Joanne M. Hall

                            38

THE THEORY OF BECOMING RESOLUTE: GUIDING MENTAL HEALTH PRACTICE WITH SURVIVORS OF MALTREATMENT

                What is your story? How would you like it to unfold?

Explicitly, the purposes of this chapter are to (a) establish marginalization as a paradigm through which to view recovery from a stigmatized condition; (b) outline the conceptual narrative threads and relationships among them in Becoming Resolute, a narratively based theory (Specter-Mersel, 2010); (c) simultaneously, ground this description in several narrative studies of women thriving post-CM; and (d) demonstrate how the theory of Becoming Resolute guides mental health practice with survivors of CM.

MARGINALIZATION AS THE PARADIGM

Marginalization is not a state of being, but rather patterns of context-specific, constantly dynamic, social structural and interpersonal changes that socially and politically peripheralize individuals and groups. The processes of marginalization are fluid in given situations, cultures, individual subjectivities, and collective experiences. These processes provide a critical paradigmatic perspective. Within this paradigm, I developed a critical feminist mid-range narrative theory of Becoming Resolute, derived from findings of a large, federally funded, interdisciplinary qualitative study of thriving in women survivors of CM (Hall et al., 2009). Becoming Resolute is context-specific to the lives of women survivors of CM, and fosters greater agency and safety, social cohesion, and thus, thriving. However, the theory is potentially applicable to many who are surviving interpersonal maltreatment and perhaps other adversities that cause complex trauma, which is not specifically amenable to approaches wherein trauma is the result of a single event or of military combat. I will explain how the practice implications are broad enough to transfer to similar contexts.

Marginalization and Narrative Voice

Hall, Stevens, and Meleis (1994) developed the concept of marginalization to guide nursing knowledge development. We theorized that persons may be marginalized due to personal characteristics, such as appearance (race, gender, body size, etc.); social status; stigmatized illness; traumatic experiences (including maltreatment); and even association with persons who are stigmatized as Others (Dussell, 1996; Puzan, 2003). “Others” suffer from what Bourdieu and Accardo (1999) called “sociopolitical stress.” After a mental health recovery, stigma continues, showing the impact of the social environment on personal identities and how marginalized persons must strategize in everyday life to avoid further exclusion (Jenkins & Carpenter-Song, 2008).

Coping with marginalization includes the ways in which individuals and groups subsist on the edge or outside of the dominant majority group with fewer resources and increased risks (Crenshaw, 1991; Hall et al., 1994; hooks, 1984). Various theories fit within this paradigm, such as feminism(s), postcolonialism, queer theory, and critical race theory. These frameworks are best applied and researched via accessing and emphasizing the narrative voice of the marginalized (e.g., see Delgado & Stephancic, 2001).

Women Survivors of Maltreatment as Marginalized

Women experiencing interpersonal violence, either as children or adults, or both, are stigmatized and marginalized by: their status as women (e.g., victim blaming in the case of abuse); rejection by family of origin through humiliating treatment; not being believed when they disclose abuse; the symptoms of posttraumatic stress; and characterizations of being “damaged goods,” that is, people who will never recover from such heinous experiences. The diversity and individual uniqueness of their experiences result in part from the secrecy surrounding abuse. Our study of thriving in survivors of CM revealed that survivors feel “different” because their maltreatment robbed them of a normal childhood, and they have disparate, usually negative experiences at developmental turning points, such as menarche and dating, as well as in their fleeing, being ejected, or removed by authorities from their homes as teens or young adults. Living on the streets, and even with foster caregivers, frequently results in further risks and serial abuse. The myriad aftereffects from abuse (e.g., depression, sexual dysfunction, anxiety disorders, chronic pain, self-harm) also make recovery experiences diverse. Thus, there is no “one size fits all” intervention strategy to assist people in recovery.

Intersectionality and Maltreatment

Often persons experience several forms of oppression, variably influencing their experience. For example, a woman who is Black and impoverished may experience marginalizing interactions based on gender, racialization, and socioeconomic status; this phenomenon is termed intersectionality, both a perspective on the complexities of multiple marginalized experiences and a method for analyzing them that grew out of law and postcolonial feminist scholarship (Anderson & McCormack, 2010; Cho, Crenshaw, & McCall, 2013; Crenshaw, 1991; Van Herk, Smith, & Andrew, 2011). For women survivors of CM, gender and racial bias, child status during abuse, stereotypes of abused persons, and trauma aftereffects are intersecting sources of oppression affecting them diversely.

The principles of marginalization and intersectionality can be seen in context in narratives of those affected. Critical race theorists and feminists have determined that narratives, including counternarratives from members of marginalized groups, are key to understanding their experiences, in view of power dynamics of the larger temporal/historical and sociocultural contexts. (Baldwin, 2013; Delgado & Stephancic, 2001; hooks, 1992). Considering these sources of inequities among the group of women survivors of CM, I hold that the life pathways of marginalized persons are best captured through narrative methodology. Likewise, narrative approaches to practice are fitting, as will be described later.

NARRATIVE AND THEORY

Narratives are historically interpretable (Bakhtin, 1981/1941), forms of expression that exhibit temporality, or quite simply, stories of social interactions, events, and their consequences over time (Tamura, 2011). Here, I am especially focused on stories of personal transitions in recovery from interpersonal trauma. Many of the general principles of transitions theory, such as the trajectory, triggers, the existence of critical points in the process, and the usefulness of debriefing apply (Meleis, 2010). Narratives are windows on transitional processes as experienced subjectively by persons.

According to Project Narrative (n.d.), narrative is a strategy via which persons make sense of the changing temporal aspects of experience. Narrative theories represent narrative structures, purposes, and consequences of events and interactions via which people make sense of the world. Although even retellings of the same story are unique, cultural influences shape common elements. In interpreting narratives it is essential to realize that in stories, time is not linear but contextual (Polkinghorne, 1988; Reissman, 2008). Stories are often not told in chronological order. Rather, events may be ordered according to priorities, meanings, emotional linkages, flashes of memory; and often vary according to the listener or the intended audience.

Theories about Narrative and Narrative Theories

In this chapter, I describe Becoming Resolute as a narratively based theory (hereafter, narrative theory). It is a theory explaining the substance of experiences narrated, not a theory about narrative. A narrative theory is not static and can be used in practice, to interpret, as well as to promote healing (Jolly, 2011; Saleebey, 1994). Narrative theories offer tools that enable representation of recovery goals, and frame and integrate relevant research studies (Floersch, Longhofer, Kranke, & Townsend, 2010; Lewis, 2012). They have been used to develop mental health interventions, for example, for depression and incest (Angus, 2012; Lindblom & Gray, 2010).

Much experiential information can be derived from specific linguistic constructions. Southall (2013) noted that patients often use metaphors to express experiences in palliative care. Thus, personal illness narratives warrant exploration of linguistic signs and patterns. For example, scholars have related autobiographical narratives to identity development, holding that persons integrate experiences in linguistic constructions, and form a narrative self, or selves (Crenshaw, 1991; Flaming, 2005; McAdams & Adler, 2010; Ricoeur, 1984, 1992).

Narratives and Nursing Theory

The narrative perspective is essential to nursing practice, and narrative research is just beginning to flourish in nursing science. Narrative theories (again, not referring to theories of narrative), however, are not common. Most nursing theories are middle range and are reasonably adaptable across similar contexts. However, even process theories that depict sequences or stages are not narrative theories if they do not connect individually specific narratives through building a core narrative that undergirds and portrays the theory. The theory of Becoming Resolute is a core narrative, and also has been further theoretically developed through identification of several component narrative strands. These strands are traceable and malleable, depicting persons’ stories, and providing guidance to patients about how to change their story, moving forward out of a traumatic, stigmatizing condition, thereby fostering and enhancing recovery. Becoming Resolute is thus usable as a middle range theory. It shares characteristics of a grounded theory, but is specifically a narrative theory, wherein narrative threads are similar to but not as fixed as concepts in conventional theories. Such narrative threads are not tangled randomly, rather, identifiable interconnected patterns of these threads facilitate the construction of a singular, core narrative, such as that of Becoming Resolute.

Narrative Theory and Practice

Williams, Anderson, Barton, and McGee (2012) used culturally relevant emotional and cognitive theory to create visual narratives for use as an intervention. The theories were conventional, but they were used to guide development of narratives. Price (2013) described inquiry using collected client, nurse, and family caregivers’ narratives and underlying discourses to inform education on prevention of neglect of older people. Similarly, Hsu and McCormack (2011) used narratives in translating for nursing practice with older people. My analysis of the “geography of child sexual abuse” (Hall, 1996) focused on narratives of social environmental consequences of abuse that permeate abused girls’ family, school, and larger community, as they moved into these new spaces. Similar findings about family, home, and neighborhood were noted in a longitudinal study of bullying; thus, in both studies, recommendations for change were socio-environmentally rather than individually based (Bowes et al., 2009).

Policy has also been initiated in a project wherein narratives were used to identify attributions and ideologies about obesity (Neiderdeppe, Robert, & Kindig, 2011). Another policy change, regarding diabetes, was instituted by reducing diverse narratives of African American women to a core narrative and then using it to persuade a wider audience (Berline, Ako, White, & Pharris, 2011). This collective narrative can be considered a counternarrative to stigmatizing or marginalizing dominant narratives, capturing historical influences on the present (Crenshaw, 2011; Delgado & Stephancic, 2001). In the stigmatized condition of HIV infection, stories of sufferers were highly persuasive to legislators and funding agencies, and public outcry moved the science and treatment forward.

Davidson and colleagues (2010) had persons with serious mental illnesses, who had recently suffered profound losses, collect narratives from each other, finding that participants desired a “map” to find their way “back to their lives”(p. 106). Developing the theory of Becoming Resolute was akin to constructing such a map. Exemplars show diverse uses of narrative as, or in conjunction with, theory to contextually describe situations, create interventions, and influence policy.

RESEARCH UNDERPINNINGS OF THE THEORY OF BECOMING RESOLUTE

The theory of Becoming Resolute stems from a series of studies that were built upon each other, moving from a problem focus related to childhood trauma to emphasizing recovery, and thriving despite this adversity. Because I propose a new theory, I capitalize Becoming Resolute. Capitalization is not necessary in usage. Using exemplars from these narrative studies, I lay out the narrative themes developed, and refined, through the most recent study in the series (Hall et al., 2009). At this juncture I will explain the theory and then describe how Becoming Resolute is useful to mental health practice, with exemplars (Hall, 1996, 2003; Hall & Powell, 2011; Hall et al., 2009). Analyses by various members of the research team who refined the narrative threads in the major study and explicated them in the major study are included (Roman, Hall, & Bolton, 2008; Thomas & Hall, 2008).

Mental health clinicians who currently use the theory in practice provide exemplars for clinical applications of the theory that were ascertained through dialogue about several cases. Excerpts of findings from previous work provide insight into practice considerations; methodologies are not emphasized, and can be considered broadly as thematic narrative inquiry.

Specific Aims of the Major Theory-Supporting Study

Aims of the study were to (a) discover aftereffects of child maltreatment (physical, sexual, emotional/verbal abuse, and neglect) as described by adult women survivors; (b) identify self-protective, health-promoting strategies as strengths for thriving; (c) explore survivors’ interactions with others as helpful, or not, in overcoming adversity; and (d) critically ascertain cultural, structural, and environmental influences on thriving post-abuse. A long-term goal was development of evidence-based interventions to improve the mental health of survivors of maltreatment.

Our team’s philosophical lens was critically based, feminist interpretive (Atwater, 1998). Accordingly, we strove to create a trustworthy space for women to tell their stories (Jansen & Davis, 1998). Many findings are reported using in vivo terms. We recognized that we did not reproduce women’s voices, but gathered practice-relevant wisdom embedded in their narratives. The research team functioned reflexively, questioning methodological decisions and findings from multiple perspectives, as in Bourdieu’s (2004) construct of epistemological vigilance.

Study Definitions

CM referred to self-reported history of neglect and/or verbal, emotional, physical, and sexual violence experienced by girls less than 18 years of age. Participants defined success as relational satisfaction, capacity for happiness, and work achievements, and successful, protective parenting as in: “a peaceful home,” “comfortable in your own skin,” and “being an educated person.” Narrative referred to text from several open-ended interviews with each participant that were intentionally focused on healing from CM, not primarily on the abuse itself.

Becoming Resolute was defined as a process of developing decisive agency and a steely willfulness in refusing to be defined by or focused on one’s abuse history. It develops through social interactions; discovering, increasing, and exerting one’s self-determination; recognizing the abusive past as deadly; and decentering it in one’s life. Keys to this process were epiphanic moments, as well as gradual realization of a new, nonabusive social world, while strategizing to form safe relationships and living environments. Success as an outcome of Becoming Resolute was revealed in sustaining a generally upward life trajectory often after a “roller coaster” pattern of progress, interrupted by setbacks, followed by new insight, seeking psychotherapy (for some), and major turning points (Thomas et al., 2008).

Basic Analysis, Reflexivity, and Rigor

Multiple interviews with 35 of the 44 participants provided depth, comparisons of story versions, a prospective view over weeks or months, and coherence and credibility (Briggs, 1986; Hammersley, 1995). Rigor was ensured by the depth of a 4-year analysis, rereading of texts; interdisciplinarity; noting narrative discontinuities; contextualizing quotations within accounts; comparing within and between accounts; and iteratively raising new questions (Barthes, 1985; Kvale, 1996). Initially we considered resilience, hardiness, agency, and action potential as fitting terms for the core theme we conceptualized. Through further word comparisons and searches, we reached consensus on resoluteness and Becoming Resolute as comprehensive, appropriate terms for describing the central motif in the narratives expressing relatively greater success in recovery.

Team members conducted subanalyses: Thomas delineated life trajectories of participants (Thomas & Hall, 2008), and Roman and Bolton described relationships over the life course that promoted healing (Roman, Hall, & Bolton, 2008). The dimensions, trajectories, and relationships that were seen to be helpful provided temporal and socioenvironmental contextual information, which was then integrated with the core narrative.

Narratives of Becoming Resolute

“Resolute” and “resolve” are derived from the Latin resolutus and resolvere: to untie; to loosen back, or loosen again (Dictionary.com, 1996–2008; Language, 2006). Resolve means to divide into parts, disintegrate, clear away doubts, settle conclusively, or transform by a process (Dictionary.com, 2008). In the narratives referred to in this chapter it is clear that participants sorted out and untied their very identities from the past maltreatment they were surviving; they cleared away doubts about the deadliness of their abuse. They certainly settled for themselves who their abusers were and that abusers had acted criminally, and learned to set boundaries with them. They extricated their wills from the force of abuse dynamics, gaining ownership of their environment, their relationships, and their future as disaggregated from their past.

Synonyms of resolute as an adjective include firm, determined, and unwavering, having a fixed purpose, determined in character or ideas, and acting on decisions despite opposition (Dictionary.com, 1996–2008; Language, 2006). Descriptors of being resolute include dead-set, hell-bent, willful, courageous, brave, tenacious, undaunted, and unwavering (Thinkmap, 2005). Many of these terms were discovered to be in vivo terms, that is, gleaned from the narratives, underscoring the fit of the term resolute as the core thematic. In-depth analyses revealed Becoming Resolute as having six dimensions that illuminated the characteristics, actions, and interactions of the more successful participants (n = 35) as opposed to those struggling daily with maltreatment consequences and persistent, abusive interpersonal dynamics (n = 9).

NARRATIVE THREADS OF BECOMING RESOLUTE

The six dimensions have been conceptualized here as narrative threads. All of these threads were not necessarily seen in each woman’s account. Rather the threads are integrated into a constructed, comprehensive core narrative; many threads were developed from the thriving survivors’ accounts. Yet, also included are the positive stories embedded in accounts of the participants with static or downward-tending trajectories; all participants had some success stories to tell. In the following sections, quotes from participant accounts illustrate the six major threads of Becoming Resolute.

The six major dimensions, plus the relationships described by survivors as helpful, constituted three types of narrative threads: supportive; centrally dynamic; and consequential outcomes, which are not specifically end points, but ensuing processes associated with a major upward turn in trajectory.

SUPPORTIVE THREADS

Determined Decisiveness

Success was associated with inner determined decisiveness, the energy for change. Intrapersonally generated momentum facilitated (a) early moves into opportune roles, (b) tenacity toward goals, and (c) a sense of self-governance and leadership: “I am learning to captain my own ship.” Determined decisiveness meant repeatedly and persistently trying different ways to surmount troubles, and with that, a growing sense of self-sufficiency:

Determination of this kind proved to be supportive to the central dynamics of Becoming Resolute.

Quest for Learning

The desire and persistence in gaining both general and trauma-specific knowledge was supportive of the core narrative. It referred to formal learning, such as academic achievements and upward mobility in employment. Informal learning consisted of seeking inspiring, justice-oriented experiences and stories and films of them. Successful participants grew up as book lovers; this relationship to books often became lifelong: “I walk into a library safe, surrounded by my friends [books].” Books included those with female heroines and or justice themes, including To Kill a Mockingbird, The Count of Monte Cristo, and Don Quixote (Cervantes & Smollet, 2001; Dumas, 1996; Lee, 1960). Repeatedly reviewing favorite films at low points in recovery attenuated emotional distress during these setbacks. Self-help books about abuse were mentioned, but less frequently than we expected. Currently, the availability of social media is another source of empowering stories, and possibly also information and social support. One woman found justice and compassion themes in a Biblical story and related it to the present, at the time of her interviews:

Another woman recalled a librarian who “saw something in her” (Roman et al., 2008) and helped in her quest for learning:

Quest for learning supported growth and allowed identification with courageous others, as did relationships and interactions fostering Becoming Resolute. Information on relationships is included later, but can also be seen in quotations illustrating the centrally dynamic threads that are described in depth.

CENTRAL DYNAMIC THREADS OF BECOMING RESOLUTE

In particular, three threads, facing down death, redefining abuse and abusers, and counter-framing perceptions were crucial and dominant, constituting a central dynamic. At least one of these three was seen in the thriving participants’ narratives. Frequently, narratives revealed that if one of these occurred, the other two of the three were triggered in turn. The reconceptualization of these major dynamic threads indicates that they were essentially tasks or actions. These were not seen linearly, or in stages. Conventional structural aspects cannot be firmly defined through narrative methods (see Figure 38.1).

Counter-Framing Perceptions

Participants described home as “hell,” “nightmare house,” “jungle,” and “prison.” This confirmed the findings of the earlier study that abuse dynamics permeated the home environment, and in fact were experienced as extending and recurring in the school and community environment (Hall, 1996). Finally, often as an adult, considering the perceptual world fostered by a terrifying and repressive situation, counter-framing was seen in gradual dawning, or, conversely, a sudden epiphany revealing that the world of abuse was limited, and not the only “reality.” There were other ways of being in the world and socially relating. Counter-framing allowed the possibility of perceptual and actual escape, opening fissures in an otherwise “totalizing” family environment (Goffman, 1962, 1974), through alternative relationships and experiences.

Counter-framing, key to Becoming Resolute, meant reframing against, challenging the tenacious, negative, and hopeless perceptions trapping their victims and forming a world that abusers had normalized. Some father perpetrators were perceived outwardly as pillars of the community; many house-holds were disguised as “perfect families.” These factors made framing against, or counter to, these highly inaccurate visions of their families an uphill battle. Counter-framing fostered a new social worldview. Some remembered having returned from eating dinner at childhood friends’ homes, reporting: “[We] ate food with a fork!” or “They argued without any blood-shed!” Thus, survivors were moving to a new “normal.”

Counter-framing was not dependent upon, and could be impeded by, disclosure of abuse in childhood. Abuse was seldom revealed to outsiders, and childhood disclosures were commonly ineffective in stopping abuse. Women recalled being rebutted, discounted, punished, and stigmatized for breaking secrecy. One recalled childhood disclosure did force incarceration of an uncle perpetrator, but abuse ensued from another male relative. When the first perpetrator was released from prison, the family embraced him, symbolizing the girl’s “insignificance.” Childhood disclosures to a nonabusing parent, teacher, or another adult almost invariably were met with indignant disbelief (e.g., “He [or she] would never do that”; anger or blaming). Again, this reinforces that the abusive patterns frequently extended from families into the school environment (Hall, 1996). A caveat here was that given the ages of the participants as generally between 30 and 60, the older cohort grew up at a period when knowledge and awareness about child abuse was limited and there were few mandatory reporting policies, for example.

One participant described a sudden adult epiphanic social counter-frame that affirmed her personhood, and led to becoming more willful and self-affirming:

Such relationships and experiences were key to breaking the abuse perceptual frame.

Facing Down Death

Facing down death, another central dynamic thread, meant overcoming the frightful terror of abuse by ethically seeing it for what it was: criminal, annihilative, and geared toward one’s personal destruction. Participants described facing a form of existential death, or soul disintegration similar to that described by Shengold (1989) in his book, aptly titled Soul Murder. Children faced mortal danger in neglect/abuse and threats to kill/hurt loved ones or split the family. One father tried (unsuccessfully) to poison all of his children by lacing candy with a heavy metal. That participant described that later, while in college, she fought the sense that her (then-deceased) father’s eyes were constantly watching her through windows or from behind trees. This affirms prior findings that abuse dynamics and perceptions persist into the community at large (Hall, 1996).

Participants painfully clarified such existential threats: “I don’t think we [siblings] existed as people, at all, ever, at any point, in our lives, to either [parents] … we were pretty much nonexistent.” Another woman reflected on her father’s denial of her personhood for his amusement:

Existential death was seen in daily annihilative speech from mothers, a death of caring that differentiated them from nonabused peers. Typically girls were told “you are stupid, fat, and ugly” and “You will never amount to anything, just like your father.” Similarly, participants who endured an abusive marriage in adulthood faced down death from their spouses, as in this epiphanic moment:

In a few accounts, adolescent girls had threatened their abusers, for example, by wielding a baseball bat, installing a lock on their bedroom door, or threatening to report the abuse to authorities in order to stop the abuse. Participants often voiced having survived by chance. Viewing abuse as criminal and deadly ultimately evidenced to participants that since they were among the many “crime victims”, it was not personal: “It could have happened to anyone,” “I was in the wrong place at the wrong time.”

Self-injurious behaviors were attempts to face down existential death by “living on the edge,” and included suicide attempts, substance misuse, and eating disorders. One woman’s suicide attempt in her 20s made her suddenly realize that she wanted to live and could change her life. One women constructed a situation that would be terrifying to her, facing deathly fear as an adult to attain mastery of it; this entailed braving a turbulent ocean on a small boat: “I told my husband, no matter what, don’t help me; I have to do this.”

Unfortunately those who had coped by using substances to the point of dependence added about a decade of continued struggle before a significant upward turn in their life/recovery trajectory. (Thomas & Hall, 2008).

Redefining Abusers and Family of Origin

This action makes up the third centrally dynamic thread. Becoming Resolute involved renaming perpetrators, and redrawing boundaries against perpetrators and unprotective others. This usually entailed temporarily, and sometimes permanently, separating from a destructive family of origin.

Stay updated, free articles. Join our Telegram channel

Join