with an already diminished sense of self due to mental illness.
In addition, stigma—negative attitudes or prejudice—associated with mental illness exerts an extremely harmful impact on consumers’ identities. This stigma leads many consumers to believe they are grievously flawed, which in turn, exacerbates their illness. A 1997 online survey conducted by NAMI2 showed that a majority of consumers were more negatively impacted by stigma than by the actual symptoms of mental illness—this even though the barriers mental illness symptoms pose to maintaining a positive sense of self are themselves substantial.
In the face of stigma and lacking a sense of self, any given diagnosed individual will feel undeserving of a life of quality, be less likely to engage in self-care, and be unable to understand that the possibility of recovery exists. Suicidal thinking may even occur. However, in spite of these devastating impacts, hope is not lost.
Patricia Deegan, PhD, is both a consumer and an advocate for diagnosed individuals, explained recovery from mental illness as a dynamic process that incorporates an individual’s strengths and weaknesses. She regards it as a personal journey that includes awareness and management of the psychiatric disorder but also growing into a positive regard for oneself and meaningful life roles beyond the illness.3 In short, the recovery process includes working toward a more positive sense of self in the face of the illness-related obstacles that threaten it.
Nathaniel Branden, PhD, defined self-acceptance in terms of being willing to take ownership and responsibility for our feelings, ideas, and behaviors without denying them and without condemning ourselves.4 I believe self-acceptance is the most ideal way to begin the work of rebuilding and enhancing one’s identity as the basis for recovery. This workbook is intended to help you as a consumer of mental health services increase your self-acceptance, enhance your sense of identity, and contribute to your growing awareness of your potential for positive change.
The Evolution of This Tool
My ideas about self-acceptance stem from a forty-year career of assisting people diagnosed with serious mental illness. I spent more than thirty-three of those years at the VA Medical Center in Sheridan, Wyoming, where I had the privilege of developing and refining programming, including this workbook, to help suffering individuals to recover. While at the VA, I had the honor of working with veterans over an extended period and the opportunity to observe the recovery process firsthand. I came to understand that even individuals with serious mental illness can recover, given supportive circumstances and appropriate tools—not the least of which is self-acceptance.
Much of the research on recovery from mental illness corroborates my experience. The next part of this introduction provides a brief overview of the history of our understanding of how mental illness and the stigma associated with mental illness undermines identity and recovery and how rebuilding one’s sense of self aids recovery. Following is a sample of the distinguished theorists and psychotherapists who believed the experience of self is central to treatment of and recovery for people diagnosed with mental illness.
Paul Eugen Bleuler coined the term “schizophrenia,” which literally means, “split mind.”5 Bleuler intended to convey that one of the paramount symptoms of schizophrenia is the fragmentation of the thought process, including the sense of identity. Building upon Bleuler’s work, Sue Estroff, a contemporary researcher in the field of the subjective experience of people diagnosed with serious mental illness, called schizophrenia an “I am” illness, conveying that having a mental illness strongly and negatively impacts sense of identity.6
Alfred Adler, noted psychoanalyst and associate of Sigmund Freud, the father of psychoanalysis, was one of the earliest mental health leaders to recognize the association of mental illness and low self-esteem, which he called “the inferiority feeling.”7 Adler was also one of the first to employ psychotherapy to assist people with serious mental illness, and he regarded helping patients pursue useful roles to promote their self-esteem as a goal of treatment.
Harry S. Sullivan, also a psychoanalyst, was well known for his work in enhancing the understanding and psychotherapeutic treatment of psychotic disorders. Sullivan theorized that problems existed in what he termed the “self-system” in individuals who developed conditions such as schizophrenia.8 Sullivan and his followers relied, in part, on improving patients’ self-systems to assist them in their recovery.
Carl Rogers, renowned psychologist and originator of “client-centered therapy,” worked with individuals suffering from a variety of psychological problems, including serious mental illness. He maintained that low self-esteem is a major component of all mental health problems.9 His methods of “active listening” and “unconditional positive regard” were shown to be associated with improvement in the self-esteem of his clients and the amelioration of their symptoms.
The psychiatrist R. D. Laing devoted his career to assisting individuals diagnosed with serious mental illness. In his book, The Divided Self, Laing described how suffering individuals lose their connection not only to the social world but also to parts of their identities.10
Over the past thirty years, researchers in the field of recovery from mental illness have demonstrated several key points you might find useful in your own journey of recovery:11
• Mental illness contributes to confusion or impoverishment about one’s sense of identity or “who I am.”
• Stigma associated with mental illness also plays a huge role in eroding self-worth and identity. Stigma can exist internally, stemming from one’s own negative attitudes about mental illness before illness onset, while the attitudes of other people, including family, coworkers, and neighbors, can perpetuate it.
• Recovery seems to proceed best when the diagnosed individual accepts the fact of having an illness but does not self-berate or self-stigmatize.
• Awareness of and building upon personal strengths and interests support the recovering individual. Therapeutic techniques aimed at increasing awareness about one’s identity also facilitate recovery.
• Psychotherapy techniques such as cognitive behavioral therapy (CBT) can foster a more realistic and holistic sense of self, helping to improve self-acceptance and facilitate recovery.
• Peer and family relationships can be vital to promoting recovery.
The remainder of this introduction features the story of Vanessa Hastings and her experience with mental illness. Vanessa describes classic symptoms of anxiety and depression, including obsessive thinking, social withdrawal, sleep disturbances, weight gain, crying spells, fatigue, and suicidal thoughts. Depression, anxiety, and other mental illnesses are often associated with experiences of loss. In Vanessa’s case, childhood losses included a separation from her parents at an early age, domestic conflict that left her with unmet needs, and a traumatizing altercation with her father during her teens.
Later, various medical problems and her father’s chronic illness and early death added to her anxiety and sense of loss. Yet, she has managed to actively support her recovery from mental illness by not only relying on psychotherapy and medication but also by engaging in frank yet gentle self-reflection, moving beyond blame, allowing herself the space and time to grieve her losses, and remaining determined to rise again after each setback. I hope Vanessa’s story inspires you to work toward self-acceptance and come to believe that you too can recover.
My Recovery from Anxiety and Depression
By Vanessa Hastings
As I recall my nearly lifelong battle with mental
