Achieving harmony of mind : a grounded theory study of people living with HIV/AIDS in the Thai context : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Palmerston North, New Zealand
The aims in this Straussian grounded theory inquiry were to gain better understanding
of the meaning of spirituality and of the process of spiritual development in people
living with HIV/AIDS in the Thai context. In Western contexts, spirituality has been
described as the essence of human existence. However, in the Thai context, where
Buddhist teachings underpin the understanding of life as body and mind, rather than as
body, mind and spirit, the concept of spirituality is little understood by lay people. This
gap in understanding called for an inductive approach to knowledge generation.
HIV/AIDS is a life-altering and deeply stigmatized disease that results in significant
distress and calls into question the meaning and purpose of life for many who are
diagnosed with the disease. Nevertheless, some Thai people living with the disease
successfully adjust their lives to their situation and are able to live with peace and
harmony. These findings raise questions firstly as to the process by which those
participants achieved peace and harmony despite the nature of the disease and the
limited access to ARV drugs at the time of that study; and secondly as to whether or not
the peace and harmony that they described could be linked to the Western concept of
Data were gathered from 33 participants from the South of Thailand, who had lived
with HIV/AIDS for 5 years or more, were aged 18 years or older, and were willing and
able to participate in this study. Purposive, snowball and theoretical sampling
techniques were used to select participants. Data collection using in-depth interviews
and participant observation methods was undertaken over a nine-month period in 2006.
The process of data analysis was guided by Strauss and Corbin’s grounded theory and
resulted in the development of a substantive theory.
The substantive theory of Achieving Harmony of Mind comprises two categories:
struggling to survive and living life. Each category has two subcategories:
encountering distress (tukjai) and overcoming distress (longjai), and accomplishing
harmony in oneself and discovering an ultimate meaning in life respectively. The
metaphor of ‘an eclipse’ was used to describe the process of the development of mind of
people living with HIV/AIDS and represents the extent to which the individual’s mind
is overshadowed by the diagnosis of HIV/AIDS and its consequences. Diagnosis of this
disease turns participants’ lives upside down. Yet selective disclosure of one’s HIV
status, resulting in the receiving of support and connectedness with others, enables
participants to find meaning and purpose in life that enables them to recover the will to
live and to attempt to stabilise their lives by learning to live with HIV/AIDS.
Most participants were able to adjust their mind to accept their new situation and find
new self value enabling them to feel free from the shadow of HIV/AIDS and live life
with HIV/AIDS as normal. Fewer participants found an ultimate meaning in life –
consistent with Buddhist teachings about suffering and uncertainty, and the
impermanence of life that links with an understanding of ‘nonself’ – that enabled them
to obtain peace and harmony of mind (kwarmsa-ngobjai). It is this latter stage that
represents spirituality in Buddhist terms. This form of spirituality differs significantly
from that found in other religions because it does not involve an engagement with
a divine and transcendent reality.
The findings of this study enhance knowledge about spirituality in the Thai context, and
provide a guide for health professionals and education curricula with the aim of
achieving more holistic care for patients.