Surviving Critical Illness: A Case Study in Ambiguity

Abstract

Social workers address issues of critical illness and end of life in multiple settings. Due to advances in medical technology, an increasing number of patients survive severe critical illnesses. Little is known about the psychological dynamics of these patients who recover from critical illness and move into the liminal space between life and death. In this article the author analyzes the psychological ambiguities present during recovery from critical illness. Using a case study, connections will be made between surviving critical illness and the theoretical constructs of liminality, illness narratives, ambiguous dying, and ambiguous loss. Practice applications for social workers are addressed.

‘Intensive care unit survivorship’ – a constructivist grounded theory of surviving critical illness

“…In essence, liminality explicates the experiences of ICU survivors’ transitions, including their inherent uncertainty and it is this aspect that is of interest to ICU survivorship. Interestingly, whilst living in and through a liminal time can be very challenging for ICU survivors, the inherent uncertainty also creates space and opportunities for growth and personal development (Johnston ).…”

Liminality as a Conceptual Frame for Understanding the Family Caregiving Rite of Passage: An Integrative Review

“…The lens of liminality has been used to describe the experience of individuals facing critical or life‐threatening illness or injury (Blows, Bird, Seymour, & Cox, ; Bruce et al, ; Johnston, ; Mwaria, ). Johnston () used the theory of liminality to describe the ambiguity experienced by a single patient recovering from a critical illness who felt marginalized living in a stressful, uncertain space where one cannot plan for the future. Blows et al (), in a narrative review of 10 studies of cancer patients, concluded that liminality accurately described the experience of the cancer trajectory.…”

The Intensity of Intensive Care: A Patient’s Narrative

“…Halucinatory experiences appear to be common for ICU patients. Johnston (2011 :373) describes these experiences as “a developmental mechanism which the patient’s mind is using to process psychological issues”. Francine’s first memories after discharge from the ICU corresponds with literature ( Johnston, 2011 ; Jones, Griffiths, & Humphris, 2000 ; Papathanassoglou & Patikari, 2003 ; Richman, 2000 ; Wallen, Chaboyer, & Thalib, 2008 ).…”

“…Illness and trauma are challenges that involve the individual as a totality. Little is known about the psychosocial dynamics of a patient who recovers from critical illness and the psychological impact of the ICU experiences have not been fully investigated ( Johnston, 2011 ). It is only since the 1990’s that authors began to describe the delirium, hallucinations and post-traumatic stress disorder symptoms experienced by ICU patients ( Johnston, 2011 ).…”

“…Little is known about the psychosocial dynamics of a patient who recovers from critical illness and the psychological impact of the ICU experiences have not been fully investigated ( Johnston, 2011 ). It is only since the 1990’s that authors began to describe the delirium, hallucinations and post-traumatic stress disorder symptoms experienced by ICU patients ( Johnston, 2011 ). Dealing with the complex bio-psychosocial and spiritual processes involved in recovering from severe illness and ICU treatment requires multi-disciplinary intervention.…”