Self, Identity, Stress, and Mental Health

It is virtually impossible to develop a theory of the etiology of mental illness without thinking about self and identity issues. Almost all approaches in psychiatry and clinical psychology (with the exception of behaviorism) view individuals’ mental health as at least partly influenced by positive self-conceptions, high self-esteem, and/or the possession of valued social identities. Conversely, psychological disorder has been attributed to unconscious conflicts within the ego (Freud, 1933), arrested or inadequate identity development (e.g., Erikson, 1963; Freud, 1933), threats to self-conception or self-esteem (e.g., Abramson, Metalsky, & Alloy, 1989), and identity loss (Breakwell, 1986; Brown & Harris, 1978; Thoits, 1986), among many related processes. Indeed, some theorists and researchers see injuries to identity or self-worth not only as precursors but as keymarkers of mental disorder (e.g., Beck, 1967; Abramson et al., 1989).1 This can be seen in the criteria for various mental disorders in the fourth edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). For example, “low self-esteem,” “feelings of worthlessness,” and/or “unstable self-image” are key criteria in the identification of major depression, bipolar disorder, dysthymia (chronic depressed mood), and borderline and avoidant personality disorders.2