Beyond exhaustion and pain : the intertwinement of health and suffering among women and mothers

Aims: The overall goal of the thesis was to understand and to conceptualize health and suffering among women living with exhaustion and long-lasting pain, with a particular focus on motherhood.

Methods: The thesis’ design was interpretative, descriptive, and observational and used both qualitative and quantitative approaches. In study I, unstructured qualitative interviews were conducted with 21 women living with long-lasting pain. These interviews were analyzed via application of Gadamer’s philosophical hermeneutics. Study II was a psychometric evaluation and further development of the Health and Suffering Scale, and both classical test theory and Rasch analysis were applied. Study III is an exploratory investigation of health and suffering and perceived social support among women and mothers with exhaustion and long-lasting pain. Study II and study III are based on the same samples of women, one sample of women living with exhaustion and/or long-lasting pain (n = 166) and one reference sample of women studying and working within health care (n = 129). In study IV, 27 phenomenological interviews were conducted with 14 mothers with exhaustion and/or long-lasting pain. The interviews were analyzed applying both Gadamer’s hermeneutics and Ricoeur’s interpretation theory.

Findings: Women living with exhaustion and long-lasting pain appear to be vulnerable on a relational level (study I, III & IV). Feeling insufficiently supported by others risked turning difficult experiences and responsibilities in life into an overwhelming burden (study I & IV). This experience could turn into suffering and carried a risk of life being perceived as meaningless. Suffering and the perception of meaninglessness in life were found to be interwoven (study I & II). Motherhood could be part of an overwhelming life burden but could also offer women an essential source of strength and meaning in life (study IV). When women were embedded in reliable relational ties or reconsidered the relations in their lives, they were better equipped to bear difficult life experiences and caring responsibilities and could reconcile their selves and lives (study IV). Suffering became integrated into life, was more bearable and one’s own health became more balanced (study II & IV). The synthesis of these findings suggest that women’s health could be understood as an ongoing movement of how one relates to essential aspects of one’s life and oneself. As a natural counterpoint to health, suffering then could be understood as an interruption of these meaningful and authentic relations in life.

Conclusion: Women and mothers suffering from exhaustion and long-lasting pain need to create and recreate essential relations in life, which would help alleviate their suffering. In this process of reconciling self and life, these women are dependent on supportive and caring relationships. Motherhood is a period in women’s life in which women are particularly dependent on support and care from others. In the effort to improve health and alleviate suffering among women, society and health care, in particular, need to broaden its understanding of health as inseparable from suffering and vulnerability and interwoven with caring responsibilities.

List of scientific papers

I. Arman, M., Gebhardt, A., Hök Nordberg, J., Andermo, S. (2020). Women’s Lived Experiences of Chronic Pain – Faces of Gendered Suffering. Qualitative Health Research. 30(5), 772-782.
https://doi.org/10.1177/1049732319888478

II. Gebhardt, A., Langius-Eklöf, A., Andermo, S., Arman, M. (2021). The health and suffering scale: Item reduction, reliability and validity among women undergoing rehabilitation for exhaustion and long-lasting pain. Nursing Open. 00, 1-12.
https://doi.org/10.1002/nop2.980

III. Gebhardt, A., Langius-Eklöf, A., Andermo, S., Arman, M. (2021). Health and suffering are associated with social support: a cross-sectional study of women and mothers with exhaustion and pain. BMC Women’s Health. 259, 1-11.
https://doi.org/10.1186/s12905-021-01398-y

IV. Gebhardt, A., Andermo, S., Arman, M. (2021). Relational vulnerability and health in motherhood – voices of women suffering from exhaustion and pain. [Manuscript]