PSYCHOTERAPIA 1 (196) 2021

strony: 75–90
DOI: 10.12740/PT/132247

Anna Bańbura-Nowak1, Katarzyna Kowara2, Małgorzata Opoczyńska-Morasiewicz1

SELF-STIGMA FOR THE TIME OF PASSING

— AN INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS
OF THE EXPERIENCE OF OLDER WOMEN STRUGGLING
WITH DEPRESSION IN THE COURSE OF MOOD DISORDERS
1
Jagiellonian University, Faculty of Philosophy, Institute of Psychology
2
Institute of Psychotherapy in Cracow

ageing
autostigmatization
depression

Summary
Objectives: Self-stigma associated with mental disorders can be an additional cause of suffering for
those affected. Our intention was to extend the assumption made in the literature that the phenomenon
of self-stigma is accompanied by only negative consequences. We made an attempt to describe and
understand the ways of experiencing oneself and relationships with others in the context of suffer-
ing from depression, and we also reflected on the multitude of possible meanings of self-stigma.
Method: Based on the data collected during individual interviews with six women aged 60+, hospi-
talized due to the severity of an episode of depression in the course of mood disorders, we conducted
an interpretative phenomenological analysis.
Results: We have identified three meanings that preoccupation with an illness may have and described
them in the areas of: (1) Dealing with depression as an important aspect of identity; (2) Depression as
one of the aspects around which thinking about the future is structured; (3) Depression as a regulator
of interpersonal relations.
Conclusions: Self-stigma was manifested in the respondents in the form of a severe devaluation
of themselves and the experience of being overwhelmed with critical thoughts about themselves.
It seems, however, that the recurring perception of oneself through the prism of the illness could also
fulfil some protective functions: filling the void left by former roles; protecting against confronta-
tion with passing and creating opportunities for contact with others. On the basis of the obtained
results, we presented suggestions for the psychoeducation of older people struggling with depres-
sion: encouraging them to create narratives about their past, enabling contact with peers affected
by similar concerns, abandoning attempts to encourage changes in the way of experiencing oneself
and revising self-narration.
76 Anna Bańbura-Nowak et al.

Introduction
Difficulties resulting from the confrontation with transience and its manifestations, such
as separation or mourning, reappear in all phases of life [1], but during the stage of aging they
may be recalled in a new way. Losses often accumulate (widowhood, illness and death of
important family members, loss of health) [2]. In addition, the ever-closer end of life encour-
ages you to look back – when you try to see what has passed, there is an opportunity to put the
experienced moments together into a coherent whole [3]. The creation of this emergent pattern
sometimes gives a feeling of completion, a finished play – as if old age revealed the message
of the “show” [4, p. 17]. However, the moment of turning back can also be the starting point
for growing despair, for reliving the pain – this time compounded by the finding that there is
no time to start over. Erikson [3], the author of the theory of psychosocial stages of life, called
these two aspects of the conflict characteristic of the stage of old age integrity and despair. As
Bugajska [5] reminds us, these two phenomena are not mutually exclusive, but are rather poles
of the continuum of experiences. Wisdom is the force that can arise from confronting both
joyful and dramatic states. The researcher modifies Erikson’s theory by proposing to add one
more life phase to the construct that would precede the last one described above. This would
make it possible to nuance the stage of old age, which today may last several decades. The
penultimate phase would be the period of retirement, which forces one to respond to major
changes in the area of ​​daily tasks and social roles. The antinomy characteristic of this phase of
life would be commitment – resignation, and the force arising from their confrontation would
be the courage necessary to face the progressive changes resulting from aging.
Success in resolving the crises characteristic of the phases described depends, inter alia,
on the socio-cultural context1, on the current possibilities, on the way in which crises in
previous life phases were developed, and on the ability to define one’s own identity. In this
context, it is worth recalling Śleszyński’s considerations [10] – he points to the phenomenon
of too strong identification with the performed role (e.g. employee, guardian), which, while
fulfilling a protective, structuring function, can also significantly limit the formation of one’s
own identity. In such a situation, the death of a loved one, a child’s marriage, or a change in
life status often precede a mental breakdown, forcing people to resign from “identifying with
the role, while there is no new identification” [10, p. 66]. One of the possible consequences
of this confrontation with changes that appear too painful and difficult to bear is melancholy.

1
According to Cruikshank [6], the category of old age considered in the public debate is extremely monolithic,
provokes prejudices, and separates part of society from the rest. Moody [7], writing about the common
phenomenon of denial of old age and passing away in public debate, shares an interesting observation that
statistically in the US there are more members of the American Academy of Anti-Aging Medicine than quali-
fied geriatric doctors. On the other hand, in Poland, Szarota [8] describes the emerging pro-senior pedagogy,
pointing to many unexplored areas of the life of older people: “the beliefs and perceptions of old people
about old people, i.e. carriers of certain beliefs and attitudes, are rarely analyzed”. Meanwhile, as Levy
notes [9], negative stereotypes about old age are formed long before reaching this developmental phase, and
after entering it, they reduce efforts to maintain the will to live (e.g. seek treatment).Therefore, taking into
account the impact of social discourse on the development of difficulties in meeting the challenges of aging
is an extremely important topic that requires a separate study.
 Self-stigma for the time of passing — an interpretative phenomenological analysis 77

Kristeva [11] refers to the phenomenon of female depression in this context – in the period
of early and middle adulthood, it is sometimes hidden behind activity, diligence and action.
These strategies can fulfil their protective function for years, until the body begins to weaken,
and when you reach retirement age, you must give up your previous job.
The difficulty of the situation of many elderly people suffering from mental disorders,
e.g. depression, was captured by Nock et al. [12], who noticed that people over 70, regard-
less of gender, almost all over the world constitute the age group most at risk of suicide,
and mental illness in this population is the strongest risk factor for taking one’s own life.
Gatz and Fiske [13] emphasize the high prevalence of self-destructive behaviours among
older women suffering from depression.
Age and illness-related concerns may be additionally reinforced by public stigma – it
includes stereotypes and prejudices (e.g. “depression is the result of laziness”) and dis-
criminatory behaviour (such as condescending treatment, attempts to limit personal rights)
[14]. One of the consequences of stigmatizing the elderly suffering from affective disorders
is the lack of success in treatment [15]. The reason may be e.g. avoiding psychological
or psychiatric help by people who potentially need it for fear of being excluded and stig-
matized by society. Recovery may be additionally hampered by pressure from relatives
who, encouraging the ill person to “pull themselves together” or “take care of something,”
increase the feeling of loneliness, misunderstanding, and hopelessness [16].
The stigma does not have to come from others but can also be directed towards oneself.
This construct was called personal stigma and, according to Brohan et al. [17], it has three
components. Perceived stigma refers to the way in which – according to the ill person –
society perceives the stigmatized group to which they belong. Experienced stigma is about
how an ill person experiences actual discrimination and exclusion from other people. Self-
stigma, on the other hand, is a stigma internalized by an ill person, expressed in a sense of
shame, guilt, inferiority, and a desire to keep the illness secret [14].
As indicated by Werner et al. [18] the personal stigma of elderly people suffering from
mental disorders is a serious and common problem, which is at the same time neglected
in the literature. The number of qualitative in-depth studies exploring the component of
the phenomenon that we are interested in – self-stigma, is particularly small. Holm et al.
[19] note that one of its serious manifestations is questioning and doubting the reality of
one’s health problems other than mental illness. Tanaka [20] notes that elderly people
suffering from depression may sometimes experience regret, guilt, and pessimism related
to it. The above-mentioned concerns include the inability to come to terms with lower
efficiency and lack of strength that would allow helping others.
Yanos et al. [21] reviewed the interventions used in the case of people affected by mental
illness manifesting self-stigma. What connects the proposed techniques is the desire to
reduce the phenomenon and, as a result of this change, improve the quality of life of the
ill person. This approach is consistent with the unequivocal recognition of self-stigma as
a maladaptive strategy resulting from the internalization of stereotypes present in society,
which should be combated or modified [22–24]. However, the literature does not ask the
78 Anna Bańbura-Nowak et al.

question of whether and what adaptive function can be present in the form of self-stigma.
Attempts to answer the question about the function of stigmatization appear only in the
context of its public displays – e.g. Kurzban and Leary [25] or Gilbert [26] assume that
prejudice against people whose behaviour differs from the norm recognized by the majority
may be a manifestation of protection against potential external threats. Existential psy-
chologists, e.g. May [27] or Opoczyńska-Morasiewicz [28] notice that creating a distance
between us (people like us) and those who are different from us, is one of the forms of
coping with the fear of what is foreign (Greek xenos). Xenophobia has a similar function;
in this case, the fear is transformed into hostility towards the other.
According to the existential thought in which our research has its origin, each symptom
of mental life is a form of being, the subjective and historical way of inhabiting the world
[29]. Thus, self-stigma – while being a part of someone’s life – can express something,
answer something, deny something. Noticing it, we may ask: why must it be so? At the
root of this question is the recognition (Er-messen) of self-stigma as a significant mani-
festation of life. It is possible that only on the basis of such recognition, which will be
not about “not noticing something abnormal in pain, suffering, or illness, but something
natural, inseparable from life” [30, p. 24], may other forms of being appear – the less pain-
ful ones. It seems certain, however, that by recognizing the value of self-stigma, we can
prevent the effects of thoughtless interventions aimed at those affected by it. We decided
to undertake the task of describing and understanding the ways of experiencing ourselves
and relationships with others in the context of suffering from depression. Our goal was to
outline the possible meanings of self-stigma.

Subjects
Six women over sixty took part in the study. They were treated at a stationary unit at
the General Psychiatric Ward at the University Hospital by two researchers (one employed
there permanently as a psychologist and therapist, the other completing an internship during
psychotherapeutic training. They were both acquainted with patients during their therapeutic
sessions, therapy, group classes and individual meetings). From among 20 seniors that were
treated during the research period, eight women were invited to be interviewed. They were
treated due to the deterioration of health accompanying an episode of depression, in the course
of mood disorders such as unipolar disorder, bipolar disorder, and organic mood disorders2.

2
The respondents share the experience of mental suffering present in deep depressive states, which was the
cause of hospitalization – although the women received different diagnoses in the area of affective disorders,
their attention is focused on this aspect of the illness – perhaps sadness, fatigue, and discouragement present
in depression are more palpable as the cause of suffering than the manic state, or the deterioration of cognitive
functioning typical of the neurodegenerative process. Moreover, it is precisely on these depressive symptoms
that the respondents focus their attention particularly strongly, also in the context of self-blame and shame
(this tendency, present during the interviews, was noticed by the authors long before the research, during the
therapeutic processes and other activities for the elderly people affected by mental disorders).
 Self-stigma for the time of passing — an interpretative phenomenological analysis 79

The interview invitation included a description of the course of the study (the informa-
tion that it would take the form of an individual interview lasting about an hour, during
which the researcher would ask for “sharing the history of life and mental breakdowns
or crises, known as mental illness”); information that the collected data will be used to
create a manuscript that will be published in a scientific journal. The invited people were
also informed about the voluntary nature of participation in the study and the possibility
of withdrawing from it at any time and assured of confidentiality (change of names to
pseudonyms, deletion of details such as city names, dates, family configurations). Two
people refused to participate in the study.
Below, we present short biographies of the respondents – it is an attempt to outline
the context in which the words spoken by our interlocutors can be heard and understood
by the reader.
Beata is 71 years old, has been retired for several years and has two adult children.
She used to be supported by her parents when she was looking after the first child. After
she gave birth to her second child, her husband began to abuse alcohol, and Beata was
diagnosed with depression for the first time. Since her husband’s death, she has been hos-
pitalized several times due to a significantly depressed mood.
Irena is 62 years old and works in a bookstore. She has grown up children and one
brother – the other brother died a few years ago. The school years were full of studying,
sports, and friendships. She began suffering from bipolar disorder more than 20 years ago,
when the nature of her husband’s work forced the spouses to separate frequently. Mental
health deteriorated again a few years ago after her husband died.
Wanda is 75 years old, she has been retired for several years. She has two sisters and
a son who is currently moving to his own home with his family. She grew up in the coun-
tryside and looked after their farm. For over 20 years, until her retirement, she worked
at school. A year after her husband’s death, Wanda was first diagnosed with depression.
Kinga is 60 years old, lives with her husband, daughter and granddaughter. Her second
daughter lives with her family. She has younger siblings, with whom she grew up in the
countryside, when her parents took care of their farm. She started suffering from depres-
sion several years ago, right after she became somatically ill.
Jadwiga is 71 years old, lives with her husband and has one daughter. She had her
first episode of depression a year ago, right after her critically ill husband was rushed to
hospital. The husband’s hospitalization was the couple’s first separation in years. Cur-
rently, her husband often visits Jadwiga in the hospital and spends time with her on leave.
Maria is 63 years old, lives with her husband, has adult daughters and is expecting
a granddaughter. For many years, she worked as a teacher. She has a close relationship
with her two sisters. She was diagnosed with bipolar disorder over 40 years ago, right after
she broke up with her then-boyfriend.
80 Anna Bańbura-Nowak et al.

Method
The study was approved by the ethics committee of the Institute of Psychology of the
Jagiellonian University and the management of the University Hospital in Krakow. The re-
spondents, after reading the instructions and signing the consent to participate in the study
and recording its course, began participating in a partially structured individual interview
lasting 45 minutes on average. The interview guide contained the following questions as
a starting point for the stories of the respondents.
1. Please share your life story;
2. Please describe the situation or the meeting during which you did not think that you
were ill;
3. Describe the situation or the meeting during which you recalled being ill.
Based on the audio recording made during the interview, transcripts were made. Three
researchers analyzed the collected data using the IPA method – interpretative phenomeno-
logical analysis [31]. This method is idiographic, i.e. it is characterized by a concentration
on individual experiences of specific people, after which one can move on to a nomothetic
description, i.e. showing common and differentiating threads present in the statements of the
respondents. Small groups of respondents are preferred, which is conducive to a thorough
and detailed analysis of the statements of specific people. Using the method based on phe-
nomenological thought made it possible to explore the experienced world (Lebenswelt) of
the respondents: not what it is, but what it appears to be in the acts of intentionally focusing
on its objects. At the same time, the second key aspect of the method, i.e. its grounding
in the hermeneutic tradition, means that the researcher makes a “translation” from what
is said to what is heard and thought – that is, from the perceptual and relational level to
the level of meaning [32].
In the beginning, we read the transcripts several times in order to get acquainted with
the entirety of the interviews and arrive at a general understanding. With time, using NVivo
[33], we started adding our own notes in the margins. Then, during subsequent readings
of the text, we created codes – in a “bottom-up” manner, directly resulting from the given
fragments of the statement. When rereading, when necessary, we assigned these generated
codes to subsequent fragments of the text. Then we grouped the created codes together,
finally formulating themes based on them showing the contexts in which self-stigma
manifests itself in the respondents. Text analysis was characterized by frequent returning
to its earlier stages and modifying the resulting constellations of codes and topics under
the influence of perceived new meanings of fragments of the respondents’ statements.

Discussion of the results

As a result of the analysis of the collected data, we identified three areas of experiencing
oneself and relationships with others in the context of struggling with depression in the
course of mood disorders: “Struggling with depression as an important aspect of identity;”
 Self-stigma for the time of passing — an interpretative phenomenological analysis 81

“Depression as one of the aspects around which thinking about the future is organized”
and “Depression as a regulator of interpersonal relations”.
1. Struggling with depression as an important aspect of identity
All respondents express anger towards themselves for not being able to fulfil life roles
in which they used to feel so well. Wanda recalls her energy and dedication to work
as a teacher, and notices an unbearable contrast with the current lack of independence.
I have worked in school for over 20 years. You had to be really agile and
resolute, you had to have eyes around your head. I was healthy. […] Now
I have a fear of leaving the house, I have various other breakdowns, it
is just difficult for me.
All respondents also emphasize the contrast between the place they occupied in the
family system in the past and the place they occupy now – three of them present ill-
ness as a factor that destroyed the idyll. Kinga is pleased to describe her part in creat-
ing a safe home, warm relationships with her relatives, and after a while adds that the
recurrence of her illness had a negative impact on the atmosphere in the family.
Everything was good for me – from cleaning to cooking, to washing, to
shopping, to everything. And today I can’t handle it anymore. I always
took the initiative. Our home has always been such an oasis of joy and
laughter. The moment I fell ill… The whole family is simply shaken
by my illness. I used to comfort others, today I need to be comforted.
It makes my daughters and grandchildren suffer because I am not able
to sacrifice myself as much as I used to when I was healthy. I don’t like
myself in this state.
Maria also describes her involvement in building loving relationships among the
household members until an episode of illness occurred.
When I am healthy, we talk nicely to each other. I say “dear husband,
Basia, never Baśka, Gosia, not Gosia.” I love my grandchildren very
much.
Barbara, going back to the period before her illness, draws attention to her social
activity, which was an important element of her identity, and to the joy derived from
contact with friends. All this disappeared when the illness appeared.
Earlier, I was going to the University of the Third Age or with a friend
for some Nordic Walking. And then I stopped going anywhere, I stopped
being in touch with my neighbours. Yes, with anyone, I didn’t even want
to go to the store, so as not to meet anyone.
Although Irena and Barbara keep thinking about returning to previously liked activi-
ties and roles with great liveliness, similarly to the rest of the respondents, they refer
to the difficulty of thinking about themselves in isolation from the fact that they are
suffering from depression. The illness, its symptoms, treatment, and consequences
82 Anna Bańbura-Nowak et al.

became the main topic of reflection. Jadwiga even talks about the physical experience
of being overwhelmed with thoughts.
Well, I just can’t get that thought out of my head. About illness and illness,
even now. It seems to me that everyone is looking at me and seeing this
illness. It’s still in my head, my head is so full. I cannot get rid of the
thought that there is an illness.
Similarly, Krystyna, when asked about situations in which she does not think about
being ill, is unable to recall such a moment.
It’s hard for me to remember the last time I didn’t think about the illness,
I keep it in mind all the time.
Irena talks about the importance of the topic of depression in her contacts with other
patients – support and encouragement accumulate around it. All respondents, except
for Maria, share similar reflections.
Here, in the ward, I talked to people who are in a similar situation. We
supported each other, we advised each other. We said that some people
are bothered by it, while others wonder why it is still there ...
It seems that in the face of the disappearance or significant limitation of the ability to
actively engage in various areas of everyday functioning, depression has become one
of the most important aspects of life with which the respondents identify themselves.
2. Depression as one of the aspects around which thinking about the future is organized
The respondents, fantasizing about the future, seem to balance between an over-
whelming fear of suffering and loneliness, and hope for recovery, sometimes equated
to full recovery (at the time of the study, only Jadwiga was preoccupied only with
pessimistic thoughts about the future).
At times, Kinga seems to expect herself to return to the same state she was in before
she fell ill – this is not surprising given that once she did return. These thoughts, how-
ever, are accompanied by the fear that it will not be possible again.
Maybe a little longer and this black hole in front of me will also move back
and I will take on my duties as I did before. I once recovered from this
illness for years, I returned to work after the first episode, because I still
worked for so many years. But I still fear the future, how will I cope, when
I get out of here. Will I jump into my duties as I did before my illness?
Similarly, Wanda looks forward to the day when she will recover and will enjoy the
same activities as before.
Then I think that someday I will also feel better, that I will be able to sit
at home and do the chores. And I have a lot of them, cooking, cleaning,
shopping.
 Self-stigma for the time of passing — an interpretative phenomenological analysis 83

However, these thoughts about the future that awaits Wanda after the end of treatment
in the hospital are also accompanied by fear of what is independent of the illness – the
lack of the daily presence of loved ones.
I wonder how I will handle it when I get home. Because they have built
homes for themselves up, they will move out, and I will be left alone. My
son will be visiting me, because he lives very near, 5 minutes from my
home. But he works, so he’ll be at his home every day.
Maria remembers the times when she had the strength and motivation to help others
and fantasizes that this strength will come back to her.
I am used to working. I was very ambitious, I worked with seriously
ill children. I worked a lot, I was so active. Now I have a very severe
depression, and I would like to be healthy and help others.
However, she also mentions sadness that seems to be naturally associated with loneli-
ness.
My daughter has built a beautiful house for herself, I will have to drive
up to her, and it is on such a big hill. And I can’t go uphill. When they
leave, I feel so sad, empty.
Beata remembers the times when, despite recurring mental crises, she managed to
cope.
I was constantly on the move, I was constantly working, taking my
medications and always on the move until retirement. Yes, it is possible that
if I was healthy and I worked, I would feel differently, because there would
be always something going on. I need some activities to keep myself busy.
The respondents sometimes also arrive at the idea of ​​accepting that the future may be
heterogeneous and have various shades. Irena hopes to return home, but takes into ac-
count the possibility that the period after leaving the hospital will require a lot of effort.
Now it’s going to be such a difficult time as I’m going home, but I’ll
face it. I am alone, my husband is gone, so I have to take care of the
apartment myself.
Kinga ends the conversation with a reflection on how to look at oneself softer.
Maybe you just have to accept the illness, if there is no way to eliminate
it, and learn to live with it – compromise. Everything had to be perfect,
everything. Apparently my psyche did not withstand this rigour anymore
and I just broke down. It is easier to let go of what I cannot do.
3. Depression as a regulator of interpersonal relations
Although the respondents blame themselves for the negative impact of the illness on
the well-being of the family, identification with depression seems to create a space
84 Anna Bańbura-Nowak et al.

for all the women to notice the care shown by their relatives. Wanda happily gives
examples of their interest in her well-being.
My granddaughter visited me. It was very nice, she surprised me. In
general, when they call, they are cordially interested, they ask “are you
better?”, “How often do you feel better there?”
In Beata’s case, deterioration caused by depression was an incentive to stay with her
family for several weeks.
I was so depressed, I slept during Christmas almost all the time. In the
afternoon, I got up, my daughter took me home, my son arrived with
my grandchildren and that’s how we spent Christmas. And she said she
wouldn’t let me out of the house until I was able to get up and take the
bus by myself.
For most of the respondents experiencing depression became (only Maria does not
mention this) also a platform for contact with peers. Beata thinks that the presence of
other patients is a reason for a significant improvement in her well-being.
Everything helps me here – the surroundings, I wake up and I’m not alone.
I will speak to this lady, to this one. I read books, newspapers, and go for
walks. Everything has changed for me in the hospital. I am not alone.

Conclusions
Integrating one’s identity in the face of all the changes that take place during aging is
a serious challenge for the elderly [34]. As Śleszyński notes [10], this integration may be
particularly threatened in a situation where it is no longer possible to fulfil the social role
with which a given person has identified so far. It seems that our interlocutors were in such
a difficult position. The analysis of their experiences allowed us to distinguish three areas
of their concerns. The first area, “Struggling with depression as an important aspect of
identity,” shows the growing void that appeared once they have lost the roles and activities
performed so far. Depression and its treatment, in turn, are at the centre of all thoughts and
actions. The women report that they are completely absorbed in this topic, it seems that
they even identify with the illness. Perhaps it is so in response to the loss of the ability to
fulfil one’s marital, parental and professional roles. From such a point of view, identifica-
tion with the illness would paradoxically protect against disintegration, disappearance in
the face of irreversible changes.
What draws attention is the idealization of their past by the surveyed women. According
to many of them, being ill has disturbed the harmonious course of life. Our interlocutors
contrast their current unsatisfactory condition with the numerous advantages or skills
which, in their opinion, characterized them in the past and would still have characterized
them if it were not for the illness. The past – although in the case of some women marked
 Self-stigma for the time of passing — an interpretative phenomenological analysis 85

by first episodes of depression – appears in the memories as a period in which one had the
strength to face everything. Such idealization may, according to Varchevker [35], protect
against getting too close to the painful aspects of reality that are hard to come to terms
with – its changeability and transience. Perhaps it is so in the case of our interlocutors.
As can be seen in the second area, “Depression as one of the aspects around which
thinking about the future is organized,” the respondents sometimes carefully develop in
their minds a vision of returning to independent everyday functioning, in which good and
bad moments can be expected. Other times, the future fills them with fear and uncertainty,
and illness appears as the main cause of unfavourable changes. It is then that fantasies
arise that if you manage to recover, it will be possible to return to the ways things were
before falling ill. Such a subconscious way of thinking could allow maintaining the vision
of oneself unchanged by the consequences of the passing time – resilience and resource-
fulness are separated from the current state only by the diagnostic limit. Of course, this
has many consequences. On the one hand, immersion in thinking about the illness may,
paradoxically, bring relief – there is a cure for it, which brings hope for the reversibility
of the course of events and a return to youth. If the past has not offered sufficiently strong
support and stability that could be internalized in a symbolic form [11], there may be
a desire to come back to it literally in reality – to be young again. Unfortunately, while
using the imagination to reach the previous stages of life may provide relief and constitute
a support for development, it may also be used to withdraw and block the possibility of
reaching the next stage of development [35, 36]. The denial of transience and the related
denial of losses and unfulfilled intentions can lead to avoiding life or even feeling sorry for
it. Self-stigma, protecting against confrontation with a passing reality, can paradoxically
be understood as a form of taking one’s own life.
The third area outlined on the basis of the analysis of the statements of our interlocu-
tors “Depression as a regulator of interpersonal relations” refers to interpersonal relations
in the context of suffering from depression. The company of others makes everyday life
not only bearable, but sometimes even pleasant, bringing both joy and reflection on wor-
ries. Self-stigma can be understood here as a kind of cry – the illness becomes the axis
around which contact with loved ones begins to accumulate. Focusing attention on the
illness, which is common and affects people of all ages (which is sometimes unnoticed by
the younger ones, who avoid facing the reality that is beyond their control) gives hope to
get the attention of others. And it happens so – the family provides support, is interested
in changes in mood, does not abandon. Paradoxically, the loneliness imposed by old age,
visible in the area of “​“Depression as one of the aspects around which thinking about the
future is organized” becomes a less acute problem at such times. This inverse relationship
also becomes apparent in the context of hospitalization. The stories told by most of the
respondents reveal the healing role of contact with other patients. The peer group gives
the opportunity to reveal difficult experiences related to losing vitality. Worries, fears, and
anxieties specific to a given period of life may be shared with others who are also at this
stage of life [37].
86 Anna Bańbura-Nowak et al.

Recommendations for practice

The willingness and readiness of older people to share stories about their lives, visible
in the area of “​“Depression as a regulator of interpersonal relations,” has already been
observed by many researchers (e.g. Bańbura and Opoczyńsa-Morasiewicz; Draaisma;
Merrill and Fivush; Tokarska) [38–41]. When designing interventions against self-stigma,
it is worth taking advantage of this natural path to introspection and expression. Tokarska
points out the great importance of creating a space for older people to remember the past
and reflect on their own experiences [41]. Narrating your life in the presence of atten-
tive listeners can bring you relief and joy, and ultimately open you to contact with what
was difficult, painful and so far not regretted in the past. Perhaps on this basis will arise
readiness to see what Frankl [42] describes as “deeds done, loves lived, and finally suf-
fering that [one] has endured with courage and dignity [...] used opportunities, fulfilled
meanings, realized values” [42, pp. 147-148]. As a result of such a view of the past, there
may also be a space for fantasizing about the future with greater flexibility and openness
to various perspectives – this gives hope for future life that can be infused with meaning
and significance [41].
Attempts at presenting one’s life as a narrative may also help to strengthen one’s sense
of identity, which, as Dyga and Opoczyńska-Morasiewicz [43] recall, is “a process, not
an achieved state” [43, p. 19]. Connecting one’s past experiences and integrating them
with current experiences and ideas about the future may strengthen the feeling that despite
changes, losses, recurring episodes of illness, “you remain yourself” – as Quinodoz [34,
p. 45] put it – “despite not being the same person all the time.”
The results presented in the area of “​“Depression as a regulator of interpersonal rela-
tions” suggest that for some people, group meetings may be particularly valuable. For
others, however, thinking about social interactions may cause fear of rejection or the loss
of important aspects of their own identity [44]. The fear of not being seen, recognized, and
appreciated can dominate the desire to share life stories with others. In such a situation,
individual contact with a psychologist, therapist or physician who is listening to the stories
about the past, present, and future life may be sufficient.
Experts face the challenge of refraining from imposing what “should” replace strate-
gies such as self-stigma. As Yalom and Leszcz [45] propose, in the face of the inevitable
a therapist may just be there – that is, accept the gift of speech from another person. Instead
of trying to turn self-stigma into affirmative thoughts, he may recognize the desires and
hopes behind the former. This recognition should go hand in hand with supporting efforts
to integrate all instances of ourselves.

Limitations and indication of areas for further reflection

Further exploration of the issue we have studied may be of great importance for creating
adequate forms of assistance. It is worth broadening the understanding of the phenomenon
 Self-stigma for the time of passing — an interpretative phenomenological analysis 87

of self-stigma accompanying elderly people affected by mental disorders, what strengthens

it, what weakens it, and above all what its significance is. When designing further stud-
ies, it is certainly worth considering the following reflections on the limitations of our
research to date.
The course of the study could have been influenced by the large age difference between
the respondents and the researchers. Talking about illness, loss and old age may have been
a bit more difficult in the company of young women who were not patients. One should
not exclude the role of feelings such as shame, which could hinder the process of freely
speaking. At the same time, the age difference may appear as an advantage and hope for
the surveyed women – that the younger generation is interested in their voice, that order
has been “restored” when a young woman listens to the older woman to learn something
herself. Moreover, the interviewed women were patients of both the therapeutic group
and occupational therapy conducted by two researchers. Such a situation seemed to have
a calming effect on the respondents: they talked to people they knew, whom they could
trust – our experience and observations of numerous studies at the University Hospital
indicate that patients prefer to talk to people they know.
The above-mentioned relationship of the two authors and professional experience in
psychoeducational and psychotherapeutic work, grounded in psychoanalytic and exis-
tential thought, certainly influenced the analysis of the obtained data and the formulation
of conclusions and recommendations based on it. However, the very basis of the chosen
method of analysis is the assumption that the statements of the respondents are translated
by researchers into the written word, and then paraphrased in interpretation. This specific
interpretation is an attempt to reflect on, to make sense of, so it does not have the status
of a conclusion “it is so”, but rather: “it may be so” in the light of the premises which
include not only the data provided in the study, but also the knowledge that the researcher
conducting the study cannot forget.

Summary
The self-stigma manifested by the examined women seems to have many meanings.
It protects them against confrontation with transience, gives hope for the future, and brings
them closer to other people. It fills the void that grows bigger with age. So, in our opinion,
it is not only behaviour that is hard to bear, but also a message that is directed at those who
experience its consequences. Recognition of self-stigma as a significant form of behaviour
may favour careful communication with the affected seniors. Seen from this perspective,
they appear as people trying to maintain integrity in the face of the challenges posed by
passing away. Recognizing self-stigma as a significant and, consequently, a valuable form
of adaptation creates the ground for finding less costly ways of experiencing the inevitable.
88 Anna Bańbura-Nowak et al.

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