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Narratives Of Cancer Survivorship: Insights On Self And Identity

Introduction

By 2040, the U.S. is expected to have 26 million cancer survivors (Tonorezos et al., 2024), while
in India, cancer accounts for 9% of total deaths, with NCDs causing 63% of fatalities (World
Health Organisation & Institute for Health Metrics and Evaluation, 2018). An estimated 2.5
million Indians live with cancer, with over 700,000 new cases and 556,400 deaths annually
(Ministry of Health and Family Welfare, 2014). Globally, advancements in early detection and
treatment have increased survival rates, with 66% of adults surviving at least five years
post-diagnosis (Aziz, 2007). In the U.S., five-year survival cases are projected to rise by 53%
from 2022 to 2040, reaching 19.2 million (Tonorezos et al., 2024). As aging populations grow
and medical innovations continue, the need for comprehensive survivorship care intensifies. By
2040, most cancer survivors will be in their 60s, 70s, or 80s, underscoring the vital role of
healthcare providers in long-term survivorship management (Shapiro, 2018).

A cancer diagnosis is a life-altering event that profoundly impacts self-perception and

social interactions. Historically feared and stigmatised (Clarke & Everest, 2006; Miles et al.,
2008; Muzzin et al., 1994; Else-Quest et al., 2009), public perceptions have evolved with
advancements in detection and treatment. However, cancer and its treatment continue to alter
identity, relationships and mental well-being. Long-term psychosocial effects include fatigue,
frailty, cognitive impairment, chemotherapy-induced peripheral neuropathy, ovarian failure or
infertility, psychological distress, cardiotoxicity and the risk of second cancers (Lustberg et al.,
2023; Ness & Wogksch, 2020). Psychological adaptation difficulties often stem from fear of
recurrence, which is linked to major traumatic outcomes. Cancer’s psychological burden is
shaped by its unpredictability, chronic nature and internal threat. Each phase of treatment acts as
a turning point, influencing psychological challenges (Martino et al., 2023). Distress,
encompassing anxiety and depression, is common during treatment and can persist as a
long-term or late effect (Stein et al., 2008). However, Bellizzi & Blank (2007) suggested that
young women may experience personal growth, transforming adversity into strength and
redefining life priorities.
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A cancer diagnosis disrupts an individual’s perception of the future, making hope and a
positive outlook essential for recovery (Landmark et al., 2002). For young patients, resuming
daily life fosters optimism, and many eventually report finding benefits in their experience
(Bellizzi et al., 2012; Yi et al., 2015). However, survivorship presents challenges, including the
withdrawal of initial support, ambivalence about ending treatment, coping with permanent
disabilities, and realising lost opportunities. Survivors may struggle with anger over their
treatment and feelings of depression despite recovery (Muzzin et al., 1994). Adjustment is
particularly difficult for those with physically debilitating cancers, such as head and neck, colon
or lung cancer, often leading to poor coping outcomes. Clinical distress peaks one to two years
post-treatment, with survivors facing stigma, depression, and financial concerns, sometimes
persisting for decades (Grinyer, 2007; Vassal et al., 2014). Despite these challenges, some
individuals experience post-traumatic growth (PTG), a process of personal and existential
transformation following highly stressful events (Zoellner & Maercker, 2006). Rather than
merely returning to pre-trauma functioning, survivors develop new perspectives, emotional
resilience, and personal growth (Tedeschi et al., 2018, as cited in Fioretti et al., 2020).

Psychological health in cancer survivors is shaped by a balance between stressors and

available coping resources, which can be intrapersonal, interpersonal, informational, or tangible
(Andrykowski et al., 2008). The psychological impact of a cancer diagnosis is not uniform but
influenced by personal experiences and social interactions (Bellizzi & Blank, 2007).
Intrapersonal resources, such as optimism (Carver et al., 2005), self-efficacy (Manne et al.,
2006), emotional intelligence (Schmidt & Andrykowski, 2004) and spirituality (Krupski et al.,
2006), enhance resilience and aid in psychological adjustment, whereas their absence may lead
to poorer coping. Interpersonal resources, particularly social support, foster emotional and
cognitive processing, helping survivors navigate their experiences more effectively (Helgeson &
Cohen, 1999). However, cancer-related stressors can disrupt previous roles and responsibilities,
affecting well-being and self-identity (Park et al., 2009). Over time, individuals may redefine
their identities, either by reconstructing pre-existing roles—such as career and family
responsibilities—or by adopting illness-related identities as they navigate survivorship (Deimling
et al., 2007). At the same time, social constraints, such as discouraging discussions about cancer,
can inhibit emotional processing and contribute to psychological distress (Schmidt &
Andrykowski, 2004). Informational resources also play a crucial role, as access to accurate
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knowledge about disease, treatment, and prognosis empowers survivors, with greater education
often linked to better psychological outcomes (Parker et al., 2003). However, individual
preferences regarding information-seeking vary, and excessive information can sometimes
heighten distress. Tangible resources, including access to medical and psychological support,
further shape survivorship experiences. The availability of therapists, social workers, support
groups, and survivorship clinics varies widely, influencing psychological health (Hollen &
Hobbie, 1995). Ultimately, a survivor’s psychological trajectory depends on how these resources
counterbalance the burdens of the cancer experience, with stronger support systems fostering
resilience and improved mental well-being (Andrykowski et al., 2008).

Cancer Survivorship

Cancer survivorship as distinct terminology was first proposed by Mullan in 1985, who himself
dealt with cancer. Mullan proposed that the label “survival” can be used for those diagnosed with
and treated for cancer, who are either ‘cured’ or ‘living with overt or covert disease’. Even
though the life courses for the cured and not cured vary, they have more in common which
separates them from the rest of the population. Mullan argued for studying survivorship as a
separate phenomenon with different phases; this scholarship would aid in understanding,
addressing, managing, and reducing the various difficulties faced by individuals diagnosed with
cancer (Feuerstein, 2017).
Mullan also proposed the 3 stages of survival: acute, extended, and permanent. The acute
stage involves the initial diagnosis and treatment and issues related to the treatment and its side
effects; the extended phase starts with termination of initial treatment and/ or remission of
cancer; this phase is accompanied by vigilance, anticipation, and regular check-ups. The last
phase is permanent survival, it develops from prolonged disease-free period where the chances of
recurrence is low (Aziz, 2007). Aziz (2002), further elaborates on the need to study late and long
term cancer effects, which are caused by the primary treatment and affect survivor’s health and
well being. Late effects refer to unrecognised toxicities which are absent during the acute stage,
these can occur months to years after primary treatment. On the other hand, long term effects
include peripheral neuropathy, pains, fatigue, cognitive problems and depression among others,
these are chronic problems resulting from side effects of the disease or its treatment. All the
problems faced by cancer survivors can't be listed down as there may be unique challenges they
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may face due to different life circumstances. The problems faced by cancer survivors are
multifaceted (they may include medical, financial, psychological, physical problems) and
dynamic in nature (Feuerstein, 2017).
​ Shapiro (2018), lists chronic pain, infertility, fatigue, insomnia, sexual dysfunction, bone
loss, cognitive dysfunction and heart failure among others as longs of cancer treatment. Late
effects of cancer treatment include osteoporotic fractures, uterine cancer, other types of cancer
including leukemia, lung, thyroid and skin. Cancer survivors are at high risk to develop
depression, anxiety, post traumatic stress disorder (PTSD), fear of recurrence, and challenges
regarding returning back to work. Many survivors also experience distress, ranging from
adjustment disorders to diagnosable mental illnesses like major depressive disorder.
Andrykowski (2008) posits that psychological health of cancer survivors can be viewed in terms
of presence or absence of distress along with different positive responses which can be termed as
post-traumatic growth (PTG). PTG may involve responses like elevated self esteem, more
appreciation for life, enhanced spirituality and feelings of peacefulness and purposefulness.
Distress and PGT are not mutually exclusive, and can be experienced parallelly by cancer
survivors. Corner (2008) points out how the stigma related to cancer can lead to social isolation,
discrimination at workplace and medical insurance along with loss of friends.
​ There has been ample research done on cancer survivorship and their narratives in the
western context but there is lack of research in the Indian context. According to Aziz (2007)
scholarship on cancer survivorship should move past the treatment lens and focus on a more
holistic approach, starting with identifying and preventing adverse effects of cancer; managing,
treating and preventing co-mobities; designing optimal care post treatment; focus on disparities
in different marginalised populations and lastly focus on the dynamic relationship between
cancer survivorship and the family’s experience. Research into cancer survivorship should also
approach it from a multi-disciplinary approach. Benish-Weisman et.al., (2014), studied narrative
characteristics in cancer survivors using a narrative framework and identified a positive
relationship between psychological health and number of redemption episodes. Mohlin and
Bernhardsson (2021), used an thematic, literary analysis from an hermeneutic, interpretative
paradigm to study the narratives of survivorships in breast cancer pathographies. A systematic
review by Jarrett et.al. (2013) found most cancer survivorship research which exits focus
disproportionately on women with breast cancer. Further most research usually ignores the long
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term implications of survivorship. Targeted research using a longitudinal framework is absent

from the scholarship on cancer survivorship.
Cancer can be a very debilitating disease, it can be viewed more as a journey rather than a
disease which can be merely treated. The journey never ends, even when in remission survivors
have to go for regular check ups and scans to check for recurrence. Unlike other physical
illnesses this stays with the individual till the end (Harley et.al., 2012). Hence understanding the
lived experiences of cancer survivors becomes an important area of study. Future interventions
should be guided by these lived experiences, however heterogeneous. The effects on an
individual’s life are ever present, physically, mentally, emotionally and socially (Shapiro, 2018).
These narratives and experiences of cancer survivors can further aid in improving healthcare
spaces and resources available to them. ​

Narratives of Illness: Pathographies of Cancer

The study of illness narratives holds important significance in psychological research. According
to Murray (2008), narrative psychology suggests that human beings are natural storytellers who
use stories to make sense of their experiences which includes their journeys through illness.
Illness narratives help individuals construct meaning and establish a coherent identity in the face
of disease-related disruptions (Murray, 2008). Illness can cause an identity crisis by disrupting an
individual’s sense of self and continuity. Rimmon-Kenan’s (2002) narrative shows how a
neurological illness led to a rupture in her professional and personal identity, a theme that is quite
common in illness narratives. Such narratives are vital in psychology as they offer insights into
how individuals cope with and reframe their experiences which impacts their psychological
well-being.

Bury (2001) explored the sociological and psychological dimensions of illness narratives,
and categorised them into contingent narratives (focuses on the onset and impact of illness),
moral narratives (addresses changes in identity and social role), and core narratives (connects
individual experiences with broader cultural meanings). These frameworks help researchers
understand how individuals articulate their suffering, resilience, and transformation in the wake
of illness. These narratives become a means of restoring coherence to disrupted lives. They allow
individuals to integrate their illness into their life story rather than seeing it as an isolated,
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meaningless event. This is important for those dealing with chronic or life-threatening conditions
where maintaining a stable sense of identity becomes challenging.

The biomedical model of illness focuses primarily on physiological processes, thus

neglecting the lived experiences of patients. Marini (2016) states that narrative psychology offers
an alternative approach that integrates patients’ personal stories into healthcare and emphasizes
the emotional and existential dimensions of illness​. Marini draws upon the work of Charon
(1993) who argued that medical interpretation should incorporate literary theory to enhance
clinical work​. According to Frank (1995) illness narratives shape an individual’s sense of self​.
Narrative medicine, as described by Greenhalgh (1999), bridges the gap between evidence-based
medical practices and the subjective experiences of patients​. By listening to patient stories,
healthcare professionals gain a holistic understanding of illness which improves patient-centered
care. Narrative psychology acknowledges that illness affects an individual’s identity,
relationships, and overall life trajectory, unlike the biomedical model, which treats diseases as
isolated physiological malfunctions​.

Narrative medicine provides a more patient-centered approach to care by encouraging

physicians to consider the unique ways individuals experience and make meaning of their
illnesses. This perspective is supported by Kleinman et al. (1978) who emphasized the cultural
aspects of illness and patient care​. It also aligns with the work of Groopman (1998) who
highlighted the importance of subjective experiences in medical practice​. This approach helps
address the emotional distress and uncertainty that often accompany diseases like cancer.
Patients who feel heard and understood tend to experience improved psychological well-being
which can positively impact their treatment outcomes. Narrative medicine recognises the social
and cultural dimensions of illness. This idea was supported by Good (1994) who argued that
Western medicine often neglects patients’ cultural beliefs​. Many patients’ experiences are shaped
by societal expectations, stigma, and personal beliefs about health and disease. By
acknowledging these influences, narrative psychology moves beyond the reductionist focus of
biomedicine and provides a more comprehensive framework for understanding and treating
illness​(Marini, 2016).
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Pathographies are autobiographical or biographical narratives that document an

individual's experience with illness and treatment. These narratives are a medium for patients to
articulate their struggles, emotions, and perspectives. Hawkins (1999) describes pathographies as
powerful tools that place the ill person at the center of their medical experience and restores the
experiential dimension of illness which is often overlooked in clinical settings. These narratives
not only help patients process their experiences but also inform healthcare professionals about
patient expectations, fears, and coping mechanisms.

Pathographies have been instrumental in understanding survivorship and rehabilitation in

cancer research. Mohlin and Bernhardsson’s (2021) study on breast cancer pathographies shows
how personal narratives reveal the long-term psychological and social challenges faced by
survivors. They argue that these narratives complement medical knowledge by providing an
individualised understanding of cancer survivorship. McKay and Bonner (1999) examined how
breast cancer pathographies are presented in Australian women’s magazines. Their study found
that while these magazines provide an important source of health information, they often
sensationalise personal illness narratives. Celebrity cancer pathographies tend to be framed as
stories of triumph, whereas ordinary women's stories are more likely to emphasise emotional
struggles and suffering. They also noted that these narratives tend to overemphasise certain risk
factors which may influence public perception of breast cancer.

The Present Study

Psycho-oncology has emerged as a crucial interdisciplinary field, driven by developments such

as the destigmatization of cancer and mental illness, evolving patient-provider relationships, and
a growing emphasis on quality of life alongside survival (Lang-Rollin & Berberich, 2018). As
medical advancements have increased cancer survival rates, research has begun to explore the
psychosocial and existential dimensions of survivorship. Cancer not only affects the body but
also profoundly disrupts an individual’s sense of self, lived time, and life trajectory, often leading
to existential distress and a search for meaning. While these aspects are gaining attention, there
remains a significant gap in research exploring how cancer survivors make sense of their
experiences and reconstruct their identities through personal narratives. Survivorship is not
merely a biological state but a deeply psychological and social journey that demands closer
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examination. Serious illnesses like cancer challenge an individual's premorbid sense of

coherence, altering their worldview and self-perception (Crossley, 2002).

This study addresses this gap by shifting the focus from clinical outcomes to survivor
narratives, exploring how individuals integrate their illness into their life stories and redefine
their identities post-diagnosis. By examining personal narratives, this research aims to deepen
our understanding of the physical, emotional, and social dimensions of survivorship.

Research Question

To explore the experiences of cancer diagnosis, treatment and recovery in a person in

remission through a narrative inquiry.

Reflexivity

When this topic first came up during our lab class discussion, I was immediately
intrigued. It was an unfamiliar area, and I had no clear idea how it would take shape. What
interested me most was the concept of the lived experiences of survivors, and one reason I agreed
to this topic was knowing a few cancer survivors who might be willing to participate. However,
as we refined the research and engaged in literature review, I became more passionate about it.
Reading about survivors’ experiences was deeply moving, and I realized how well narrative
analysis suited this subject. The idea that participants' lived experiences would take centre stage
was something I looked forward to, as it allowed for a deeper, more personal understanding of
survivorship. Exploring an unfamiliar area, engaging with the emotional depth of these
narratives, and my personal connection to some survivors made this study both meaningful and
engaging for me. It also challenged me to reflect on my own understanding of the word survivor,
while ensuring that the narratives remain true to the voices and experiences of the participants.

Method
Narratives and Their Significance in Psychology

Narratives play an important role in psychology because they provide individuals with a means
to organise, interpret, and make sense of their experiences. It is through storytelling that people
construct their identities, process emotions, and communicate their lived realities. Narrative
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psychology has gained prominence as a qualitative approach that places significance on personal
stories in understanding human behaviour and social interaction. As Ricoeur (1984) notes,
storytelling provides a way to structure experiences through “emplotment,” which helps
individuals impose coherence on otherwise chaotic events​. A narrative is more akin to a
significant segment of one’s life rather than a simple recounting of an event. As Mishler (1986)
explains, “The story has a beginning, middle, and an ending. The story is held together by
recognizable patterns of events called plots. Central to the plot structure are human predicaments
and attempted resolutions.”
Bruner (1990) suggests that narratives are crucial in moments of dissonance such as
illness, bereavement, or identity crises when individuals seek to bridge the gap between
expectation and reality​. An important function of narratives in psychology is their role in shaping
identity. McAdams (1993) argues that personal narratives contain key features such as settings,
characters, initiating events, and consequences, all of which contribute to constructing a coherent
sense of self​. Through storytelling, individuals choose what aspects of their experiences to
highlight or omit to craft a unique narrative identity (Howitt, 2016)​. Narrative analysis examines
the structure, themes, and functions of stories. Researchers such as Riessman (1993) and
Crossley (2000) highlighted the importance of analysing how narratives are constructed and what
they reveal about an individual’s psychological state​. For example, Frank (1995) categorises
illness narratives into three types: restitution narratives (expecting recovery), chaos narratives
(lack of hope), and quest narratives (seeking meaning through suffering)​. Such classifications
help psychologists understand how individuals cope with health crises (Willig, 2021). According
to Murray (2003), individuals can possess multiple narrative identities, each connected to
different social relationships.
​ Narrative therapy, which was developed by White and Epston (1990), focuses on helping
individuals reconstruct their stories to promote personal growth and empowerment​. This
therapeutic approach enables individuals to reframe problematic narratives and explore
alternative perspectives, which can be beneficial for individuals dealing with trauma, depression,
or identity-related challenges. Beyond the individual level, narratives play a significant role in
social movements and collective identity formation. Lock and Kaufert (1998) show how
narratives of women with breast cancer contributed to a resistance movement that influenced
healthcare policies and research funding​. Narratives of marginalised groups can serve as
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powerful tools for advocacy to help challenge dominant discourses and promote social justice.
Therefore, narratives are a fundamental aspect of human psychology as they allow for
meaning-making, identity construction, and emotional processing, which can provide insights
into individual and collective experiences.

Narrative Interview as a Method of Data Collection in Qualitative Research

Narrative interviews (NI) is an unstructured, in depth interview commonly used in qualitative

research which developed in response to the question-answer design of the usual interview where
the interviewer imposes structure by choosing the theme, order of the questions and the wording
and language of the questions. To reduce the interviewer's influence on the process, NI confines
the interviewer by removing their pre-structuring part of the interview from the interview
process. NI fundamentally encourages the interviewee/ informant to narrate a story about a
particular event in their life which has some significance, the primary goal in NI is the
reconstruction of events from the informants perspective as accurately as possible (Jovchelovitch
& Bauer, 2000).

The narration is a result of peculiar cues, and once the informant starts the story, it will
maintain a flow of narration based on certain tactic rules. Schema refers to a semi autonomous
process which is activated by a predetermined situation. A narration is not without structure, it
has a formal structure as a self generating schema with three defining features: detailed texture,
relevance fixation and closing of the Gestalt. The narrator provides a detailed event by event
description, which makes transition to the next event more plausible; a story being plausible is
necessary for it to be considered a story. The story should take into account details like time,
location, motivation, ideas and capabilities. The narrator takes it upon himself to choose what
features of the event they consider relevant and hence share. The event’s account is selective.
The theme centers which emerge out of the narration, gives us an idea about the relevance
structure of the narrator. The narrator's core event should have a beginning, a middle and an
ending if the event has ended. This threefold composition helps in the flow of the story
(Jovchelovitch & Bauer, 2000).
According to Jovchelovitch & Bauer (2000), NI can be viewed as a four phase process,
preceded by preparation for the interview. The four phases include: initiation, main narration,
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questioning phase, and lastly concluding talk. Preparation involves the researcher making
themselves familiar with the field of study and based on this initial inquiry come up with a list of
exemplary questions which reflect the researchers interest. The first phase, initiation includes
obtaining informed consent, giving the informant a brief overview of the research and explaining
the process of NI, emphasising on uninterrupted narration which will be followed by questions.
The second phase, main narration involves uninterrupted narration till a clear coda, i.e when the
narrator signals that the narration has ended. During this phase the interviewer refrains from
verbal comments, however the interviewee can show non verbal cues to indicate they are
listening. Interviewer is allowed to take some notes for the questioning phase, as long as it
doesn't interfere with the narration. When the narration ends, the third questioning phase begins.
The interviewer shouldnt ask why questions and instead ask questions regarding the event only;
direct questions about beliefs and judgments should be avoided. The questions should be framed
only using the narrator's words. The interviewer should also refrain from pointing out any
contradictions in the narration. This phase provides new information and material which is not
included in the self generating schema. After this phase recording stops and phase four, the
concluding talk takes place. Only during this phase may the interviewer ask why questions which
can be used in the analysis of the narration.

Participants

The study employed purposive sampling, selecting individuals aged 18 and above who had been
diagnosed with any type of cancer and were in remission for at least six months. There were no
restrictions on cancer type, allowing for a diverse representation of survivors with varying
backgrounds and experiences.
Tools

Informed Consent

The informed consent form highlighted the purpose of the study, information about how
the collected data will be kept strictly confidential and used only for academic purposes.
Participants were informed of their right to withdraw from the study at any time without any
consequences. Permission was sought to record the narrative interview to ensure accurate data
collection and analysis.
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SQUIN

​ A SQUIN (Single Question aimed at Inducing Narrative) is an open-ended question

designed to encourage interviewees to share their experiences freely and in their own words. It
serves as the starting point of a Biographical Narrative Interpretive Method (BNIM) interview
and is carefully formulated to elicit Particular Incident Narratives (PINs)—detailed accounts of
specific experiences (Gunaratnam, 2015). The key principle behind a SQUIN is to allow the
interviewee’s narrative to emerge naturally, without interruption or direction from the
interviewer, recognising that personal narratives have an inherent structure or gestalt, shaped by
past experiences and individual relevance frameworks (Wengraf, 2001). Unlike structured or
semi-structured interviews, which often reflect the researcher’s predefined expectations
(Bryman, 2008), a SQUIN ensures that participants share what is meaningful to them. After the
initial interview, follow-up sub-sessions allow for more probing questions, focusing on clarifying
or expanding on PINs.

Procedure

After multiple rounds of discussion and a thorough literature review, we finalised our research
topic. Given that we were conducting a narrative interview, we decided to structure it with only
one open-ended question at the beginning. Following this, we developed an informed consent
form. We then began reaching out to potential participants through personal networks and social
media, and scheduled interviews based on their availability and preferred locations. The
interview took place in a café and lasted for approximately 45–50 minutes. All interviews were
conducted in person, beginning with rapport-building to ensure comfort. Once rapport was
established, participants were provided with the informed consent form, which they signed
before proceeding. With their permission, the entire conversation was audio recorded. The
interview commenced with the initial open-ended question, allowing participants the space to
share their narratives in their own way. Upon completion, participants were thanked for their
time and contributions.
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Results

Elements Verbatim from Participant

Orientation “2020 mei diagnose hua tha.”

“17, us age ke lie toh mere lie kaafi badi cheez thi.”

“mujhe stage 4 cancer tha…Acute lymphoblastic leukemia”

“Joint family mein rehte the uss time, government hospital mein
treatment chal raha tha.”

Complicating Action “Kaafi delay hua diagnosis mein.”

“family ki kami ek void ho gaya tha mere liye.”

“Friends se thoda dur hogya tha…cut off hi krdia tha maine social
media, sab kuch ek tareeke se mera world hi ban gya tha khud, baki
dunia se cut off hona.”

“Jab mera relationship khatam ho gaya tha, toh merko yeh laga ki
kuch toh life mein ho gaya hai aisa bada, ki ab main waisa nahi
hoon jaisa pehle tha.”

“Parents unka work load double triple hua mere wajh se, apna
kaam bhi sambhalna mera bhi sambhalna. Toh kabhi kabhi voh bhi
pareshan ho jate the.”

“Main padhai par bilkul dhyan nahi diya tha.”

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“Par phir ek point aaya, jab maine socha, chhodo koi nahi, ab
rebuild karna chahiye is cheez ko.”

Evaluation “thoda sunne mein unnatural lagta hai, par jab mujhe pata chala
tha poori condition ke baare mein, to ek bohot short period of time
hi main thoda sa scared tha. Aur uske baad pata nahi kyun, mere
andar strength aa gayi thi ki us cheez ko peeche chor krke, treatment
ka jo period hai use survive krna hai….To mere paas yeh tha ki,
mujhe lag raha tha ki main jaisa tha treatment se, pehle ab shayad
waisa nahi ho paaunga, matlab main degrade ho chuka hoon…
Parents unka work load double triple hua mere wajh se, apna kaam
bhi sambhalna mera bhi sambhalna. Toh kabhi kabhi voh bhi
pareshan ho jate the.”

“maine apne emotions ko suppress kia vo badme mujhpe fireback

kie, treatment ke baad, matlab jo bhi issues create kie us illness ne,
unhe solve nahi kr rha tha mai, meri insecurities kafi badh jati hai
aise time pe.”

“Jo bhi mere insecurities thi, to main thoda sa harsh tha khudko
leke, confidence toh mera chala hi gya tha, So I had to do
something hard, I had to achieve something hard. So that I get the
proof that I am capable of doing things. So in a way, NEET ke lie
appear hona isi strategy ka part tha.”

“Main YouTube pe motivational videos dekhta tha, lekin zyada

interest comments mein hota tha. Log apni problems share
karte the, aur agar mujhe lagta tha main madad kar sakta
hoon, toh main unhe reply karta tha. Ye meri ek hobby ban
gayi thi — pareshan logon ko kuch support dena. Jab wo log
reply karte the, toh mujhe lagta tha main kisi ke kaam aa raha
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hoon. Ghar pe sab meri care kar rahe the, aur mujhe lagta tha
main unpe dependent hoon, thoda burden jaisa. Lekin jab
main ye karta tha, toh thoda useful aur connected feel hota
tha kyunki main kaafi akela mehsoos karta tha uss waqt.”

“mereko confidence wapas se gain hone laga, Mere ek fear nikal

gaya. Mere ko is cheez ka fear tha, starting se matlab meri jo
progress hai, agar wo abolish ho jaye toh merko bahut zyada
problem hoti thi. Par yeh fear nikal gaya tha mera, kyunki jo kuch
bhi maine build kiya tha, sab ek snap mein chala gaya, phir maine
wapas se wo kiya. Toh, yeh cheez ab mere saath hamesha rahegi,
lifetime ki, matlab, kitna bhi kharab ho jaye, sab kuch mera khatam
ho jaye, par hamesha koi na koi ek rasta hota hai, bhagwan dikhai
deta hai”

“Iron Man Banne ki naakam koshish ki, situation ki severity mai

convey nhi kar paya toh mujhe jitni need thi us level ka support nhi
milta kbhi, not that ki kisi ne deny kiya but mai hi communicate nhi
kr paya toh logo ko kbhi kbhi mera behaviour unjustified lgta tha jo
aur problems create krne lga. So han ye iron man wali strategy toh
flop rahi, i think mujhe real rehna chahiye tha."

“Abhi bhi merko kisi cheez ko leke insecurity aati hai, main kisi ko
compare karta hoon, to phir mai khudko yaad dilata hu ki meri
starting point voh nahi hai jo baki logo ki hai, maine kafi peeche
start kiya hai, mai kisi ke barabar nahi hu toh kisi se kam bhi nahi
hu. Matlab Meri journey alag rahi hai, iske liye to main satisfied
hoon.”

“fir mujhe smajh agya tha ki sabki journey alag hoti hai, har kisi kin
life mei problem toh aati hi hai, mere liye yeh time abhi aya hai,
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sabke lie kabhi ata hai, toh fir samjh gya tha life same nahi hoti hai
sabki.”

“self compassion ne bohot important role play kiya is journey me,

negative self talk completely cut kiya and jab self compassion
practice kiya toh emotionally independent bhi hua kuch extent tk.”

Resolution “Fir maine decide kiya ki NEET dena hai. College physically
possible nahi tha, toh ek saal ka break liya — health build
karne aur preparation dono ke liye. 11th–12th properly nahi
padhe the, toh drop year lena hi tha. Is dauraan main khudko
occupied rakhta tha health, NEET, kaam sab par focus karna
tha. Yeh sab mere liye tha, overthinking se bachne ke liye bhi.
Aur iss journey ka result bhi mila, academics aur health dono
improve hue.”

“Maine gym join kiya, din bhar padhai, shaam ko workout,

aur diet ka bhi dhyan rakha. Din mein bilkul time nahi bachta
tha, aur mujhe yeh routine pasand tha. Mera drop year meri
life ka sabse disciplined aur best phase tha. Busy rehna, ek
structured life — usse mujhe results mile, exam clear hua,
health bhi better hui. Ab yeh mera purpose ban gaya hai, aur
main apne decision se khush hoon. NEET dena khud ko prove
karne ke liye nahi tha — par agar woh phase nahi hota, toh
shayad main MBBS bhi nahi kar raha hota.”

Coda “Ab dar khatam sa ho gaya hai. Jab itni badi problem dekh li, toh
lagta hai ab kya hi bacha hai jo aur hila sake. Jo kuch guzra hai,
usne ek alag hi himmat de di hai. Ab jo bhi mushkilein aayengi, unse
nipatne ka hausla hai. Jo past ka experience tha na, woh ab mere
 17

saath hai, ek silent support jaisa. Aur usi se lagta hai ki ab kuch bhi
ho, sambhal hi lunga.”

"Jo hota hai ache ke liye hi hota hai, is cheez ka toh strong believer
ban chuka hu mai.”

“ aaj jaha pe hu, vahan pe hona zaroori tha, sablog sahi jagah pe
pahonch hi jaate hain.”

Abstract

This narrative inquiry explores the illness trajectory and psychosocial adaptation of a
20-year-old who was diagnosed with Stage 4 Acute Lymphoblastic Leukaemia at the age of 17.
The participant began his account by describing the delayed diagnostic process and the
subsequent transition from private to government medical care. His experience was marked by
physical isolation due to sterile living requirements, a disruption in social and familial
relationships, and a deep sense of emotional disconnection. The participant's narrative reveals
significant psychological shifts, including diminished self-perception, guilt associated with
familial burden, and emotional suppression. However, it also reflects emergent resilience and
meaning-making. A pivotal moment occurred during a voluntarily undertaken academic break,
wherein the participant engaged in focused self-discipline studying for a competitive medical
entrance examination and investing in physical recovery.. The participant reflects on his journey
as not merely one of survival, but of personal transformation, acknowledging that past hardships
continue to serve as a source of strength and grounding.

Orientation

The participant, a 20-year-old male from New Delhi, began his narrative by recalling the
year 2020, when he was diagnosed with Stage 4 Acute Lymphoblastic Leukaemia at the age of
17. At the time, he was in the 11th standard, a period already marked by academic transitions. At
the onset of his illness, the participant was living with his joint family. His treatment initially
 18

began at a private hospital, and once his condition was stabilised, he was transferred to a
government hospital for continued care.

Complicating Action

The speaker recounts a series of disruptive life events and emotional challenges that
significantly altered their personal and social functioning. A delayed medical diagnosis marked
the beginning of a difficult period, followed by social withdrawal, including distancing from
friends and cutting off social media. The absence of family support created a sense of emotional
void. The end of a romantic relationship was perceived as a major turning point, evoking a deep
internal shift in the speaker’s identity and emotional state. These struggles also impacted the
family, increasing their responsibilities and stress levels. Academically, the speaker lost focus
and motivation. However, a moment of realisation eventually emerged, a shift in mindset toward
rebuilding and moving forward.

“Friends se thoda dur hogya tha…cut off hi krdia tha maine social media, sab kuch ek tareeke se
mera world hi ban gya tha khud, baki dunia se cut off hona…- Jab mera relationship khatam ho
gaya tha, toh merko yeh laga ki kuch toh life mein ho gaya hai aisa bada, ki ab main waisa nahi
hoon jaisa pehle tha.”

Evaluation

For the participant, the experience of illness and remission held layered and often conflicting
meanings. On one hand, it exposed vulnerabilities - both physical and emotional, that challenged
their prior sense of self. There was a distinct feeling of decline, of not being able to return to who
they once were, accompanied by guilt over the toll their condition took on the family. Yet, these
feelings also coexisted with an emergent inner resilience. The crisis catalyzed a re-evaluation of
self-worth and capability. The participant recognized how suppressing emotions only intensified
their insecurities, prompting a need to regain control and rebuild confidence. Setting a difficult
academic goal, such as appearing for a competitive exam, became a form of self-validation, a
way to counteract the perceived degradation and prove to themselves they were still capable. At
the same time, engaging in acts of support for strangers online offered a quiet sense of purpose
and connection. These small but meaningful exchanges helped alleviate feelings of dependency
 19

and isolation. Ultimately, the participant’s evaluation reveals a journey marked not just by
survival but by a deep introspective struggle to reclaim identity, restore agency, and find meaning
through both achievement and compassion.

“thoda sunne mein unnatural lagta hai, par jab mujhe pata chala tha poori condition ke baare
mein, to ek bohot short period of time hi main thoda sa scared tha. Aur uske baad pata nahi
kyun, mere andar strength aa gayi thi ki us cheez ko peeche chor krke, treatment ka jo period hai
use survive krna hai….To mere paas yeh tha ki, mujhe lag raha tha ki main jaisa tha treatment
se, pehle ab shayad waisa nahi ho paaunga, matlab main degrade ho chuka hoon… Parents
unka work load double triple hua mere wajh se, apna kaam bhi sambhalna mera bhi sambhalna.
Toh kabhi kabhi voh bhi pareshan ho jate the.”

The participant’s account reflects a significant internal shift, one that begins with
disruption but gradually moves toward reconstruction and meaning-making. The participant
expressed a deep sense of loss of their previous self, of confidence, and of perceived normalcy.
They began to view themselves as diminished, especially in relation to the toll their condition
placed on their family, which contributed to a sense of guilt and emotional burden. This
emotional strain led the participant to adopt strategies of suppression and self-demand. The act of
pushing down emotions, rather than resolving them, intensified their insecurities post-treatment.
A strong desire to reclaim control and prove capability emerged, culminating in the decision to
pursue a difficult academic goal. Yet, beneath this striving was a struggle with visibility and
expression an acknowledgement that their efforts to appear strong (likened to being an "Iron
Man") often masked their true needs and resulted in unmet emotional support.

“Abhi bhi merko kisi cheez ko leke insecurity aati hai, main kisi ko compare karta hoon, to phir
mai khudko yaad dilata hu ki meri starting point voh nahi hai jo baki logo ki hai, maine kafi
peeche start kiya hai, mai kisi ke barabar nahi hu toh kisi se kam bhi nahi hu. Matlab Meri
journey alag rahi hai, iske liye to main satisfied hoon……fir mujhe smajh agya tha ki sabki
journey alag hoti hai, har kisi kin life mei problem toh aati hi hai, mere liye yeh time abhi aya
hai, sabke lie kabhi ata hai, toh fir samjh gya tha life same nahi hoti hai sabki.”

Resolution
 20

The decision to take a drop year became a turning point, not out of compulsion, but as a
conscious choice to rebuild, both physically and academically. With health concerns making
regular college unfeasible and academic gaps from earlier classes, the year became an
opportunity rather than a setback. Anchoring himself in a strict routine of studying, working out,
and maintaining discipline, he found not just progress in academics and health, but a rhythm that
grounded him. What began as a break turned into a deeply personal journey of purpose, clarity,
and commitment, one that laid the foundation for pursuing MBBS, not to prove something to
others, but because it genuinely aligned with what he envisioned for himself.

“Fir maine decide kiya ki NEET dena hai. College physically possible nahi tha, toh
ek saal ka break liya, health build karne aur preparation dono ke liye. 11th–12th properly
nahi padhe the, toh drop year lena hi tha. Is dauraan main khudko occupied rakhta tha
health, NEET, kaam sab par focus karna tha. Yeh sab mere liye tha, overthinking se
bachne ke liye bhi. Aur iss journey ka result bhi mila, academics aur health dono improve
hue.”

Coda

The participant’s narrative concludes with a clear sense of personal growth and emotional
resilience. Having navigated the uncertainty and emotional weight of cancer, they now describe a
shift in perspective, challenges that once felt overwhelming are no longer experienced with the
same intensity. The past is not seen as something to move on from, but rather as a steady source
of inner strength that continues to support them silently. They speak of being able to face future
difficulties with greater composure, relying less on external help and more on their own capacity
to reflect and self-regulate. There is also a sense of meaning-making in how they interpret their
journey: a belief that the experiences they went through were necessary for reaching their current
state. In closing, the narrative reflects a quiet confidence, not that life will be free of hardship,
but that they now feel equipped to face it with a calm and centred mindset.

“Ab dar khatam sa ho gaya hai. Jab itni badi problem dekh li, toh lagta hai ab kya hi bacha hai
jo aur hila sake. Jo kuch guzra hai, usne ek alag hi himmat de di hai. Ab jo bhi mushkilein
aayengi, unse nipatne ka hausla hai. Jo past ka experience tha na, woh ab mere saath hai, ek
 21

silent support jaisa. Aur usi se lagta hai ki ab kuch bhi ho, sambhal hi lunga… aaj jaha pe hu,
vahan pe hona zaroori tha, sablog sahi jagah pe pahonch hi jaate hain.”

Discussion

This study aimed to explore the lived experiences of individuals currently in remission from
cancer through narrative analysis. By concentrating on participants’ personal stories, the research
sought to understand how they make sense of their illness journey, reconstruct their identity, and
navigate the transition from treatment to survivorship. Narrative analysis allowed for detailed
insights into the psychological, emotional, and social dimensions of remission. The discussion
that follows highlights key findings from the narratives, contextualised within existing literature
and theoretical perspectives.

The account of a 20-year-old male participant, diagnosed with Acute Lymphoblastic

Leukaemia (ALL) at 17, offers a compelling lens into the challenges faced by young adults in
remission. A striking element of his story was the deep sense of isolation and loneliness
experienced during the treatment phase, particularly in relation to his immediate social circle. He
described a growing emotional distance from both friends and family, suggesting a perceived
lack of understanding or shared experience. This aligns with existing scholarship on chronic
illness, where social withdrawal and emotional seclusion frequently emerge as secondary
burdens of disease (Barlow et al., 2015). As literature suggests, social isolation refers to an
objective lack of social connections, whereas loneliness is the subjective feeling of being
emotionally disconnected, even in the presence of others (Jenny et al., 2006). The
interrelationship between chronic illness and broader life circumstances often initiates a decline
in social status and access to resources, as individuals reduce or withdraw from work, education,
and leisure activities, a pattern that incrementally contributes to experiences of loneliness
(Daker-White et al., 2014). In the participant’s account, this was reflected in his inability to
attend major life events and his sense of detachment from close friends, reinforcing the idea that
loneliness is not simply a lack of company but a lack of meaningful connection. As Franklin et
al. (2018) highlight, loneliness emerges in the absence of relational depth, in moments where
individuals perceive a lack of validation, esteem, or emotional presence from others.
 22

What stands out in this narrative is that the experience of loneliness did not remain
confined to interpersonal dynamics but extended into a form of alienation from the self. Lewis et
al. (2024) conceptualise loneliness as unfolding across multiple relational dimensions: the
personal, marked by disconnection from one’s pre-illness identity; the interpersonal, a growing
gap between self and intimate others; and the societal, a broader feeling of estrangement from
one's community. The participant’s story resonated with all three, particularly when he described
feeling left behind as his peers progressed through normative life milestones, entering
relationships, pursuing careers, or making future plans. This perception of halted progression
underscores May’s (2017) assertion that loneliness can carry a temporal dimension, rooted in the
loss of a past sense of belonging that no longer aligns with one’s present. To cope with emotional
disconnection, the participant turned to online platforms, finding agency and purpose by
supporting others, echoing Chou et al. (2009), who highlight the growing use of digital spaces by
those with chronic illnesses for connection and mutual support.

The transition from active treatment to remission represented a critical juncture in the
participant’s illness narrative. Although remission is commonly understood both socially and
medically as a phase of relief or resolution, for this individual, it was instead marked by
heightened emotional vulnerability and a sense of disorientation. Rather than yielding to despair,
however, he consciously reframed this uncertain period as a “rebuilding phase”: a time for
introspection, rediscovery of purpose, and the cultivation of a more disciplined, goal-oriented
way of life. This process echoes the observations of Mesquita et al. (2017), who suggest that the
cancer experience often acts as a catalyst for profound reflection, prompting individuals to
engage with their spiritual and emotional needs while seeking renewed meaning in life.
Importantly, remission for the participant did not entail a return to pre-illness normalcy. Instead,
it marked the emergence of a reconfigured self, one shaped by both the disruptions and the
revelations brought on by illness. This trajectory of personal transformation is in line with Clarke
et al. (2010), who argue that growth following serious illness often involves the discovery of
latent inner strengths and the development of adaptive coping mechanisms. The participant’s
account also strongly aligns with Frank’s (1995) concept of the ‘quest’ narrative, wherein the
individual engages with illness not as a detour but as a meaningful journey. Through this journey,
the person seeks insight, embraces change, and ultimately reclaims agency in the face of
adversity. His narrative further resonates with Booker’s (2006) archetypal story structure, in
 23

which the protagonist confronts a major life challenge, overcomes both internal and external
obstacles, and experiences a transformative shift from victimhood to heroism, a pattern also
highlighted by C. Williams (2017).

In this light, the participant’s remission phase emerges not as an end point but as a
turning point: one that reflects a deeper psychological and existential evolution, rather than a
mere medical milestone. As the participant reflected on his overall experience, he highlighted
how the illness served as a catalyst for a substantial realignment of his values and priorities,
particularly strengthening his familial relationships. Despite the profound challenges he endured,
he described emerging from the experience with an enhanced sense of self-efficacy and
emotional maturity. This personal evolution resonates with the principles of narrative identity
theory, which posits that individuals form a coherent sense of self by constructing integrative
life stories that connect their past, present, and imagined future (McAdams & McLean, 2013).
The participant’s reframing of adversity as growth illustrates how agentic narratives can foster
resilience and well-being, supporting the idea that identity reconstruction is key to recovery and
long-term psychosocial development.

The participant’s narrative captures this dynamic, portraying survivorship not as a passive
aftermath but as a deliberate process of growth and redefinition. In this sense, illness becomes a
pivotal turning point in one’s life story, a space for intentional transformation rather than merely
an experience to be endured and left behind (Kerr et al., 2019).

Conclusion

This study examined the lived experience of cancer through narrative inquiry, focusing on how
individuals make sense of diagnosis, treatment, and remission. The participant’s narrative
revealed that remission is not merely the conclusion of a clinical timeline but rather the
beginning of a nuanced and often demanding process of identity reconstruction. Emotional
introspection, renewed personal discipline, and the pursuit of meaning emerged as central to this
post-treatment phase. These insights underscore the importance of understanding illness as a
holistic experience, one that encompasses not only physical but also psychological, social, and
existential dimensions. By situating personal narratives at the heart of inquiry, the study
emphasises the value of individual storytelling in capturing the full spectrum of survivorship.
 24

The findings offer implications for more responsive, person-centred healthcare practices that go
beyond treatment outcomes to address the enduring emotional and social impacts of illness.

As this research comes to an end, I reflect on how much my perspective on illness,

especially cancer, has changed. This entire process has helped me look beyond just the medical
aspects of illness and see the whole person behind the diagnosis. The way the narrative analysis
brought out the participant’s story made the experience feel much more human; it was no longer
just about illness but about the emotional, relational, and personal journey they went through. It
made me realise that coping with illness isn’t just about managing symptoms; it’s about a deeper,
sometimes transformative process that affects every part of a person’s life. I also came to
understand that illness, particularly cancer, isn’t a single-dimensional experience. The
participant’s story highlighted how cancer doesn’t just change your body; it changes how you
relate to others, how you see yourself, and how you navigate the world. Using narrative inquiry
helped me understand what “lived experience” truly means. It gave me a lens to see beyond the
statistics and clinical definitions, allowing me to appreciate the complexity of human experience.
When I started, I knew very little about the psychological side of cancer remission. I came into
this research with an open mind, ready to learn. Now, having gone through this process, I feel
like I have a better understanding, not just in theory, but in how real people live through it. This
has been such an inspiring journey, and it’s made me want to explore even more topics in this
area in the future.
 25

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