The Aim of the Book
We would like to start with a quote from Elyn Saks,Reference Saks1 who suffers from schizophrenia: “While medication had kept me alive, it had been psychoanalysis that had helped me find a life worth living” (p. 298).
Elyn Saks studied at world-leading universities. She pursued a career in academia and presently holds a position as professor at the University of Southern California, where she founded the Saks Institute for Mental Health Law, Policy, and Ethics. In her autobiography, The Center Cannot Hold – My Journey through Madness, she tells her story of struggling with delusions, resisting medication, and years of psychoanalysis. The opening quote is deeply touching, and it captures important insights that deserve more attention. Let us unpack it a little bit. First, the quote clarifies that although medication is lifesaving, it has limits. Psychopharmacological drugs may relieve symptoms, prevent suicide, and be a crucial part of treatment. Even then, problems remain. Individuals need more than medication to recover from mental disorder and find well-being.Reference Slade2 Second, the quote also reveals that Elyn Saks interprets her schizophrenia as costing her a life worth living, a life that had to be restored. She perceived psychoanalysis as helping her gain value in life, but psychoanalysis may not work for everyone. What other experiences do individuals with psychiatric disorders narrate as propelling them toward well-being, happiness, and thriving? Toward a satisfying life with meaning, joy, and other positive emotions? These reflections drove us to formulate the central questions that this book will seek to answer:
1. What do life stories reveal about subjective consequences of suffering from mental illness?
2. What do life stories reveal about experiences bringing well-being when living with mental illness?
Throughout the book, we use diverse terms, including mental illness, psychiatric disturbance, mental disorder, psychopathology, and others. Each term comes with its own associations and understandings of the central phenomenon.Reference Andresen, Oades and Caputi3–Reference Slade5 For example, the terms illness and pathology signify (brain) disease, but not all researchers agree that disease is involved. Rather, they comprehend mental disorder as the severe end of a spectrum of psychological problems or as a disability. We will return to these varying models later in the book. Views also vary with the type of diagnosis considered. For example, current understandings of schizophrenia emphasize pathological brain processes,Reference Walker, Mittal and Tessner6 whereas this is less the case for other types of psychopathology, such as personality disorders.Reference Bateman and Fonagy7 Given that there are no clear-cut answers about the validity of these conceptualizations, we adopt the perspective that the different frameworks and their associated terms all capture part of the picture concerning mental disorder. As such, we embrace the view that psychopathology is complex and that we may gain insights about mental illness through the lens of diverse models. Whether we comprehend mental disorder following a disease model, as the severe end of a psychological problems dimension, or as disability, afflicted individuals will experience costs. These costs may hinder well-being and our book will foster ideas about how to support individuals with mental illness in recovering a good life.
Broadly speaking, we examine whether personal stories, like Elyn Saks’, provide unique insights into mental illness not captured by traditional medical and psychological research. Systematic research on narratives has emerged over the last decades as scientists began to recognize the power of stories.Reference McAdams and McLean8–Reference Habermas11 Personal stories capture the richness of subjective experience, the meaning individuals imbue their lives with, and impact how they act. Examining how individuals with mental disorder story the costs of their illness and sources of well-being can yield knowledge crucial for tailoring interventions to support recovery from psychopathology. In later chapters, we elaborate on the nature of personal stories and analyze life stories told by 118 individuals living with psychiatric disorders. First, we consider autobiographies by authors struggling with mental illness as these provide cues for answering our two questions. These authors differ from many other people with mental disorder since not everyone can publish their memoires. Their stories have surely been adapted to become widely read, but they may still inspire our thinking about how individuals interpret the consequences of their illness and create possibilities for happiness.
Mental Illness Portrayed in Autobiographies
Elyn Saks is one of many people who have shared their experiences of living with psychopathology. Others include Kay Redfield Jamison (who wrote about her life with bipolar disorder), Susanna Kaysen (narrating her hospitalization for borderline personality disorder), and Matt Haig and Elizabeth Wurtzel who both disclosed their stories of depression. If you have read any of these books, they probably moved you. They certainly moved us. We think this is what good books can do. They move people, change their attitudes, and transform their view of themselves and other people.
Autobiographies about psychiatric disturbance vary in many ways. This is natural as the authors are very different people who suffer from distinct mental illnesses. At the same time, common threads run through the stories. We read the autobiographies paying close attention to how psychopathology impacted the authors’ lives and found convergence on some themes. The writers talk about fundamental issues like loss of time, loss of future, and loss of life. They depict difficulties with accepting their mental illness. They share stories about keeping their disorder secret, about pretending, in fear of stigmatization. Further, they portray the pain of abandoning hopes for work and relationships and the loss of a “normal life.” Finally, most of the narratives feature a frightening loss of self and describe how selfhood is damaged and tainted.
Elizabeth Wurtzel was a young and gifted student at Harvard University when depression hit her: “No matter if I ever got out of this depression alive, it made no difference because it had already fundamentally changed me. There had been permanent damage” (p. 84).Reference Wurtzel12
Matt Haig also talks about how mental illness affected his sense of self. After finishing his university studies, he was putting off adulthood by working a last summer job in Spain. First, panic swallowed Matt, then depression: “I can remember the day the old me died. It started with a thought. Something was going wrong …. And then my heart started to go. And then I started to go. I sank, fast, falling into a new claustrophobic and suffocating reality. And it would be over a year before I would feel anything like even half-normal again” (p. 9).Reference Haig13
Kay Redfield Jamison, an accomplished psychologist and researcher suffering from bipolar disorder, echoes this loss of self: “I was confused and frightened and terribly shattered in all of my notions of myself; my self-confidence, which had permeated every aspect of my life for as long as I could remember, had taken a very long and disquieting holiday …. I had a horrible sense of loss for who I had been and where I had been” (pp. 85 and 91).Reference Jamieson14
These quotes illustrate the harm to selfhood sometimes accompanying mental illness. The autobiographies display a multitude of devastating losses flowing from mental illness. However, although most of the consequences are negative, there are reflections about the silver linings. These are tiny bits in the overall stories, but we found some.
Matt Haig, who is very explicit about the costs of his anxiety and depression, states:
Depression, for me, wasn’t a dulling but a sharpening, an intensifying, as though I had been living my life in a shell and now the shell wasn’t there. It was total exposure. A red-raw, naked mind …. You know, before the age of twenty-four I hadn’t known how bad things could be, but I hadn’t realized how good they could feel either. That shell might be protecting you, but it’s also stopping you feeling the full force of that good stuff .
Kay Redfield Jamison expresses a similar theme. She notes that some of her milder manias came with increased creativity and work productivity: “So why would I want anything to do with this illness? Because I honestly believe that as a result of it I have felt more things, more deeply; had more experiences, more intensely” (p. 218).Reference Jamieson14
What do the writers have to say about experiences important to well-being? They emphasize stable, loving relationships with partners, friends, and parents who do not shy away as the authors fall into darkness. They focus on working with therapists who respect their autonomy and go out of their way to care for them. Not that all close others and therapists are viewed as guardian angels. In fact, the writers often describe unhelpful behaviors by others and therapists. Nevertheless, other people are often depicted as crucial to thriving. Some authors also vividly describe how well-being resulted from accepting their mental disorder and speaking openly about it. Below, we present two exemplar quotes illustrating this point.
Early in her autobiography, Elyn Saks uses the metaphor of a riptide to understand her relationship with her illness and explains how you cannot resist a riptide. If you do, it will pull you under. Still, throughout much of her book, she describes fighting the idea that she had schizophrenia, trying to get off medication, which would soon leave her psychotic again. However, at some point, she starts a new type of medication and things change:
The most profound effect of the new drug was to convince me, once and for all, that I actually had a real illness …. There’s no way to overstate the thunderclap this revelation was to me. And with it, my final and most profound resistance to the idea that I was mentally ill began to give way. Ironically, the more I accepted I had a mental illness, the less the illness defined me – at which point the riptide set me free.
Matt Haig’s book, Reasons to Stay Alive, reached a wide audience and made it to the top of the Sunday Times bestseller list. However, for a long time, he kept his disorder very private. In the book, he describes the realization that openness about the illness brought him hope: “It took me more than a decade to be able to talk openly, properly, to everyone, about my experience. I soon discovered the act of talking is in itself a therapy. Where talk exists, so does hope” (p. 68).Reference Haig13
What we can learn from these autobiographies is that across a range of psychopathologies, individuals story their illness as having profound consequences for their lives, some good, but mostly bad. Although some of these perceived outcomes are unique to the individual, to the particular circumstances of the author’s life, there are convergent themes. Similarly, the authors agree to some extent about which experiences they narrate as helping them gain well-being despite the costs of mental illness. Some of the themes emerging from these autobiographies foreshadow what our participants describe in their life stories. They may not be as verbally fluent nor as vivid in their descriptions. After all, they did not publish their life stories as memoires. Our participants represent a broader spectrum of people living with psychiatric disturbance and examining their narratives systematically will expand our knowledge about how people make meaning of mental illness and pursue personal recovery.
How the Book Complements Existing Research in Mental Illness
Answering questions about the personal impact of mental illness and pathways to thriving is important for a broader perspective on mental illness. However, the scientific study of psychopathology has tended to focus on etiology and treatment, that is, examining causal mechanisms behind a given disturbance, such as schizophrenia or bipolar disorder, and employing this knowledge to design effective treatments. The basic idea is that if therapy can reverse the causal mechanism, it will alleviate mental illness. For each disorder, scientists have put forward theories explaining the biological, psychological, and social processes leading to the eruption of psychopathology. Grounded in these theories, psychologists and psychiatrists have developed treatments to remedy the faulty processes and cure mental illness. Let us illustrate this general idea with an example. Established theories hold that schizophrenia is caused by genetic vulnerability leading to altered brain functioning.Reference Weinberger15, Reference Lysaker and Lysaker16 This vulnerability combined with environmental stress leads individuals toward psychotic episodes. Following this theory, treatment includes medication to restore normal brain functioning and psychotherapy to reduce stressors. For other mental illnesses, the logic is similar. We are presenting a simplified picture here; research has begun to illuminate mental illness from a broader perspective (see Chapter 4). Nevertheless, this picture captures a central truth about the scientific framework for psychopathology. For many years, it has centered on understanding the objective causes of mental illness and developing treatments to target these causes.
The perspective of this book complements such etiology-driven understandings. We need to pay more attention to the subjective experience of mental disorder. What personal consequences of psychiatric disturbance emerge when individuals make sense of their lives through narrative? And which experiences are storied as helping well-being in the face of the losses flowing from mental illness? These questions focus our attention on what happens after mental illness, rather than what happened before the illness and caused it. They emphasize first-person narratives, rather than objective events. Answering these questions is important because it will broaden our scope in efforts to support individuals with psychopathology. As a case in point, listen to one of our participants, a 26-year-old woman, who was diagnosed with bipolar disorder when she was 21:
Those years are characterized by mood swings: Three depressions/mixed episodes and hypomania. I feel like I lack a stable core/personality, and there is no consistency …. I am “hospitalized” at home for three summers and cared for by my parents. It provides safety, but it feels like a step back compared to my “independent” peers. I cannot complete an education; behave embarrassingly dramatic half of the time and the rest of the time I cannot deal with other people. It feels like there is no hope, as the mania/depression pattern repeats itself three years in a row.
The narrative illustrates a cascade of negative outcomes following from her disorder, including loss of self, lack of independent living, missing out on education and relationships, just to name a few. However, later she writes about how starting a new study program had positive effects: “I start a new study program, which offers stability and purpose. I feel a bit more like myself before I became ill …. I have hope for my future.” Such narratives drive home the point that supporting individuals with psychopathology in gaining well-being is about restoring the massive losses of self, relationships, future, meaning, and purpose.
We are not arguing that professionals should abandon efforts to understand the causes of psychiatric disturbance and the development of treatment grounded in such causal models. We are simply suggesting that we, as researchers, healthcare professionals, and individuals with mental illness, focus more on addressing the massive personal costs that stand in the way of well-being. We are arguing that researchers should conduct more studies examining the subjective consequences of mental illness, so we can support recovery from the losses associated with the illness and foster well-being. This could be an especially valuable perspective on severe psychopathology with periodic relapse, where afflicted individuals may profit from efforts to attain thriving not driven by symptom remission.
While most research on psychopathology has traditionally emphasized etiology and treatment, scientists have also identified the costs of mental illness. Studies addressing this issue paint a bleak picture. Having a mental disorder is associated with costs across a range of areas, such as lower educational attainment, unemployment, and higher mortality.Reference Kessler17–Reference Javaras, Zanarini, Hudson, Greenfield and Gunderson19 Turning to research on the psychosocial outcomes of mental illness, studies show reduced well-being and stigmatization.Reference Corrigan, Kleinlein and Corrigan20, Reference Michalak, Murray, Young and Lam21 However, these studies do not address how individuals with psychopathology interpret the consequences of mental illness and they leave us in the dark concerning experiences narrated as restoring well-being. In other words, how do people make meaning of mental disorder and construct their personal recovery?
Why Life Stories?
Life stories are precisely the tool we need to understand the subjective side of psychopathology. Human beings are natural born storytellers.Reference Bruner9, Reference Polkinghorne10 We understand events in our lives by forming stories, connecting events to their causes and consequences. We remember life in storied forms.Reference Bluck and Habermas22–Reference Conway, Singer and Tagini24 We process emotions by contextualizing them in narratives.Reference Habermas11 We share stories when connecting with friends, when falling in love, and when conveying lessons to our children.Reference Alea and Bluck25, Reference Pasupathi26 We gain identity through crafting narratives.Reference McAdams27–Reference Habermas and Bluck29 When we use a life story perspective to understand mental illness, we read personal tales and examine them for insights about how individuals view the devastating impact of illness and their paths to well-being. Because our participants told their stories in an open-ended manner, often spanning decades of their lives, the narratives portray a broad range of identity-salient consequences and well-being sources.
Individuals interpret the significance of their experiences for identity through constructing life stories, also termed narrative identity.Reference McAdams and McLean8 Therefore, our analyses yield insights about how identity is impacted by mental illness and is involved in attaining well-being and personal recovery. Given that narrative identity shapes how individuals engage with the world and direct future action, our analyses concern the consequences and well-being sources most likely to pervasively impact individuals with mental illness. The close interaction between experiences and narrative identity entails that our analyses provide answers at two levels. First, we explore what individuals experience as costs (e.g., relationship rupture), and paths to well-being (e.g., creative activities). Second, we address how these experiences color identity (e.g., identity conclusions such as “I am a burden to other people”) and how identity is involved in thriving (e.g., identity conclusions such as “I am creative”).
One could argue that life stories are so subjective and unique that we can learn nothing general from them. That is, insights will only apply to the individual who told the story. Based on extensive research, we disagree with this standpoint. While life narratives are unique and capture the particulars of each individual, they also share commonalities.Reference McAdams27, Reference Dunlop30, Reference Adler, Lodi-Smith, Philippe and Houle31 Although we are different, we are also similar, because we share nature as well as culture.Reference Singer32 Analyzing a large number of life stories draws attention to similarities in the meaning of mental illness, while also showcasing different tales of the costs of mental illness and sources of thriving. Maybe you watched A Beautiful Mind, the movie depicting John Nash, who perceived patterns invisible to other people? We watched the movie and realized that John Nash, like Elyn Saks, needed more than psychopharmacological drugs to get well. A brilliant scientist and Nobel Prize winner, Nash developed a delusional disorder early in adulthood. Gradually, delusions took over his life: his work, his marriage, and his role as a father. He lost his job, a primary source of value and meaning in his life. While medications helped, he still experienced symptoms along with side effects of the drugs. He spent most of his time sitting on the porch, smoking. Then things changed. In a salient scene, he goes to see the head of the mathematics department at Princeton, a former fellow student, seeking a teaching job. He explains that he and his wife believe that he needs to be with people. Soon after, he starts teaching and interacting with students who read his famous work. Although he still experiences symptoms, life is better. In the present context, the movie serves as an illustration that removal of symptoms and a good life are not the same thing. The symptoms of mental illness may be alleviated, but individuals will experience little well-being if lost sources of value and meaning cannot be restored. As such, the movie echoes themes expressed in autobiographies of psychopathology and testifies to shared experiences across individuals. In other words, although life stories are unique, we can use common themes as guidance in assisting individuals with mental disorders to thrive, even when symptoms remain, and relapse is likely.
Others would argue that the subjective interpretations captured in stories might simply be untrue. For example, a woman could talk about mental illness having cost her a job that she loved, but objectively speaking the job loss occurred because of downsizing at the workplace. The question is what does “objectively speaking” mean? For the woman who lost her job, her boss may identify downsizing as the reason for firing her and her former colleagues may accept this explanation. Nevertheless, the woman experienced the job loss as a direct result of her mental illness, and this subjective interpretation is what stories are all about. The interpretations feel true to the storyteller, and this subjective reality has important consequences. The woman who lost her job may blame her job loss on the illness and base future decisions on this interpretation. The point is that the subjective interpretations that form a key part of narrative identity matter.
A final reason for analyzing life stories from individuals living with psychiatric disorders is that first-person perspectives are valuable supplements to research,Reference Slade5, Reference Lysaker and Lysaker16, Reference Ridgway33 which takes concepts and theories as the starting point. The recovery movement has argued that individuals have unique knowledge of their own mental illness, grounded in rich and contextualized experience, which can yield insights overlooked in scientific studies with a priori specification of concepts. Individuals with psychopathology have first-hand knowledge of the consequences of mental illness and sources of well-being and it simply makes sense to use their expertise in building a broader framework for how narrative identity and mental illness interact. Analyzing life stories to grasp the complexities of living with mental illness yields an understanding that is not limited to objectively established causes and does justice to the immense personal impact of psychopathology individuals need to recover from.
About Us
Before moving on, we would like to introduce ourselves. We have researched life stories for years and have been drawn to the question of how narratives can illuminate mental illness, in particular what life stories can tell us about how individuals suffering from psychopathology understand themselves. This fascination was fueled by four PhD projects. Tine Holm dedicated her PhD project to examining life stories in individuals with schizophrenia.Reference Holm, Pillemer, Bliksted and Thomsen34–Reference Holm, Thomsen and Bliksted36 Rikke Amalie Agergaard Jensen followed up on Tine Holm’s research by interviewing individuals with either schizophrenia or severe depression to understand similarities in past and future life story chapters from individuals with different diagnoses.Reference Jensen, Thomsen, Bliksted and Ladegaard37, Reference Jensen, Thomsen, Lind, Ladegaard and Bliksted38 Majse Lind broadened the scope of our research by interviewing individuals with borderline personality disorder about both their own and their parents’ life narratives.Reference Lind, Jørgensen, Heinskou, Simonsen, Bøye and Thomsen39, Reference Lind, Thomsen, Bøye, Heinskou, Simonsen and Jørgensen40 Finally, Anne Mai Pedersen thought that narrative identity research was necessary to gain a deeper understanding of problems with selfhood in bipolar disorder.Reference Pedersen, Nielsen Straarup and Thomsen41, Reference Pedersen, Straarup and Thomsen42 Our most significant contributions to the field sprang out of these studies where we share our insights about relations between psychopathology and identity as represented in narratives. Furthermore, we have introduced the concept of vicarious life stories, that is, the stories of others (e.g., parents, peers) that individuals keep and use as guidance,Reference Thomsen and Pillemer43, Reference Panattoni and Thomsen44 an idea we return to several places in the book.
Well-being and mental illness have always been topics close to our hearts. In our previous work, we have endeavored to increase knowledge about how life stories facilitate well-being,Reference Pedersen, Nielsen Straarup and Thomsen41, Reference Holm, Thomsen, Huling, Fischer and Lysaker45, Reference Thomsen, Panattoni, Allé, Bro Wellnitz and Pillemer46 and we review relevant studies in Chapter 6 as a part of contextualizing the present life story analyses. As mentioned above, we have explored how life stories illuminate mental illnesses. Such clinically inspired research often emphasizes deficiencies in narrative identity (e.g., lack of coherence) based on the assumption that maladaptive storytelling contributes to mental illness and poorer well-being. The present book contrasts this perspective. Here, we zoom in on the content of the stories, taking our participants’ interpretations of costs and helpful events at face value, to learn about their perspective. To anchor the book in clinical practice, we have asked friends and colleagues with extensive clinical experience to consider the practical utility of the ideas advocated in the book. We believe that the book can add new perspectives to the science of mental illness by allowing afflicted individuals to emerge as protagonists who strive to find meaning in their lives and thrive while struggling with their own minds.
As a final note of introduction, we would like to share our own experiences with psychopathology. Some of us have personal and painful experience with mental illness (see Appendix 1). Therefore, like many other people around the world, we have psychopathology as a part of our lives, and we want to make sense of it.
Outline of the Book
It is almost time to get started and here we give a brief overview of the chapters. This overview serves the purpose of presenting the structure of the book and guide selective reading of chapters. We hope the book will reach not only a professional audience, including researchers and healthcare professionals, but also individuals with a more personal interest – readers who have mental illness in their own or close others’ lives. Hence, we wrote the book with these different audiences in mind, realizing that the background of the reader matters to the relevance of the chapters. At the end of each chapter, we therefore provide a summary of the main content to assist readers who prefer to skip detailed reading but desire a quick overview. For readers who wish to delve more deeply into the research, we provide references at the end of the book as well as more extensive method descriptions in Appendices 4–6. Throughout the book, but mostly in Chapters 9–12, we present extended quotes from the life stories of our participants and emphasize these in italics.
In Chapter 2, we contextualize the book with reference to the science of mental illness. The chapter opens with considerations on the disease model of mental illness and a description of the diagnostic system, which comprise the established taxonomy in the area. Here, we give more details on the symptoms of the four disturbances our participants suffer from, including bipolar disorder, schizophrenia, major depressive disorder, and borderline personality disorder. As a contrast to this approach, we highlight support for transdiagnostic approaches to psychiatric disorders. We argue that although the diagnostic system represents these as distinct disorders, meaningful insights may surface when analyzing life stories across disorders. By exploring life stories from individuals with different mental illnesses, we can discover both commonalities and contrasts in the personal costs and well-being sources that become a part of their narrative identities and shape their lives.
In Chapter 3, we turn to diathesis-stress models, which is the main framework guiding research on psychopathology. Within this framework, we describe examples of theories that seek to explain schizophrenia, bipolar disorder, major depressive disorder, and borderline personality disorder. We show that despite their differences, the theories are similar in their foci on understanding causal mechanisms and utilizing knowledge of causal mechanisms to develop treatment. Subsequently, we review research on consequences of mental disorders. Based on these two lines of research, we argue that mainstream research in mental illness needs to be extended with research on subjectively experienced consequences. Furthermore, if we acknowledge that disorders give rise to multitudes of costs to identity, this begs the question of how individuals living with psychiatric disorder can experience well-being and personal recovery?
Expanding on these issues, we highlight insights from the literature on recovery in Chapter 4. We outline different approaches and then zoom in on personal recovery, including positive identity, hope, purpose and meaning, social connection, and taking responsibility for managing one’s mental illness. As such, personal recovery is closely related to well-being. We argue that our analyses illuminate narrative identity processes involved in personal recovery, including costs individuals with psychopathology need to recover from and experiences narrated as facilitating well-being. Note that we employ a variety of terms to capture a broad conceptualization of well-being, including happiness, thriving, and a good life.
In Chapters 5 and 6, we take readers into the scientific study of life stories and describe the central concepts in this area (we use the terms story and narrative interchangeably). We explain how narratives are a basic mode of understanding and how individuals craft life stories to create identity. To introduce readers to the deeply social nature of narrative identity, we review ideas suggesting that relationships and culture impact how people story their identities. We present novel studies suggesting that individuals do not just construct stories about their own lives; they create narratives with other people as the main characters. These vicarious life stories embody the storyteller’s version of close others’ lives and intertwine with personal life stories. Research on vicarious life stories is especially relevant for this book, because it suggests that others’ stories may inspire readers to reflect on, and possibly modify, their own life narratives. In Chapter 6, we discuss diverse perspectives on relationships between narrative, mental illness, psychotherapy, and well-being showing how the present book is inspired by and broadens this research. We close the chapter with a selective review of previous studies relevant to our main questions.
Chapter 7 is a method chapter and here we summarize information about our participants and the methods used to elicit life stories in the different studies. In addition, we explain the analyses we employed to extract themes from the life stories and briefly discuss limitations of the approach that should be borne in mind when reading Chapters 8–12. In the chapter, we give an overview and provide more details for readers interested in the mechanics of research in Appendices 4–6.
Chapters 8–12 are the core of the book and here we present the results of our analyses. In Chapter 8, we provide an overview of the consequences of mental illness and well-being sources individuals story into their identities. We display tables with an overview of the number of participants showing evidence of each theme, including information about frequencies for individuals with schizophrenia, major depressive disorder, bipolar disorder, and borderline personality disorder. In Chapters 9–12, we dive deeper into the diverse meanings and identity conclusions expressed by our participants when narrating the costs of mental illness and well-being experiences. We organize these analyses into four superordinate themes: relationships (Chapter 9), self (Chapter 10), functional level (Chapter 11), and treatment (Chapter 12). In each chapter, we first describe subthemes and associated identity conclusions emerging from our analyses on personal consequences. We contrast these with subthemes and identity implications surfacing from analyses of thriving experiences. We develop models of common storylines for subjective impact of psychopathology and well-being, step by step in the four chapters. Illustrating the subthemes, we include a broad selection of extensive examples from participants, increasing the transparency of the analyses. We hope that the life story quotes will serve as vicarious life narratives to readers and inspire reflections on their own lives.
In the final three Chapters (13–15), we summarize the findings, integrate them with existing literature, and consider practical implications. In Chapter 13, we discuss how insights from our analyses supplement existing research in mental illness and personal recovery. Based on a synthesis of our analyses and literature reviewed in earlier chapters, we develop a framework for understanding psychopathology from a narrative identity perspective in Chapter 14. As a part of this, we discuss narrative identity as a vulnerability to mental illness, how narrative identity is challenged by psychopathology, and how it is crucial to personal recovery. Finally, in Chapter 15, we use this framework to suggest that healthcare professionals and individuals living with psychopathology employ our narrative identity approach to aid exploration of personal consequences of mental disorder and possibilities for thriving. To render the approach easily accessible, we outline a structured guide for narrative repair. The guide targets the narrative identity problems that we identified in our analyses as arising from mental illness. It aims to facilitate coping with fear of the ill self and grief for lost selves and dreams, and to resist negative self-views. It further structures narrative work to revive and identify valued aspects of the self, to construct hopeful, yet realistic futures, and to anchor these selves and futures in daily life. To illustrate how the guide can be employed, we have included a case story in Appendix 8. We hope the guide will advance interventions targeting the identity challenges facing many individuals with mental disorder, thereby assisting personal recovery.
