The Janus influence and discovering a life : a study of people living with coexisting mental health and substance use disorders : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at Massey University, Albany, New Zealand
This grounded study examines how people who are dually diagnosed with a major mental illness and substance use disorder 'recover' their lives from a past of 'intemperate insanity' and discover a world in a rich and productive present. Thirty participants, including consumers, staff and families, took part in the study. Additional slices of data were retrieved from the analysis of six 'policy' documents and 72 hours of participant observation. All data were constantly compared and analysed using Glaser's emergent approach to grounded theory. Research and literature on those with coexisting disorders has been dominated by the 'medical model' with a focus on assessment, diagnosis, treatment and rehabilitation both in addiction and mental health settings. Whilst these aspects of 'management' of coexisting disorders are important, this acute phase of intervention represents only a small fragment of a person's life. These people are not their disease, and the coexisting disorders are not the totality of their being. 'Discovering a life' was an emergent theme that formed the basic core category. Intemperate insanity, naked in Woolworths (the crisis), shedding the armour (recovery) and living without the armour (maintaining the change) and Janus' temple (service provision) formed the theoretical codes which made up the entity discovering a life. There also emerged a further 'natural division', a critical juncture essential to discovering a life - sobriety. Without sobriety, participants' lives took a different path which linked them back to a past of intemperate insanity. Literary images of the Roman God Janus are used as a metaphor throughout the thesis to elucidate aspects of the participants' lives. Janus was the God of endings and new beginnings, of youth and age, and is portrayed in historical texts with a double head, one looking backwards and the other forwards. It is this need to remind themselves of the past in order to imagine the future, a need to track the metaphorical trajectory from youth to age that informs the basis of 'wellness' in the present for my participants. Service provision in the mental health and alcohol and drug fields is aimed at early intervention, the acutely ill and early phase rehabilitation. There are clearly ways of analysing and approaching the 'illness' at this initial point of the continuum that are efficacious and cardinal to the ultimate well-being of the individual. What I am proposing here is not an alternative to this bio-psycho-social explication, but a second-level, substantive theory that offers an insight into the way a diversity of people with coexisting mental health and substance dependence disorders integrate their human imperfections into their lives. They have found a way of accepting, rather than transcending, the human condition. At the same time, this new paradigm has implications for the way we provide a service to people with coexisting disorders. Service providers are invited to participate in a way that shifts the emphasis of intervention from 'doing' (tasks and skills-related activities), to 'being' (with a focus on integrating coexisting disorders into identity of 'self'). A therapeutic emphasis on 'caring', not 'curing', creates an environment that allows consumers to realistically live rich and meaningful lives.