pro seminar final kenyon stanley final final
TRANSCRIPT
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Making Sense Out of Sense-Making : A qualitative analysis on sense-making and uncertaintyreduction in the mentally ill homeless community 1
R unning Head: Making Sense Out of Sense-Making: A qualitative analysis on sense-making
and uncertainty reduction in the mentally ill homeless community
Making Sense Out of Sense-Making: A qualitative analysis on sense-making and uncertaintyreduction in the mentally ill homeless community
Kenyon Stanley
COMM 602
Dr. Zachary White
December 3 rd, 2010
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Abstract
The mentally ill homeless community is a population that has not been given a voice. Until now,
the sense-making and uncertainty reduction methods mentally ill homeless men and women
utilize everyday has been unknown to care givers and communication scholars. Utilizing a
qualitative interpretive approach, data from 10 mentally ill homeless men and women revealed
reoccurring themes that has been previously unknown. The need to give a voice to the voiceless
is needed in order to understand and develop programs for any marginalized group. This report
sheds new light on a community that is crying out for help.
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In every major city, one could find tall buildings, bright lights and sounds that indicate a
thriving and positive culture. However, there is a darker side. Intermingled within the normalcy
of big city life, is an increasingly marginalized community of homeless people who cannot
overcome barriers which relegate them to survive on the streets. Living a life of continual
uncertainty, many of the homeless struggle to cope with various addictions, unemployment and
finding effective treatment for a broad range of mental illnesses. Unless we listen to the voices of
the mentally-ill, we will not be able to understand how this cohort of marginalized people sense
make and cope with uncertainty and anxiety. We have a responsibility to ensure that the
homeless men and women struggling with mental illness have the opportunities to live a life of certainty and self-sufficiency.
For the better part of ten years, I have worked in homeless shelters and faith based
outreach agencies serving the needs of the homeless. In my experience, I have noticed that
agencies tend to compartmentalize the treatment efforts for the mentally ill. There has been little
effort to hear the voices of the mentally ill and ascertain the thought processes and coping
mechanisms employed by the clients agencies endeavor to serve. Additionally, with the
struggling economy, funding for new programs has dwindled, while the overall homeless
population has soared. For example, in 2009, the Mens Shelter of Charlotte housed on average
450 people per night. While in 2010, the same shelter (on average), housed people per night.
Understaffed and underfunded, the necessity to ensure that the clients are fed, clothed and
housed is a continual challenge. Therefore, the individual stories of the homeless are not simply
heard, leading to a deficiency in cultivating relationships between staff and client. The inability
for shelter staff to build relationships with the clients has resulted in an overall institutional
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mentality among the clients, and overall mistrust between clients and shelter staff. Perhaps now
is the time to actively hear the voices of this voiceless subset of American society.
Our society is filled with different people with different histories. Hearing the stories of
the mentally ill will allow both agencies serving the homeless community, and the
communications community, a window into the lives of a previously voiceless population. My
research will reveal patterns of sense making and uncertainty reduction in a community of
individuals who view life different than mentally sound individuals. For the agencies,
understanding how the mentally ill homeless sense make and deal with uncertainty will assist
service providers in the development of relationally orientated programs designed to assist
clients to living a self-sufficient life. For the communication community, the door for further
research will be wide open as there has been very little communications research that focuses on
the mentally ill homeless.
Literature Review
We first situate mentally ill homeless research within narrative paradigm and uncertainty
reduction tenets, and then we focus on communication research in these areas.
Narrative Paradigm and Uncertainty Reduction in the lives of mentally ill homeless
The narrative paradigm functions as a metatheoretical lens by which the mentally ill
homeless stories reveal how they view the world around them. According to Walter Fisher
(1984), humans are narrative beings in who, experience and comprehend life as a series of
ongoing narratives, as conflicts, characters, beginnings, middles, and ends (p. 341). Homeless
people live a life of perpetual uncertainty. Every day, a typical homeless person is uncertain of
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where he/she is going to sleep, how she/he is going to keep protected from the elements, is
he/she going to be fed and many other uncertainties only a homeless person can identify.
According to William Gudykunst (1993), uncertainty management is continually under
construction. Gudykunsts view is particularly relevant to mentally ill homeless people.
Depending on the particular diagnosis, a mentally ill homeless person may feel an unusual high
amount of anxiety simply because although he/she may have previously navigated through a
particular situation, the mental barriers may cause a mentally ill individual to deal with situations
like it was the first time. Therefore, narrative paradigm and uncertainty reduction are two
theories that go hand in hand when attempting to identify cognitive patterns in the mentally illhomeless community.
According to Em Griffin (2006), The Narrative Paradigm Theory has five basic
assumptions. First, people are essentially storytellers. Currently, the mentally ill homeless
population does not have a platform to tell their stories. Also, the homeless shelters are simply
trying to provide basic needs and short term care (e.g. shelter, food and clothing). An
individuals history and perspective on life is not in the vision of care facilities. Therefore, if
people are essentially storytellers, then the mentally ill homeless are not being afforded the
opportunity to participate in an essential component of human interactiondialogue.
Secondly, according to Griffin (2006), people make decisions on the basis of good
reasons, which vary depending on the communication situation, media, and genre (p. 343). A
homeless person suffering from mental illness doesnt have very many communication situations
nor do they have access to media in the same manner that others have. How a homeless mentally
ill individual determines the criteria for good reasons is relatively unknown. The narratives of
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the mentally ill homeless community will produce insightful and unknown data regarding their
decision making, sense making and uncertainty reduction process.
Third, what we consider good reasons is determined by biography, culture and character
(Griffin 2006). The mentally ill homeless are comprised of men and women of different cultures
and backgrounds. Therefore, identifying common patterns of sense making and uncertainty
reduction will shed light on how this marginalized and voiceless population rationalizes what is a
good decision.
Fourth, according to Griffin (2006), the coherence and fidelity of our stories is the
determining factor of narrative rationality. Depending on the specific diagnosis, mentally ill
individuals have difficulty forming a coherent thought process. I expect that my research will
show a significant lack of coherence. However, identifying the patterns of incoherence in the
narrative will give researchers, care providers and scholars additional insight into the how
mentally ill homeless people rationalize their past, present and future.
Finally, according to Griffin (2006), The world is a set of stories which we choose, and
thus constantly create, our lives (p. 343). Quite often, mentally ill people are disconnected from
reality. Some talk to imaginary people, some dont believe they have an illness. Whatever the
case may be, hearing the narratives of mentally ill homeless people will provide researchers and
care givers new insight regarding the histories, current situations and futures of the individuals
silently crying out for new care methods. In order to create new and successful programs,
agencies must understand how their clients manage uncertainty.
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According to Griffin (2006), uncertainty/anxiety reduction theory posits that increased
uncertainty produces an increase in anxiety. Conversely, a decrease in uncertainty will produce a
decrease in anxiety. Since homeless people have to navigate basic need requirements more often
than a non-homeless person, homeless people generally deal with an extraordinary amount of
uncertainty. The mentally ill homeless people have an even more difficult time managing
uncertainty and anxiety due to their mental deficiencies. Whether an individual suffers from
depression or schizophrenia, it is reasonable to assume that the uncertainty of ones past
decisions, present situation and overall outlook of his/her future will heighten the anxiety of a
mentally ill homeless person. My research will reveal and highlight common themes in thesense-making and uncertainty reduction process within the mentally ill homeless population.
Research on Mentally Ill Homeless People
Although psychology has conducted research within the mentally ill homeless
community, Communication research has looked into this marginalized and voiceless
community. Furthermore, studies have usually been limited in scope to quality of care, and the
historical circumstances which led to an individual becoming homeless. Additionally, there has
been some research which questions the housing methods employed by agencies in the United
States and Europe. Specifically, the enhancement of the quality of life when mentally ill
homeless individuals are moved from a shelter based environment to a home/community.
According to Moxam, L. & S. Pegg (2000), the manner society provides housing for the
mentally ill is inadequate. Additionally, the authors suggest that providing more community
based environments will lead do deinstitutionalization in the men and women who suffer from
mental illness and are homeless. Lastly, the authors highlight the importance of supportive and
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flexible housing alternatives, especially housing options which allow the residents more control
over their options. Their voice matters.
Moxam et al (2000) provides an out of the box idea that directly challenges the current
methodology agencies employ when housing indigent mentally ill patients. The notion of
institutionalization is a reality that I witness every night when attempting to serve the needs of
mentally ill homeless women and men. While my research is designed to give a marginalized
group a voice, out of the box ideas need to be explored if effective treatment is ever going to be
actualized. R ight now, the mentally ill homeless population is housed in homeless shelters.
Their needs are expected to be met by staff that is not qualified to diagnose or treat mental
illness. My research will provide insight into some of the functional and dysfunctional sense
making patterns through the stories of individuals who have been silenced by society. If
progress is ever to be achieved in effectively treating the mentally ill homeless community,
researchers and care givers must understand how cultural values affect their clientele.
In 2009, E. Youngs provided a qualitative analysis of four individuals stories
highlighting the detrimental impact that cultural values have in effectively treating mental
illness. Additionally, Young examines how each individual was forced to deal with the guilt and
shame that arose when their mentally ill condition left them unable meet the cultural expectation
of society. Furthermore, Young highlights how superimposing cultural values and expectations
on mentally ill subjects made the diagnosis and treatment more difficult. Lastly, Young posits
that the mentally ill are a voiceless group that is in desperate need of further exposure.
Youngs report focuses on the clinical diagnosis of depression. For many years,
depression was not taken seriously in society. Many people believed (and still believe) that
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people diagnosed with depression should simply suck it up, pull up their boot straps and take
responsibility. Depression is a serious problem within the homeless community. Depression
leads to suicidal thoughts, fatigue and many other factors which can render a homeless individual
simply incapable of appropriately navigating him or herself to a life of self-sufficiency. While
Youngs report highlights the dysfunctional social construction methods which mentally ill
subjects employ, my research will reveal needed sense-making and uncertainty reduction
methods mentally ill homeless subjects engage in during narrative discourse. Thus providing
care providers and communication scholars with additional insight into the communication
practices of the homeless mentally ill; provided that concrete reoccurring themes emerge duringthe interviews.
In order to discover reoccurring themes, L. R itchie (2009) attempted to utilize peer group
discussions of homeless individuals in order to discover reoccurring themes and metaphors. The
group sessions were recorded and transcribed by students of Dr. R itchie. The analysis revealed
several reoccurring themes. One of the themes exposed was that several of the subjects chose to
blame others for their situation and/or the system. There were absolutely no occurrences where
the subjects blamed themselves for their failure to live a self-sufficient life. Additionally, the
subjects unanimously agreed that substance abuse was a coping mechanism for their hard life
instead of a barrier to better their situations. Again, many of the subjects blamed the system for
inadequate drug treatment programs, thus exemplifying the blame the system metaphor. I will
be interested to see if the mentally ill homeless population has a propensity to blame others
instead of taking responsibility for their situation.
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R itchie provides a great study where the voices of homeless people are given a platform.
R itchie effectively exposes that many homeless people blame others for their situation, thus
suggesting that while constructing reality, taking personal responsibility is secondary while
blaming others is a primary coping mechanism. Considering my report deals with mentally ill
homeless people, it will be interesting to see whether or not the reoccurring metaphors in
R itchies study occur in my study. R itchies qualitative analysis will provide a platform to
compare the sense making process between mentally ill homeless individuals with a cohort of
mentally sound homeless people
In 2006, B. Heuchemer & S. Josephssons conducted a qualitative analysis of two
homeless women who suffer from chemical dependency issues. The authors use a comparative
analysis between the two homeless drug abusers and two individuals who dont have substance
abuse issues or homeless situations. By utilizing a narrative approach, the researchers found that
the homeless women initially thought that drugs would provide a solution to their problems but
soon realized that using drugs turned out to be a significant barrier to self-sufficiency.
Additionally, the researchers found that the women suffering from homelessness and chemical
dependency viewed life in the short term and intense. In contrast, the women who didnt suffer
from homelessness or drug addiction viewed life through a long term lens and were less intense.
Lastly, the report gives the reader a unique snapshot into the lives of a vulnerable and
marginalized faction of society that doesnt get much exposure.
While the research was conducted in Sweden, chemical dependency and homelessness
are mutually inclusive. Drugs are a major factor as to why society has struggled to understand
and effectively end homelessness. Although my research will focus on the mentally ill homeless,
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many mentally ill homeless people suffer from chemical dependency issues as well.
Furthermore, when substance abuse is added as a barrier to the mentally ill homeless, the
combination of prescribed medication and mind-altering drugs further disrupt the mentally ill
homeless from connecting with their own socially constructed reality. Therefore, it is quite
possible, that in order to treat the mentally ill homeless, effective substance abuse treatment may
need to be addressed as well. By highlighting the similarities that the women in Heuchemer & S.
Josephssons 2006 study share with the subject(s) in my research, the complexity mutually
inclusive relationship between homelessness, chemical dependency and homelessness will be
highlighted.
In an attempt to evaluate supportive housing, Nelson, Clarke, Febbraro & Hatzipantelis
(2006) hear the stories of twenty homeless individuals who suffer from mental illness. The
purpose of the study is to evaluate the effectiveness supportive housing has on the mentally ill
homeless population. Using a qualitative approach, the researchers discover that the quality of
life before the individuals entered supportive housing was filled with anxiety and generally dark
Nelson et al (2006). In contrast, following the participants entrance into supportive housing, the
participants reported a significant brighter perspective on life in general. Although the quality of
life of the participants were enhanced after entering a supportive housing system, some of the
subjects reported negative aspects about their supportive housing environment (e.g. struggles
with substance abuse & access to medication).
While this report evaluates supportive housing, there is a great deal of information that
my research can glean off of. For example, the report is a narrative approach. By hearing the
voices of the mentally ill, patterns of sense making emerge and give the reader a snapshot into
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the lives of some of our most vulnerable citizens. The sense making patterns in this report will
complement the patterns which show themselves in my study.
In an attempt to evaluate supportive housing, Nelson, Clarke, Febbraro & Hatzipantelis
(2006) hear the stories of twenty homeless individuals who suffer from mental illness. The
purpose of the study is to evaluate the effectiveness supportive housing has on the mentally ill
homeless population. Using a qualitative approach, the researchers discover that the quality of
life before the individuals entered supportive housing was filled with anxiety and generally dark.
In contrast, following the participants entrance into supportive housing, the participants
reported a significant brighter perspective on life in general. Although the quality of life of the
participants were enhanced after entering a supportive housing system, some of the subjects
reported negative aspects about their supportive housing environment (e.g. struggles with
substance abuse & access to medication).
While Nelson et al (2006) evaluate supportive housing, there is a great deal of
information which will enhance my research proposal. For example, the report is a narrative
approach. By hearing the voices of the mentally ill, patterns of sense making emerge and give
the reader a snapshot into the lives of some of our most vulnerable citizens. The sense making
patterns in this report will complement the patterns which show themselves in my study.
Another study was conducted by J. Theiss and D. Solomons in 2008. Their article
examines uncertainty, openness of communication and the uncertainty reduction process as they
simultaneously affect intimacy in romantic relationships. Using a quantitative approach, the
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study surveys a cohort of traditional college age students over a six week period. The results of
the study indicate that reducing uncertainty is the only significant predictor of intimacy.
As my research will explore sense and sense making and uncertainty reduction within the
mentally ill homeless population, it is critical to reduce uncertainty and increase self-disclosure
of the subject(s) who will be studied. In my experience, I have noticed that homeless men in
general are skeptical and generally dont trust others. The mentally ill homeless men I encounter
are even more difficult to reach. Therefore, decreasing the uncertainty of the subjects about the
nature of my study will increase the level of intimacy (trust) the interviewer has with the
subject(s).
Research Questions
How people make sense out of sense making has been a question frequently researched
by communication scholars. However, identifying patterns of sense making and uncertainty
reduction within the cohort of mentally ill homeless individuals has not been done. By utilizing
a narrative approach my research will identify how mentally ill homeless men and women sense
make and reduce anxiety in their unique and obvious uncertain world. Furthermore, my study
will add and break new ground to the current scholarship by taking a discursive lens to find out
the sense making and uncertainty reduction process utilized by mentally ill men and women who
are struggling with homelessness.
R Q1: What are the reoccurring patterns of sense making that mentally ill homeless men
and women share in their narratives of their past, coping with their present
situation and planning their future?
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R Q2: How do mentally ill homeless men and women reduce uncertainty and anxiety?
M ethod
To explore the sense making and uncertainty reduction process in the mentally ill
homeless population, I will conduct an in-depth qualitative study of 20 homeless people who
suffer from at least one diagnosed mental illness. After the study, I will be better able to better
understand the thought patterns of the mentally ill homeless population.
O rganization
The participants will be pooled from two agencies serving the homeless. The first agency
is The Harvest Center in Charlotte, North Carolina. The second agency is Union Gospel Mission
in Seattle, Washington. Both of these agencies are faith based, and both provide housing for the
homeless; many of whom suffer from various mental illnesses. As Program Director of the
Harvest Center, I am able to gain full access to the interviewees currently being housed at our
facility. The Director of the Union Gospel Mission in Seattle, Washington has given me
unfettered access to the mentally ill homeless men and women housed at the Seattle facility.
Participants
Ten men and ten women who are mentally ill and homeless will be recruited and
interviewed. Ideally, I will interview eight African American men and women and two
Caucasian men and women. I hope to find a broad generational demographic within the
interviewees. Ideally, the majority will fall into the 30-50 year-old age range. The interviews
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will be conducted on a volunteer basis and each will be paid ten dollars for their participation.
Additionally interviewees will be given a consent form to sign prior to being interviewed.
Procedures
As a qualitative ethnographic study, data will be gathered using a semi-structured
interview protocol which focuses on sense making and uncertainty reduction. The interviewees
will be asked four basic sample questions with follow up questions designed to encourage self-
disclosure from the interviewees (see appendix A).
As a participant observer, I will be conducting the interviews and recording the answers
and transcribing them at a later time. The environment will be as comfortable and
nonthreatening as possible. It is our goal to provide an atmosphere that produces as little anxiety
as possible.
Limitations
While there should be a lower level of uncertainty with the participants at The Harvest
center (where I am Program Director). My status and intimate relationship with the clients at at
The Harvest Cent However may cause the interviewees to reveal information that they perceive I
want to hear instead of how they honestly navigate through the situations presented in the
interview questions. Additionally, both The Harvest Center and The Union Gospel mission are
agencies that are isolated from the community surrounding them. The isolated atmosphere from
both the Seattle and Charlotte location may reveal reoccurring themes which occur only in their
immediate environment instead of the overall mentally ill homeless population.
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D iscussion
The life of a homeless person is filled with uncertainty and turmoil. For A mentally ill
homeless person to be restored to self-sufficiency, agencies serving the needs of the homeless
need to understand the sense making and uncertainty reduction process of their clients.
Unfortunately, the current philosophy of agencies nationwide focuses less on case management
and more on providing homeless men and women with basic services.
After conducting this study, communication scholars and homeless service agencies will
benefit from the results. Service agencies will benefit from the study because they will have a
better understanding of the patterns of sense making and common uncertainty/anxiety reduction
methods employed by their clients. Having that knowledge will better enable agencies to design
and implement programs specific to the unique needs of the mentally ill. The communications
community will benefit from this study for the simple fact that there is little research focusing on
the mentally ill homeless. By using a qualitative approach, and revealing common themes in
both how mentally ill homeless men and women sense-make and navigate uncertainty, a
previously silenced voice will be given a much needed microphone.
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References
Fisher, W. Narration as a Human Communication Paradigm: The Case of Public Moral
Argument, C ommunication Monographs, Vol. 51, 1984, pp. 1-22.
Griffin, E. (2006). A First Look at C ommunication Literacy. San Francisco, CA: McGraw Hill
Publications.
Gudykunst, W.B., Toward a Theory of Effective Interpersonal and Intergroup Communication:
An Anxiety/Uncertainty Management (AUM) Perspective, in Intercultural
C ommunication C ompetence,R
.L. Wiseman & J. Koester (eds.) Sage, Newbury Park,
CA, 1993, pp. 33-71.
Heuchemer, B., & Josephsson, S. (2006). Leaving homelessness and addiction: Narratives of an
occupational transition. Scandinavian Journal of O ccupational Therapy , 13(3), 160-169.
doi:10.1080/11038120500360648.
Moxham, L. & Pegg, S.(2000). Permanent and stable housing for individuals living with a
mental illness in the community: A paradigm shift in attitude for mental health nurses.
Australian & New Zealand Journal of Mental Health Nursing , 9(2), 82-88.
doi:10.1046/j.1440-0979.2000.00162.x.
Nelson, G., Clarke, J., Febbraro, A., & Hatzipantelis, M. (2005). A narrative approach to the
evaluation of supportive housing: Stories of homeless people who have experienced
serious mental illness. Psychiatric Rehabilitation Journal , 29(2), 98-104. R etrieved from
Academic Search Premier database.
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Appendix A
R esearch Sample and Follow up Questions
Read aloud: Homeless people have to deal with many circumstances which many people
may not be fully aware of, it is the goal of this interview to get your interpretation, through
your stories so that others may be better able to understand your thought process.
Interview Question #1
What are some of the reasons why you are (or have been) homeless?
Follow up: Who do you feel is/was responsible for the circumstances you just described?
Follow up: Why do you feel that way?
Follow up: What specifically happened during that event?
Interview Question # 2
What mental illness have you been diagnosed with?
Follow up: Do you agree with the diagnosis?
Follow up: What medications are you currently taking?
Follow up: Do you feel better after taking the medication?
Follow up: Please tell me about a time you felt afraid when you were on and off your
prescribed medication.
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Question #3
What does a regular week look like for you?
Follow up: What did a regular week look like for you when you were on the streets?
Follow up: Tell me how you felt and what you did during those weeks.
Follow up: Please give me one example.
Interview Question # 4
Tell me about the last time you felt that you wouldnt be able to eat or find shelter?
Follow up: Who do you blame?
Follow up: What did you do to ensure that you ate and were out of the elements?
Follow up: What advice would you give to someone who is new to a homeless
environment.
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Appendix B
Letter to the ISB
Dear Sir/Madam,
My name is Kenyon Stanley and I am a graduate student at Queens University of
Charlotte. I am writing you this letter in hopes that I will be able to get approval for my attached
research proposal.
The purpose of my proposal is to gain insight into how the mentally ill homeless
population sense-make and reduce uncertainty and anxiety. If approved, my research will shed
new light on how the mentally ill homeless community process and navigate through their hard
lives.
The method for the research will be qualitative and dialogic in nature. Mentally ill
homeless men and women have not had a voice in the communication or therapeutic society.
While my sampling will be limited in scope, the results will provide care providers and
communication scholars data that will open the doors for further studies.
Thank you in advance for considering my research proposal. If you have any questions,
or if you require any additional information, please feel free to contact me at your convenience.
R egards,
Kenyon Stanley