family life, it is clear that he doesn’t know how to tell his wife
that he is afraid; he feels that he must be the strong, patriarch of the family.
He now faces the prospect that one day his condition will prevent him
from providing for his family in the same way that they have become
100112120 Qualitative Portfolio. Mathew Mark Aspey
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accustomed, is a huge blow to his masculinity and sense of pride. Gerschick
and Miller (1995) suggest that, when faced with chronic illness or disability,
men are caught between the pressure of dominant masculinity and the
limitations they face as a result of their illness. They suggest that in order to
come to terms with the illness, men must reconcile the pressures of
masculinity with the limitations of the illness. He feels as though he has let his
wife and infant son down and his fear of confirming these suspicions only
serve to fuel these fears. On page 180, line 21, he says: -
“questions like, “does my being sick make you afraid?
Are you disappointed that I’m different now from when
you married me? Are you worried about the future?
would you love me if you knew I’m afraid, I’m
disappointed, I’m worried about the future?” all went
unasked”.
Michael is projecting his own feelings and fears onto his wife. His fears
of what she must be thinking about him appear to be escalated by his
reluctance to address them and discuss them with her. This reluctance is a
result of him being afraid to ask her about her feelings in case his fears are
confirmed; she thinks he is weak, doesn’t love him the same as a result of his
situation, or is disappointed by the man that he has become.
As a way of protecting himself from having to face this, he builds a sort
of self-contained bubble of solitude around himself, which, for him, provides a
sort of womb-life comfort in order to protect him from facing the prospect of
his own inadequacy. On page 169, line 24 he says: -
“the bath tub became my refuge, my hiding place”
On page 170, line 8, he describes his constant desire to hide himself
from the world and stay in the safety and comfort of his bathtub for hours and
hours: -
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“afraid to leave my artificial womb, to go outside
where I could only cause trouble, disappoint my
family and myself. Best, I thought, to stay right here
where I couldn’t fuck anything up”
Here he has established a safe place where he can hide away from all
the disappointment and expectations from his family, as he is sure that if he
attempts to engage in any form of normalcy that he is certain to ‘fuck it up’.
Because he is so reluctant to stray from the sanctity of his ‘artificial womb’, his
fears about disappointing people are never really put at ease and the longer
he distances himself from his loved ones, the stronger his fears and ultimately
his depression becomes. There is a vast body of research into the
relationship between depression and PD; it is becoming evermore apparent
that depression and anxiety share co-morbidity with PD, with great
speculation regarding whether or not depression is in fact a symptom of PD
due to the effects of neuro-degeneration. Research has shown prevalence in
up to 40% of PD patients (Walsh and Bennett, 2001).
Career worries: -
With regards to his professional life, before having PD, he was enjoying
a high point in his movie career. So when he was diagnosed, he began to
worry that the success that he had worked so hard for and the career he had
built over the years was about to be swept from under him. On page 146, line
24, he says: -
“I wasn’t just losing my brain, I was losing my franchise”
This suggests that he is in a state of panic about the loss of control he
will eventually have over his body, but also the impact this will have on his
‘franchise’; his credibility as an actor. Along with his credibility, PD would also
affect his actual ability to act, as many of the symptoms involve either
involuntary tremor throughout various parts of the body along with diminished
deliberate movements in other areas, particularly in the facial muscles. PD is
a “chronic degenerative neurological ailment” (Bensing et al, 1998) Young
100112120 Qualitative Portfolio. Mathew Mark Aspey
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Onset Parkinson’s Disease (YOPD) is the disease that develops in people
under the age of 40. The symptoms of PD include tremor, bradykinesia
(poverty of movement), postural instability, muscular rigidity, and diminished
facial movement, these are known as cardinal symptoms and are common
across all ages. With regards to YOPD, sustained abnormal posturing is also
common, although tremors are uncommon, when they are present, they can
be much more troublesome than in older patients. These physical symptoms,
which would be difficult to disguise, would make a high profile movie career
difficult to maintain. On page 153, line 24, he says: -
“PD was going to rob me of the ability to work in front of
the camera as an actor”
This fear is also compounded by the fact that he has a young family to
provide for; losing his credibility would mean losing the security that he was
striving to provide for them in the future. In order to combat this, he begins to
set up deals that would ensure him well-paid work in exchange for sacrificing
his creative talent. This is described on page 152, line 4: -
“I could simply try to repeat myself, and pray lightening
would strike twice. This meant chasing my tail, playing it
safe by doing formulaic romantic comedies that had a
shot at doing blockbuster business.”
He later realises that this was not healthy practice in coming to terms
with his condition. On page 162, line 32, he describes his recovery from
alcoholism and how he would use his victories gained from not drinking to
distract himself from having to deal with his condition: -
“I was still pursuing the same fear-based agenda that
had gotten locked into place in the days following my
diagnosis”
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He was merely replacing the distraction that alcoholism provided with
the distraction of sobriety. Although his behaviour was, outwardly, a much
more positive step, with regards to the bigger picture he was still hiding from
his disease. In acting out of fear, in both these cases, he was actually causing
more damage to his professional, as well as his personal life, than would
have been caused by PD alone.
Anger: -
In the early days of his diagnosis, Michael reports a great deal of
anger, some of which he aimed towards the diagnosing doctor. After a long
period of denial, convinced that he had been given an incorrect diagnosis, due
to perhaps an error in the tests or just plain incompetence on the doctor’s
part. Once he began coming to terms with the prospect that he had PD, he
refused to follow up with the diagnosing doctor as a way of ‘shooting the
messenger’. On page 141, line 21, he says: -
“I was plain pissed off at the guy for having the balls
to suggest such a fate was mine”
Due to his somewhat meteoric rise to fame, Michael was not used to
things not going his way and it is easy to become accustomed to that sort of
lifestyle. He, therefore, found it difficult to come to terms with what he
describes as “the ultimate no”. In his initial state of shock at his diagnosis, he
needed to be able account for his anger in some way. Therefore his anger
was indirectly placed upon this doctor, and he would require a second and
third opinion in order to reveal his ‘colossal mistake’.
He discusses how his anger was not aimed at anyone in particular, he
didn’t feel the need to blame someone, moreover, he felt betrayed by life; that
this had happened to him. This began to affect his relationships with the
people closest to him. On page 180, line 27, he says: -
“no one was to blame for my disease, not even
myself, yet it left me with a sense of betrayal – and
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in time, I came to project that onto everyone else,
even the person closest to me”
He didn’t feel like the people in his life had betrayed him, but that life
itself had somehow turned its back on him, leaving him with nothing but
anguish. This bitterness towards life spilled out into his interactions with
people until his feelings of betrayal became projected onto his loved ones,
making it seem as though he was blaming everyone else for his condition.
Throughout the extract, Michael takes the reader on a journey down his
road towards coming to accept himself as a sufferer of PD. Even when he
finally does accept that this is his life and it was actually happening to him,
this realisation was met with great anger and emotional pain. On page 177,
line 31, he says: -
“acceptance didn’t come without flashes of anger
and pain, psychic as well as physical”
The physical pain that Michael is experiencing becomes a great source
of emotional pain for him, as the symptoms of PD are so persistent and
continuous, it is difficult for him to find distraction from them, which became a
source of frustration for him.
As his anger was generally not aimed towards anyone in particular, it
was often the case that in his frustration he would direct his anger inward, or
more directly, at the manifestations of the disease. On page 177, line 33,
when recounting his sessions with his psychologist, he recalls her observation
of how he would deal with his symptoms at that stage: -
“when my arm would tremor violently during
sessions, I would punch it with my clenched fist –
sometimes pummelling it until I raised bruises”
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- 19 -
This suggests a great deal of frustration at his inability to control his
own body. The fact that he is displaying this behaviour in front of a third party
may suggest that he was perhaps embarrassed by this as he is willing to
engaged in somewhat desperate behaviour in order to stop these symptoms
from occurring by allowing his anger to manifest itself into violence towards
his PD. In this case the trembling arm is the representation of his entire
disease and he is releasing his anger upon the representation of his disease
as a whole.
In summary, it may be postulated that Michael went through what may
be considered to be ‘text book’ reaction to the initial diagnoses of a major
chronic disease such as PD. Based on the accounts he gives within the
extract, it may be the case that his particular reaction had been exacerbated
by his extremely high profile at the time, along with the pressure that come
with that status.
His journey through PD was not an easy one by any means, the extract
suggests that he was on the verge of, if not in fact having, a nervous
breakdown when faced with the prospect of his happy, successful life being
taken away from him. His journey to acceptance required him to hit rock
bottom in many respects, as he had to face losing the things that really
mattered to him, such as his family, to make him realise that what he thought
he was losing was not all that important in the wider picture than he’d initially
thought.
Word Count = 2,441 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 20 -
References.
 Bramley, N. & Eatough, V. (2005). The experience of living with
Parkinson’s disease: An interpretative phenomenological analysis case
study. Psychology and Health, 20(2): 223–235
 Fox, M. J. (2002). Lucky Man: A Memoir. London: Edbury Press.
 Gerschick, T. J. & Miller. A. S. (1995). Coming to Terms: Masculinity
and Physical Disability. In Sabo, D. & Gordon, D. F. Men’s Health and
Illness: Gender, Power, and the Body. (eds). Pp. 183–204. Thousand
Oaks: Sage.
 Kübler-Ross, E. On Death and Dying. Macmillan, NY, 1969. Retrieved
on Tuesday 6th January 2009 from
http://changingminds.org/disciplines/change_management/kubler_ross/
kubler_ross.htm
 Martínez-Martín, P. (1998) An introduction to the concept of “quality of
life in Parkinson’s disease”. Journal of Neurology, 245, S2–S6.
 Reese, S. Young-Onset Parkinson's Disease Information & Referral
Center. American Parkinson Disease Association. Retrieved on
Tuesday 6th January 2009 from
http://www.yopa.org/page/page/1702947.htm
 Schreurs, K. M. G., De Ridder, D. T. D. & Bensing, J. M. (2000). A one-
year study of coping, social support and quality of life in Parkinson’s
Disease. Psychology and Health, 15, 109-121.
 Smith, J. A. (1996a). Beyond the divide between cognition and
discourse: Using interpretative phenomenological analysis in health
psychology. Psychology and Health, 11, 261–271.
 Smith, J. A., Jarman, M., & Osborn, M. (1999). Doing interpretative
phenomenological analysis. In: Murray M., & Chamberlain K. (Eds.),
Qualitative health psychology: Theories and methods, (pp. 219–240).
London: Sage.
 Walsh, K. & Bennett, G. (2001). Parkinson's disease and anxiety.
Postgraduate Medical Journal, 77, 89-93.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 21 -
Ethical Discussion.
Discussion of Ethical Issues
Involved in Conducting
Qualitative Research.
Word Count = 724 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 22 -
Discussion of Ethical Issues Involved in Conducting
Qualitative Research.
When conducting qualitative research, there are many ethical issues
that must be taken into consideration. Ethical guidelines are in place in order
to protect participants, to ensure that the research that psychologist conduct
does not put them at any risk of either physical or psychological harm. With
regards to psychological research, the British Psychological Society (BPS)
lays out ethics, in this country. The BPS requests that all research proposals
are presented before an ethics committee, who must then approve of its
methodologies before any research may be administered.
Ethical guidelines request that researchers always obtain consent from
participants and in cases where it is possible, informed consent must also be
obtained. This is to ensure that participants are aware of the purpose of the
research and fully consent to the use of their results within the research
findings. When obtaining consent, it is also important to give the participant
the right to withdraw from the study at any time they choose. If a participants
requests to withdraw after they have provided data, then it is important that
researchers either hand all copies of their data back to them or allow them to
witness the data being destroyed.
In some cases, it may be absolutely essential for the participants to
mislead their participants in some way. Here, it is important for researchers to
make the study as ethically sound as possible, to ensure that the participant
does not feel uneasy about participating once they are informed of the actual
purpose retrospectively. It is also very important to debrief participants, in
order to let them know the exact purpose of the research, as well as what the
research found and how their data contributed to the overall findings.
It is also important to ensure that participants are granted anonymity
within the research data, particularly in the case of qualitative interviews,
where participants may be divulging highly sensitive and personal information
about themselves. It is therefore important to ensure that participants may not
be identified in any way from their data, this may involve allocating them an
anonymous participation number and taking out any information that may
reveal their identity.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 23 -
Finally, and perhaps most important of, is ensuring the safety of
participants at all times. This can be achieved by ensuring that none of the
question asked will be particularly upsetting to them, this is particularly
important when studying health issues such as illness. Health and safety risk
assessments must be completed to ensure that participants do not find
themselves in an environment in which they may incur physical harm also.
With regards to the research that I conducted; the semi-structured
interview regarding general health issues and the media critique, there were
many ethical issues that I had to take into account.
In the case of the media critique, I used an autobiography, which had
been published for public reading. It was therefore unnecessary to ensure
anonymity, as the writer intended the information to be viewed by the general
public. Had the information have been gleaned from a health discussion
forum, it would have been important to gain consent as people write in forums
under the understanding that they are sharing their experiences with other
sufferers and therefore do not expect their information to be viewed by people
outside of that population. It was also unnecessary to ensure confidentiality,
as the information was a story that the writer had decided to share with the
world prior to my using it within my research.
In the case of the interview, I was sure to obtain fully informed consent
from the participant, who was completely aware of their right to withdraw from
the study. The questions that were asked were general inquiries about what
they considered to be a healthy lifestyle, and the responses were more or less
participant driven so there was no way that the questioning could cause any
psychological harm in any way. The participant was also allowed to listen to
the recording of their interview and read through the transcript and was happy
that they had not been misrepresented in any way. The participant was also
given complete anonymity as their transcripts were coded with an anonymous
participation number, which only I was aware of and all distinguishing
statements, if any, were removed from the transcript.
Word Count = 724 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 24 -
Reflective Account.
Reflection and Reflexivity on
the Experience of Conducting
Qualitative Research.
Word Count = 722 words.
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 25 -
Reflection and Reflexivity on the Experience of Conducting
Qualitative Research.
When I was given the assessment criteria for this qualitative portfolio, I
wasn’t sure what I’d have like to research or how I would research it. In
honesty I found myself acting rather tentatively to whole process, I wasn’t
really that familiar with conducting qualitative research, and the few times that
I had, I never really enjoyed it, or was particularly interested in it for that
matter.
I knew that for the interview piece, I wanted to conduct a semi-
structured interview focusing just on general aspects of a healthy lifestyle, I
didn’t really have a particular research question in mind at this point, I was
more interested in seeing what kind of topics came out of the interview when
a participant was given a wide scope, in order to generate their own idea of
what a healthy lifestyle entails. I knew the participant very well and have
interviewed her for a project before so I was aware that she would provide he
with very detailed answers.
The media article, I knew that this would be a lot trickier. I started to
look around the Internet for media articles and forum discussions, but nothing
really struck my interest. I also felt somewhat uncomfortable with the whole
idea of ‘lurking’ and taking strangers accounts without any form of
participation or consent on their part. I have, however, been interested in
Parkinson’s Disease for quite some time now and a forum discussion I found
was related to this topic. Although I was not particularly engaged by the
discussion, it made me think back to a couple of years ago when I read an
autobiography by Michael J. Fox, in which he recounts, in great detail, his
experience with Parkinson’s Disease. So I thought it would be very interesting
for me if I used an extract from the book to investigate Parkinson’s Disease
from the personal perspective of one patient.
I found this much easier to use as research, as I was using an extract
from a book which had been published, and which I had bought myself. This
was not a random patients experience that they had decided to share with a
group of fellow patients, in an effort to gain their own understanding of their
illness. This was a global celebrity who had decided to she his experience
100112120 Qualitative Portfolio. Mathew Mark Aspey
- 26 -
with the whole world, in an attempt to raise public awareness of an illness that
affects so many, but gets so little attention.
I decided to conduct an Interpretative Phenomenological Analysis (IPA)
on the extract, as I felt this would be most appropriate given the vast amount
of information I was dealing with. As I re-read the extracts for the first time, I
began to realise just how raw, and detailed account it actually was. I quickly
began to build a picture of the many themes that were present within the text
and how they were relevant to what I wanted to find. I found it quite amazing
to discover how the words in the text were beginning to guide me research, as
I initially assumed that my research question would guide the themes that I
would take out of the text.
As I began pulling themes out of the text, I decided that it would be
more appropriate, to base my research on his experience during the period
following his initial diagnosis and how that effected him, being in the spotlight.
I found it very interesting to see how the research evolves as more and
more themes emerge and become grouped together, it is almost as though
you see yourself progressing as a qualitative researcher, as your research
points become stronger. I think that conducting this kind of analysis made the
assessment much more interesting for me as I felt it enabled me to really
engage with the subject matter. This something that my past experience with
qualitative methods has lacked.
As I read through my finished analysis, I feel as though I had become
deep immersed in the subject, it’s clear that I found it to be engaging. Before
conducting this piece of research, I was not at all confident with qualitative
research. I now feel like my ability to conduct research in this area has grown
much stronger.
Word Count = 722 words.

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qualitative portfolio

  • 1. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 1 - Theoretical Critique. Critically Evaluate the use of Qualitative Methods in Health Psychology Research. Word Count = 1,495 words.
  • 2. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 2 - Theoretical Critique. Critically Evaluate the use of Qualitative Methods in Health Psychology Research. Qualitative researchers suggest that in order to fully analyse and explain behaviour: figures and statistics simply don’t examine behaviour in enough detail to achieve these goals. The concern of qualitative research is therefore, meaning, as researchers are interested in how people make sense of the world and more importantly how they react to situations Bannister, Burman, Parker, Taylor & Tindall, 1994). This is particularly important with regards to health psychology, particularly with regards to chronic illnesses, as it is often the case that patient experiences differ from case to case. Therefore a much more individual approach is required in order to fully understand what is like, for the individual, to experience these conditions. Unlike quantitative research, which uses statistics to examine the incidence of a an event in order to establish population norms, qualitative research delves much deeper by attempting to gain greater understanding of an event by exploring it within its contextual setting. Finch (1986) suggested, “Qualitative research is taken to encompass techniques which are not statistically based, but are especially suited to small-scale analysis, and in which the researcher gets to know the social world being studied at first hand” In the case of quantitative research, there is a heavy emphasis on using statistics and manipulating variables in order to predict behaviour. The point of qualitative research, however, is to disregard the shackles of preconceived variables and attempt to describe and explain events, which occur naturally within the participant’s own environment. Psychologists in favour of quantitative research may argue that qualitative research takes “insufficient account of the need for scientific replication of data” (Morgan, 1996). That is to say that qualitative research does not adhere to the criteria, which must always be met when conducting ‘scientific research’. The main focus of this argument rests on the lack of reliability found qualitative research; whereas quantitative researchers can
  • 3. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 3 - settle disagreements over data by looking at the objectivity provided by statistics, qualitative researchers, however, to produce the same interpretations of subjective ‘opinions’ expressed within their data (Morgan, 1998). Qualitative researchers, on the other hand, suggest that ‘objective reality’, as proposed by Morgan (1996), is unattainable. They suggest that qualitative research provides understanding of the human mind, whilst taking into account the changeability of the social world (Cooper and Stevenson, 1998). Furthermore, Burt and Oaksford (1999) suggested that the ‘scientific methods’ of quantitative research tend to focus on areas where “theories can be can be built, tested and applied”. Quantitative research, therefore, ignores areas that are not easily grafted to objective methods. Qualitative research provides a much more tangible method of investigating such areas. There are many advantages to using qualitative research with regards to Health Psychology. Qualitative research brings much insight into the field as it enables researchers to gain understanding of health issues that in most cases are highly specific to the individual. Quantitative research approaches health research as though all sufferers of respective illnesses share the same experiences with may be predicted and manipulated. Qualitative research shows that this is often not the case, the symptoms of illnesses may be largely generalisable across patient populations, but it is often the case that people’s interpretation and understanding of their symptoms can vary greatly. Qualitative research provides patients with a platform on which to voice their experiences so that greater understanding may be gained. With regards to healthy behaviours, there have been many models developed in order to predict the likelihood that people will engage in specific behaviours, such as the Theory of Planned Behaviour. The success of these models can be measured statistically using quantitative research. Qualitative methods investigate behaviour in great detail, with the use of subjective information, in order to gain the individual’s perspective and attitudes, which can often be the driving force in most behaviour. This can therefore be used to help researchers investigate why some models may be more successful at predicting healthy behaviours than others within different health settings.
  • 4. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 4 - The data gained from qualitative research is highly rich in detail and topics may often come out of the research that the researcher may not have thought of. Therefore the use of qualitative methods may be used in order to explore health issues in greater detail and perhaps identify new avenues of research, which may enhance our understanding further. With regards to debilitating illnesses, it may be the case that an elderly person who is house bound, will experience very different emotional and psychological responses than a much younger person, who may have bills to pay and a family to provide for. Quantitative research may find it difficult to account for this, particularly in cases where illnesses, such as Parkinson’s Disease (PD), where the vast majority of sufferers are elderly. The individual nature of qualitative research takes into account the context in which behaviour is occurring, in order to account for these issues of under- representation within research. In spite of these many advantages to the use of qualitative methods, there are still many quantitative psychologists who remain sceptical about its validity as a robust methodology. This is mostly due to the many drawbacks relating to conducting qualitative research. Qualitative research can often be extremely time consuming, particularly with regards to research that employs interview methodologies, whereby data must be transcribed and subsequently analysed. As a result of this, they can also prove to be rather expensive to administer due to the extensive labour that must be implemented on the part of the researcher, whom may often require a research assistant in order to share in the process of transcription. Qualitative research often proves to be rather difficult to replicate, this is largely due to the fact that it deals with highly personal and individual experiences that they may become difficult to apply to other participants who may have different experiences with the same illness. This is a common phenomenon with degenerative diseases such as PD whereby one patient may experience tremors along with bradykinesia and muscle rigidity, another patient may experience bradykinesia and muscle rigidity but have absolutely no experience of the tremors. This will inevitably make it difficult to make
  • 5. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 5 - assertions towards all PD patients based upon the testimony of a few individual’s. Due to the intensity of the information being gathered, along with the aforementioned constraints upon time and resources, it is much more practical to conduct qualitative research using very small sample sizes. This makes it extremely problematic when attempting to generalise the findings to a population based upon individual accounts. With regards to the methods in which qualitative data is collected, it is commonly upheld that researcher biases are built-in and therefore are often unavoidable in many cases. Qualitative research can often become a collaborative effort between the researcher and participant. In order to gain the most detailed information possible, researchers may ask questions that may steer the conversation towards certain points that the researcher is trying to investigate in greater detail. It is important, for the advancement of qualitative research, that all research conducted in this area is conducted in the correct, robust manner. Lincoln and Guba (1985) suggested four main criteria for producing valid qualitative research: Credibility (accurate representations of the participant’s perspective), Transferability (producing findings that are not only specific to the context in which they are found), Dependability (reliability, taking into account contextual changes) and Confirmability (minimising researcher bias in the interpretation of data). Looking at these criteria, it is clear that there is great importance on qualitative research representing it’s participants in an accurate manner as inaccurate representations could then lead to us having an inaccurate understanding of the subject. This could potentially be harmful to the reputation of qualitative research. Silverman (1993) stated that “… methods and methodologies aren’t true or false, good or bad, rather they are more or less useful dependent upon the aim of the research.” This suggests that there is air of futility in trying to argue for one method being better than the other, it is therefore much more beneficial to select the research method that would provide the most useful information with regards to the research aims. To conclude, in many cases it may be beneficial to collaborate the use of qualitative and quantitative measures in a symbiotic relationship in order to
  • 6. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 6 - attain maximum information about behaviour, as each method is appropriate to different phases of research. In support of this, Nicholson (1995) stated that when qualitative research is conducted well it is “as scientific as quantitative psychology” and that employing the use of both techniques in their respective settings, “is more likely to enhance understanding of the issues being investigated than hinder them”. These differing methods of research may help guide one another in delving much deeper into health issues, quantitative data may be used in order to map out specific questions which may be tackled in greater depth using qualitative data and likewise, qualitative research may be employed in order to produce pilot data, which may then guide qualitative data collection. Word Count = 1,495 words.
  • 7. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 7 - References.  Bannister, P., Burman, E., Parker, I., Taylor, M. & Tindall, C. (1994). Qualitative Methods in Psychology: A Research Guide. Buckingham, Open University Press.  Burt, K. & Oaksford, M. (1999). Qualitative methods: Beyond beliefs and desires. The Psychologist, 12, 332-335.  Cooper, N. & Stevenson, C. (1998). Qualitative research: ‘New science’ and psychology. The Psychologist, 11, 484-485.  Finch, J. (1986). Research and Policy: The Uses of Qualitative Methods in Social and Educational Research. Falmer Press. 1986.  Lincoln, YS. & Guba, EG. (1985). Naturalistic Inquiry. Newbury Park, CA: Sage Publication  Morgan, M. J. (1996). Qualitative research: A package deal? The Psychologist, 9, 31-32.  Morgan, M. J. (1998). Qualitative research: Science or pseudo- science? The Psychologist, 11, 481-483; (& the Postscript, p. 488)  Nicholson, P. (1995). Qualitative research, psychology and mental health: analysing subjectivity. Journal of Mental Health, 4, 337-345.  Silverman, D. (1993). Interpreting Qualitative Data. Methods for Analyzing Talk Text and Interaction. Sage. London. 1993.
  • 8. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 8 - Completed Analysis. “The Gift that Keeps on Taking”: A Young Man’s Experience of Being Diagnosed with Young Onset Parkinson’s Disease whilst Living in the public Spotlight. Word count = 2,441 words.
  • 9. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 9 - “The Gift that Keeps on Taking”: A Young Man’s Experience of Being Diagnosed with Young Onset Parkinson’s Disease whilst Living in the public Spotlight. Method: - Data Collection: - An extract was used from the book, ‘Lucky Man: A Memoir’ by Michael J. Fox; in which he describes his experiences with Young Onset Parkinson’s Disease (YOPD), from dealing with the initial diagnosis through to living with the disease and having to adapt to it’s symptoms. Participant: - At the beginning of the extract, Michael is a thirty-one year old Hollywood actor at the height of his movie career. He has a wife and an infant son and a promising future ahead of him until he is diagnosed with Parkinson’s Disease. The extract chronicles his journey from the initial diagnosis, through periods of denial, anger, depression and escapism, to the point where he is beginning to accept his condition and deal with it constructively. As the extract is taken from the participant’s autobiography, which has been published for the purpose of public viewing, it is not necessary to protect anonymity throughout this analysis. Procedure: - An extract from pages 140 – 181 was analysed using Interpretative Phenomenological Analysis (Smith, 1996a, 1999). The extract was read and re-read numerous times in order to gain an in-depth understanding of the writer’s account. The process used was identical to that used by Bramley and Eatough (2004). During this process, the researcher made notes of any points they found interesting and produced their own interpretation of what was being said and picked out relevant quotations from the text in order to highlight these interpretations. These quotes were then coded invivo, using examples from the text e.g. quotes that related to solitude were coded under the heading ‘Solitude’. These were then listed and grouped together in order
  • 10. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 10 - to produce Sub-ordinate Themes; these are clusters of quotes, which may share a common theme, e.g. quotations that shared commonalities were clustered in order to form sub-ordinate themes such as solitude and self- loathing. These sub-ordinate themes were then listed and grouped together further in order to create Super-ordinate Themes, which are clusters of themes, which may share a similar topic of interest, e.g. the sub-ordinate themes; ‘Solitude’ and ‘Self-loathing’ are clustered in order to form the super- ordinate theme; ‘Isolation’. A master table was produced in order to show the link between quotations and themes within their designated sections (as shown in Table 1). Findings: - Table 1: Quotations and their emerging themes throughout the extract: - Super- ordinate Themes Sub-ordinate Themes Quotations Page Line 1. Denial 1. Avoidance 1. “colossal mistake” 141 9 2. “reasons to disqualify myself” 141 27 3. “hadn’t (…) surrendered my denial” 147 16 4. “defy the odds (…) magically disappearing” 147 20 5. “threw myself into a maniacal fitness regime” 153 9 6. “(…) plotted ways to busy myself (…)” 163 19 7. “don’t I pay someone to take care of this” 167 16 8. “if I cant fix it, I don’t even want to talk about it” 179 32 2. Alcoholism 1. “when I was drunk, it was all a little easier to ignore” 156 35 2. “(…) ally in my struggle (…) yet another adversary” 160 14 2. Distress 1. Fear 1. “I was losing my franchise” 146 24 2. “exasperation, frustration and fear were my only companions” 147 27 3. “was I really ready for life without anesthesia? 161 26 4. “fear-based agenda” 162 32 5. “afraid to leave my artificial womb” 170 8 6. “a little boy who’d rather die than admit how scared he was” 175 5 7. “my anxiety was liquid” 176 2
  • 11. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 11 - 8. “would you love me if you knew I’m afraid (…) about the future?” 180 21 2. Career worries 1. “PD was going to rob me (…) as an actor” 153 24 3. Anger 1. “pissed off at the guy (…) fate was mine” 141 21 2. “acceptance didn’t come without flashes of anger and pain” 177 31 3. “I would punch (…) until I raised bruises” 177 33 4. “no one was to blame (…) project that onto everyone else” 180 27 3. Isolation 1. Solitude 1. “drinking was now about isolation and self medication” 155 18 2. “the distance that my behaviour was opening (…) frightened me “ 156 26 3. “you don’t understand” 156 31 4. “I was still isolating myself (…) turmoil that I could not comprehend” 163 11 5. “our deepening emotional distance” 163 16 6. “no, I’ll get through this on my own” 168 33 7. “the bath tub became my refuge, my hiding place” 169 24 8. “I sure as hell didn’t want company” 170 25 9. “bad enough I had allowed PD to own me, (…) I had made them slaves to it as well” 180 3 2. Guilt 1. “I put a lot of pressure on a four year old (…)” 171 24 3. Self Loathing 1. “disappoint my family and myself” 170 9 2. “”does she still love me?” and if she did, “how is that possible?”” 171 18 4. Hiding Parkinson’s Disease 1. “keep anyone else from noticing” 150 9 2. “the good news was, now I could hide it” 150 27 3. “even as I was growing sicker, (…) healthier than ever” 153 33 4. Labelling as PD Sufferer 1. Labelled As Parkinson’s Sufferer 1. “forever be locked into a prognosis” 146 5 2. “my most trying personal experience reduced to a common laundry list (…)” 146 13 2. Identifying Other Sufferers 1. “I observed what seemed like millions of people with symptoms (…)” 142 14 2. “I tried to remember (…) might have been affected” 143 7 5. Positive Steps 1. Taking Control 1. PD’s brutal assumption of authority (…) still have sovereignty” 160 23
  • 12. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 12 - 2. “I did, indeed, need help and was ready to accept it” 161 22 3. “thankfully, something deed inside would not allow me to quit” 174 31 4. “I didn’t have to hide in the bath tub anymore” 177 8 5. “claim my Parkinson’s diagnosis” 177 30 6. “it came down to showing up for my life (…)” 181 7 2. Finding Direction 1. “(…) accounting of where I was in my life (…)” 164 9 2. “I could find some peace, or (…) where to turn next” 171 3 3. “getting results” 176 17 4. “I made a commitment to it” 176 32 5. “scheduled an appointment myself” 178 3 6. “beginning to accept my diagnosis” 181 3 3. Finding Peace 1. “the only reward I sought was relief” 174 23 2. “(…) freed me up to live the rest of my life” 177 2 3. “rediscovering the shower” 177 11 4. information helped chip away at my uncertainty and sense of isolation” 178 29 6. Support 1. Support Network 1. “she, along with an ever-widening circle of friends (…) live a life without alcohol” 162 1 2. “no red flags warning me that my trust had been misplaced” 176 25 3. “Sam’s going to love being a big brother” 181 17 2. Asking For Help 1. “I have a drinking problem (…) if you know somebody I could talk to (…)” 161 9 2. “I just couldn’t handle this by myself any more” 172 3 3. Vulnerability 1. “this time I didn’t have a clue where to start” 174 26 2. “find myself this beaten down and vulnerable” 174 29 3. “little boy who’d rather die than admit how scared he was” 175 5 4. “defenceless, as if all my skin had been peeled away” 176 6 Analysis: - The following analysis explores Michael’s personal experience of Parkinson’s Disease (PD), via the in-depth exploration of one of the six super- ordinate themes that emerged. This is theme of ‘Distress’. This theme illustrates his emotional state throughout the period immediately following his diagnosis and incorporates sub-ordinate themes such as ‘Fear’, Career Worries’ and ‘Anger’.
  • 13. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 13 - Distress: - Fear: - When first presented with the news that he has PD, Michael’s first reaction is fear. When faced with serious illnesses that will inevitably change their lives, people often go through what is generally considered a textbook process of coming to terms with their condition. In order to describe this process, Kübler-Ross (1969) developed a definitive model, ‘The Grief Cycle’, consisting of five stages: Denial/ Isolation, Anger, Bargaining, Depression and finally Acceptance. It suggests that when faced with a period of intense grief, people go through these stages before arriving at the acceptance stage. This is illustrated throughout the extract. During the period after being diagnosed, he often reports feeling afraid as he struggles to cope with the implications of being diagnosed with PD. On page 147, line 27, he says: - “exasperation, frustration and fear were my only companions in those early days” Describing these feelings as his ‘only companions’ suggests that there is a sense of feeling alone here. In these early days, he has little understanding of PD or what to expect as it progresses. He rationalises that if he didn’t fully understand what was happening to him, then how could he expect anyone else to. At this stage, it appears as though he has resigned himself to the fact that this is his problem and his alone, which he must deal with himself. Martinez-Martin (1998) suggested that the frustrations caused by PD are heavy burdens for both the patient and their family to bear. Up until this point, Michael enjoyed a fairly active lifestyle. At the time of his diagnosis, he is a high profile actor in his early thirties with a wife and young son to take care of. It may be due to this situation that he reports his fears towards the prospect of not being able to perform the tasks that he is used to performing, both in his family life and his professional life. With regards to his family life, it is clear that he doesn’t know how to tell his wife that he is afraid; he feels that he must be the strong, patriarch of the family. He now faces the prospect that one day his condition will prevent him from providing for his family in the same way that they have become
  • 14. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 14 - accustomed, is a huge blow to his masculinity and sense of pride. Gerschick and Miller (1995) suggest that, when faced with chronic illness or disability, men are caught between the pressure of dominant masculinity and the limitations they face as a result of their illness. They suggest that in order to come to terms with the illness, men must reconcile the pressures of masculinity with the limitations of the illness. He feels as though he has let his wife and infant son down and his fear of confirming these suspicions only serve to fuel these fears. On page 180, line 21, he says: - “questions like, “does my being sick make you afraid? Are you disappointed that I’m different now from when you married me? Are you worried about the future? would you love me if you knew I’m afraid, I’m disappointed, I’m worried about the future?” all went unasked”. Michael is projecting his own feelings and fears onto his wife. His fears of what she must be thinking about him appear to be escalated by his reluctance to address them and discuss them with her. This reluctance is a result of him being afraid to ask her about her feelings in case his fears are confirmed; she thinks he is weak, doesn’t love him the same as a result of his situation, or is disappointed by the man that he has become. As a way of protecting himself from having to face this, he builds a sort of self-contained bubble of solitude around himself, which, for him, provides a sort of womb-life comfort in order to protect him from facing the prospect of his own inadequacy. On page 169, line 24 he says: - “the bath tub became my refuge, my hiding place” On page 170, line 8, he describes his constant desire to hide himself from the world and stay in the safety and comfort of his bathtub for hours and hours: -
  • 15. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 15 - “afraid to leave my artificial womb, to go outside where I could only cause trouble, disappoint my family and myself. Best, I thought, to stay right here where I couldn’t fuck anything up” Here he has established a safe place where he can hide away from all the disappointment and expectations from his family, as he is sure that if he attempts to engage in any form of normalcy that he is certain to ‘fuck it up’. Because he is so reluctant to stray from the sanctity of his ‘artificial womb’, his fears about disappointing people are never really put at ease and the longer he distances himself from his loved ones, the stronger his fears and ultimately his depression becomes. There is a vast body of research into the relationship between depression and PD; it is becoming evermore apparent that depression and anxiety share co-morbidity with PD, with great speculation regarding whether or not depression is in fact a symptom of PD due to the effects of neuro-degeneration. Research has shown prevalence in up to 40% of PD patients (Walsh and Bennett, 2001). Career worries: - With regards to his professional life, before having PD, he was enjoying a high point in his movie career. So when he was diagnosed, he began to worry that the success that he had worked so hard for and the career he had built over the years was about to be swept from under him. On page 146, line 24, he says: - “I wasn’t just losing my brain, I was losing my franchise” This suggests that he is in a state of panic about the loss of control he will eventually have over his body, but also the impact this will have on his ‘franchise’; his credibility as an actor. Along with his credibility, PD would also affect his actual ability to act, as many of the symptoms involve either involuntary tremor throughout various parts of the body along with diminished deliberate movements in other areas, particularly in the facial muscles. PD is a “chronic degenerative neurological ailment” (Bensing et al, 1998) Young
  • 16. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 16 - Onset Parkinson’s Disease (YOPD) is the disease that develops in people under the age of 40. The symptoms of PD include tremor, bradykinesia (poverty of movement), postural instability, muscular rigidity, and diminished facial movement, these are known as cardinal symptoms and are common across all ages. With regards to YOPD, sustained abnormal posturing is also common, although tremors are uncommon, when they are present, they can be much more troublesome than in older patients. These physical symptoms, which would be difficult to disguise, would make a high profile movie career difficult to maintain. On page 153, line 24, he says: - “PD was going to rob me of the ability to work in front of the camera as an actor” This fear is also compounded by the fact that he has a young family to provide for; losing his credibility would mean losing the security that he was striving to provide for them in the future. In order to combat this, he begins to set up deals that would ensure him well-paid work in exchange for sacrificing his creative talent. This is described on page 152, line 4: - “I could simply try to repeat myself, and pray lightening would strike twice. This meant chasing my tail, playing it safe by doing formulaic romantic comedies that had a shot at doing blockbuster business.” He later realises that this was not healthy practice in coming to terms with his condition. On page 162, line 32, he describes his recovery from alcoholism and how he would use his victories gained from not drinking to distract himself from having to deal with his condition: - “I was still pursuing the same fear-based agenda that had gotten locked into place in the days following my diagnosis”
  • 17. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 17 - He was merely replacing the distraction that alcoholism provided with the distraction of sobriety. Although his behaviour was, outwardly, a much more positive step, with regards to the bigger picture he was still hiding from his disease. In acting out of fear, in both these cases, he was actually causing more damage to his professional, as well as his personal life, than would have been caused by PD alone. Anger: - In the early days of his diagnosis, Michael reports a great deal of anger, some of which he aimed towards the diagnosing doctor. After a long period of denial, convinced that he had been given an incorrect diagnosis, due to perhaps an error in the tests or just plain incompetence on the doctor’s part. Once he began coming to terms with the prospect that he had PD, he refused to follow up with the diagnosing doctor as a way of ‘shooting the messenger’. On page 141, line 21, he says: - “I was plain pissed off at the guy for having the balls to suggest such a fate was mine” Due to his somewhat meteoric rise to fame, Michael was not used to things not going his way and it is easy to become accustomed to that sort of lifestyle. He, therefore, found it difficult to come to terms with what he describes as “the ultimate no”. In his initial state of shock at his diagnosis, he needed to be able account for his anger in some way. Therefore his anger was indirectly placed upon this doctor, and he would require a second and third opinion in order to reveal his ‘colossal mistake’. He discusses how his anger was not aimed at anyone in particular, he didn’t feel the need to blame someone, moreover, he felt betrayed by life; that this had happened to him. This began to affect his relationships with the people closest to him. On page 180, line 27, he says: - “no one was to blame for my disease, not even myself, yet it left me with a sense of betrayal – and
  • 18. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 18 - in time, I came to project that onto everyone else, even the person closest to me” He didn’t feel like the people in his life had betrayed him, but that life itself had somehow turned its back on him, leaving him with nothing but anguish. This bitterness towards life spilled out into his interactions with people until his feelings of betrayal became projected onto his loved ones, making it seem as though he was blaming everyone else for his condition. Throughout the extract, Michael takes the reader on a journey down his road towards coming to accept himself as a sufferer of PD. Even when he finally does accept that this is his life and it was actually happening to him, this realisation was met with great anger and emotional pain. On page 177, line 31, he says: - “acceptance didn’t come without flashes of anger and pain, psychic as well as physical” The physical pain that Michael is experiencing becomes a great source of emotional pain for him, as the symptoms of PD are so persistent and continuous, it is difficult for him to find distraction from them, which became a source of frustration for him. As his anger was generally not aimed towards anyone in particular, it was often the case that in his frustration he would direct his anger inward, or more directly, at the manifestations of the disease. On page 177, line 33, when recounting his sessions with his psychologist, he recalls her observation of how he would deal with his symptoms at that stage: - “when my arm would tremor violently during sessions, I would punch it with my clenched fist – sometimes pummelling it until I raised bruises”
  • 19. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 19 - This suggests a great deal of frustration at his inability to control his own body. The fact that he is displaying this behaviour in front of a third party may suggest that he was perhaps embarrassed by this as he is willing to engaged in somewhat desperate behaviour in order to stop these symptoms from occurring by allowing his anger to manifest itself into violence towards his PD. In this case the trembling arm is the representation of his entire disease and he is releasing his anger upon the representation of his disease as a whole. In summary, it may be postulated that Michael went through what may be considered to be ‘text book’ reaction to the initial diagnoses of a major chronic disease such as PD. Based on the accounts he gives within the extract, it may be the case that his particular reaction had been exacerbated by his extremely high profile at the time, along with the pressure that come with that status. His journey through PD was not an easy one by any means, the extract suggests that he was on the verge of, if not in fact having, a nervous breakdown when faced with the prospect of his happy, successful life being taken away from him. His journey to acceptance required him to hit rock bottom in many respects, as he had to face losing the things that really mattered to him, such as his family, to make him realise that what he thought he was losing was not all that important in the wider picture than he’d initially thought. Word Count = 2,441 words.
  • 20. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 20 - References.  Bramley, N. & Eatough, V. (2005). The experience of living with Parkinson’s disease: An interpretative phenomenological analysis case study. Psychology and Health, 20(2): 223–235  Fox, M. J. (2002). Lucky Man: A Memoir. London: Edbury Press.  Gerschick, T. J. & Miller. A. S. (1995). Coming to Terms: Masculinity and Physical Disability. In Sabo, D. & Gordon, D. F. Men’s Health and Illness: Gender, Power, and the Body. (eds). Pp. 183–204. Thousand Oaks: Sage.  Kübler-Ross, E. On Death and Dying. Macmillan, NY, 1969. Retrieved on Tuesday 6th January 2009 from http://changingminds.org/disciplines/change_management/kubler_ross/ kubler_ross.htm  Martínez-Martín, P. (1998) An introduction to the concept of “quality of life in Parkinson’s disease”. Journal of Neurology, 245, S2–S6.  Reese, S. Young-Onset Parkinson's Disease Information & Referral Center. American Parkinson Disease Association. Retrieved on Tuesday 6th January 2009 from http://www.yopa.org/page/page/1702947.htm  Schreurs, K. M. G., De Ridder, D. T. D. & Bensing, J. M. (2000). A one- year study of coping, social support and quality of life in Parkinson’s Disease. Psychology and Health, 15, 109-121.  Smith, J. A. (1996a). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology and Health, 11, 261–271.  Smith, J. A., Jarman, M., & Osborn, M. (1999). Doing interpretative phenomenological analysis. In: Murray M., & Chamberlain K. (Eds.), Qualitative health psychology: Theories and methods, (pp. 219–240). London: Sage.  Walsh, K. & Bennett, G. (2001). Parkinson's disease and anxiety. Postgraduate Medical Journal, 77, 89-93.
  • 21. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 21 - Ethical Discussion. Discussion of Ethical Issues Involved in Conducting Qualitative Research. Word Count = 724 words.
  • 22. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 22 - Discussion of Ethical Issues Involved in Conducting Qualitative Research. When conducting qualitative research, there are many ethical issues that must be taken into consideration. Ethical guidelines are in place in order to protect participants, to ensure that the research that psychologist conduct does not put them at any risk of either physical or psychological harm. With regards to psychological research, the British Psychological Society (BPS) lays out ethics, in this country. The BPS requests that all research proposals are presented before an ethics committee, who must then approve of its methodologies before any research may be administered. Ethical guidelines request that researchers always obtain consent from participants and in cases where it is possible, informed consent must also be obtained. This is to ensure that participants are aware of the purpose of the research and fully consent to the use of their results within the research findings. When obtaining consent, it is also important to give the participant the right to withdraw from the study at any time they choose. If a participants requests to withdraw after they have provided data, then it is important that researchers either hand all copies of their data back to them or allow them to witness the data being destroyed. In some cases, it may be absolutely essential for the participants to mislead their participants in some way. Here, it is important for researchers to make the study as ethically sound as possible, to ensure that the participant does not feel uneasy about participating once they are informed of the actual purpose retrospectively. It is also very important to debrief participants, in order to let them know the exact purpose of the research, as well as what the research found and how their data contributed to the overall findings. It is also important to ensure that participants are granted anonymity within the research data, particularly in the case of qualitative interviews, where participants may be divulging highly sensitive and personal information about themselves. It is therefore important to ensure that participants may not be identified in any way from their data, this may involve allocating them an anonymous participation number and taking out any information that may reveal their identity.
  • 23. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 23 - Finally, and perhaps most important of, is ensuring the safety of participants at all times. This can be achieved by ensuring that none of the question asked will be particularly upsetting to them, this is particularly important when studying health issues such as illness. Health and safety risk assessments must be completed to ensure that participants do not find themselves in an environment in which they may incur physical harm also. With regards to the research that I conducted; the semi-structured interview regarding general health issues and the media critique, there were many ethical issues that I had to take into account. In the case of the media critique, I used an autobiography, which had been published for public reading. It was therefore unnecessary to ensure anonymity, as the writer intended the information to be viewed by the general public. Had the information have been gleaned from a health discussion forum, it would have been important to gain consent as people write in forums under the understanding that they are sharing their experiences with other sufferers and therefore do not expect their information to be viewed by people outside of that population. It was also unnecessary to ensure confidentiality, as the information was a story that the writer had decided to share with the world prior to my using it within my research. In the case of the interview, I was sure to obtain fully informed consent from the participant, who was completely aware of their right to withdraw from the study. The questions that were asked were general inquiries about what they considered to be a healthy lifestyle, and the responses were more or less participant driven so there was no way that the questioning could cause any psychological harm in any way. The participant was also allowed to listen to the recording of their interview and read through the transcript and was happy that they had not been misrepresented in any way. The participant was also given complete anonymity as their transcripts were coded with an anonymous participation number, which only I was aware of and all distinguishing statements, if any, were removed from the transcript. Word Count = 724 words.
  • 24. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 24 - Reflective Account. Reflection and Reflexivity on the Experience of Conducting Qualitative Research. Word Count = 722 words.
  • 25. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 25 - Reflection and Reflexivity on the Experience of Conducting Qualitative Research. When I was given the assessment criteria for this qualitative portfolio, I wasn’t sure what I’d have like to research or how I would research it. In honesty I found myself acting rather tentatively to whole process, I wasn’t really that familiar with conducting qualitative research, and the few times that I had, I never really enjoyed it, or was particularly interested in it for that matter. I knew that for the interview piece, I wanted to conduct a semi- structured interview focusing just on general aspects of a healthy lifestyle, I didn’t really have a particular research question in mind at this point, I was more interested in seeing what kind of topics came out of the interview when a participant was given a wide scope, in order to generate their own idea of what a healthy lifestyle entails. I knew the participant very well and have interviewed her for a project before so I was aware that she would provide he with very detailed answers. The media article, I knew that this would be a lot trickier. I started to look around the Internet for media articles and forum discussions, but nothing really struck my interest. I also felt somewhat uncomfortable with the whole idea of ‘lurking’ and taking strangers accounts without any form of participation or consent on their part. I have, however, been interested in Parkinson’s Disease for quite some time now and a forum discussion I found was related to this topic. Although I was not particularly engaged by the discussion, it made me think back to a couple of years ago when I read an autobiography by Michael J. Fox, in which he recounts, in great detail, his experience with Parkinson’s Disease. So I thought it would be very interesting for me if I used an extract from the book to investigate Parkinson’s Disease from the personal perspective of one patient. I found this much easier to use as research, as I was using an extract from a book which had been published, and which I had bought myself. This was not a random patients experience that they had decided to share with a group of fellow patients, in an effort to gain their own understanding of their illness. This was a global celebrity who had decided to she his experience
  • 26. 100112120 Qualitative Portfolio. Mathew Mark Aspey - 26 - with the whole world, in an attempt to raise public awareness of an illness that affects so many, but gets so little attention. I decided to conduct an Interpretative Phenomenological Analysis (IPA) on the extract, as I felt this would be most appropriate given the vast amount of information I was dealing with. As I re-read the extracts for the first time, I began to realise just how raw, and detailed account it actually was. I quickly began to build a picture of the many themes that were present within the text and how they were relevant to what I wanted to find. I found it quite amazing to discover how the words in the text were beginning to guide me research, as I initially assumed that my research question would guide the themes that I would take out of the text. As I began pulling themes out of the text, I decided that it would be more appropriate, to base my research on his experience during the period following his initial diagnosis and how that effected him, being in the spotlight. I found it very interesting to see how the research evolves as more and more themes emerge and become grouped together, it is almost as though you see yourself progressing as a qualitative researcher, as your research points become stronger. I think that conducting this kind of analysis made the assessment much more interesting for me as I felt it enabled me to really engage with the subject matter. This something that my past experience with qualitative methods has lacked. As I read through my finished analysis, I feel as though I had become deep immersed in the subject, it’s clear that I found it to be engaging. Before conducting this piece of research, I was not at all confident with qualitative research. I now feel like my ability to conduct research in this area has grown much stronger. Word Count = 722 words.