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How can I maintain my sense of self?

An interview with Susan McFadden, Chair of the University of Wisconsin-Oshkosh Psychology Department

What does the “loss of self” mean for elderly individuals?
I think it’s an emotional response that individuals have to uncertainty, and fear about the future. People have a sense of self built up from the past and may feel this loss when looking ahead to the unknown. The extent to which this happens depends on the person you’re talking about. People who have invested a great deal of their identity in appearance or in physical ability, or in many friends or in a professional role, might feel like they are losing a sense of self when they no longer connect with what has given them meaning. If on the other hand a person’s sense of self is determined by values held over time or relationships that are still ongoing, then that person may not feel a “loss of self” when, for example, he or she relocates to a long term care facility.

What are the symptoms of the “loss of self?”
Sometimes, people tell you directly that they feel this loss! If other signs of depression are present, then there ought to be a mental health assessment in order to determine whether various pharmacological or therapeutic interventions are called for. Sometimes, however, complaints about a “loss of self” are more existential. The person may be feeling a loss of the sense of life meaning and purpose. When older people say “I feel my life has no meaning anymore” they need someone to talk with them about things on a spiritual level and to help them identify values that are still important. Perhaps there are also deep, longstanding questions about sources of life meaning that have never been fully addressed. I’ve found that many older people really do want to talk about these things, but no one ever opens up the discussion for them. So when a resident says, “I don’t feel like myself anymore,” I would want to see if there was a treatable mental health problem and if not, then find out if the person is open to talking with a chaplain in a facility. Chaplains don’t just run religious services; many are wonderful at understanding residents in a holistic sense and do all kinds of creative programs with older adults who are struggling with questions about meaning and the “loss of self.”

What are contributing factors to loss of self?
Being treated as a generic old person. Even before entering a nursing home, many individuals have had this experience out in the community in stores, doctors’ offices, and perhaps even in community organizations where, because they’re older and may have physical or mental problems, they no longer feel valued. Thus, they may come into a facility expecting more of the same. What a surprise and joy it can be if they discover caring people there who really want to know who they are and are committed to honoring their individuality.

How does aging affect a “loss of self?”
In many ways, a sense of self has to do with how we feel on the inside, but it also has to do with all the external support that we have around us. With aging comes change—change in appearance and physical ability, change in the way we think and feel, change in our roles and relationships. Sometimes we experience these changes as positive and sometimes they threaten our core sense of who we are. In addition, we experience continuity of basic personality characteristics, continuity in terms of what we hold most dear, continuity in the way we tell the story about our lives. We also have external continuities in terms of people we cherish, valued possessions, various ways we go about living daily life. So, aging is not all about change; there’s a lot of continuity. When people experience a great deal of change, balanced by no internal or external sense of sameness, they may then feel a “loss of self.”

How can nursing homes help their residents maintain a sense of self?
We should not treat older adults generically—like they’re all the same! We must acknowledge their unique individuality, and find ways of eliciting their stories. We hold ourselves together by the stories we tell about our lives and these stories relate internal and external continuities as well as how we have dealt with change. Although a dementia process may destroy some of those continuities, if we look closely, we can still see certain long held characteristics that carry over into life with dementia. Organizations that embrace the conviction that all older people retain personhood find creative ways promote it through things like memory boxes and reminiscence programs. They also recognize that activities that support creative expression tap into enduring and significant components of the self.

What would be an example of a facility that does not promote self and individuality?
These facilities don’t support staff in getting to know residents. Perhaps they are understaffed so there is little time for doing this. However, even in those situations, I think the organizational culture can promote personhood by encouraging busy personnel to take time to call people by name, look them in the eye, and in all interactions, to remember that this is a person and not an object! Sometimes, facilities treat their staff like objects, too! When that happens—when employees have no sense of being valued as persons—there’s a high risk that residents will not be valued either.

Is this “loss of self” something that every elder person will feel?
I really don’t think so. Continuing care facilities now are doing a really good job of encouraging people to bring personal objects with them and supporting other sources of continuity, especially in terms of staying in touch with people who are important to residents. Obviously, there are losses when people make this move, but we can help people reframe the experience in order to be able to say “I feel lighter now; I feel like I’ve cast off all of this stuff that has weighted me down and I’ve made a choice about what I truly value and I’ve brought that with me.” I think it’s important to have rituals that help people make the transition from living “independently” into a care facility, rituals that acknowledge that, yes, this is a huge change but there are also continuities that are not just about possessions. Of course, this relates back to the way the person has organized identity much earlier in life. If you have invested your whole sense of identity in what you own and in your status and prestige in the community, then you are going to have a really tough time. Thus, there will be a lot of individual differences that are based upon the way identity has been structured.

What can an older person do to maintain their sense of self when entering a continuing care facility?
They need to identify what’s truly important to them and how they can maintain a sense of continuity with significant people, things, activities, and values. If they cannot to this, they need to grieve the loss and try to find ways of coping, perhaps by identifying new interests. For example, the mother of a friend of mine has discovered a love of and talent for painting that she never knew she had before she moved to a continuing care facility. People should also make an effort to maintain relationships with others as much as possible in order to hold onto a sense of community. However, some older people have never really done much to nurture a sense of community with others or they have experienced so many losses, there’s not much community left outside the facility. That’s why it’s so important for facilities to find ways to create community among people who entered as strangers but who can form important friendships even in very late life.

Susan H. McFadden, Ph.D., is Professor and Chair of the Psychology Department at the University of Wisconsin-Oshkosh. Her teaching responsibilities include Adult Development and Aging, Psychology of Religion, and History of Psychology. For many years, her research and writing have addressed aspects of older adults' religiousness; recently, her work has focused on people with dementia and their experiences with the arts.

Who am I
when I'm old?

Essay by Wendy Lustbader

»Interview with Susan McFadden


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