title: Shifting normalities: interactions of changing conceptions of a normal life and the normalisation of symptoms in rheumatoid arthritis.
abstract: Biographical disruption and related concepts have been widely applied in chronic illness. Different conceptualisations of normalisation have also been proposed in order to explain individuals' diverse responses to illness on their biography, but as yet, not clearly related to changing bodily experience or normalisation of symptoms. This article aims to examine the relevance of these concepts in rheumatoid arthritis (RA), an unpredictable autoinflammatory disease characterised by painful and swollen joints, disability, fatigue and joint damage. Interviews were conducted with 23 people living with RA, and analysed using Framework, to enable people's whole narratives and context to be considered. Six typologies of normality emerged from the data: disrupted; struggling to maintain; fluctuating; resetting; returning; and continuing normality. Multiple normalities were often present in individuals' narratives, with one normality typology usually dominating at the time of the interview. The typologies connect to several biographical concepts, and instances of 'biographical reinstatement' were also found, where participants described returning to normal life, through perceived effective medication rather than reconceptualisation of health. The concept of 'shifting normalities' is proposed, providing a dynamic explanatory model of chronic illness that captures the interaction of changing conceptions of a normal life and the normalisation of symptoms.
authors.affiliation: Faculty of Health and Life Sciences, University of the West of England, Glenside Campus, Blackberry Hill, Stapleton, Bristol. tessa2.sanderson@uwe.ac.uk
authors.forename: Tessa
authors.initials: T
authors.lastname: Sanderson
authors.forename: Michael
authors.initials: M
authors.lastname: Calnan
authors.forename: Marianne
authors.initials: M
authors.lastname: Morris
authors.forename: Pam
authors.initials: P
authors.lastname: Richards
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewlett
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000523:psychology*; D001294:Attitude to Health; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011788:Quality of Life