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| Identity in the Rebuilding Stage: Self-redefinition |
Identity in the Rebuilding Stage: Self-redefinition
Rebuilding a positive identity requires first developing a positive sense of self that is not defined by the illness. Introspection in the Preparation stage results in the person reaffirming his or her personal strengths and core values that are still present despite the illness (Davidson and Strauss, 1992). Having tested his or her new-found agency on simple tasks, the person acquires the confidence to pursue more complex and important goals (Davidson and Strauss, 1992). In this manner the person elaborates and enhances his or her sense of identity.
The third and final pillar of my recovery was discovering how to summon my own personal strengths and resources to go back and reclaim my personal voice and keep my place at the table . . . like professional meetings and social gatherings. (Weingarten, 2005, p. 79)
As we discussed in the Awareness stage in Chapter 5, finding an explanation for the illness that is acceptable to one’s sense of self is an important step. Fekete (2004) found that the medical model of illness enabled him to reclaim his identity:
As I grew to understand the medical model of bipolar disorder, I was able to overcome the stigma associated with my illness and to redefine my person as it relates to my illness. . . . I am an ordinary person with a physical disorder. (Fekete, 2004, p. 192) However, as we have noted, others find the medical model limiting and stigmatizing, as they feel it gives them no option of wellness (e.g. Davidson and Strauss, 1995; Thornhill, Clare and May, 2004). Wentworth (1994) elaborates:
The medical model is especially harmful in how little vision and hope it offers to the mentally ill. The ‘mentally ill’ are as varied as any population and even if most don’t at this time use their ‘illness’ as a vehicle for working to understand and learn to grow, we should be given the opportunity to do so. (p. 88)
Either way, Curtis’ (2000) description holds true: [The spirit of the recovery process is]: I am no longer defined by myself or by others as my mental illness or disability, nor am I limited in opportunity, responsibility or direction. It is not who I am – though it may be a small part of me at times. (p. 4)
Having found a recovery-congruent explanation for the illness, the person can move forward in developing a positive identity. Fekete (2004) talked of a pilgrimage: ‘The pilgrimage I refer to is the overwhelming crisis of identity that psychosis brings as one begins to recover’ (p. 189).
Rebuilding a positive identity often requires changing a previously held identity. This can mean either letting go of the ‘illness identity’ and building a more positive sense of self, or it may require incorporating the illness into a previously held very positive identity and constructing a new ‘future self’. Crowley (2000) echoes a number of consumer-authors with this sentiment:
Much can be accomplished when we let go of who we were and get to know who we are now and who we can become. Instead of trying to figure out, ‘Why did this happen to me?’ ‘What could I have done to prevent it?’, ‘What did I do to deserve it?’ it is often more productive to ask, ‘What can I do about it?’ and to move forward. (p. 11)
‘This is the paradox of recovery: in accepting what we cannot do or be, we begin to discover who we can be and what we can do’ (Deegan, 1988, p. 56).
A number of consumers we have quoted have described how the illness itself, and the journey of recovery, provided them with a new vocation in life, for example, Armstrong (1994), Anonymous (1994a), Berman (1994), Koehler (1994), Lynch (2000), Weingarten (1994) and Wentworth (1994). Berman (1994), mentioned earlier, who was by age 60 also coping with physical illness, decided to discontinue lithium and abandoned his career goal to replace it with a retirement goal. He describes his decision as a change of attitude. The decision to retire did not take the form of helpless resignation. Rather, the tenor of his quote is hopeful for the future:
Itwas obvious that I could not return towork in ameaningful manner because ofmy age andmultipleinfirmities, thus Iconcludedthathavinghadtwocareers, thefirst inchemistry andthe secondas a lithium-bluntedmanic-depressive, thetime hadcome forme toregard myself as retired rather than disabled and to rebuild a new life on this basis. (p. 43) Berman was determined to once again experience ‘real life’ without the dulling effects of medication. An anonymous consumer, a qualified attorney, writes that it took much introspection to realize that he was projecting his insecurities about himself onto others (Anonymous, 1994a). Challenging these assumptions then freed him to move forward: ‘I’ve begun to loosen up and become more accepting of myself as I am’ (p. 17). As he gained confidence, he moved out of his parents’ home, began volunteer work, began continuing education with other lawyers and renewed contact with extended family and friends. He continues: ‘And significantly, I’ve developed some relationships with people whereby my sense of humanity and worth have been reaffirmed’ (Anonymous, 1994a ‘p. 17’).
McDermott (1994) also highlights the importance of others’ affirmation of the self in recovery, writing that, amongst other things, she ‘chose to be with nurturing, non-shaming people in healthy environments’ (p. 66). McDermott also writes that, in order to develop positive relationships with others, she attended many courses to ‘develop my self esteem, reduce my shame, increase my assertiveness and learned how to deal with anger appropriately’ (p. 66).
Success in battling with illness while at the same time holding down a responsible position can be in itself a source of self-affirmation. One consumer prides himself on his ability to draw on the healthy part of the self. In the absence of role models of heroes with a mental illness, he says, ‘I look at myself as my own hero, working on my illness while educating my students with well-thought-out lectures. I give myself a lot of credit for letting my healthy side predominate and for reaching out to help others’ (Anonymous, 1994b, p. 25).
For many people, the illness strikes before they have commenced adult life or formed a mature sense of identity. One such person is McQuillin (1994), who developed schizophrenia at age 19, and writes that this ‘suspended normal maturation’ (p. 9). He says:
I am still searching for a place in the world, but the task is becoming clearer now. I recently completed an evening course in the Principles of Marketing at the local community college. I received an A in the course, which gave me self-confidence and pride. I plan to take further courses next term, maybe day courses. (p. 9)
The importance of being patient with oneself, knowing when to slow down, and rebuilding one step at a time was a recurring theme. Koehler (1994) describes his approach:
One of the coping skills I use is pacing. For instance, I reassure myself . . . that if I reduce my expectations, my performance will improve.... I take frequent breaks at work . . . I have a long-range vision of myself several months into the future, so that minor problems can get put in perspective and don’t become catastrophes. (p. 23)
In the Rebuilding stage, then, ‘the individual’s personal path of redefinition through action’ (Lunt, 2002, p. 39) takes place. Lunt stresses that the person is empowered in this process by the help of others. Mead and Copeland (2000) emphasize the importance of the attitude of mental health staff in nurturing the personal agency required for the task of reconstructing a positive identity:
Our only hope for accessing internal resources that have been buried by layers of imposed limitations is to be supported in making leaps of faith, redefining who we’d like to become, and taking risks that aren’t calculated by someone else. (p. 321)
The importance of supporting personal goals is a core tenet of Self Determination Theory (Ryan and Deci, 2002). The ‘innate tendency to develop an increasingly elaborated and unified sense of self’ (p. 5) entails the pursuit of goals that are reflective of one’s values (Ryan and Deci, 2002). Autonomous goals are more than merely self-chosen goals; autonomous goals are those that are self-integrated, that is, they are an expression of the person’s core values (Ryan et al., 1996). Autonomous goals, rather than goals chosen for extrinsic reasons – for example, to please others – induce greater motivation, leading to enhanced goal attainment (Sheldon and Elliot, 1998). When a person has examined his or her core values and developed a sense of self, then support in choosing and working towards value-congruent goals is likely to lead to greater commitment, greater success and a positive sense of identity.
Rebuilding a positive identity requires first developing a positive sense of self that is not defined by the illness. Introspection in the Preparation stage results in the person reaffirming his or her personal strengths and core values that are still present despite the illness (Davidson and Strauss, 1992). Having tested his or her new-found agency on simple tasks, the person acquires the confidence to pursue more complex and important goals (Davidson and Strauss, 1992). In this manner the person elaborates and enhances his or her sense of identity.
The third and final pillar of my recovery was discovering how to summon my own personal strengths and resources to go back and reclaim my personal voice and keep my place at the table . . . like professional meetings and social gatherings. (Weingarten, 2005, p. 79)
As we discussed in the Awareness stage in Chapter 5, finding an explanation for the illness that is acceptable to one’s sense of self is an important step. Fekete (2004) found that the medical model of illness enabled him to reclaim his identity:
As I grew to understand the medical model of bipolar disorder, I was able to overcome the stigma associated with my illness and to redefine my person as it relates to my illness. . . . I am an ordinary person with a physical disorder. (Fekete, 2004, p. 192) However, as we have noted, others find the medical model limiting and stigmatizing, as they feel it gives them no option of wellness (e.g. Davidson and Strauss, 1995; Thornhill, Clare and May, 2004). Wentworth (1994) elaborates:
The medical model is especially harmful in how little vision and hope it offers to the mentally ill. The ‘mentally ill’ are as varied as any population and even if most don’t at this time use their ‘illness’ as a vehicle for working to understand and learn to grow, we should be given the opportunity to do so. (p. 88)
Either way, Curtis’ (2000) description holds true: [The spirit of the recovery process is]: I am no longer defined by myself or by others as my mental illness or disability, nor am I limited in opportunity, responsibility or direction. It is not who I am – though it may be a small part of me at times. (p. 4)
Having found a recovery-congruent explanation for the illness, the person can move forward in developing a positive identity. Fekete (2004) talked of a pilgrimage: ‘The pilgrimage I refer to is the overwhelming crisis of identity that psychosis brings as one begins to recover’ (p. 189).
Rebuilding a positive identity often requires changing a previously held identity. This can mean either letting go of the ‘illness identity’ and building a more positive sense of self, or it may require incorporating the illness into a previously held very positive identity and constructing a new ‘future self’. Crowley (2000) echoes a number of consumer-authors with this sentiment:
Much can be accomplished when we let go of who we were and get to know who we are now and who we can become. Instead of trying to figure out, ‘Why did this happen to me?’ ‘What could I have done to prevent it?’, ‘What did I do to deserve it?’ it is often more productive to ask, ‘What can I do about it?’ and to move forward. (p. 11)
‘This is the paradox of recovery: in accepting what we cannot do or be, we begin to discover who we can be and what we can do’ (Deegan, 1988, p. 56).
A number of consumers we have quoted have described how the illness itself, and the journey of recovery, provided them with a new vocation in life, for example, Armstrong (1994), Anonymous (1994a), Berman (1994), Koehler (1994), Lynch (2000), Weingarten (1994) and Wentworth (1994). Berman (1994), mentioned earlier, who was by age 60 also coping with physical illness, decided to discontinue lithium and abandoned his career goal to replace it with a retirement goal. He describes his decision as a change of attitude. The decision to retire did not take the form of helpless resignation. Rather, the tenor of his quote is hopeful for the future:
Itwas obvious that I could not return towork in ameaningful manner because ofmy age andmultipleinfirmities, thus Iconcludedthathavinghadtwocareers, thefirst inchemistry andthe secondas a lithium-bluntedmanic-depressive, thetime hadcome forme toregard myself as retired rather than disabled and to rebuild a new life on this basis. (p. 43) Berman was determined to once again experience ‘real life’ without the dulling effects of medication. An anonymous consumer, a qualified attorney, writes that it took much introspection to realize that he was projecting his insecurities about himself onto others (Anonymous, 1994a). Challenging these assumptions then freed him to move forward: ‘I’ve begun to loosen up and become more accepting of myself as I am’ (p. 17). As he gained confidence, he moved out of his parents’ home, began volunteer work, began continuing education with other lawyers and renewed contact with extended family and friends. He continues: ‘And significantly, I’ve developed some relationships with people whereby my sense of humanity and worth have been reaffirmed’ (Anonymous, 1994a ‘p. 17’).
McDermott (1994) also highlights the importance of others’ affirmation of the self in recovery, writing that, amongst other things, she ‘chose to be with nurturing, non-shaming people in healthy environments’ (p. 66). McDermott also writes that, in order to develop positive relationships with others, she attended many courses to ‘develop my self esteem, reduce my shame, increase my assertiveness and learned how to deal with anger appropriately’ (p. 66).
Success in battling with illness while at the same time holding down a responsible position can be in itself a source of self-affirmation. One consumer prides himself on his ability to draw on the healthy part of the self. In the absence of role models of heroes with a mental illness, he says, ‘I look at myself as my own hero, working on my illness while educating my students with well-thought-out lectures. I give myself a lot of credit for letting my healthy side predominate and for reaching out to help others’ (Anonymous, 1994b, p. 25).
For many people, the illness strikes before they have commenced adult life or formed a mature sense of identity. One such person is McQuillin (1994), who developed schizophrenia at age 19, and writes that this ‘suspended normal maturation’ (p. 9). He says:
I am still searching for a place in the world, but the task is becoming clearer now. I recently completed an evening course in the Principles of Marketing at the local community college. I received an A in the course, which gave me self-confidence and pride. I plan to take further courses next term, maybe day courses. (p. 9)
The importance of being patient with oneself, knowing when to slow down, and rebuilding one step at a time was a recurring theme. Koehler (1994) describes his approach:
One of the coping skills I use is pacing. For instance, I reassure myself . . . that if I reduce my expectations, my performance will improve.... I take frequent breaks at work . . . I have a long-range vision of myself several months into the future, so that minor problems can get put in perspective and don’t become catastrophes. (p. 23)
In the Rebuilding stage, then, ‘the individual’s personal path of redefinition through action’ (Lunt, 2002, p. 39) takes place. Lunt stresses that the person is empowered in this process by the help of others. Mead and Copeland (2000) emphasize the importance of the attitude of mental health staff in nurturing the personal agency required for the task of reconstructing a positive identity:
Our only hope for accessing internal resources that have been buried by layers of imposed limitations is to be supported in making leaps of faith, redefining who we’d like to become, and taking risks that aren’t calculated by someone else. (p. 321)
The importance of supporting personal goals is a core tenet of Self Determination Theory (Ryan and Deci, 2002). The ‘innate tendency to develop an increasingly elaborated and unified sense of self’ (p. 5) entails the pursuit of goals that are reflective of one’s values (Ryan and Deci, 2002). Autonomous goals are more than merely self-chosen goals; autonomous goals are those that are self-integrated, that is, they are an expression of the person’s core values (Ryan et al., 1996). Autonomous goals, rather than goals chosen for extrinsic reasons – for example, to please others – induce greater motivation, leading to enhanced goal attainment (Sheldon and Elliot, 1998). When a person has examined his or her core values and developed a sense of self, then support in choosing and working towards value-congruent goals is likely to lead to greater commitment, greater success and a positive sense of identity.
