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Article Excerpt
This article addresses the impact of aphasia on construction or storying of self, particularly the way in which one's ability to manipulate one's social/cultural tool kit is impaired when language as a tool is disrupted. If language is essential to the construction of the self, how does one participate in self-construction in the face of its impairment? The theoretical perspectives of Holstein and Gubrium (2000), Giddens (1991), and Swidler (2001) are used to clarify the ramifications of this altered social construction of self in aphasia. Examples are provided to demonstrate how an aphasia communication group may help persons with aphasia engage in the self-reconstruction process.
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Aphasia is typically defined as an impairment in the ability to understand and/or use language symbols as a result of neurological impairment. Historically, treatment of aphasia has taken place within the broader framework of the medical model in which the person with aphasia is stigmatized as damaged and thus inferior (Duchan, Maxwell, & Kovarsky, 1999; Gee, 2000). In this model, rehabilitative efforts focus on reducing impairment, with health care professionals exerting control over most interactions due to the power conferred by their role as the one who can "fix" the problem (Simmons-Mackie & Damico, 1999). The person with aphasia is seen as lacking agency and thus may leave the medical system with an internalized sense of self-as-incompetent, of being disconnected from previous selves, a concept captured in Mackay's (2003) article titled "Tell Them Who I Was." This experience has been described as resulting in a kind of identity theft that occurs, in part, because language is a critical tool for the maintenance of situated identity (Shadden, 2005; Shadden & Agan, 2004). Challenges to identity may be seen as the consequence of the "unsettled lives" produced by aphasia (Swidler, 1986).
The medical model is a poor metaphor for the psychological healing needed in dealing with the impact of aphasia. While aphasia interventions have shifted in recent years to focus more on both quality of life and life participation as desired outcomes (Cruice, Worrall, Hickson, & Murison, 2003, 2005; LaPointe, 1999; LPAA, 2001; Worrall & Holland, 2003), there is still limited attention to the profound consequences of impairment of language on the social construction and mediation of identity. Gover and Gavelek (1996) suggest that identity, to be socially viable, must be constructed with socially understood materials and preexisting meaning systems. For them, identity is at stake any time people use words, symbols, or gestures to map themselves onto the world. Thus talk-as-tool is fundamentally disrupted for persons with aphasia. Further, this occurs when the experience of an unexpected disabling event has created a fork in the developmental timeline of one's identity (Harrison & Kahn, 2004), a kind of biographical disruption (Mold, McKevitt, & Wolfe, 2003).
The term identity can be misleading, since it implies a single construct, whereas, at the very least, there is probably a social/collective, personal, and situational identity (Dowd, 2004; Mold et al., 2003). Gover and Gavelek (1996) suggest that "identity" is comprised of the concepts of both person (as socially defined and endowed with power and capacity for meaningful action) and self (as a more private experience that is phenomenologically at the center of one's existence). Regardless of one's definition, as Moya (2002, p. 87) suggests, "identities provide people with frameworks for interpreting their experiences," and that interpretation is contingent upon an understanding of one's self in relation to people and even circumstances.
This article addresses the impact of aphasia on construction or storying of self, rather than identity per se. Of particular interest is Holstein and Gubrium's (2000) discussion of self, coupled with Swidler's (1986, 2001) focus on the ways in which people manipulate cultural tool kits in the construction of self and Goffman's (1959) discussion of power or agency in interactions. These theoretical perspectives are used to explore the ramifications of altered social construction of self in aphasia, particularly in the context of a diminished ability to use words as psychological tools that mediate the human action needed to story self. Examples are provided to demonstrate how an aphasia communication group may help persons with aphasia engage in the self-reconstruction process.
STORYING OF SELF
The Self and Language
Holstein and Gubrium (2000) argue that there is no core identity that transcends situations. Rather, they make three related points: (1) The self is constructed and presented in every social interaction, (2) the self is constructed through local discourse, and (3) every individual situation is the site of self-construction. For these authors, social...
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