Source: Katie Willard Ferrant
The Oxford Dictionary defines identity as “who or what a person or thing is.” Identity is multifaceted. We have ethnic identity, gender identity, geographic identity, professional identity – and these categories are only scratching the surface. Your values, relationships, hobbies, and even small daily choices contribute to making you the person you are.
Chronic illness, of course, profoundly affects identity. It changes who we are in so many areas, and it affects our lives in ways big and small. It is not a select experience. It is often a harrowing experience, and it becomes woven into the fabric of our identity. Many people describe a large gap that divides themselves before illness and themselves after illness. Crossing this dichotomy is not easy.
When we face the division between our pre-illness and post-illness selves, we wrestle with our identity. Before illness, we inhabited the world in a certain way. After illness, we find that those old ways are closed to us. We are forced to change and adapt to our new reality. Our mission is to incorporate disease into our perception of who we are, to develop a “disease identity”.
Disease Identity Countries
Researchers have visualized four different states of disease identity: rejection, ingestion, acceptance, and enrichment. Each of these conditions has repercussions on our mental and physical health.
rejectionIdentity Identity Refusal: Identity status denial includes refusal to accept chronic illness as part of an individual’s identity. Illness is seen as incompatible with one’s sense of self. People in denial either refuse to believe they have a disease, or they downplay the impact of the disease. Their inability to integrate illness into their identity leads to choices that negatively affect their health. For example, they tend not to follow treatment regimens or make lifestyle changes that support their health.
ingestion: The case of disease identity of ingestion is the opposite of rejection. In this case, disease overwhelmingly dominates life, and becomes a primary concern. Other aspects of identity – such as relationships and hobbies – are ignored. It is understood that depression and anxiety increase if ingested.
AcceptanceAcceptance disease identity status: includes acceptance of illness as part of a person’s identity. Disease is not ignored and does not consume everything. Grief is part of true acceptance, and so is the move toward a healthy adjustment. Depression and anxiety decrease for those in acceptance.
enrichment: In the case of enrichment disease identity, there is recognition that positive changes have occurred as a result of the disease. These changes may include increases in flexibility and strength, a renewed appreciation of life, and an elucidation of values. Improved well-being is associated with this disease identity state.
Working with countries with pathological identity
I think we move between cases of disease identity throughout our lives. In fact, I think we’re holding on inside of us All of these states simultaneously, with a different state moving to the fore at different times. When our disease is very active, for example, it makes sense to feel swallowed up. It is hard to enjoy other aspects of our identity when we are in crisis. When our disease is more stable, it is easier to lean towards acceptance and even states of enrichment.
It is useful to define our dominant base case. If we are constantly in situations of rejection or ingestion, it is important to be curious about it. It may be that the illness and/or the pain is not adequately controlled, necessitating medical advice. It can be difficult to move forward with a process of grieving the losses caused by the disease, which necessitates a psychiatric consultation.
Even if your primary, dominant state is acceptance and/or enrichment, there will be times when you feel a strong urge to reject or indulge your illness identity. Know and name those conditions, and allow yourself to feel the sadness that is part of living with the disease.
Living with a chronic illness is a complex lifelong journey. Understanding that these illness ID states are predictable parts of the journey can ease the way.