Abstract
Being diagnosed with cancer can be one of those critical incidents that negatively affect the self. Identity is threatened when physical, psychological, and social consequences of chronic illness begin to erode one’s sense of self and challenge an individual’s ability to continue to present the self he or she prefers to present to others. Based on the notion of illness trajectory and adopting a Ricoeurian narrative perspective, this theoretical paper shall explore the impact of cancer disease on identity and establish the crucial importance of metaphor in the narratives of life with cancer. Findings indicate that in cancer narratives the illness experience supplies the narrative structure with temporal and spatial meeting points that make the narrative comprehensible and meaningful. Cancer forces identity changes not only from having to endure the long-term physical and psychosocial effects of the disease, but also from inevitable existential questions about life’s meaning. Improved medical knowledge today means improved ethnomedical practices. Metaphor can bridge the gap between the cancer experience and the world of technology and treatment, helping patients to symbolically control their illness.
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Notes
Narrative inquiry is the methodology for investigating the interpretation of human experience as it is described in the storied lives of individuals grappling with making sense of life events (Chase 2003; Connelly and Clandinin 2006). Using narrative inquiry, one attempts to understand how people think through events and what they implicitly assume (Riessman 2008).
Ricoeur reveals how the art of creating a plot responds to the aporia of time. This aporia refers to a gap between a phenomenology of time (mortal, subjective) and cosmic time (scientific, objective). Cosmic time refers to infinite age of the cosmos considered as endless and natural time (the time of astronomy and physics). Phenomenological or mortal time refers to the average finite life span of humans. The contrast between these two times is what defines us along a continuum of life-to-death: “Would we speak of the shortness of life, if it did not stand out against the immensity of time?” (Ricoeur 1988, p. 93).
The lived body is an inseparable unity of mind, body, and world, which is always oriented towards the world outside itself, in a constant flow. It is the place where the world reveals itself, a consistency of meaning and significance. The body is the medium through which a person intentionally carries out daily tasks and activities, and through which a person comes to know the body not through abstracting it but through living it. In other words, we do not have our bodies; we are our bodies. A person’s embodied presence in the world is the necessity of all knowledge and experience (Merleau-Ponty 2002; Bullington, 2009).
Personal identity is constituted by an inextricable tie between ‘idem’ an ‘ipseity’. Without both forms of identity, there can be no self because a self has both an idem and an ipse identity. However, both aspects of identity are quite different. Idem identity is that which gives the self it spatio-temporal sameness; ipse identity gives the self its ability to initiate something new. For Ricoeur, identity is not idem; it is selfhood: “I have repeatedly affirmed, identity is not sameness” (Ricoeur 1992, p. 116).
Maslow propounded a theory of motivation based on a hierarchy of five human needs. These needs in ascending order are physiological, safety, love/belonging, esteem, and self-actualisation. According to Maslow, personal growth is contingent on the sequential fulfillment of these needs.
Another pertinent theory worthy of mention here was proposed by Bronfenbrenner (1979) who created ecological systems theory, later renamed the bioecological systems theory. According to this theorist, the development of a person is viewed as a combination of biological disposition and environmental forces.
Halliday (1975) has defined text as a semantic unit containing specific components that make the text internally cohesive and able to function as a whole.
Ricoeurian philosophy works with the idea of ‘discourse’ as a way in which language and texts are used in our understanding (narratives) of the world, to enable or disable particular ways of acting or being acted upon.
Subjectivity, broadly speaking, refers to an individual’s sense of self. An individual’s subjectivity involves a continual process where the self is produced through interactions and experiences with others. Subjectivity is both being ‘subject to’ and ‘subject of’ cultural narratives and the discourses that enable them (Ricoeur 1991a, b).
One definition of chronic illness is an illness that lasts longer than 3 months, but chronicity is more than just a dimension of time. Other factors are its interference with the person’s physical or social functioning, the degree of permanence versus possible reversibility and the regimen of symptom management (Sidell 1997).
Transition is defined as “a passage from one fairly stable state to another fairly stable state and it is a process triggered by change” (Meleis 2010, p. 11).
For this article, ‘self-identity’ concerns both who we are and what we think of who we are and is influenced by social structures within a cultural context (Charon 2004).
Three subtypes of quest narratives are proposed. The first is memoir in which events are related simply. The second is manifesto in which illness becomes a motivator for social action or change. The third is automythology in which illness is expanded to reveal fate or destiny (Frank 1995).
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Acknowledgments
This theoretical paper is part of the Doctoral Research Program developed at the University Institute of Applied Psychology, Lisbon, Portugal. The author wishes to thank Professor Paula Ponce de Leão for her encouragement, kindness and supervision and Professor Isabel Leal for her insight and thought-provoking critique.
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Laranjeira, C. The role of narrative and metaphor in the cancer life story: a theoretical analysis. Med Health Care and Philos 16, 469–481 (2013). https://doi.org/10.1007/s11019-012-9435-3
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DOI: https://doi.org/10.1007/s11019-012-9435-3