The Shattered Self

With Dr. Kerstin Fugl-Meyer
  • Lena Nilsson Schönnesson
  • Michael W. Ross
Part of the AIDS Prevention and Mental Health book series (APMH)


As important as it is to recognize and appreciate the adaptation processes within the HIV disease scenario, it is as vital to acknowledge the internal psychological world through which these processes are mediated and can be understood. The internal psychological world refers here to the self, encompassing the individual’s self-image and self-esteem. It constitutes the third component of the individual psychological landscape. The sense of self (or self-cohesion) provides the individual with a sense of stability. At first glance, these concepts may appear far away from HIV realities. However, we agree with Abramowitz and Cohen1 that self psychology offers a useful psychodynamic bridge between the physical, social, and sexual consequences and the intrapsychic effects of HIV. The qualitative analysis of the psychotherapeutic notes of the 38 Swedish gay men supported this perspective in that we found a very large proportion of the psychotherapeutic work focused on the self. Further, just as HIV-related threats and psychological issues have to be processed and adapted to (Chapter 8), the men also struggled with processing and restoring their more or less shattered self. The latter is partly the result of the psychological impact of HIV on the individual’s self. We would suggest that the HIV-disease adaptation processes interplay with the self adaptation processes and that they are both embedded in the existential context of death, freedom, isolation, and meaning.


Adaptation Process Therapeutic Relationship Death Anxiety Disease Phase Love Relationship 
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Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Lena Nilsson Schönnesson
    • 1
  • Michael W. Ross
    • 2
  1. 1.Department of Social WorkUniversity of GothenburgGothenburgSweden
  2. 2.WHO Center for Health Promotion Research and Development School of Public HealthUniversity of Texas, Houston Health Science CenterHoustonUSA

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