Introduction
Narratives and storytelling have been espoused with the development of our sense of self and personal identity. Illness on the other hand has been shown to potentially impact on the development of the self and identity. Medical sociologists create a distinction between disease and illness describing disease in terms of biology that is the underlying pathology and illness as the social response to diseases especially in light of the fact that we exist within a social context. Illnesses therefore have no biological basis and are termed social constructs of diseases. In essence therefore, the way a particular illness is perceived varies from one culture to another and hence the variability in its impact on our sense of self and identity (Conrad and Barker, 2010).
In this paper I will describe how narrative and story-telling contribute to how we construct our sense of self and identity. Further, I will investigate how illnesses subvert the process of construction of sense of self coupled with identity from narratives and storytelling specifically in regard to direct injury to focal areas in the brain as well as social constructions of illnesses. Finally, I will highlight how we as nurses can help our patients use narratives to reconstruct their selves and identities shattered due to illnesses.
Body
A narrative is defined as a sequence of events that have a temporal association (Lamarque, 2004). “Our lives have a narrative structure that is; they comprise an unfolding structured sequence of events, actions, thoughts and feelings related from an individual’s point of view” (Goldie 2000, p. 294). Our identities as individuals on the other hand are a hyper-generalized personal sense which provides us with a background upon which our day to day functioning is grounded. Our personal identities are not a permanent phenomenon rather; they are continuously re-created via momentary incidences of foregrounded and explicit identity-dialogues (Martsin, 2010). Narrative theories about our sense of identity are cognizant of the fact that our individual contexts make it imperative for us to express ourselves in terms of narratives and texts.
The development of our sense of self as well as our personal identities starts at around adolescence and continues up to adulthood. Our person’s sense of self during the two stages is shaped and continues to be shaped by important life events. This implies that who we are is a product of remembrance and interpretation of our past experiences that is our life story. However, personal identity so constructed must change with time due to accommodate new experiences with the life story forming the basis upon which the new events are interpreted (Pasupathi et al, n.d.). In effect therefore, narratives shape our personal identity on a constant basis as opposed to a once in a life time experience (Habermas and Bluck, 2000).
The disruption as well as fragmentation that characterize traumatizing experiences accentuate the narrative construction of sense of self and identity; findings from research studies have shown that individuals who have experienced some form of trauma use narratives and story-telling to re-build their shattered sense of self and identity from the prevailing disorder and incoherence (Crossley, 2000). This is so because trauma subverts the orderliness and coherence of the individual’s self and personal identity and hence the need to re-construct the two.
Findings from a myriad of research studies indicate that individuals with focal brain damage involving the neural networks responsible for creation of narratives lose their sense of selves and thereby serve to reinforce the inseparable nature of narratives and personal identity. Our focal neural networks involved in narration and storytelling include the amygdalo-hippocampal system which is thought to be responsible for the initial coding autobiographical as well as episodic memories, the area responsible for language formulation that is the peri-Sylvian region and the frontal cortices together with their subcortical connections which are responsible for the classification of individuals and entities into either real or fictional temporal narrative frames (Young and Saver, 2001).
Narrative construction of our sense of self can occur in two forms the first one being abstraction form whereby the narrative self is perceived to occur as an abstraction and the second one is as an embodied narrative account in which our sense of self comprises of narratives which we can tell and an embodied sense of consciousness (Menary, 2008).
As I previously mentioned, traumatizing experiences such as illnesses alter the construction of our sense of self and identity. This occurs either as a result of direct injury to the primary focal areas responsible for the processing and storage of information on narration in the brain that is the amygdalo-hippocampal sytem, peri-Sylvian region and the frontal cortices as well as their subcortical connections.
Alternatively, subversion of our sense of self and identity in illness can be due to the fact that there is a social constructionist approach to illness. In other words, every illness is affixed a certain meaning within the social context and since us as individuals exist within societies, our illnesses will be interpreted via these meanings. More interesting is the fact that these arrays of cultural meanings do not in any way represent the biologic condition associated with an illness. In our social contexts, labels attached to illnesses are such that some illnesses are stigmatized, contested or perceived to be disabilities. This kind of labeling has more to do with the social response to an illness, the clinical manifestations of the illness as well as group of people who tend to suffer from the disease (Conrad and Barker, 2010).
Of further note is that unlike the biological aspect of the disease which trigger biophysiological changes, the labeling of illnesses potentially impacts on our sense of self and identity (Brown, 2007 cited in Conrad and Barker, 2010). For example, Antelius (2009) demonstrates through the narration about Peter that an inherent power struggle exists between the social constructionist view that tends to label those with significant physical impairment like Peter as disabled and patients with these impairments who want to retain their sense of autonomy and conversely their personal identity and sense of self. To achieve the latter, Antelius presumed that the human body can in itself act as a communicative tool whereby the movement of the body of a person with severe disability is interpreted as a narrative that is told via the embodiment of space.
Additionally, our relationship to an illness potentially alters how we perceive ourselves as well as how other people tend to perceive us (Wiengarten, 2001). More importantly, our diseases cannot be viewed as natural events occurring beyond the boundaries of the language in which they have been described (Bryan turner, 1995 cited in Conrad and Barker, 2010). Contrary, diseases are a product of medical discourse which has the power to influence our person’s sense of self and identity as well as the embodiment of subjective experiences in our life stories.
Of further significance is that we as individuals participate in social interactions and therefore we lent ourselves to detailed evaluations of our illnesses in the course of these social interactions which impact on the performance of our self (Charmaz, 1991 cited in Conrad and Barker, 2010).
We as nursing professionals can help our patients reconstruct their sense of self and personal identity by utilizing the narrative theoretical nexus which provides us with a framework for nursing practice (Bradbury and Miller, 2010). To achieve the latter, we as nurses require must have a pre-requisite understanding and ability to interpret both verbal and non-verbal components of our patient’s narratives. This is best captured in the example of Peter given by Antelius (2009) whereby the nurses repeatedly ignored Peter’s bodily communications whenever he requested to go out for a smoke. By failing to recognize and respond to his body language, the nurses were reinforcing the theme of dependency on Peter; they have control over where he should be at any time as well as what he should be doing. Peter on the other hand felt that such incidences subverted his sense of self since he craved for autonomy although no one was willing to help him achieve albeit some degree of it.
Moreover, we as nurses must carefully evaluate the meanings of the various social labels attached to illnesses as well as the impact of such a label on the patient’s sense of self and identity. Further, it will require that we as nurses identify the coherence, closure and interdependence traits of the various illnesses with which our patients present with. To help our patients rebuild their shattered images therefore requires that we as nurses’ move away from the tendency of labeling patients to perceiving patients as able to still exercise some degree of personal autonomy regardless of their physical impairments. We must also depart from the notion that our patients with significant impairments are mere passive recipients of the care we offer. In addition, we must foster a willingness to respect the patient’s right to self-determination (Antelius, 2009).
Conclusion
In conclusion therefore, narratives and storytelling contribute to the construction of our sense of self and identity. These constructions are more akin during our adolescence and adulthood and continue to occur on a constantly throughout our lives. Previous life stories form the basis upon which our new life experiences are analyzed and integrated into our sense of identity. Studies on patients with focal brain damage especially the amygdalo-hippocampal system, peri-Sylvian region and frontal cortices the three primary areas responsible for narration support the notion that narratives significantly contribute to the development of our sense of self and identity.
Illness subverts the process by which narration and storytelling contribute to the development of our sense of self and identity primarily because illnesses are interpreted within a social context. Social constructions to a medical diagnosis influence the manner in which our patients interact with others as well as the relationship between the patient and the illness which potentially impacts on the patient’s sense of self and identity. Stigma and disability are amongst examples of social constructs appended to illnesses that impact on self. Direct injuries particularly to the focal regions of the central nervous system responsible for the processing and storage of information on narratives and storytelling often result in impaired sense of self and identity in our patients.
We as nurses can help our patients’ use narratives to re-construct their sense of selves and identity disrupted by illness mainly by respecting their autonomy, right to self-determination and moving away from social constructs that tend to affix labels with different meanings to these patients.
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