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| Meaning in the Moratorium Stage: Loss of Purpose in Life |
Meaning in the Moratorium Stage: Loss of Purpose in Life
The occurrence of serious mental illness is a traumatic event. A traumatic event challenges a person’s basic beliefs about him or herself and about the world, creating a crisis of meaning (Emmons, Colby and Kaiser, 1998; Janoff-Bulman, 1992). There are two broad categories of the use of the word ‘meaning’ in the recovery literature.
First, there is the meaning of the illness: What does the illness mean about me as a person? (e.g. Bjorklund, 1998; Murphy, 1998; Deegan, 1997; Pettie and Triolo, 1999; Chovil, 2000; Fekete, 2004; Henderson, 2004). This question clearly ties in with the sense of identity, but is also related to how the person reacts to the illness, and can influence his or her recovery (Davidson and Strauss, 1995). The second sense of the term relates to meaning in life or purpose in life. The loss of meaning in life has been investigated in other forms of loss or trauma (e.g. Jaffe, 1985; Elliott, Kurylo, and Rivera, 2002). It refers to the loss of purpose resulting from the loss of the constellation of goals and roles around which the person had structured his or her life (Emmons, Colby and Kaiser, 1998; King, 1998).
The effect of the construed meaning of the illness was explicated by Davidson and Strauss (1995). In explaining the necessity for understanding a person’s relationship with the illness, Davidson and Strauss demonstrated how the meaning attributed to the illness can affect how a person reacts. In a case study, ‘Mr J’, whose illness first manifested after his divorce, viewed the illness as punishment for being a poor husband. Therefore, when each subsequent failed relationship initiated another episode of the illness, his theory that he was ‘condemned to failure as a man’ (p. 8)
was further confirmed. When the person sees the symptoms of the illness as coming from a higher power, he or she can feel unable or even unwilling to avoid the symptoms. An early question a person asks when struck by mental illness is, Why did this happen to me? (Pettie and Triolo, 1999). If the person believes the answer is that he or she somehow deserved the illness as punishment, this can be detrimental to recovery, as the person is not sure that he or she is worthy of any gains in success or happiness (Pettie and Triolo, 1999). Janoff-Bulman (1992), in her theory of adjustment to trauma, distinguished between characterological self-blame and behavioural self-blame, claiming that the former explanation undermines selfworth, while the latter implies some control (Janoff-Bulman, 1992). Watson (1994) expressed such self-doubt: ‘I have asked myself, as unfortunately do many mental patients, was this period of anguish punishment from God for my sin and rebellion’ (p. 71).
Chovil (2005) describes another way in which the meaning of the symptoms can lead to helplessness. He tells of his delusions that powerful aliens had chosen him as the future of humankind. After a time, these ‘aliens’ had complete control over him.
Chovil explains that to doubt the authority behind such hallucinations can be a test of faith, as the person has invested heavily in their reality. He writes that ‘frightened individuals become helpless face to face with these powerful forces’ (p. 70). When the person eventually chooses to defy these forces, and seek help, they may transfer their dependency to mental health services. Chovil (2005) suggests that this path to dependence and helplessness is possibly more relevant in the current climate than institutionalization caused by long-term hospitalization. Mental health services, he suggests, rather than engendering helplessness, are responding to helplessness.
When a person does come to a medical or psychosocial understanding of the illness, they then face the prospect that it may be a long-term problem (Spaniol, Gagne and Wewiorski, 2002). The acknowledgement that one needs professional help is a difficult step to take towards recovery, because the person is confronted by the loss of independence and sense of control (Young and Ensing, 1999). Then, when the person has achieved some stability, he or she may find it difficult to take steps towards engagement in new activities, due to fear of failure or of a return of symptoms (Strauss et al., 1989; Spaniol, Gagne and Wewiorski, 2002).
This brings us to the second sense of meaning used in recovery – purpose in life. This use of meaning is the more prevalent one in the consumer accounts of recovery. Harvey (2000) defines a ‘major loss’ as one in which one’s sense of self is fundamentally changed, and which disrupts a person’s beliefs about his or her reasons for being (Harvey, 2000). Serious mental illness represents such a loss. The loss of one’s important goals in life is one of the greatest and well-documented hurdles in coping with any chronic illness or acquired disability (e.g. Emmons, Colby and Kaiser, 1998; Lukas, 1998; Elliott et al., 2000). Our long-term goals imbue our lives and our daily tasks with meaning. Clinging to unattainable goals can cause depressive symptoms, and ruminating on lost goals can lead to reductions in daily functioning and increased psychological distress (Klinger, 1975). This is particularly poignant when the goal that has become unattainable is central to a person’s life and sense of identity (Brandtstadter, 2009).
Early in the illness, not only are previous meaningful life roles and goals lost, but the person can also have difficulty formulating and pursuing new goals. Spaniol et al.
(2002) quote ‘Mr F’ as describing his life as ‘like a revolving door. One minute it’s one way, next minute it’s another way’ (p.330). Although prior to the illness he had worked professionally in a scientific laboratory, Mr F now had an irregular work history in menial jobs (Spaniol et al., 2002). The loss of meaning when no longer able to pursue previous goals is illustrated by Fekete (2004), who experienced a psychosis whilst writing his dissertation. The psychosis caused written language to appear as a secret code that he could not understand, rendering him unable to continue with his scholarly work:
Everything had lost its significance for me. Everything seemed meaningless. There was no enjoyment in things that used to amuse me . . .. There seemed no point in doing anything . . .. I saw myself as old, physically deteriorated and, basically, done with life. I seemed to myself to have succeeded at nothing. (p. 191)
And the impact of the loss of future goals is captured in this passage, in which Deegan (1997) looks back on herself as a 17 year-old: No, this is not mental illness I amseeing. I amwitnessing the flame of the human spirit faltering. She is losing the will to live. She is not suicidal, but wants to die because nothing seems worth living for. Her hopes, her dreams, her aspirations have been shattered. She sees no way to achieve the valued roles she once dreamed of. (p. 17)
This loss of future goals then impacts on motivation in the present: As for the present, it was a numbing succession of meaningless days and nights in a world in which we had no place, no use and no reason to be. (Deegan, 1988, p. 55) The person’s interpretation of his or her symptoms, the chosen meaning of the illness to the person, and the loss of meaningful roles therefore conspire separately, or in combination, to rob the person of any motivation to work towards recovery.
The occurrence of serious mental illness is a traumatic event. A traumatic event challenges a person’s basic beliefs about him or herself and about the world, creating a crisis of meaning (Emmons, Colby and Kaiser, 1998; Janoff-Bulman, 1992). There are two broad categories of the use of the word ‘meaning’ in the recovery literature.
First, there is the meaning of the illness: What does the illness mean about me as a person? (e.g. Bjorklund, 1998; Murphy, 1998; Deegan, 1997; Pettie and Triolo, 1999; Chovil, 2000; Fekete, 2004; Henderson, 2004). This question clearly ties in with the sense of identity, but is also related to how the person reacts to the illness, and can influence his or her recovery (Davidson and Strauss, 1995). The second sense of the term relates to meaning in life or purpose in life. The loss of meaning in life has been investigated in other forms of loss or trauma (e.g. Jaffe, 1985; Elliott, Kurylo, and Rivera, 2002). It refers to the loss of purpose resulting from the loss of the constellation of goals and roles around which the person had structured his or her life (Emmons, Colby and Kaiser, 1998; King, 1998).
The effect of the construed meaning of the illness was explicated by Davidson and Strauss (1995). In explaining the necessity for understanding a person’s relationship with the illness, Davidson and Strauss demonstrated how the meaning attributed to the illness can affect how a person reacts. In a case study, ‘Mr J’, whose illness first manifested after his divorce, viewed the illness as punishment for being a poor husband. Therefore, when each subsequent failed relationship initiated another episode of the illness, his theory that he was ‘condemned to failure as a man’ (p. 8)
was further confirmed. When the person sees the symptoms of the illness as coming from a higher power, he or she can feel unable or even unwilling to avoid the symptoms. An early question a person asks when struck by mental illness is, Why did this happen to me? (Pettie and Triolo, 1999). If the person believes the answer is that he or she somehow deserved the illness as punishment, this can be detrimental to recovery, as the person is not sure that he or she is worthy of any gains in success or happiness (Pettie and Triolo, 1999). Janoff-Bulman (1992), in her theory of adjustment to trauma, distinguished between characterological self-blame and behavioural self-blame, claiming that the former explanation undermines selfworth, while the latter implies some control (Janoff-Bulman, 1992). Watson (1994) expressed such self-doubt: ‘I have asked myself, as unfortunately do many mental patients, was this period of anguish punishment from God for my sin and rebellion’ (p. 71).
Chovil (2005) describes another way in which the meaning of the symptoms can lead to helplessness. He tells of his delusions that powerful aliens had chosen him as the future of humankind. After a time, these ‘aliens’ had complete control over him.
Chovil explains that to doubt the authority behind such hallucinations can be a test of faith, as the person has invested heavily in their reality. He writes that ‘frightened individuals become helpless face to face with these powerful forces’ (p. 70). When the person eventually chooses to defy these forces, and seek help, they may transfer their dependency to mental health services. Chovil (2005) suggests that this path to dependence and helplessness is possibly more relevant in the current climate than institutionalization caused by long-term hospitalization. Mental health services, he suggests, rather than engendering helplessness, are responding to helplessness.
When a person does come to a medical or psychosocial understanding of the illness, they then face the prospect that it may be a long-term problem (Spaniol, Gagne and Wewiorski, 2002). The acknowledgement that one needs professional help is a difficult step to take towards recovery, because the person is confronted by the loss of independence and sense of control (Young and Ensing, 1999). Then, when the person has achieved some stability, he or she may find it difficult to take steps towards engagement in new activities, due to fear of failure or of a return of symptoms (Strauss et al., 1989; Spaniol, Gagne and Wewiorski, 2002).
This brings us to the second sense of meaning used in recovery – purpose in life. This use of meaning is the more prevalent one in the consumer accounts of recovery. Harvey (2000) defines a ‘major loss’ as one in which one’s sense of self is fundamentally changed, and which disrupts a person’s beliefs about his or her reasons for being (Harvey, 2000). Serious mental illness represents such a loss. The loss of one’s important goals in life is one of the greatest and well-documented hurdles in coping with any chronic illness or acquired disability (e.g. Emmons, Colby and Kaiser, 1998; Lukas, 1998; Elliott et al., 2000). Our long-term goals imbue our lives and our daily tasks with meaning. Clinging to unattainable goals can cause depressive symptoms, and ruminating on lost goals can lead to reductions in daily functioning and increased psychological distress (Klinger, 1975). This is particularly poignant when the goal that has become unattainable is central to a person’s life and sense of identity (Brandtstadter, 2009).
Early in the illness, not only are previous meaningful life roles and goals lost, but the person can also have difficulty formulating and pursuing new goals. Spaniol et al.
(2002) quote ‘Mr F’ as describing his life as ‘like a revolving door. One minute it’s one way, next minute it’s another way’ (p.330). Although prior to the illness he had worked professionally in a scientific laboratory, Mr F now had an irregular work history in menial jobs (Spaniol et al., 2002). The loss of meaning when no longer able to pursue previous goals is illustrated by Fekete (2004), who experienced a psychosis whilst writing his dissertation. The psychosis caused written language to appear as a secret code that he could not understand, rendering him unable to continue with his scholarly work:
Everything had lost its significance for me. Everything seemed meaningless. There was no enjoyment in things that used to amuse me . . .. There seemed no point in doing anything . . .. I saw myself as old, physically deteriorated and, basically, done with life. I seemed to myself to have succeeded at nothing. (p. 191)
And the impact of the loss of future goals is captured in this passage, in which Deegan (1997) looks back on herself as a 17 year-old: No, this is not mental illness I amseeing. I amwitnessing the flame of the human spirit faltering. She is losing the will to live. She is not suicidal, but wants to die because nothing seems worth living for. Her hopes, her dreams, her aspirations have been shattered. She sees no way to achieve the valued roles she once dreamed of. (p. 17)
This loss of future goals then impacts on motivation in the present: As for the present, it was a numbing succession of meaningless days and nights in a world in which we had no place, no use and no reason to be. (Deegan, 1988, p. 55) The person’s interpretation of his or her symptoms, the chosen meaning of the illness to the person, and the loss of meaningful roles therefore conspire separately, or in combination, to rob the person of any motivation to work towards recovery.
