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       Orientation to Self-Acceptance

Why Self-Acceptance?

      Not long ago, serious mental illnesses such as schizophrenia, bipolar disorder, and recurrent major depression, among others, often meant resignation to a life of institutionalization, a life devoid of any satisfaction or accomplishment. Fortunately, this prognosis of doom no longer applies.

      With the rise of the recovery movement over the past thirty years, now more than ever before, hope exists for people diagnosed with serious mental illness to live full, meaningful lives. In fact, many people diagnosed with serious mental illness are leading normal lives that include career and family.

      Improvements in the effectiveness of psychotropic medication contribute to this positive and optimistic outlook. In addition, newer forms of psychotherapy, including psychosocial rehabilitation approaches, such as social-skills training and illness awareness and management programs, have proven supportive of recovery. Most recently, cognitive enhancement therapies have been effective in improving ability to focus, organize, and problem-solve.

      Even more important than these developments, in my opinion, is mental-health-services consumers’ expanding awareness of the possibility of personal change and growth despite the devastating impact of mental illness. Many peer-supported and self-help resources have become available to recovering individuals. The Wellness Recovery Action Plan (WRAP),¹ developed by recovering consumer Mary Ellen Copeland, is but one example of such tools. The National Alliance on Mental Illness (NAMI) offers peer-led support groups for both consumers and family members of consumers to help recovering individuals help themselves.

      With such a broad array of recovery resources, including self-help materials, what makes self-acceptance so important and why is this workbook necessary?

      The Importance of Self-Acceptance

      Loss of identity and self-esteem are among the most significant casualties people diagnosed with mental illness experience. For people diagnosed with schizophrenia, disorganized thinking and difficulty with accurately perceiving reality can interfere with maintaining a clear sense of self. Individuals diagnosed with bipolar disorder also struggle with identity: During the manic state of the disorder, the self may take on “grandiose” or superhuman proportions, but during the inevitable depressive state, feelings of guilt and inadequacy lead to feelings of worthlessness. For individuals diagnosed with recurring major depression or persistent depression, feelings of worthlessness may continually interfere with maintaining a realistic sense of self-esteem and a positive identity.

      The nature of these illnesses can lead to a snowball effect in that diagnosed individuals commonly experience losses of employment and educational opportunity, as well as in relationships with family and friends and in other important areas of life. Because we often define ourselves by our vocational and social roles, when we lose these roles, we lose part of our identities, and this inevitably results in a diminished sense of self. This is especially true for those struggling 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

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