Negotiating Illness in Medical Interactions: Narrative Styles of two Children with Leukaemia

The illness narratives presented in this paper were video‐recorded as part of child patient–staff interaction, during more than a year of ethnographic fieldwork at a paediatric oncology centre. The two children tended to ‘do illness’ differently, producing different types of narrative accounts. One of them presented accounts that invoked ‘fight’ metaphors, whereas the other one invoked patient identities. Also, the medical staff deployed different interactional strategies with different children in response to their narrative constructions of themselves and their leukaemia.     

Disability Identity Formation and Affirmation: The Experiences of Persons with Severe Mental Illness

This article examines the pervasive nature and extent of the debilitating sense of shame associated with disability. It then explores the emergence of disability identity, pride, and culture to challenge such shame—illustrated in personal narrative accounts of the individual and collective journeys of people coping with severe mental illness.     

Friendship Talk as Identity Work: Defining the Self Through Friend Relationships

This paper places friendships at the center of individuals' identity work, examining how individuals construct self‐identities through their talk about friend relationships and networks. We conceptualize this “friendship talk” as a subcategory of identity talk. From interviews with emerging adults, we find three strategies of friendship talk: envisioning self through others, betterment distancing, and situating with networks. These strategies demonstrate unique ways identity construction occurs through talk about friends. Individuals verbally connect with and separate from friends while constructing desired selves and moral identities. We suggest that friendship talk strategies may be generic social processes that apply beyond emerging adulthood.     

Disability and Chronic Illness Identity: Interviews with Lesbians and Bisexual Women and Their Partners

Disability rights activists and cultural workers are articulating disability identity and culture. Through interviews with lesbians and bisexual women with disabilities or chronic illnesses and their partners, the present study examined disability/chronic illness identity on the level of individual, couple, and community. Participants shared differing perspectives about how disability/chronic illness identity relates to other aspects of identity, and about whether disability/chronic illness identity is fluid or constant. They described several challenges they have encountered in developing disability/chronic illness identity. Couples talked about developing boundaries and balance in their relationships, and about how disability or chronic illness has strengthened their relationships. A number of participants spoke about identity as intimately linked with community. Implications for community building are discussed.     

Using Social Media to Change the Narrative Around Chronic Illness

Chronic illness is a prevalent issue for many individuals. Various theoretical approaches have been employed in the psychotherapeutic treatment of chronic illness and the effects it has on the individual with the illness. These approaches frequently overlook the strengths of the person living with the illness as well as fail to address aspects of modern life such as social media use of the client and the influence it holds for those living with a chronic illness. This paper proposes the application of narrative therapy and social media use as a narrative therapeutic technique when treating those who suffer from chronic illness. A clinical vignette is used to illustrate possible applications of therapeutic techniques in conjunction with therapist-directed social media use. Implications for clinical practice and limitations are discussed.     

THE RHETORIC OF SELF-CHANGE: Illness Experience as Narrative

A rhetoric formulating the self as a project for change has developed in our century. Within this rhetoric certain events and experiences are understood as occasions for changing the self; illness is a prime example. In most narratives of illness the author makes some claim for self-change, though these claims vary. The paper identifies several types of claims for self-change and then considers the relation of rhetorical structures to personal experience.     

The Mental Health System and Sense of Self Among Adults with Serious Mental Illness

Abstract

Development of a sense of self is a lifelong process. One's sense of continuity in the context of the demands of multiple role identities contributes to both psychological well-being and opportunities for acceptance into valued social roles. The onset of a mental illness can rupture an emerging sense of self and require intense and painful restructuring of one's beliefs and expectations. This study was a secondary analysis of qualitative data from interviews with twenty people who self-identified as having serious mental illness to explore how well the mental health system addresses the ingredients that promote, create, or restore a valued and adaptive sense of self.     

A Self-Psychological Perspective on Chronic Illness

It is becoming increasingly common to encounter patients seeking psychotherapy for symptoms resulting from chronic illness. Regardless of the specific diagnosis, chronic illness is a phenomenon with deep implications for disruption of self-states and narcissistic injuries. Working with chronically ill patients presents many challenges to the patient and the therapist, ranging from acute grief and loss to a reworking of unresolved developmental issues. This paper explores the use of a self-psychological perspective in the treatment of chronic and terminal illness. Approaching treatment from a self-psychological perspective, psychoanalytic psychotherapy can be successfully utilized in conjunction with supportive therapy.     

Challenging Dominant Discourses: Peer Work as Social Justice Work

ABSTRACT

People with mental illnesses are overrepresented in the criminal justice system, and discourses concerning the medical model, criminalization, and criminality dominate the intervention landscape for this population. Using a critical postmodern lens, 45 in-depth interviews with peer specialists who had incarceration histories were analyzed to understand how they approach their work. Peer specialists with incarceration histories constructed new identities through their training and peer work by valuing experiential knowledge. Even in the face of power differentials, they challenged dominant discourses directly and indirectly and advocated for various forms of help for the people with whom they worked.     

Cultural studies as praxis: (making) an autobiographical case

This autobiographical essay ‘takes cultural studies personally’, drawing on experience, identity and the personal to indicate how and why the author is proponent of and is working on developing a model of cultural studies as social justice praxis despite the constraints academia in general and of the university as an institution in particular. The paper travels roughly from the author’s student and teacher days in Sierra Leone through his graduate student days in Canada to his current role as university teacher in the USA. He selectively concentrates on his experience as a teacher of literature (and African multi-role utilitarianism), education and cultural studies (using one of his cultural studies courses and students’ questions about the utility of cultural studies as example), his shifting and overlapping racial/ethnic identities (African/black) and the politics of identity, and his thoughts on the place of theory in cultural studies and a black approach to theory (black ambivalent elaboration) as contributory factors. While this account acts in its own way as an argument for conceptualizing cultural studies as praxis, the primary focus is more modestly on my own autobiographical account as a specific case. In fact, an autobiographical approach is employed precisely to be specific and in the attempt to avoid the pitfalls of over­generalization and the authority of authenticity.     

Parental Grief and Serious Mental Illness: A Narrative

Serious mental illness is associated with substantial personal and interpersonal distress and life disruption for the sufferer and for his/her family. A common response to having and caring for a family member with a serious mental illness is feeling loss and grief. This paper presents a representative narrative that attempts to capture the essence of the experience as conveyed by 22 parents of adult children with a serious mental illness. The implication of the narrative is examined.     

Illness uncertainty and illness intrusiveness as predictors of depressive and anxious symptomology in college students with chronic illnesses

Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between November 2013 and May 2015. Methods: Participants completed online measures of psychosocial functioning, including illness uncertainty, illness intrusiveness, depression, and anxiety. Results: Students with chronic illnesses other than asthma or allergies evidenced the greatest levels of anxious (p <. 05), but not depressive symptomology. Additionally, this group reported greater illness uncertainty and intrusiveness (p <. 05) compared to their peers. Uncertainty and intrusiveness independently predicted depressive and anxious symptoms for students in both illness groups. Conclusions: Compared to peers with asthma or allergies, college students with other chronic illnesses reported higher levels of anxious symptoms. Illness uncertainty and intrusiveness appear to be predictors of psychological distress, regardless of illness.     

Understanding Parental Grief as a Response to Mental Illness: Implications for Practice

ABSTRACT

Parents who are raising children with mental illness struggle with feelings of grief and loss. Kubler-Ross' (1969 Kubler-Ross , E. ( 1969 ). On death and dying . New York : Scribner . [Google Scholar]) stages of grieving (denial, anger, bargaining, depression, and acceptance) are examined as experienced by parents raising children with chronic mental illness. Practice implications for social workers who are working with children and their parents are discussed. Acknowledging and understanding parental grief, while providing emotional support, leads to a more effective working partnership. This collaboration of parents and social worker can result in more effective treatment for the child with mental illness. Examples from one of the co-author's personal experiences are included.     

Contending Stories: Narrative in Social Movements

Study of stories and storytelling in social movements can contribute to our understanding of recruitment that takes place outside formal movement organizations; social movement organizations' ability to withstand strategic setbacks; and movements' impacts on mainstream politics. This paper draws on several cases to illuminate the yields of such study and to provide alternatives to the overbroad, uncritical, and astructural understandings of narrative evident in some recent writings. It also urges attention to the role of literary devices in sociological analyses of collective action.     

Socioeconomic Status and Mental Illness in Japan*

Abstract Since the pioneering work of Faris and Dunham (1938), a number of studies in the United States have documented an inverse association between socioeconomic status (SES) and mental illness both at the aggregate and the individual levels, and both for the treated and the general population. However, there are few studies of whether this relationship holds in other countries. This study examines socioeconomic characteristics and mental illness in Japan, which has a very different social stratification system from that of the United States. It was found that, at the aggregate level, the “inverse” association between socioeconomic characteristics and the rate of treated mental illness does not hold in Japan. Instead, the relationship is curvilinear: mental illness is higher in districts with large numbers of blue collar and upper white collar workers than in districts with large numbers of lower white collar workers. The effect of SES on mental illness operates through economic stress embedded in the macro social context. Because different social structures lead to different patterns of economic stress, the inverse relationship between socioeconomic status and mental health cannot be assumed to hold in all countries.     

Negotiating Personal Experience over the Lifetime: Narrative Elasticity as an Analytic Tool

Sociology and neighboring disciplines have produced different analytic tools to examine the dialogical relationship between individuals and society (“narrative work,” “identity work,” “moral career,” “moral breakdown”). However, the question of how individuals negotiate the interpretation of personal experience over their lifetimes in a changing cultural context remains unexplored. This article introduces narrative elasticity as a feature of narrative work and as a time‐sensitive analytic tool for conducting inquiries into processes of temporal retraction and expansion of what storytellers conceive as the normal order of significance. The application of this tool to the analysis of mature and elderly Chileans' life stories shows how cultural change occurs at the individual level, considers factors that motivate and inhibit processes of reinterpretation of personal experience, and identifies different levels at which it operates.     

Obtaining Informed Consent When a Profession Labels Itself as Providing Treatment for Mental Illness

Abstract

This paper examines when informed consent laws mandating explanation of the risks and benefits for proposed treatments (some talk intervention) and alternative to the proposed treatments (e.g., medications) apply to the social work profession. The reasons why an explanation of alternative treatments, including explaining medications, might be part of securing informed consent are proffered. Following this, consideration of how the task of explaining alternatives might be addressed is examined. The particular example of antidepressant medications provides a context for considering how to discuss medications as a treatment alternative. The kind of information a social worker might be obligated to possess and then impart to the client in fulfilling the task of obtaining informed consent is considered.     

Comorbid Substance Abuse and Mental Illness

Abstract

Literature concerning assessment and treatment of comorbid substance abuse and mental illness is reviewed. Currently, comorbidity is under-diagnosed and dually diagnosed clients are under-served. Those clients, who are so diagnosed, are most often offered dichotomous parallel or serial interventions. However, research suggests that an integrated approach is preferable. Enhanced training of mental health and substance abuse professionals is urgently needed as is further research concerning the efficacy of various treatment modalities. Improved identification and treatment of comorbidity may reduce the revolving door effect among these individuals and thereby lower health care costs.     

Family Work in Oncology: Trusting the Narrative

The author describes her work with a dying patient, work that extends from the patient to his wife and adult offspring, and has transformative benefits for the family.