RJONES_ FOR

Chronic Illness and Possible Selves in the Identity Development Process of Midlife Graduate Students

By: Robin L. Jones

Fielding Graduate University

“The gift of the possible self is that it provides the element of potential, opening doors to

that which we might become in life” ~ Jones

Why I Chose this Topic:

• Technological advances make it possible for a more diverse population to enter into graduate school.

• Experience of peers

The number of Americans afflicted with chronic illness is currently estimated at approximately 133 million (National Health Council, 2012). So, needless to say this research is of import not solely to graduate students, or people in midlife; what we learn here has the potential to help us care for a far greater number of people.

• What’s out there in the literature:

• research on the challenges inherent to the midlife as developmental stage

• how individuals cope with chronic illness.

• literature about professional identity development

• What is lacking is a specific body of literature that addresses the mechanisms of the identity development process when people find themselves facing multiple life transitions.

Brief Description of Study Purpose: to understand the relationship among chronic illness, possible selves, and identity

development as people experience multiple life transitions, i.e. chronic illness, graduate school, and midlife.

A transition, for the purpose of this study, is the process through which a person renegotiates identity following any situation that might pose significant psychological and physiological challenges associated with sense of discontinuity or incongruence with prior aspects of life and sense of self (Kralick & van Loon, 2010).

Midlife is a phase of development with a propensity for significant challenges to one’s way of living. It constitutes, for some, a transition. There are some challenges in midlife that could be significant enough to serve as a catalyst for identity renegotiation or development.

Conceptual Framework for the Study

Possible Selves Theory

Self-Determination Theory (SDT)

Discussion of Possible Selves Theory

Possible Selves Theory is a “cognitive approach to the study of self-concept” (Markus & Nurius, 1986, p. 955)

Assumptions

Self-concept is thought to consist of a network of cognitive-affective structures manifest as self-knowledge (Markus & Nurius; Dunkel, 2000).

Everyone has possible selves that are readily called to mind.

Possible selves can be either hoped for or feared/past or future.

Possible selves are both dynamic and socially constructed, “informed by one’s social context, including past and anticipated experiences” (Dunkel, p. 252).

Possible selves are structures of the self and are important in meaning making.

Possible selves serve as goals towards which we aspire; or ends we try to avoid.

Discussion of Self-Determination Theory

Self-determination theory (SDT) is a “theory of motivation and personality within social contexts, that is concerned with the relative assimilation of goals, values, and identities” (Ryan & Deci, 2012).

Components

Competence: a feeling of effectiveness.

Connectedness/Relatedness: a feeling of being cared for or loved.

Autonomy: perceived ability to self-regulate behaviors.

Self-determination states that universally, humans have a strong need for these things.

Identities are assimilated either in the service of such needs or because these needs are thwarted by life events or significant others (Chen, Boucher, & Tapias, 2006; Ryan & Deci, 2012).

A Word about Identity

Identity defined: For the purpose of this study, I utilize Josselson’s (1987) definition of identity: the representation of one’s self in relation to both self and others.

Identity is both dynamic and multidimensional.

Identity is at the same time personal and social and comprises those aspects which are most central and salient to the concept of how one defines oneself.

Identity develops over time and has a dynamic nature based upon cognitions, emotions, and social interactions.

A Word Self-Concept in Relation to Identity

The self-concept is considered dynamic in that the possibility inherent in possible selves is the harbinger of “action, change, and development” (Markus & Nurius, p. 960). The self-concept is made up of cognitive-affective structures that manifest as self-knowledge.

Specifically, the “addition of the ‘possible’ to the concept of self…provides a lens for examining self-views that encompass a future [emphasis added] orientation” (Hamman et al., 2010, p. 1351).

It could reasonably be argued that identity, at any point in time, is essentially the same as the working self-concept, or stated another way, the particular aspect of the self-concept that is salient at any given moment. Ruvolo and Markus (1992) state that while self-concept is made up of a “shifting array of accessible self-knowledge” (p. 98), the working self-concept is just one of many possible self-representations made salient in the moment.

Important in the Literature

Frazier, Cottrell, & Hooker (2003)-effect of chronic illness on possible selves (PD, AD, healthy control)

Interview, list of possible selves compiled.

Using a Likert-type scale- rated current accuracy of each possible self description, likelihood of achieving/avoiding each possible self, and perceived capability in achieving or avoiding each possible self.

Statistically speaking, PD and AD groups had about the same number of possible selves as control group.

The lack of anticipated impact of illness on the presence of possible selves was interpreted as a sign of flexibility of possible selves. They suggest that the flexible nature of possible selves “may actually be associated with maintenance, modification, and changes in form of one’s visions of future selves” (p. 9).


Maliski et al. (2008)- reconstruction of masculine identity in men who experienced erectile dysfunction following surgery for prostate cancer

When men were unable to work due to their illness, it affected their sense of competence and ultimately their identity as a man.

Ability to focus on different, previously less valued, aspects of being a man allowed for some reconstruction of identity.

*Most possible self research that is health-related focuses on older individuals, rather than on individuals in midlife


Research on Cognitive Strategies for Coping with Disrupted Identity (Integration and Separation)

Whittemore & Dixon (2008)- interviews/questionnaires to study process of integration when individuals (ages 25-80) are faced with chronic illness

Phases of integration: shifting sands, staying afloat, weathering the storms, rescuing oneself, and navigating life

Shifting sands – affective experiences and adjustment

Staying afloat – learning about disease and self-care, making changes, struggle between dependence and independence

Weathering the storms – barriers to integration including disease trajectory and everyday hardships i.e. financial, etc.

Rescuing oneself – attempts at regaining a sense of normality

Navigating life – ongoing struggle between “living a life and living an illness”

*Experiences were common across heterogeneous diagnostic categories


Miles et al. (2005)- experience of chronic pain and integration of this experience into life. Through interviews with 29 participants, ages 21-84, the following coping strategies were identified.

Integration (acceptance)

Assimilation (incorporated into pre-existing identity, with small changes made to maintain sense of continuity)

Accommodation (new normal; often radical life change or new ways of thinking)

Separation (rejection)

Subversion (attempting to maintain an outward appearance of the previous identity and life being unchanged despite sometimes significant alteration of activities)

Confrontation (disregard of illness identity; attempt to preserve life as normal despite any associated risks)

Miles et al. (2005) state, “There are clear parallels between coping with the restrictions of pain and coping with the restrictions associated with aging.” I would offer that likewise, there are parallels with chronic illness experience as a whole, making this research particularly salient in light of the population from which I drew my sample.


Aujulot et al. (2008) - research in which they conducted interviews with 40 participants, ages 23-75, who had been diagnosed with forms of chronic illness. These interviews were analyzed to gain an understanding of empowerment as well as the processes of reconstructing both identity and the illness experience.

Participants spoke of a state of powerlessness that evolved from feeling a loss of sense of identity.

Some participants were empowered by reconciling identities. These participants said that the disease was part of them but did not define them. People who fit this category were more likely to conceive of and commit to goal pursuits and lifestyle changes.

Participants who engaged in integrative strategies, or letting go of previous identities had narratives that conveyed attempts to make meaning from their situation. A part of this process appeared to relate to looking for a causative factor for the illness. For others, the ability to make meaning of and integrate their illness was rooted in identifying a personal mission or purpose such as helping others through their experience with chronic illness.

Other participants who were focused on controlling the disease found themselves facing higher levels of negative affect. In the language of Miles et al. (2005), these participants might be considered to be engaging separation-type coping strategies


SDT Vignoles et al. (2006,2008)- study to determine motives involved in identity

construction Vignoles at al. define identity motives “as pressures toward certain identity states and

away from others, which guide the processes of identity construction” (p. 309). They furthermore state that these same motives are likely reflected in peoples’ possible selves.

Vignoles et al. (2006) had 90 participants, ages 15-79, generate 12 aspects of their identity and rate them for positive affect, degree of centrality, identity enactment and satisfaction. Two months later this process was repeated. (They define identity enactment as the extent to which people try to convey aspects of their identity to others with whom they interact on a daily basis.)

Analyses showed that identity enactment was predicted by self-esteem, belonging, degree of centrality, and efficacy. Their findings lend support to self-determination theory, which posits that people tend to behave in ways that maximize their ability to meet their needs of autonomy, competence, and relatedness.

In an extension of the above, another study was conducted which found that the most hoped for and least feared possible selves were those associated with self-esteem, efficacy, meaning, and continuity. Belonging contributed indirectly.


Igreja et al. (2000)- compared gay men diagnosed with HIV to a control group of gay men without an HIV diagnosis and examined their pursuit of various self-generated goals.

Goals were then classified as either integrated or introjected. An introjected goal is one that is pursued out of a sense of obligation or to avoid some negative affective state. An integrated goal is pursued because the person perceives some sort of meaning or value in the pursuit or acquisition of the goal.

Hypothesized: pursuit of integrated goals would be positively correlated with a greater sense of well-being and lower levels of distress whereas pursuit of introjected goals, in some cases, increase level of distress.

Findings showed that the pursuit of introjected goals left the need for autonomy thwarted whereas the pursuit of integrated goals led to increased sense of well-being.

There were no significant between group differences. Therefore, we can infer that the experience of autonomous goal pursuits is predictive of well-being for individuals with and without chronic illnesses.


Possible Selves in Career Development

Plimmer & Schmidt (2007)-Five mechanisms by which possible selves operate in CD

Reflection of values, meaning, belief systems

Presence of salient elements of self-concept

Presence of an affective element

Cognitions, in the form of well-developed strategies, that assist not only in information processing but also in achievement or avoidance of imagined selves

A proportionate balance of hoped for and feared selves, which when present serves as impetus to achieve or avoid

The more elaborate and accessible one’s concept of a future self, the less salient the perception is of present and past selves


Ibarra (1999) – Provisional selves

Provisional selves are possible selves that are actually “tried out” or practiced rather than simply envisioned.

In some academic domains, the opportunity exists for students to not only learn from faculty mentors and instructors in a classroom setting, but also in fieldwork type opportunities such as practica and internships. Images of professional identity are conveyed during these types of experiences.

In cases where such fieldwork is not an opportunity, the images of professional identity generated by faculty may be incomplete, leaving students with some degree of ambiguity in regards to their possible and provisional selves.

Jazvac-Martek (2009) – Oscillating Role Identities in Doctoral Students (RIT)

People possess multiple identities and therefore, place themselves in multiple roles.

Role identities are “analogous to the idea of cognitive schema…and act as reference frames for appraising thoughts and actions, the primary source for plans of further action” (p. 255). Therefore, it is easily inferred that role identities are analogous to possible selves, which are defined as cognitive structures or schema that perform the same functions.

A basic tenet of RIT is that different roles or identities are enacted based upon the contexts in which a person finds himself or herself; they are the products of intersubjectivity.


For graduate students, this enactment provides feedback to help bridge the gap between the current identity and the future identity towards which the student aspires.

Two-year longitudinal study of nine individuals who were either actively working on or had recently completed their doctoral degrees, and were aspiring towards academia.

Analysis of interviews, logs, and questionnaires showed doctoral students oscillate between academic and doctoral student role identities.

Doctoral student roles included “teaching assistant, the research assistant, the dissertation proposal-writer [and] the novice researcher” (Jazvac-Martek, 2009, p. 258). Academic role identities included but were not limited to examples such as conference presenter, grant recipient, published author, and being sought out as a consultant.

Findings: individuals were more likely to feel like an academic in situations where they felt actively engaged in a community of scholars – perhaps when they experienced a sense of belonging. Confirmation of roles helped ease transition from one identity to the other.


Midlife and Chronic Illness

Kralick (2002)- narrative study of midlife women living with adult onset chronic illness. Two main themes.

Ordinariness (life as normal); Two subthemes:

Chronic illness as transformative

Ability to regain some sense of control over life

Extraordinariness (disruption); Two subthemes:

Rapidity with which life can change

Feeling cut off from normal life and sense of self

The experiences of ordinariness and extraordinariness make up the illness transition.

Research Questions

When midlife individuals going through professional transitions face chronic illness, how do they integrate their changing identities?

What is the experience of possible selves in the face of chronic illness during a midlife professional transition?

Participants

Demographic info

My participants were one male and seven females between the ages of 36-51 who were either in graduate school or had finished graduate school within the past year. All identified as Caucasian.

Participants came from five different educational institutions, three of which were traditional while the other two were blended programs which included both face-to-face and online components.

Counseling Psychology, Clinical Psychology, General Psychology, Public Health Administration, and Educational Leadership

Married = 5 Single = 1Divorced = 2

With Children in household = 5

Participants

Participants were diagnosed with chronic illness during the course of their studies.

“Chronic illness” and terms used interchangeably referred to any medical condition that progresses slowly and is long lasting in duration. Conditions exhibiting “flare-ups” were also considered chronic, so long as the diagnosed condition itself was not expected to resolve.

Brief Participant Bios

Dan (Male):

Age 36 – youngest participant Resides in mid-Atlantic region/single-family dwelling

Married – 2 children Employed in mental health field

Nadene (Female):

Age 37 Resides in northeastern U.S./other half of parents’ duplex

Single – 1 child Employed in hospital H.R. – out on maternity leave

Claire (Female);

Age 51 – oldest participant Resides in suburb of large SE city/single-family Victorian home

Divorced – 2 adult children, little contact Employed in mental health field

Barbara (Female):

Age 49 Resides in SE college town/single-family home

Married – 2 adult sons (1 in assisted living) Preparing to leave for internship in Psych with ABA

Brief Participant Bios

Lady D (Female):

Age – 39 Resides in upper NE/single-family dwelling

Committed relationship Full-time doctoral student in Clinical Psychology

Sheila (Female):

Age – 44 Resides in upper Midwest/single-family home and boathouse

Married – 3 children Full-time IT educator/full-time doctoral student Ed. Leadership

Veronica (Female):

Age – 37 Resides in rural area of mid-Atlantic state/single-family home

Married – 2 children Preparing to begin internship in Counseling Psych

Audrey (Female):

Age – 50 Resides in rural area of a southern state/single-family home

Married – 1 child; MIL Full-time doctoral student in Clinical Psychology

Chronic Illness Diagnoses of Participants

Dan - syringomyelia (SM), which is characterized by a cyst on the spinal column

Nadene - supraventricular tachycardia; she had experienced only heart palpitations at the time of our interview

Claire - unnamed chronic respiratory condition

Barbara - Hashimoto’s Thyroiditis; she experiences fatigue, aching joints, weak muscles, and depression. She has a pre-existing dx of fibromyalgia

Lady D - sinus polyps and Temporomanidbular Joint Disorder (TMJ)

Sheila - hypertension and sleep apnea

Veronica - mitral valve prolapse, diabetes and Stage 2 kidney disease

Audrey - breast cancer

The Study Design

What – Narrative research

How – Semi-structured interviews via Skype or in-person (total time per interview < 3 hrs.)

Why - It was my hope that the current study would, while capturing both emotional experience and cognition, help “give voice” to the moving, lived experience of my participants, capturing the essence of human beings and being as dynamic and “existing on multiple planes of present experience, poised in complex relation to the past and to the future” (Josselson, 1995, p. 37).

I would like to hear about your life as a midlife, graduate student and about how chronic illness has affected your plans for your life. Please include all the experiences which were important for you, starting wherever you like.

In narrative interviews, the frequency with which participants refer to specific possible selves is an indicator of salience. The elaboration of possible selves is also an important concept and can be discerned by the level of description and detail that appears in the narrative in regard to specific selves.

Assumptions related to this study:

Every person has possible selves and that these selves can be called to mind with relative ease (Markus & Nurius,1986).

While possible selves may be brought to mind without much effort, the same cannot be said for the motives related to goal pursuit.

Self-deception and other forms of cognitive bias may be involved or these motives may simply be operating at a different level of awareness that is not easily accessible (Vignoles et al., 2008).

Coding and Analysis

Utilized Thematic Analysis (TA) method by Braun and Clarke (2012)

TA is a way of identifying, organizing, and offering insight into themes across a data set. By looking across cases we can identify commonalities in the way participants experience and assign meaning to their experiences.

Coded for possible selves and elements of SDT; then themes were identified.

Analysis of the narratives provides answers to the research questions.

Domains and Themes and Subthemes

Possible professional Self

Pursuit of Graduate Degree

Personal Relevance: Fulfillment and Moral Purpose, Reasonable Next Steps, Testing the Waters

Professional Direction: Certainty vs. Uncertainty, Avoiding Devalued Selves

Insights about Professional Development

Self-View Changed vs. Not Changed

Ill Self

Reactions to Health Complication

Physical Experiences and Challenges

Psychological Reactions: Too Young, Inconvenience due to Timing, Under Siege/Loss of Control

Self with Doctors

Affective Experiences: Frustration, Mistrust, Confusion ↓

Feelings of Powerlessness: Unheard, Undiagnosed, Seeking Control ↓

Knowledge is Power

Domains and Themes and Subthemes

Interactions between Possible Selves

Sacrifices

Balancing ↓

Sacrifices made in Service of the Professional Self

Disruption vs. Continuity

Adaptations and Avoiding Feared Possible Selves: Priorities, Slow down, Diet, Help

Perceived View of Self in Relation to Others

Use of Resources: The Value of Relationships

Effects of Illness on Self-View

A New Me (5) vs. Same Old Me (3)

Quest for Meaning

DOMAIN: POSSIBLE PROFESSIONAL SELFTHEME: PURSUIT OF GRADUATE DEGREE

Personal Relevance in Pursuing Graduate Degree: Fulfillment and Moral Purpose

Claire: I think there’s just this professional challenge where…I wanted to have some command of some portion of that domain anyway and be able to do something meaningful with it. That was really, I guess it was really a search for meaning…I already had a good job, it just did not meet the standards that I had always imagined for my professional work. I had imagined developing expertise. And I had imagined being independent. And, I think the autonomy was important but it wasn’t just the autonomy because I could have been an autonomous business person, which I did not want to be, you know, so it wasn’t just that.

Nadene found fulfillment in “the whole learning process.”

Personal Relevance in Pursuing Graduate Degree: Fulfillment and Moral Purpose

Lady D also mentioned a “quest to learn.”

Barbara: Thinking back to when I was younger, I was always able to empathize with others. I was always very quiet and shy; I was always just observing. But I always felt like I could understand.

Personal Relevance in Pursuing the Graduate Degree: Reasonable Next Steps

Dan (in regards to pursuing the Ph.D.): …because it was worth it to have something you could at least make some money off of.

Nadene: Um, it was, it was never really a question…I just, I knew that it was my next step from the start.

Audrey: I’d say probably before I was even licensed [in counseling psychology] I was going now I want a PhD.

Sheila also found the opportunity to pursue a Ph. D. meaningful as a way to continue to develop professionally: That’s very important to me that I have the credential and be positioned to advance if that’s what I choose to do.

Personal Relevance in Pursuing the Graduate Degree: Testing the Waters

Lady D: I knew I didn’t want a purely academic career but I knew I also wanted variety and I wanted the ability to have the choice, like do I want to do teaching, do I want to see clients? It seemed like [graduate school] would be a great stepping stone for me so I can decide.

Veronica: They informed me that [this place] was needing a counselor because we do not have counselors or psychologists in our area. We have to drive to a different county to be able to receive services. Uh, so I said, okay I don’t mind [trying] to help so I said just give me a chance to see if I could do it and be able to help out and see if I’m able to handle these types of cases. And I tried it and fell in love with it.

Professional Direction: Certainty vs. Uncertainty

Sheila: I think, you know, just thinking about the rest of my work, you know. You know, I'm 44 and I think I'm at the point where I'm trying to figure out if, am I on the right path, am I on the right career path?

Dan: I wanna stay, do the full go-round, get the full retirement and then do whatever else I want to do when that’s all over. Go back and teach or go back and do private practice. You know, basically have enough put aside that I don’t have to worry about finances before I go out and try to reinvent myself again. Because I did private practice and it was not easy. It was hard. So I have no desire to pick and hunt and be stressed out.

Nadene: I'm out on maternity leave right now, and I'm hoping…to maybe get a slight promotion for when I go back and change positions since my office has already been without me for so long…So hopefully, if that happens, I'll probably give this company another year but continue to look. I really, really would love to be in a position within one of the county or state departments.

Professional Direction: Certainty vs. Uncertainty

Barbara: I don’t even know what I’m going to do with this degree yet, specifically. I don’t know what my practice will look like, or what the funding source will be for my services or anything like that yet.

Sheila: I, you know, I think about that a lot and I have no idea. The um, you know, you know, right now there's a Vice President position open, yet I know that definitely, that's not what I want to do right now. I haven't ruled it out for the future but, I would say that in the next five years, I don't want to do that. I know more about what I don't want to do than about what I really want to do.

Audrey: I honestly see that I have the degree and um, and maybe teaching and I’m thinking maybe a private practice.

Professional Direction: Avoiding Devalued Selves

Claire: And maybe I’m kinda interested in tough cases. You know, [a colleague] said, “I have families coming to me and saying ‘My son got a B. What can we do?’” You know, I’m just not, sorry. You know, it’s not what I want to be spending the last years of life doing.

Dan: When I was realizing that working for the… center was just completely killing me, because of the stress that I was under, I had applied to work [elsewhere].

Barbara: Well, I had been a radiation therapist for about 15 years and I had always thought that when I couldn’t physically do that job anymore, all the moving, the heavy blocking the patient that I would go into the symmetry aspect of it, the treatment planning part which I enjoyed. But across those 15 years everything became very digital and computerized and 3-dimensional, which is good, but it’s a whole separate degree. I would have had to go back to school for two more years and then the job would consist of sitting at the computer all day long. And that is not who I am or what I want to do (laughter) for any period of time, so, I set that aside.

DOMAIN: POSSIBLE PROFESSIONAL SELFTHEME: INSIGHTS ABOUT PROFESSIONAL DEVELOPMENT


During the interview, one of the questions that I asked participants was whether they felt any change in their sense of who they were thus far, as a consequence of their pursuit of a graduate degree.

Dan felt “no different” although when queried directly later about whether he felt more competent he responded in the affirmative.

Claire said she felt she now had “that intensity as a professional.”

Sheila: I think that myself, I've become more confident in having conversations with people in higher level positions or in large groups. I think my speaking skills are improved, my writing skills, so it's kind of a lot of different areas as far as, uh, building my confidence and my competency.

Barbara: I was there as a professional.

Nadene: Um, yes. I mean, it's definitely an accomplishment, um, it, it makes me feel, I'm not sure how to word this but it, it sorta makes you feel like you have more worth…and not self-worth, but worth in society, as far as how other people might see you.


Lady D: So, um, I feel like I dunno, I had this image of me before graduate school that wow I would come out and I would be this articulate and like super smart you know, savvy, confident psychologist or person and I, (chuckling) I hate to say this. I don’t, it’s not that I feel like I’m not, but I, I definitely, if anything feel like I’m more humble. Like, I feel like I still have tons more to learn, I, my confidence still needs to be boosted quite a bit…It’s definitely not where I thought it would be.

Veronica: Mmm. I don't think so (sounds a bit unsure). I mean, I would like to believe that it will not change my view of myself, um, but then again there's a part of me that's seeing potential for anything and I want to feel that even though I can add the doctor to my name, and to my role in life, um, I want to feel that I'm still learning, that I can still learn …when I'm finished. *

Lady D: I think first of all it’s going to take a little time for that to set in because (sigh) it might be on paper and you know it might be in my hand, so to speak, but um, this might sound a little sad to say, I don’t know. I definitely can tell you without a doubt I’m not going to be like oh look at me, I’m doctor so-and-so and get on the whole bandwagon of you know, I can conquer the world. *

DOMAIN: ILL SELFTHEME: REACTIONS TO HEALTH COMPLICATION

Physical Experiences and their Challenges

Lady D: I think [the health issues] loom over me now as we speak still because you know, this is a real stressful part of the program, is finishing and the dissertation so short term I kind of am a little bit worried like I hope nothing else creeps up; it’s sort of that kind of thing. I hope I don’t have another major flare-up so to speak.

Audrey: And um, I thought, I’m going to just keep right on fighting through, and then out of that, I just completely and totally froze, and when I say froze, I mean FROZE. I mean, I’m trying to get into my internship and do my dissertation but I spent this bulk of time where I just was like, I just completely froze. I went through so much, if you’ll pardon me, hell.

Veronica: When all this was going on, I was very worried about whether I was going to be able to continue on, health-wise, because I kept feeling very anxious and very nervous, and scared to death really and truly

Physical Experiences and their Challenges

Barbara: I do feel that I had to work a lot harder than other students, because of, um, some of my, I dunno, I don’t want to call them weaknesses or challenges, challenges I guess I’m ok with, but yeah, so, there were a lot of times that I thought I wouldn’t make it, when I thought I was going to get a C in this class, and I still had one more semester so, that could be the nail in the coffin.

Dan: I was experiencing or starting to develop chronic pain of the right hand, so the whole right arm, right hand goes numb, it burns, it’s… temperature sensitive. So I had all that going on. And so we discovered the more I type, the worse it gets, which was kind of interesting to find out over time, once I started.

Psychological Reactions: Too Young

Audrey: And it’s kind of surreal when you’re, when you know what something is that’s really rare, that not only is it super rare, but um, people, of your age don’t get it.

Sheila: I think, um, you know I feel like I'm too young to be dealing with all these issues so it's frustrating and you know, I, you know, maybe I'm a little bit surprised that I'm having to deal with the high blood pressure thing and some of the chronic, some of the other chronic ailments that come along with the age thing, um, you know, I think the being physically out of shape and seeing the physical decline of you know, of my body and that sort of thing I think is not what I expected and not a pleasant thing.

Nadene: I'm 35, I know that that's older but it's not OLD. I'm not supposed to have these issues yet!

Psychological Reactions : Inconvenience due to Timing

Audrey: I mean the surgery and all that stuff happened around the same time I mean I’ve got cancer, you’ve gotta have this surgery, I’m doing my writing of the exam, you know, all right in that whole. It was all kibosh, right there and then going to my comprehensive exam, after the surgery.

Lady D: I feel like, you know, I was just really unfortunate. It was bad timing and everything came, and at the height of everything it was a bad time.

Sheila (in regards to the illness coming while she was in school): It was a stressful time.

Psychological Reactions: Under Siege/Betrayed

Barbara describing Hashimoto’s: It’s your immune system attacking your thyroid [and your body] not functioning the way it should be.

Sheila: I can’t believe I always take good care and eat healthy and do the right things and, I couldn’t skip this. I couldn’t get past this.

Veronica: I got an answer why I’m feeling this way, why I cannot use the skills that I know actually work, why I can’t make it work, so it was helpful to know that it was, uh, my body was, um, causing me to act the way, my body and the medication was causing me to feel this way.

Barbara: I was very healthy, very active, very strong and then all of the sudden, I couldn’t function well anymore.

DOMAIN: ILL SELFTHEME: SELF WITH DOCTORS

Affective Experiences: Frustration, Mistrust and Confusion

Dan: I realized you don’t actually know anything of this…And when it came down to it, it was my body. It wasn’t theirs. They didn’t have to go home with it. They didn’t have to feel it. They didn’t understand it. So, it just got to the point that it wasn’t worth bothering with them about it because all they did was make me feel worse. (frustration)

Veronica: So they said well, let's do a CT scan; that's when they found out that I was allergic to the fish dyes and I had went into cardiac arrest…and they injected me full of all kinds of medicines and steroids trying to get it to filtrate through my system and my kidneys was shutting down due to the fact that, that it didn't want to work, so, um, that led to, it got the dye through to where they could see everything (chuckling) and do the test but I was dying in the process (laughter). But yeah, it was very stressful whenever they did all that so after we went through all that experience I was kind of like jaded in regards to going back down there to them. (mistrust)

Experiences: Frustration, Mistrust and Confusion

Audrey: They couldn’t find it to begin with. When I had it, I’m the one that diagnosed it…It wasn’t found in the blood tests, it wasn’t found in the mammograms, it wasn’t found in anything they did um, over and over again. It wasn’t found in biopsies two or three times. (mistrust)

Claire: Because every person I went to had a different take on it…So, yea, I felt like we are at that point of specialization in medicine where nobody can see very clearly. On the other hand I just didn’t care. I think I was so consumed with staying better and staying ahead of the problem, that I assumed that people were going to be wrong. I mean they had been in the beginning. (mistrust)

Affective Experiences: Frustration, Mistrust and Confusion

Barbara: And you don’t know who to listen to. Every expert that you talk to thinks that they have the answer and this is what’s going on. (confusion)

Lady D: [The conflicting opinions] made the stress even worse and the worry even worse because I respected both [professionals]. They had both been like, like I went to the dentist, the same dentist since I was a kid. I went to the same ENT since I was a kid so, it confused me because it was like, well I could see if one of them was, but they both seemed so sure of their opinion. (confusion)

Veronica: Um, you're confused a lot of times in regards to uh, why me? So you go through that whole process blaming yourself or thinking about your life in regards to why did this happen to me now and uh, why is this going on with me. (confusion)

Feelings of Powerlessness: Unheard

Claire: In some ways I felt like they didn’t listen and in other ways I felt they overdramatized.

Audrey: Um, and they’re kind of looking at you and going you have that and you’re going, I know. I knew that like six weeks ago, when I was telling you about this experience.

Feelings of Powerlessness: Seeking Control

Audrey: Being a student as I am, I um, went online and I searched out uh, the um, information and I knew what it was before the doctors knew what it was.

Veronica: I’m going to have to discontinue [the medication] on my own; if you’re not going to be willing to take and help me out with this, I’m going to have to find somebody else.

Dan: I mean if you think about it from the medical standpoint, I am the poster child for against medical advice (grins broadly) because I had a series of three epidurals, I let them do two and then I refused to do the third.

Feelings of Powerlessness: Seeking Control

Dan: And so when I saw them, they said that I was not a candidate for surgery. Cause they did all kind of (indecipherable word) testing; they couldn’t do surgery. They couldn’t clear the cyst. Uh, so I was just going to have to learn to live with it and be on pain management for the rest of my life. And so that’s when I fired them. (Chuckles to himself).

Knowledge is Power

Veronica: I guess after I received the news yeah, we finally figured out what’s going on, I kinda felt more relieved, um, because at least now I know that I’m not crazy.

Claire: They found out all the stuff that wasn’t wrong with me, which is kind of reassuring. I didn’t have any major disease that was going to tow me under.

Lady D: They’re not life threatening. That was a positive. They were not cancerous; that was a positive. Uh, but one thing at a time. So, and that I could contend with.

Nadene: Once they said that it wasn't life threatening, they gave the parameters of at what point it becomes an issue, and at this point it was not. They sort of laid everything out for me and gave me the information; it didn't really change anything.

Knowledge is Power

Audrey: But also the other interesting thing is, um, when the doctor says well we’re going to do this surgery, and we’re going to do this treatment, but somehow through whatever it is, whether it’s divine intervention or prayer or medical intervention, you go from you know, a double mastectomy and uh, and all kinds of medical interventions, that are very invasive, to the least invasive. You go to the least invasive things that they could possibly do and it’s not so bad. They’re going to do what they need to do and I’m going to be okay.

DOMAIN: INTERACTIONS BTWN POSSIBLE SELVESTHEME: SACRIFICES

Balancing

Barbara: I felt like I had a pretty good taste of how it might be to balance everything and have that heavy workload and just have to be able to focus and do what I needed to do, but, that did not prepare me for graduate school. It pretty much kicked my butt!

Audrey: It’s a struggle (then louder) It’s a struggle! Then what do I have to do? I don’t know. I have a dissertation and internship. I have a daughter. She’s [x] years old. I have to help her with her homework and I have to help her with, well, homework. Crap, I have to help her with life.

Claire: And I got worse and by November I was in pretty bad shape. And I was, uh, of course still working full-time and doing school full-time. And you know, I mean during this process I got divorced, I got this illness, you know, all these things.

Veronica: I thought that I had to be Superwoman and I was drinking a lot of the energy drinks to be able to be mom, to be, um, to be a parent, to not only be a parent but to work full-time, not only to work full-time but to raise the farm and to be a business manager in regards to having the farm, but also take on the role of as wife to my husband and caretaker of the house, caretaker with my mom and my sister.


Veronica: I was really overwhelmed with everything and I was putting the pressure on myself to be able to perform as, again like my husband said, as Superwoman. But in that aspect, I was pushing myself because I wanted to provide more to my community…I think that I pushed myself way too much.

Sheila: I haven’t done a lot of lifestyle modifications to address [my symptoms] just because I feel like I don’t have time. So, I think that has been frustrating to me. And I see, I see myself as not disciplined enough to do those things, to manage all of this, you know, I think that’s just a, how do you juggle all the time you need to do the dissertation work, with being, staying healthy, eating healthy, walking, exercising, all of that, getting enough sleep. I may be sacrificing a little bit of that to get through this [graduate program].

Dan: But it’s hard to parent from being far away. I did it all the whole year for internship and now I’m doing it again so, those are limitations that are hard to deal with. I mean you can only Facetime and phone call so much to get through to people.

Audrey: I put so much value into my job. I would go to work when they called me. I would leave to go to work and take care of whatever they needed. I left my daughter alone at home, with her family. I mean she was never alone, she was with family. But I wasn’t with her. You know what? My being with her was more important than that person sitting out there, who they called me for. She’s more important to me than them.


Barbara: Having such a strong focus, I feel like it has sucked the life out of me (chuckles) for a long time. For two whole years, I have only done this program. I’ve kinda been a wife. (laughter) I’ve kinda been a mom.

Claire, too, spoke of the “grim isolation that grad school imposed.”

DOMAIN: INTERACTIONS BTWN POSSIBLE SELVESTHEME: DISRUPTION VS. CONTINUITY

Disruption vs. Continuity:

Dan: And I got to the point that you felt hopeless and helpless, like you can’t stop this and this is going to take over and this is going to destroy everything.

Barbara: I’m not going to say that there were never times when I didn’t get depressed, because I did have, when the fatigue was so bad that I couldn’t get up.

Lady D: I think a lot of times, what you can easily fall into the trap of, which I did, is you become the illness. Or the illness takes over your life. You can’t make it the grand overshadowing cloud. *** You have to make it like, ok, this is part of me but it doesn’t define me. I may have it but I’m not the illness, I am this, and then you, you, you work on the rest of the roles. You start to create the niche that you want for yourself.

Disruption vs. Continuity

Veronica: You’ve still gotta be strong because life is still going on, your kids are still growing up, your husband is still needing you to do several things, there are 40 cows out in the field that you still gotta go feed and so there’s, there’s, there’s not been really a lot of time to grieve and woe is me kind of sentiment. And um, I believe that after they told me that this is what’s wrong; as long as there’s a way to work on it, I was willing to work on it.

Nadene: [The doctors] gave me the parameters of at what point [my condition] becomes an issue, and at this point it was not; they sort of laid everything out for me and it didn’t really change anything.

Audrey: I’m much, much stronger than I ever give myself credit for, I mean, I, I do things sometimes, when I look at things I do sometimes, I am amazed at myself. I see a whole lot of strength. Incredible strength, that I don’t give myself credit for. Uh, a lot of strength. And intelligence and other things. I’m stubborn. Um, I mean I make up my mind to do something and I’m going to do it. Um, that’s why I keep going. Even though now it’s still hard to keep going. I still would rather quit than keep going.

Adaptations and Avoiding Feared Possible Selves

Barbara: I mean, you’ve got to prioritize. One of the things I had the hardest time- this is going to sound so silly- that I had the hardest time letting go of is keeping up with all of my family members’ birthdays (laughter) …And it’s one thing when it was happening and oh my gosh, it’s their birthday tomorrow and I don’t have anything done. That’s a bad feeling. It was better when I could consciously make the choice that, that I just need to let everyone know that this is kicking my butt and they’re not going to get a card from me this year.

Sheila: I think I always knew I would continue on and work through it, um, you know, I think it's slowed me down because I, I obviously can't sit at a laptop as long as I used to and um, just the actual work of working on my dissertation, and the anxiety that that produces I think has impacted my blood pressure ongoing. And so it's, I think from my standpoint, it's going to take me longer and at a more reasonable and not such a crazy pace. I think it's slowed me down.


Claire: I figured it was time for me to take a leave of absence from school. So I took it. I took three months off, and I think within a week of me taking the leave of absence, I was hospitalized. [And when I got out I thought]…. I don’t care what I have to do. I don’t know if you’ve ever had an intention with your whole body, but it was, I am never going to be in this shape ever again.

Veronica: Yeah, I’ll have to try to do something because I do not want to get to the point where I was last time in regards to going [for treatment]. I have to take time for myself. I have to monitor myself. I have to make sure that I eat. I have to make sure that I take my medicine. And I have to time, be very conscious to the time, um, um, because if not, I’ll be back down again. And I don’t want that and there’s a fear that I have in the back of my head at all times, is the fear of if I keep going, if I keep pushing myself, if I don’t watch myself, uh, that I’m going to end up back down again.


Nadene: In my family, everything is heart disease and diabetes. And so I’m conscious of the fact and I know there are different things you can do, even if I’m overweight and that’s going to be a risk factor for me for both heart disease and diabetes. I know that eating, eating healthy and making sure to eat your green vegetables and making sure to eat your proteins and not overeat on your carbs, are the ways to sorta help combat it so I had always, um, I’d done well up til now.

Sheila: I've relied a lot on my husband to take up, you know, organizing the kids’ activities and doing the bills and all that just because I feel like I can't add one more thing into my brain at this point and so some of that, you know, I've had to rely on other people to do things that I would have normally done…I need to be disciplined about that. And it comes back to balance and picking and choosing which things I'm going to be able to give my time to.

Perceived View of Self in Relation to Others Dan: I think it’d be different if you know, I had an arm amputated or something [visible] like

that but when I look good and everyone from the outside says, ‘You look healthy, but you’re always in pain,’ it’s hard to rationalize and explain that to somebody that hasn’t gone through it.

Lady D: It kind of felt like you know maybe, like people might see me as a failure, or you know, not strong, or weak-minded or um, just less than desirable like, well, maybe you shouldn’t be a student if you can’t even handle this; especially faculty. I totally felt that way. I always have this fear that they must think less of me or that they must see me as less than competent or like some kind of wuss or something.

Veronica: I was scared of how it was presenting me as a human and as professional or as a student of psychology. It was very scary to me because I was thinking, if I’m already starting to feel like this and I’m already starting to show these types of symptoms, um, I wonder what the doctors are thinking about me, um, and how I’m going to look as a psychologist in time. Um, so I was very worried, about all that.

Barbara was concerned she would come “across as being flaky, unreliable, and those kinds of things.”


Barbara: My faith definitely got me through; that was a big factor for me. I felt like I was there for a reason, and if I was to complete the program I would, by the grace of God and it was that simple for me. I just kept going and got through it.

Veronica: So I’ve tried to look at life as you need to value what little bit of time you’ve got here with each other, and enjoy it.

Audrey: It’s not that I didn’t know that my daughter, my father, and my husband were important to me. But the, effort that I would put into, um, I won’t ever, I don’t think I’ll ever choose to. I won’t choose to, since I have observed the other people after me who chose to leave at 5:00 instead of choosing to stay until 8:00. I won’t choose to be the person at work who takes responsibility for everything. I won’t do that. There are protocols and procedures for all that stuff. I don’t have to be responsible for everything. That didn’t serve me. It didn’t serve my family.


Lady D: I cannot emphasize enough the appreciation and the necessity, it’s almost like to me, it’s a life necessity, um for social support. No matter how physically ill you are, or mentally distraught, you know, it shouldn’t be a battle you go through by yourself, so to me yeah, like I think social support and having that network and building it, building upon it is huge. That to me is, is not, I never um, take it for granted and if anything it’s made me seek it out more and be more grateful and thankful that I have what I have and who I have in my life.

Nadene: I think the biggest thing that happened in the past few months was [my dean] really advocating for me and going to the dean of the school and the dean of our program and getting them together and saying, ‘Look, this girl’s done the work. ’ And my group advocated for me and my dean spoke with everybody in my group, all seven people in my group, and my whole group said, ‘No, she’s absolutely deserves to graduate. Let’s do whatever we can to push her through and get her, get her to be able to finish with the rest of us. And so that was really huge. It was probably one of the first times [my work] was really and truly acknowledged.

Use of Resources: The Value of Relationships Barbara: My advisor, was not relating well with me or supportive of me, and there

were a lot of times when I didn’t know if I was still in the program. Last summer when she said, ‘You can’t be here,’ I didn’t know if she would take me back in the fall. It felt like she wasn’t being supportive of me. She didn’t want me around. She allowed me to come back and I felt like I was on probation even though she never said that to me.

Claire: After a year they make me faculty. So I would have kind of a base of operations and then I would be. And you know, I think it’s a good thing, I mean, you’re in a community and you want, kinda, you want some, you want to be known as a quantity, especially starting out really late.

Dan: So, during that time period, you know, the one thing that was just overwhelming was every single day I showed up there, somebody who I worked with said they appreciated something I did, every day I showed up. And there is an unbelievable amount of faith in the people that work [there]. It’s unbelievable. And it’s just like, you wanted to be around these people. And these were your coworkers.

DOMAIN: INTERACTIONS BTWN POSSIBLE SELVESTHEME: EFFECTS OF ILLNESS ON SELF-VIEW

A New Me vs. Same Old Me

Audrey: Two months ago I would probably say I don’t know, I can’t answer your question. Which is odd. Actually it’s really weird because like right away, if you would have asked me that right when I got diagnosed, I would have said, I’m stronger, I’m not going to let this stop me and if you would have asked me a little bit after that, I would have said I don’t know, I’m a basketcase, I can’t deal with this. Um, my life is falling apart. And now I’m a little bit past that and I would say I think I’m stronger right now and I think I’ve pulled everything together and I think I know what I need to do to be okay.

Claire: I mean, one reason I wrote you back about all this, is that I thought it did change me. It wasn’t just a blip that caused me some irritation or distress or inconvenience. It did seem to have a qualitative effect on things. It didn’t just drag the program out six months or whatever. There are no five year plans in my world. Yea. And again, not, I mean, it probably started because that’s all I had energy for but ultimately it just became my way because that’s reality. We don’t know any more than that. And it’s just kind of a waste of time or you know, some of projection just to go any further.


Dan: I think probably in hindsight this has probably made me better than worse. I realize there’s a lot I can put up with now that I never thought I could.

Lady D: I um, felt, I was angry at myself. I felt like I wasn’t, you know, I berated myself a lot, put myself down, I think I, my self-esteem went from low to even lower, you know. So it was all these whys. So I, I felt like my self-esteem was in the toilet. I felt like mentally I was a wreck. I felt like should I even be, should I even remain a student at this point? Because I was so anxious. So I was questioning you know, my ability as a student. You know, I just questioned. It shook me to the core. It was kinda like, ‘What am I right now?’ It was a really dark time. [Now] I would say [I’m] a lot more, um, stable, positive, encouraged.


Barbara: So it’s been very rough sometimes but it hasn’t changed my identity to make me feel like I’m less of a person, or that I’ve become dependent on others, because I’m fiercely independent.

Sheila and Nadene also reported no real change in how they saw themselves as a result of their experience thus far with chronic illness.

DOMAIN: INTERACTIONS BTWN POSSIBLE SELVESTHEME: QUEST FOR MEANING

Quest for Meaning

Whether this quest was deliberate or not was not entirely clear. Some individuals were able to take their adverse circumstances and find a way to utilize them while others sought meaning by focusing on aspects of their lives where they felt strong and sure.

Sheila: My kids are at an age where I think it’s valuable for them to see their mom working hard, you know, in academics and recognizing, helping them recognize that if you want to move forward in life that you have to make choices and balance, and education is one commitment that needs to be there. And so they see me maybe, investing in and bettering myself, and that’s an important piece that I value right now.

Audrey: I would hope that I would um, help other people or guide other people through their own…crossroads of life where they didn’t know what their future would hold, if it was life or death for them, I want to help them or guide, you know, help them figure out their next few months or years of being. You know, what would they do or how would they be or how would they live, or if it were 20 or 100 years.

Quest for Meaning

Lady D: As [my father] was getting sick and even when he passed, as much as I felt like saying school is meaningless compared to this, it’s so minimal in the grand scheme of life, I almost felt compelled that I had to finish it. I almost felt like it would have been, I feel in some ways now, I’m even finishing it more for him than me.

Dan: It’s not my position to judge the decisions that this person made. But they’re sitting here in front of me and I’m trying to help them with whatever the issue is, because that’s the right thing to do. I guess I like helping people everybody else has given up on.

Quest for Meaning

Claire: I could have gone out and volunteered, which I did actually… and done good things but without developing the expertise. That didn’t make me happy. Uh, just developing the expertise didn’t do any good either, because then I wasn’t sort of morally satisfied. So, it was a complex equation, I think. I mean I really viewed it, as soon as I figured out that’s what I needed to do, there was no turning back. Competency and helping others are the two values that drive me, and I need to have the intellectual feedback.

Veronica (in regards to giving back to her community): It’s a challenge but very rewarding whenever you see them be able to really address the issues that they’re having.

Sheila: I want to be recognized as a credible problem solver, being looked to, to come in, in complicated situations and help find the answers.

FINDINGS

All participants evidenced a quest for meaning that highlighted the importance of possible selves as a motivating factor that helped them continue their pursuit of a professional identity despite chronic illness. Often possible selves contained features of autonomy, connectedness, and competence.

Identified motivation (in the form of integrated goals) is what gave participants’ professional pursuits personal relevance and this identified motivation was often located in the presence of feelings of autonomy, connectedness, and competence.

At times, participants implicated past selves as a basis for avoiding feared possible selves.

FINDINGS

Not all participants experienced change or change to the extent expected in conjunction with pursuit of a doctoral degree and some participants actually appeared to harbor some resistance to the possibility for change in identity, evidencing a feared possible self. For some participants this feared possible self was based on the professional image presented by a mentor or other senior person in their field.

Possibly the most common theme to occur was that of balancing or role conflict - balancing school, work, family responsibilities. In the course of this, participants, by and large, pursued their professional identity at the risk of their health and their relationships.

Experiences with doctors appeared to mirror a developmental journey in regards to participants’ level of autonomy. While the experience of illness may at times be associated with feelings of helplessness, the narratives of my participants made it clear that a state of helplessness would not govern their experience of life within the context of illness. They were often able to utilize skills learned within the context of their professional identity development to assist them in managing the transitions associated with chronic illness.

FINDINGS

Almost all participants experienced disruption due to their medical issues struggle for continuity.

Feared possible selves appeared to be a factor in motivating participants’ adaptations in response to illness. Adaptations were made not only in the service of preserving the hoped for possible self, but also in the service of preventing the feared possible self.

The quality of support derived from relationships with mentors or advisors had the potential to affect participants’ self-views and motivation in significant ways and took on increased importance when participants struggled with ramifications of their medical issues.

Participants were divided regarding whether their view of self was changed by their experience with chronic illness.

An initially surprising finding was that a conscious identification with the age aspect of midlife appeared to be overshadowed by participants’ identification with other aspects of life, primarily chronic illness and professional pursuits.

Connectedness, as evidenced by talk about relationships with family members, friends, and connection on a grander scale, appeared to be salient across domains.

Summary of Findings

When midlife individuals experience the novel challenges of chronic illness during graduate school, an image of possible selves serves to motivate them to persevere towards their goal of attaining a professional identity.

The hope for connectedness, competence, and autonomy as aspects of possible selves appears to be an important driving force in this process and likely serves, in part, to combat the perceived loss of autonomy that comes with the experience of chronic illness.

Although chronic illness threatened to rob participants of autonomy, the pursuit of possible professional selves appeared to be a strong enough source of identified motivation such that even illness could not dissuade them from their pursuit.

It appeared that the highly valued, central possible professional self served to shift participants’ focus away from the present ill self, rendering the ill self less salient.

“The underlying assumption is that in negotiating the changes and transitions of adulthood, individuals will use their possible selves as psychological resources to motivate and defend themselves.” ~Cross & Markus, 1991, p. 231

So how did we answer the research questions?

(Q) When midlife individuals going through professional transitions face chronic illness, how do they integrate their changing identities?

Managing the Ill self (Cognitive Coping Strategies)

Integration and Separation of the Ill Self

Assimilation (integration into pre-existing identity)

Accommodation (acceptance and creation of new normal)

Subversion (rejection despite changes made in hopes of reclaiming healthy identity)

Confrontation (rejection/separation with continuation of previous way of life)

Assimilation: Taking Care of Business

Assimilation is a means of attempting to maintain continuity in life

Dan, undaunted by being diagnosed with a chronic illness continues on his professional journey but has made minor adjustments to his life, in that he now engages in massage therapy on a regular basis. He could best be understood as having assimilated his ill self into his pre-existing central identity as a professional. Realizing a feared, incapable self, he acknowledges that someday the illness may prevent him from carrying out activities that are required of him at work, but for now he is able to continue on due to social support from his family, coworkers, and strong faith.

Audrey’s situation was complicated by the fact that she had been diagnosed with breast cancer and then in a relatively short period of time, relieved of her job as well. It was difficult to really know how she was coping with her illness. It appeared that at the time of the interview Audrey was in a liminal phase, not fully having cut her ties with her former professional identity and not having started to reconstruct a new identity.

Since then Audrey has found new employment and has been able to integrate a new professional identity, thus providing herself with some semblance of continuity. In addition it appeared that she had assimilated her ill self into her identity, maintaining a relatively normal way of life and she had formulated a plan to utilize her life or death experience in an altruistic way.

Accommodation- New Beginnings

In narratives of life transition, accommodation is evidenced in the admission that one has been truly challenged by life experiences, that one has been forced by circumstance to actively shift one’s sources of meaning ~King, Scollon, Ramsey, & Williams, 2000

One of the first things that Claire told me when I sat down in her parlor was, “I mean, one reason that I wrote you back about all this, is that I thought it did change me. It wasn’t just a blip that caused me some irritation or distress or inconvenience.” Claire is the one participant in the study who made it very clear that she was not the person she used to be. She accepted that she was ill and she allowed it to transform her, living with it in a sort of coexistence. Of course she wanted to be healthy but she had come to terms with a new reality and the loss of her former identity as a healthy person.

Accommodation allowed Claire and the other participants who engaged in this strategy to create for themselves a new way of being in the world, a new normal by which they were able to continue their pursuits, essentially learning to live with instead of against their illnesses.

Accommodation – New Beginnings

Barbara engaged in accommodation as a way of integrating chronic illness into her identity. Her experience with fibromyalgia was an example of this strategy. Although she told me she had “never really grabbed onto that diagnosis” early in midlife, her fibromyalgia had forced her to abandon her previous work role as a radiologist, a job she had cherished. There were no signs that she was attempting to protect her pre-illness identity in the sight of others, as she did with the premenopausal symptoms (discussed later). At about the same time in her life she decided to relocate with her family and in a liminal phase moved with no prospects for or visions of a job. During that phase, she was able to identify a new possible self and at the urging of a friend, she applied and was accepted into graduate school. She made adjustments that she needed to in order to accommodate the symptoms of her illness and at the same time forged a new life for herself. So, in Barbara’s case, the new professional self was itself an accommodation to her illness.

Veronica created a new normal for herself. She realized that she can no longer pursue her degree at the speed which she had hoped and she made significant changes to her lifestyle. Perhaps most significantly characteristic of accommodation, Veronica experienced loss; she realized that it would be detrimental to her health if she and her husband continued to run their farm in addition to her academic pursuit.

Accommodation – New Beginnings

During the course of graduate school, Lady D was diagnosed with two different chronic conditions. Her level of pain was such that she felt that she had to adapt to a new way of living. She has experienced a certain level of loss in that she felt she could no longer live spontaneously. She described what was becoming her new normal, having accommodated her condition into her way of living.

“Um, I’m still adapting. I still find myself having good days, bad days, and adapting to okay what can I do. You know, what do I need to do if I’m going here, if I’m going to lift this, if I’m going to do that you know. I kinda have to plan in advance. So I find myself, like I said, I think a good analogy for me is as I mentioned earlier, like a machine. You do the checking of the car. You make sure the oil is in the car, the tires are full of air, and it’s ready to go. So I kinda feel like that’s it. I can’t just take it up and go to work and go to school. It’s like I gotta, alright, do a maintenance check. You know, do I have [everything]?”

Subversion – Keeping up Appearances

Barbara also engaged in subversion. Part way through graduate school, she began to experience novel, seemingly unrelated symptoms and was diagnosed with another medical issue; she was premenopausal. Although earlier in life she had used accommodation as an integrative strategy, now she engaged in subversion. She did not want those around her to see her as anything other than how she had seen herself – competent, determined, and youthful. At the same time she made significant changes, having a hysterectomy and engaging in hormone replacement therapy. Barbara explained her that her attempts to preserve her identity in front of others appeared to have worked and explained that she felt she hid her struggles well.

Sheila was informed by her doctors that her blood pressure was high. Although her father passed away of heart problems, which she is now concerned about, her medication regimen is the only change she has made to her life following her diagnosis. It seemed as though she was clinging to her former identity as her taking medication, unbeknownst to anyone outside the family, seemed to work to preserve her presentation of self to others.

Prior to this interview she Sheila never thought of herself as middle aged but during our discussion she said she now realized that maybe her health issues were a result of that, and she said that it scared her. It was almost as though her telling of her story precipitated the move toward a liminal phase, placing her between her identity as a healthy, youthful professional and that of a middle aged professional whose health was beginning to decline. Reconstruction of her identity was taking place as we spoke.

Confrontation – Just You Wait

Nadene was the only person in the study who engaged in confrontation. Learning of her diagnosis and that it did not pose an imminent threat, but that it would require monitoring over the course of her lifespan, Nadene chose to do nothing about her medical condition. If things changed, then she would do something.

She did not speak of a feared ill self and she eschewed the illness identity and elected not to take the medication her doctor had prescribed for her, as it could have deleterious effects if she were to become pregnant. She instead chose to continue life as usual, despite any possible risks to her health, and to focus on her goal of possible self as mother to a second child. That identity was more salient to her than any potential health concerns that she had yet to fully experience.

This does not mean that Nadene did not have a feared ill self rather, she appeared to take at face value the words of her doctor, that at this point in time her condition was merely an annoyance. Nadene seemed to live in the moment rather than focusing on the “what ifs” of the future.

(Q) What is the experience of possible selves in the face of chronic illness during a midlife professional transition?

In narratives we see oscillation between ill and healthy selves

My research showed that possible selves (both past and present) are crucial to integration of the ill self, serving as motivation.

Possible selves can be instrumental in integration of the ill self, but other significant transitions seem to minimize this effect. (Audrey - It is likely that having an envisioned possible self was not as helpful to her in aiding her recovery since the firing from her job was, in some manners, directly related to the possible self which she was attempting to cultivate.)

The transitions (lost possible selves) from which Audrey and Lady D were trying to recover impaired the progress of identity renegotiation.

The Experience of Ill Self

For most participants, the illness-related possible self was seen as a negative self which if allowed to become ill enough, might thwart their pursuit of their professional identity. motivated toward self-care, to prevent or at least reduce the likelihood of their most feared possible self. Five of eight participants experienced a state of illness extreme enough to prompt them to fear reaching that point again in the future

Conversely, two participants felt that dedicating time to self-care might have a greater chance of interfering with their pursuit of a possible professional self than would taking a chance on contending with symptoms from their illness; it should be noted that Sheila and Nadene were essentially in the infancy of their illness trajectories and that after assessing their situations, they felt they were not at risk of any imminent danger from their medical conditions.

Experience of Possible Professional Self: Competence, Relatedness, and Autonomy

Future professional selves were often well articulated and were perceived as meaningful, in part, because they met psychological needs for autonomy, connectedness, and competence; in many cases they were also a means of striving for continuity in life

A prime example is Claire, whose future possible self she sees as being not only autonomous, but competent and connected on a larger scale with society.

Audrey also seeks to become more competent while wanting to connect with and help people on a deeper, more meaningful level.

Experience of Possible Professional Self:

Participants able to assign personal meaning to a future identity appeared to be less affected by their diagnosis as long as the future self still seemed readily attainable

Furthermore, so long as it is perceived as attainable, there seems to be a protective factor provided by having an elaborate, well-articulated hoped for future identity.


Provisional selves = possible selves that are practiced rather than simply envisioned.

Both Veronica and Lady D made references to using their professional journey as a means of testing for goodness of fit. This appeared to be a way of reducing the risk associated with potentially fully committing to a career path that might not lead to an optimal possible professional self.

Are possible professional identities integrated or introjected?

An integrated goal is pursued because the person perceives some sort of meaning or value in the pursuit or acquisition of the goal. In other words, there is identified motivation.

When speaking with my participants about why they chose to pursue a graduate degree, all participants were able to assign some sort of value to the pursuit, something that gave it personal meaning for them. In many cases, this identified motivation was often located in the presence of feelings of autonomy, relatedness, and competence.

An introjected goal is one that is pursued out of a sense of obligation or to avoid some negative affective state.*


Kroger (2007) writes that midlife is often a time of reflecting upon one’s professional journey and making new commitments in the case that a person feels unfulfilled.

For several of my participants the choice to pursue graduate school in midlife, was due to dissatisfaction with past decisions related to career choice. This transition was made despite that the timing was “not right.”

The most common experience wrought by the transitions of midlife, graduate school, and chronic illness was that of balancing roles through cognitive efforts aimed at attempting to either integrate or separate the various aspects of identity that were involved.

The fact that participants, by and large, chose to continue to pursue their possible professional selves even at the risk of their health and relationships, suggests the degree to which these possible professional selves were central to identity.

Interaction between Possible Selves

My analysis revealed meaningful experiences related to the interaction of possible selves; a finding of particular relevance is that professional identity appeared often to serve as a protective factor, perhaps preventing the ill self from becoming the most central and salient facet of identity.

Participants’ cognitive styles of integration and separation of the ill self appeared to reflect the way the person not only perceived and managed the possible self of illness but also preserved the degree to which the possible professional self was readily attainable.

Limitations and Directions for Future Research

The characteristics of the sample:

Only 8 (7:1)

All Caucasian

Assuming accurate recollections of their experiences; the information gleaned here may be different than if the study had actually been longitudinal.

Knowledge about experience of possible selves in this case is extremely limited in that all of the participants had either achieved their goal of completing graduate school or were still actively pursuing their degree.

This study does not provide any insight into how the experience may have been different for someone who, after being diagnosed with a chronic illness, decided to or was forced due to their illness to withdraw from the program. It is important that future studies include individuals from the above mentioned categories.

Another avenue for future research might consider people diagnosed with chronic illness in midlife when they do not have well-detailed possible selves towards which they are striving and whether this absence of a potential motivator makes them more prone to engulfment by illness related identities.

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Appendix A – Interview Questions I would like to hear about your life as a midlife, graduate student and about how chronic illness has

affected your plans for your life. Please include all the experiences which were important for you, starting wherever you like.

How long had you been in graduate school when you were diagnosed and how did the diagnosis impact your pursuit of your education?

Tell me how, if at all, your view of your educational pursuit changed following your diagnosis. In your opinion, why did it/did it not change?

(When a specific possible future self is mentioned) Describe what you see or feel when you imagine yourself as ___(identity mentioned). (additional prompt if necessary) What is it about seeing yourself as ____(identity mentioned)___ that is compelling (or aversive)?

Tell me about why you chose to pursue a graduate degree. (additional) What, if anything, gives this pursuit meaning for you? Did that meaning change with your diagnosis?

In what ways might your experience with a chronic illness have impacted your feelings about the pursuit of your degree?

What do you see yourself doing in the future?

Why is achieving or avoiding this [possible self] important to you? (or) Are there certain aspects of this possible self that are desirable or frightening? What do you stand to gain or lose?

When a specific possible self is mentioned, ask what the person valued/s about the role or what he/she gained/s from it.

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