Pro Seminar Final Kenyon Stanley Final Final

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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

[email protected]

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