The self-concept is predicated on taken-for-granted ways of thinking, feeling, and acting that become defining characteristics of an individual and distinguish him or her from other people. Chronic illness disrupts these taken-for-granted notions about self, as well as daily habits that support this self. Yet not all people define the disruption that they experience as serious illness with lasting consequences. Their habitual ways of defining self do not permit them to accept altered images of self—even those given in experience. Thus they avoid viewing themselves as chronically ill and resist reconstructing an altered self around illness until they exhaust other plausible explanations and learn over and over in their daily lives that they have changed. The implications for occupational therapists are that patients may either view treatment as irrelevant for their future selves or see the self-images reflected in treatment activities as at odds with their habitualized self-concepts. The article draws on narratives from a qualitative interview study of 140 people with serious chronic illnesses.
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