I’m often moved by the stories my readers share with me here. Most of them start with dramatic cardiac crises, with survival, with the sudden shock of learning what it means to become a “patient”, with the skilled cardiologists who saved them or the ones who misdiagnosed them. Others share personal hardships they’ve been enduring long before their first cardiac event ever occurred. At age 10, for example, Marie sat in her bathtub one day and counted 33 bruises on her small body, all caused by vicious beatings with a wire coat hanger at the hands of both her mother and sister.* In a family defined by alcoholism, violence and drug abuse, her siblings also suffered terribly. Two of her brothers became heroin addicts and died within months of each other.
Yet what truly struck me about Marie is that she tells her story without blame or resentment or self-pity. She points instead to what has helped her avoid her siblings’ fate. What Marie is quietly demonstrating is how she decided to create her own narrative identity. . .
Narrative identity, as explained by Northwestern University professor of psychology Dr. Dan McAdams, is basically the story of who we are and where we’re going. As he told a Nautilus interviewer:
“It’s a story you’ve got about how you came to be, who you are, and where your life’s going. Narrative identity is just as much about how you imagine the future even though it hasn’t happened yet as it is about how you reconstruct the past.”
In Marie’s case, she could clearly recall both the horrors of an abusive childhood and also the powerful factors that changed the trajectory of her own life, e.g. her faith, her childhood vow to never touch drugs or alcohol, an influential high school teacher, finding a sense of purpose in helping others.
It turns out that as we get older (particularly after age 50), our life stories tend to become more positive, and sometimes a little simpler, too, says Dr. McAdams. It’s called the positivity bias in aging.
That statement made me wonder, as a person well past 50, how we will one day look back on the COVID-19 crisis and describe our experience during the pandemic. We’re still in the thick of it, of course (despite the dangerous pronouncements of ignorant politicians and their conspiracy-theorist supporters), but will we one day look back on this time and describe it differently than we do right now, or will it depend on whether we are the patients or the front-line healthcare professionals or the journalists writing about it?
Researcher Dr. Laura Carstensen at Stanford explains positivity bias as the realization that we don’t have a lot of time left in life. As we get older, and the end is approaching, it’s as if we start saying: “What good is it going to do me to obsess over all the negatives? Maybe it’s better for me to focus on the positive.”
Easing up on the precise recall of every hurt, every insult, every failing doesn’t mean those things didn’t happen or didn’t matter, as Dr. McAdams reminds us:
“You live your life and you collect material as you’re going along for your life’s story. You’ve always got this material, but you could also reshape it. You can rewrite it. I think we’ve evolved not to have perfect memory, but to have strategic memory, memory that helps us accomplish our goals.”
And we all grow up within unique cultures, he adds, where we learn how to tell stories, and what makes a convincing story.
Our own cultural influences have been a focus of researchers for decades, specifically on how those stories can unfold in a way that mirrors what we heard while listening to our families describe their own history of getting through the hardest times.
In other words, how did our own families look back on economic hardships, or medical crises, or the unfairness of life? Did they blame the banks, the doctors, and the “system”? Or did they demonstrate a less dramatic and mellowed positivity bias as they grew older?
Researchers Drs. Marshall Duke and Robyn Fivush at Emory University suggest that rolling with the punches may indeed be a learned skill from childhood. They summarize three general forms of family story-telling(1):
- Ascending family narrative (“Things always got better for us.”)
- Descending family narrative (“Things always got worse for us.”)
- Oscillating family narrative (“We’ve been up. We’ve been down. We’ve had terrible, painful times but we got through them. We’ve also enjoyed the best of times, but when they didn’t last, we survived no matter what.”)
And as I wrote in my book (A Woman’s Guide to Living with Heart Disease, Johns Hopkins University Press, 2017):
“In my experience with heart disease, I learned to cope with crisis by coping. I learned to adapt to crisis by adapting. I learned to roll with the punches because, like so many of us, I’ve practiced rolling with so many figurative punches during my life.
“It’s not because I needed the crisis to become a better person, not because the diagnosis itself was some kind of a gift, and certainly not because I needed to add meaning to a meaningless existence, but because human beings have a remarkable ability to get used to almost anything in life (both positive and negative).”
As Marie told me after I’d published her essay here, she had been raised to believe she deserved to be last on any priority list. But as she grew up and was diagnosed with coronary microvascular disease (a diagnosis I share with her, by the way), she decided this:
“If childhood trauma set me on this course, I can at least now try to get on a better track in terms of caring for myself, body, mind, and soul. It actually gives me more impetus to give myself permission to treat myself with more kindness.”
* Marie is not her real name, by request.
1. Duke, M.P., Lazarus, A., & Fivush, R. Knowledge of family history as a clinically useful index of psychological well-being and prognosis: A brief report. Psychotherapy Theory, Research, Practice, Training, 45, 268-272. 2008.
Image of pink flowers: Vinson Tan, Pixabay
Q: How has your own narrative identity changed as you get older?
– Read the rest of Marie’s essay in “Dear Carolyn: People Can Change for the Better”
– Oh, great. Another cardiac risk factor to worry about… my original blog post on how Adverse Childhood Experiences (ACE) are often linked to future health issues, the post that inspired Marie’ to share her story here
– More about ACE – take the ACE test, and learn more about how to help prevent the poor outcomes associated with ACE
– When an illness narrative isn’t just about illness (the preface of my book, citing physician and author Dr. Suzanne Koven’s CBC Radio interview with Michael Enright about writing “sick lit”)
– Almost anything written by Dr. Jonathon Tomlinson, a GP in East London who writes eloquently about ACE issues and social determinants of health in his highly recommended blog.
– Dr. Victor Montori works on a unique concept focused on reducing a patient’s “burden of treatment”, which he and his Mayo Clinic-based team call “Minimally Disruptive Medicine”. His wonderful little red book Why We Revolt calls on his medical colleagues to provide care that is careful and kind. .