Interplay of identities: A narrative study of self-perceptions among immigrants with severe mental...

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published online 14 October 2014Transcultural PsychiatryEvgeny Knaifel and Julia Mirsky

immigrants with severe mental illness from the former Soviet UnionInterplay of identities: A narrative study of self-perceptions among

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Interplay of identities: A narrativestudy of self-perceptions amongimmigrants with severe mentalillness from the former Soviet Union

Evgeny KnaifelBen-Gurion University of the Negev, Israel

Julia MirskyBen-Gurion University of the Negev, Israel

Abstract

This study explored the self-perceptions of individuals with mental illness who immi-

grated from the Former Soviet Union (FSU) to Israel. In particular, we examined the

double stigma borne by these individuals as new immigrants and psychiatric patients,

which may threaten their identity and render them at risk for social marginalization. We

interviewed 12 FSU immigrants diagnosed with severe mental illness (SMI), who had

been hospitalized in psychiatric facilities in the past and, at the time of the interview,

were residing in community rehabilitation centers. Their narratives revealed that they

constructed multiple identities for themselves: as bearers of Russian culture, as Soviet

Jews, as normative immigrants, and only lastly as consumers of mental health services.

In the case of FSU newcomers with mental illness immigration may serve as a normal-

izing and positive experience. Study findings suggest that stressing patients’ identity as

mentally ill may be counterproductive in their rehabilitation; instead, clinicians may

consider working to mobilize patients’ personal and cultural assets and helping them

reinstate a more complex self-perception. Further research is needed to explore how

immigration may affect self-perceptions of individuals with SMI from other cultural

groups.

Keywords

identity, narrative method, self-perception, severe mental illness, Soviet immigrants,

stigma

Corresponding author:

Evgeny Knaifel, Spitzer Department of Social Work, Ben-Gurion University of the Negev, PO Box, 653,

Beer-Sheva, 84105, Israel.

Email: [email protected]

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Personal identity is formed in the course of an ongoing dialogue between theindividual and his or her environment and influenced by psychological, social,and cultural factors (Erikson, 1968). Identity formation is a dynamic process com-prising continuous interpretation of experiences that the individual encountersthroughout life and evolving identity expansion and revision through dynamicself-perception (Mishler, 2004). How an individual constructs his or her identityis affected by self-perception at a given time and in a given context, as well as byunfolding life events. The present paper explores how coping with both mentalillness and immigration affects identity formation.

Mental illness, stigma, and identity construction

Major psychiatric disorders provoke disabilities and symptoms that affect identityand impair an individual’s functioning and self-perception. For example, the psych-otic experience of individuals with schizophrenia presents the danger of narrowingan individual’s identity to include only those aspects related to the illness, dimin-ishing other aspects of the personality to the point of extinction (Estroff, 1989). Theaccompanying helplessness, passivity, and despair may lead to a perceived loss ofcontrol over one’s life (Yanos, Roe, & Lysaker, 2010). Thus, a person coping withsevere mental illness (SMI) may feel dispossessed of his or her former social roleand place in the world.

Psychiatric hospitalization may further contribute to feelings of incompetence orlack of control, often triggering a redefinition of the sense of self (Lally, 1989); iftraumatic, hospitalization may also threaten an individual’s sense of agency andefficacy (Roe, 2005). Living in a psychiatric institution, along with the intrapsychiceffects of the illness and of hospitalization, encourage the internalization of anidentity of “psychiatric patient,” which often becomes the dominant identity ofpersons with SMI in Western societies (Yanos et al., 2010).

In addition to the ramifications of illness and hospitalization, persons with SMIalso cope with social stigma that can have devastating effects on their lives, impair-ing well-being, and leading to social isolation and discrimination (Corrigan, Green,Lundin, Kubiak, & Penn, 2001; Corrigan & Kleinlein, 2005). Stereotyping, preju-dice, and discrimination may become central to the identity of people with psy-chiatric disabilities (Corrigan & Watson, 2002), who adopt, often unconsciously,the negative attitudes towards “the mentally ill” prevalent in general society.Internalized stigmatization may negatively affect self-perception, leading todecreased self-esteem and a lowered sense of self-efficacy (Corrigan, Watson, &Barr, 2006). Self-stigmatization can also elicit shame, social anxiety, acquired help-lessness, lack of motivation, and avoidant behavior (Link, Struening, Neese-Todd,Asmussen, & Phelan, 2001).

The loss of sense of self and identity connected to mental illness, which isintensified by social and self-stigma, renders the individual particularly vulnerableto the loss of core identity and the adoption of a thin, one-dimensional “illnessidentity” (Yanos et al., 2010). Recovery often entails the search for a sense of self

2 Transcultural Psychiatry 0(0)




and the broadening of identity beyond illness (Roe & Davidson, 2005). The presentpaper attempts to illuminate the self-perceived identity of individuals who, in add-ition to coping with SMI, grapple with processes of immigration and transition to anew country.

Immigration, acculturation, and identity formation

Immigration offers special opportunities to study identity formation, as it encom-passes a dramatic change in many aspects of life and induces complex psycho-logical and social processes. Classical psychological conceptualizations ofmigration center on the accompanying losses that ensue and on the process ofmourning it entails (Grinberg & Grinberg, 1984; Mirsky & Kaushinsky, 1989).In the direct and continuous encounter with a new culture, the immigrant experi-ences many emotional and social difficulties, often termed “culture shock”(Pedersen, 1995). This encounter gradually generates change in the immigrant’semotions, cognitions, behavior, and values. He or she learns to adjust to the newenvironment, and the initial anxious, confused, and incoherent identity undergoesreorganization and reconstruction into a new cultural identity. This identity ispart of self-perception; it derives from one’s connection to a social groupand the emotional significance of this connection (Schwartz, Montgomery, &Briones, 2006).

Acculturation frameworks for understanding the effects of migration on culturalidentity and psychological adjustment address the tension between preserving the“heritage identity” as defined in the culture of origin and the “mainstream identity”that results from continuous exposure to the new culture (Ryder, Alden, &Paulhus, 2000). Earlier unidimensional perspectives proposed that the adjustmentto a new culture implies disavowal of an old and the acquisition of a new identity(Bar-Yosef, 1968; Gordon, 1964). A bidimensional perspective, however, holds thatthe integration of heritage and mainstream identities leads to an optimal psycho-logical adjustment (Berry, 1997, 2001; Phinney, Horenczyk, Liebkind, & Vedder,2001; Ryder et al., 2000). This perspective assumes that bicultural identities per-ceived in a positive way may become a source of psychological, social, and materialassets that can help newcomers cope with the difficulties of cultural transition(LaFromboise, Coleman, & Gerton, 1993). A multidimensional perspective,which favors multiculturalism, assumes that a range of different ways of accultur-ating can be beneficial for different groups and individuals, in different places, andat different times (Birman, Trickett, & Buchanan, 2005; Rudmin, 2009).

Immigrants who belonged to an ethnic minority group in their countries oforigin may construct more than two identities. One such group is that of Jewswho lived in the Former Soviet Union and, during the 1990s, immigrated toIsrael, Germany, and USA. Studies of this group of immigrants showed that inthe course of a continuous encounter with the new society, they tended to formmultiple cultural identities including Jewish, Russian, and new “mainstream” iden-tities (Ben-Rafael et al., 2006; Horenczyk, 2000; Persky & Birman, 2005).

Knaifel and Mirsky 3




The present study focused on the identity formed by Soviet Jews who immigratedto Israel and who, parallel to acculturation, cope with SMI.

FSU immigrants with mental illness in Israel

In the 1990s, about one million Jews from the Former Soviet Union (FSU) immi-grated to Israel (Central Bureau of Statistics, 2010). They differed from othergroups of immigrants in the country in their very high level of education and ofparticipation in the labor market in their country of origin (Markowitz, 1993). Inthe Soviet Union, most Jews had enjoyed relatively high socioeconomic status andfelt part of Russian culture, even shaping aspects of it (Rapoport & Lomsky-Feder,2002). Many sustained this identity long after leaving the FSU, and despite theirrapid instrumental adaptation, some characteristics of Russian culture, like lan-guage and traditions, still typify FSU immigrants in Israel today (Remennick,2007). Moreover, they have made efforts to preserve their culture by establishingRussian language press (Elias & Lemish, 2011) and Russian restaurants and clubs.

While some immigrant groups from the FSU are adjusting well, others showelevated levels of distress, psychiatric disorders, somatization, and alcoholism(Jurcik, Chentsova-Dutton, Solopieieva-Jurcikova, & Ryder, 2013).Epidemiological research in Israel has found high rates of psychological distressand psychiatric morbidity in this population (Lerner, Kertes, & Zilber, 2005;Mirsky, 2009). FSU immigrants were found to be at about 1.5 times greater riskof developing a common mental disorder than native-born Israelis (Mirsky, Kohn,Levav, Grinshpoon, & Ponizovsky, 2008).

At the same time, FSU immigrants display relatively negative attitudes toward,and a low level of utilization of mental health services (Levav, Kohn, Flaherty,Lerner, & Aisenberg, 1990; Shor, 2006). Research suggests that these immigrantsprefer nonformal sources of help such as friends and family (Leipzig, 2006). Whenseeking professional help, they have been shown to prefer their GPs rather thanmental health professionals or services (Ristner, Ponizovsky, Kurs, & Modai,2000). Negative attitudes towards mental health services may be related to distrustof representatives of the establishment due to the institutional abuses of psychiatryin the Soviet Union (Lavretsky, 1998; van Voren, 2009). Additional sources of suchattitudes may include social stigma and the fear that disclosure of mental illnessmay harm the social position of the individual (Polyakova & Pacquiao, 2006).

Immigrants with mental illnesses deal with a double stigma, both as immigrantsseeking to assimilate into a new culture and as individuals with psychiatric disabil-ities attempting to integrate into normative society. Such double tagging may mar-ginalize them, separating them from both the new society and the normativeenvironment (Bhugra, Leff, Mallet, Morgan, & Zhao, 2010). The double stigma-tization may also severely threaten their coherent self-perception and lead to feelingsof alienation and marginalization (Kidd, Veltman, Gately, Chan, & Cohen, 2011).

Although numerous studies have focused on the mental health of Soviet immi-grants, very few have specifically addressed immigrants with SMI and almost none





of them have used a narrative methodology. One study on FSU immigrants withmental illness in the USA is an exception in this respect (Polyakova & Pacquiao,2006). Using qualitative methods, this study revealed that although respondentswere coping with multiple adjustment difficulties, negative attitudes towards mentalhealth services led them to avoid seeking help, hide their illness, and suffer consid-erable psychological distress. This study, however, did not address the issues ofdouble stigma and identity.

The present study aimed to fill this gap by studying mentally ill Soviet immi-grants’ subjective perceptions of their illness and immigration experiences. Thestudy focused on the following questions: (a) What kinds of identities areformed by FSU immigrants who suffer from SMI? (b) How do they cope withtheir double stigma as immigrants and as mentally ill? (c) What are the implicationsof this experience of double stigma for their self-perception?

Method

The study adopted a narrative approach that relies on the postpositivistic notionthat narratives report on and, at the same time, create the reality of human experi-ence (McAdams, Josselson, & Lieblich, 2006). This qualitative research method-ology was chosen because it is especially appropriate for the study of identity.It posits that the best channel for understanding identity is through the contentand form of a life story, or the subjective manner in which people present their livesand interpret circumstances, events, and relationships (Alasuutari, 1997;McAdams, 1993). The narrative approach presumes that life stories not only rep-resent identity, but also construct it; through the telling of life stories, narratorsconstruct continuity and coherency in their self-perception and endow their experi-ences with meaning (Mishler, 2004). Based on the assumption that narrative is infact the main method of identity development, the term “narrative identity” wascoined to refer to stories people tell about themselves in order to define—for othersand for themselves—who they are (McAdams et al., 2006).

Narrative methodologies have increasingly permeated the field of mental health,previously dominated by positivistic paradigms. In psychiatric rehabilitation, andeven more so within the context of recovery-oriented rehabilitation, it is nowwidely accepted that research should address the subjective experiences of con-sumers (Davidson, 2003; Kirkpatrick, 2008). Similarly, the narrative paradigmhas been embraced in immigration research; through narrative, immigrants canvoice their subjective experiences and their personal as well as sociocultural iden-tities (Polkinghorne, 1991).

Participants

Participants included 12 immigrants coping with SMI. Verification of this criterionwas based on (a) recognition of handicapped pension eligibility by governmentalauthorities within the 5 years preceding the interview, and (b) utilization of a





mental rehabilitation service offered solely to those recognized as severely mentallyill within the 12 months preceding the interview. Individuals who were hospitalizedwithin 6 months of the interview were excluded. All respondents were over 18 whenthey emigrated from the FSU between 1990 and 2000. Onset of illness was eitherbefore immigration (seven respondents) or afterwards (five respondents). Allreported more than one hospitalization in the FSU or Israel. Nine men andthree women were interviewed; their ages ranged from 29 to 67 and they lived inmajor Israeli cities, representing a wide variety of demographic areas. Eight of therespondents were diagnosed with schizophrenia, two with a bipolar disorder, onewith PTSD, and one with major depression. Most of the respondents wererecruited through snowball sampling. Some were recruited with the help of liaisonpersons in the mental health system who had previously been in contact with ser-vices such as a half-way house, protected living, or social clubs. Others were foundvia informal social networks through recommendations by colleagues or by inter-viewers in the study.

Data collection

We used a two-phased narrative interview (Rosenthal, 1993). The first part was anopen life-story interview (main narrative) with minimal interviewer involvement,beginning with the request, “Please tell me your life story.” The aim of this phasewas to identify the weight respondents ascribed to their illness and to immigrationand to see what other themes they raised. The second phase consisted of an inter-view based on a list of open-ended inquiries such as: How are you affected by thecombination of your illness and coping with immigration? Please describe yourrelationships with native-born Israelis? Please tell me about incidents when youfelt rejected because you are coping with a mental illness? If a book were to bewritten about your life, what chapters would it include? The respondents were thenasked to give a title to their life story and to draw a graph of their life. They werealso asked to clarify themes raised in the first part of the interview. Finally, bio-graphical information was collected and the respondents were invited to participatein a joint reflection on their life stories (Spector-Mersel, 2011).

The 30- to 90-minute interviews were conducted by the senior researcher at siteschosen by the participants. Ten respondents chose to be interviewed in Russian andtwo in Hebrew. The interviews were audio-recorded, transcribed, and then trans-lated into Hebrew by the researcher, who is bilingual. In order to establish theaccuracy of the translation, the first two interviews were independently translatedby both researchers and the versions compared.

The research was approved by an ethics committee at Ben-Gurion University.The respondents’ written informed consent was obtained at the outset of eachinterview and they were provided with a written assurance of confidentialityfrom the researcher. To preserve confidentiality, the names of the participants, aswell as any personal detail that might identify them, have been deleted orchanged here.





Data analysis

The interviews were analyzed in light of the holistic principle of combining contentand form analysis (Lieblich, Tuval-Mashiach, & Zilber, 1998). The analysis wasperformed on the individual interview level according to a model suggested bySpector-Mersel (2011). The model aims to unveil the claimed identity (Mishler,1986), or the “end-point” (EP) that the respondent conveys to the interviewereither consciously or unconsciously (Gergen & Gergen, 1988). According to thismodel, six mechanisms of narrative selection, through which a given story evolvesout of the pool of factual material available in the life history, help create claimedidentities (Spector-Mersel, 2011). Inclusion refers to the representation of facts,events, and periods of the life history that are compatible with the story’s end-point (EP), thereby affirming the claimed identity. Some of these facts, events, andperiods gain prominence through the mechanism of sharpening, namely, elaborat-ing and exaggerating parts of the story. Through the mechanism of appropriatemeaning attribution, the narrator attributes a new interpretation to biographicalfacts and events in a way that harmonizes with and strengthens the claimed iden-tity. Omission and silencing are the opposite mechanisms, referring to the nonre-porting of life facts, events, and periods, either because they are irrelevant to the EP(omission) or they contradict it (silencing). The last mechanism, flattening, is theminimization of facts, periods, and events in the life story that are reported butmarkedly reduced.

The first step of analysis entailed comparing each participant’s lifeline and story-line, while trying to recognize what, out of the range of alternatives available, wasrepresented in the life story and how (Spector-Mersel, 2011). Lifeline here refers tothe summary of a life history, including major events, the year they occurred, andthe narrator’s age at the time (biographical information based on the second partof interview). Storyline here refers to a “road map” of the narrative text, providinga general picture of its content and formal features (main themes based on the first,open part of the interview). The transition from the individual-level analysis to across-sectional one was guided by the principles of grounded theory (Strauss &Corbin, 1994). Understanding of the “meta-narrative” was achieved through an“inductive spiral” analysis, a repeated motion between the individual narrative,common themes, and theory.

Several measures were taken to improve the validity of the analysis. The first wasreporting the results as “thick description,” which guarantees that the text isadhered to and thus that the researchers’ interpretations can be assessed by thereaders (Riessman, 1993). Respondents’ titles for their narratives were used fortriangulation (Kacen, 2010); it was assumed that these titles were keys to the mean-ing of the narratives, and many of them indeed corresponded with the claimedidentities extracted by the researchers. The third procedure was obtaining feedbackfrom four respondents 1 year after data collection (Lincoln & Guba, 1985). All fourconcurred with the claimed identities discovered in their narratives and stated thatthe results accurately reflected their experiences.





Results

The respondents, who related many events that had molded and remolded theiridentity, presented multiple identities around which their self-perception seemedto be organized. The claimed identities common to most respondents include:(a) a Russian cultural identity; (b) a Jewish identity, specifically as membersof a persecuted minority; (c) the identity of FSU immigrant in Israeli society;(d) a “heroic” identity, coping unaided with life challenges and distresses; and,only lastly, (e) a patient identity. The order in which these various identities arelisted is based on the order of their appearance in the narratives, their volume, theirfrequency of occurrence, and their weight in the respondents’ titles for their stories.The volume of a theme was calculated as the length of a given period (the numberof years out of the narrator’s entire life) and its relative share in the narrative(the number of lines/words about this period out of the total number of lines/words in the narrative) (Spector-Mersel, 2011). These identities are elaborated inthe sections that follow.

Culturally Russian

The respondents’ narratives regarding the claimed identity of “culturally Russian”appeared to be addressed not only to the interviewer but also to Israeli society.Two themes typically associated with the Russian-Soviet culture were emphasizedin the context of these narratives: education and employment (Markowitz, 1993).

Education. Notably, the majority of participants opened their narratives by describ-ing their education, thus situating themselves within the Russian cultural group,which places a high value on education, and more specifically, as members of itselite (“intelligentsia”). Most had studied in prestigious institutions of higher edu-cation and presented these years as the most significant and happiest in their lives.Through this theme, the respondents appeared to emphasize their normalcy, someby describing how they excelled in studies and others by expressing their desire foreducation.

In the excerpt that follows, for example, Arie describes himself having been anormal child from a Russian cultural perspective: clever, fond of studying, andespecially talented in math. He emphasizes his childhood uniqueness and genius asa support for his normative identity:

I was born in 1966, developed early, and was . . . a “wunderkind” . . . I was already

swimming at the age of 4. My mother was a teacher and my father was a driver . . . In

1980–1982 I studied in a special high school for math—you couldn’t be accepted

unless you excelled. I was the fifth highest there.

Slavik also began his narrative with events related to his academic excellence,proud that before he became ill he was no less talented than his brother and





made similar achievements. The words “study” and “studying” appear very fre-quently in his narrative:

Me and my brother, we studied in high school. We won a competition and were

accepted to the best high school . . . . We were very good at math, solving complicated

equations and problems orally. We studied there from Grade 8 to Grade 11 in math

class. At the same time we studied in a railroad engineering university preparation

class [where we] completed the first year of studies and were accepted to the second

year. We were also accepted for computer programming studies at the Technion, so

we decided to immigrate to Israel.

In terms of form, Slavik’s narrative significantly overrepresents the academicperiod of his experience; Grade 8 to university constitute 27% of his life butaccount for 60% of his spontaneous narrative.

The fact that Yaakov did not have the opportunity to enjoy academic educationmade him feel he missed something, and he regretted not opting for universitystudies before enlisting in the Israeli military service. His attempt to resume studieswas one of the highlights of his rehabilitation process:

The studies helped a lot. I found new friends and realized I was no worse than others,

because I also helped others. In the [university] preparatory course many [students]

didn’t know the material from school as well as I did. This positively affected my self-

image.

Yaakov graduated the preparatory course with honors and began his junior yearat the university in mechanical engineering, but his mental health deterioratedunder the pressure of schoolwork and he eventually dropped out. Yaakov’snarrative overrepresents his university days; although he studied for only2 years (6% of his life experience), he devotes a central part of his narrative(23%) to this period. The words “education,” “learning,” and “knowledge” arerepeated many times, underscoring the importance he attributes to theseelements.

Employment. The theme of employment was prominent in all the interviews; findingwork was perceived as very important in the context of immigration, and many ofthe respondents compared their employment status before and after immigration,with most reporting difficulties in integrating into the normative Israeli labormarket.

Many respondents reported having worked in the FSU despite their illness; likeeducation, employment appeared to contribute significantly to their identity andwas a source of pride and self-fulfillment, hence their disappointment and theaffront to their self-image when they could not find normative employment inIsrael. Like many other immigrants, our respondents attributed this to their age,





the fact that they were immigrants, discrimination on the part of locals, and lan-guage difficulties.

Eldar, for example, recalls the time before his emigration, when he worked hardand was happy:

In the last 6 years we lived in Moscow and I had no choice but to work at six different

jobs . . . I worked as a piano specialist, I taught, worked as a driver in my own car, and

so I earned well . . . Looking back, this was the happiest time of my life because I was

getting positive feedback for my work in music and for my conscientiousness.

After Eldar immigrated to Israel with his family, he began working to save moneyfor an apartment. Although he was not as successful as he had been in the FSU, hepersevered and managed to find work in his profession while also taking on oddjobs. Olga also began to work as soon as she came to Israel:

I work. An absolutely regular job. When I arrived in Israel, I began working. There

was no other choice; I had to earn money. I didn’t study anywhere and so my Hebrew

is very poor, very poor. I don’t practice; I speak only Russian with friends. So a

regular job . . .where the language is . . . very simple . . . and so is the work.

As part of their rehabilitation, respondents were entitled to supported employment.Some respondents neglected to mention this in their spontaneous narratives unlessspecifically asked; most seemed to resent working within such frameworks becauseit confirmed their association with the mental health system. Supported employ-ment is not only poorly paid and unappreciated in society, but it seemed to bringrespondents face to face with the reality of their illness.

Arie summarized common feelings on employment, stating that normativeemployment is an entry ticket to Israeli society and the heart of the rehabilitationprocess: “The goal is to work . . . at a normative job, with normative people, innormative conditions, and with a normal salary.”

Soviet Jews

Many participants ascribed their motivation for immigrating to Israel to the bla-tant and covert anti-Semitism they encountered in their homeland. They describedthe complicated status of being a Jew, a member of an ethnic and religious minorityin a totalitarian society, and the influence of this status on their identity. Maria, forexample, recalls the parades and demonstrations in Ukraine where anti-Semiticoutcries were common and reflected the anti-Jewish sentiments of the population:

The Jews weren’t liked in Russia and Ukraine. . . . People would curse them in dem-

onstrations and parades, and also at private parties. At one May Day parade people

were shouting, “Beat the Jews—save Russia!” It wasn’t easy living there.





Andrey was the son of a Jewish mother and a Russian father, a complicated statusin the FSU:

My mother used to say, “If you want be Russian, you can be Russian, and if you want

to be Jewish, be Jewish; it’s your choice.” But my father used to say, “No, you’re half-

Russian and half-Jewish” . . . . I could have reconciled myself to that. But if my father

treats me badly, how would other Russians treat me? Like a Jew, of course. That’s

why I was forced to leave. I experienced anti-Semitism and it made me nervous and

sick. I even . . . made my mother feel like I was anti-Semitic towards her. I was wrong.

I hope she forgave me.

Arie’s family began to become observant in the USSR at a time when open reli-gious practice put one in danger of arrest or forced psychiatric hospitalization:

I studied Hebrew from the age of 6. I learned to pray and studied Jewish tradition.

This was very complicated because they taught communism at school, and I received a

Jewish education at home. There were constant questions . . . about becoming fully

observant. When I was 12 I already used to ask who is more important . . . and who

would win, Lenin or Moses? . . . I used to teach Hebrew to people in the commu-

nity . . . . Then I got to know Chassidic envoys from the US and representatives

from Jewish communities all over the world who managed to enter the Soviet

Union. I went to the synagogue from the age of 16. So did my father and so did

my grandfather, until he died. That was our life.

Immigrant minority

The process of migration, its experiences and ramifications, were an integral part ofrespondents’ narratives and of their identities. They emphasized their immigrantidentity in interviews and tended to associate the problems they encountered withadjustment to a new country rather than their illness. Some referred to difficultiesin integrating into a new society and acquiring a new language, expressing frustra-tion and feelings of discrimination in their encounters with individual Israelis andwith the system.

Maria found it difficult to accept Israelis because of cultural differencesand the language barrier. In this excerpt, she describes feeling that Israelis donot accept FSU immigrants who do not adhere to religious Jewish dietaryprohibitions:

They don’t like us here, the Israelis. They don’t like us, the Jews. They call us

“Russians” and “swine” . . . I don’t like them either. Their language is very hard.

I don’t even try to learn it, just a couple of words . . . . I learned a few sentences but

can’t remember them.





Olga, who talked at length about her adjustment difficulties in Israel, silenced hermental illness and titled her life story, “I’m an ordinary immigrant, likeeveryone else.”

Eldar attributed his employment problems to general discrimination towardsRussian speakers on the part of locals. He described how, in the first years after hisarrival, he was fired from his job after getting into an argument with a client of thecompany he worked for:

This man approached us, an Israeli, and started preaching that the “stinking”

Russians came and brought here dirt. I told him: “What are you talking about, the

Russians brought here culture and education. See how we are cleaning here, investing

effort in our job, do you have complaints?” He said: “No, I don’t have complaints.”

But he went on cursing the Russians and we stopped ourselves from cursing him back.

When we went home, I told my colleague: “We will not be working there anymore; he

will tell on us to the boss and he will fire us.” And this is what happened. When we

came in the next day, the boss said that we are fired because we insulted a good and

respectable man. I told him what had really happened and even told him we had two

witnesses, but it did not help. This is how we were fired. What I mean to say is, that

I encountered good people in Israel, but regretfully, also many, many lies.

Gregory, like Eldar does not trust the locals. He feels discriminated against notonly by Israelis, but also by the Israeli establishment. For example, in relation tohousing, he claimed, “There are many thieves here, corruption. Not only in thegovernment, also in the public housing companies.”

Lonely heroes

Our respondents indicated that their illness and the move to a new country sepa-rated them from former sources of social support and that they were largely unsuc-cessful in establishing significant new relationships. Nevertheless, they mostly didnot report loneliness and did not consider social support to be important for them.This stance may reflect an attempt to regain a sense of control: respondents pre-sented the identity of a person who was alone by choice, not because of externalcircumstances.

Often there was also a heroic quality to the respondents’ claimed identity. Forexample, it was important for Yaakov, in spite of all difficulties, to fulfill his drivefor adventure:

Everything started when I moved alone to Israel. I immigrated in order to meet new,

interesting people and also with the specific purpose of serving in the army . . .Because

it is fun and also to learn new things, and also because it gives a good push for future

life in Israel and in the whole world . . .During the military service, I could have

studied or taken a course that would have been useful in civil life. But, I was young

and wanted a combat unit . . . to prove to myself and to others that I am worth





something. I could have made my life simpler, without the consequences I am experi-

encing now.

This quality of heroism was frequently linked to respondents’ previous religiousand Zionist activism in the USSR, and especially their opposition to the totalitar-ian regime; some had engaged in courageous activism under the threat of impris-onment or forced psychiatric hospitalization for “crimes” against the nation.

Arie, for example, was proud of his overt religious and Zionist activities, whichhe maintained even during his service in the Red Army: “In 1985 I was draftedinto the Soviet army . . . . I prayed and went to the synagogue during my service.They wrote about my having a relative in capitalist Israel . . . and that I was anobservant Jew.”

Arie described his Zionist and antiregime activity in the Soviet Union at length;he believed that his political activity is what prompted his psychiatric hospitaliza-tion. The title he gave to his story reflects this identity: “There I was a Zionistactivist, and here they turned me into a patient.”

Dmitry also presented the claimed identity of a hero, but an undergroundone—a “gangster”: “Everybody knew about me there, and everything was OK.No one messed with me because I was an important man and got a lot of respect.I was a ‘legal thief’ there, [part of the] elite.”

During his interview Dmitry exhibited an aggressive speaking manner, withsomewhat threatening intonations and a heavy use of slang and swearing; at theend of the interview he made a comment that clarified this behavior: “If they ask . . .why I swear a lot, tell them that I’m a gangster [laughs]”. When asked to give a titleto his life story Dmitry said, “My whole life is one big adventure. What I experi-enced, 20 people couldn’t experience. Everything happened in my life.”

Mental patients

The participants’ mental illness comprised the least volume and the last priorityof all the themes in their narratives. When they did relate to it, it was super-ficially. In respondents’ spontaneous narratives they typically avoided mention-ing the illness and excluded it from the identities they presented. Mostsuppressed the fact that they were living in a protected rehabilitation settingand utilizing mental health services. Some mentioned that they were recipientsof National Insurance handicapped stipends but didn’t mention the psychiatricbackground.

Gregory referred briefly to his mental illness, explaining why he was not workingin his profession but instead taking odd jobs. He mentioned neither his clinicaldiagnosis nor his experience as a patient:

Then I became [mentally] ill in the 1970s and stopped working in information systems;

I barely managed to finish university. [He sighs] After becoming ill, I went from one

job to another; I used to give private math and physics lessons. There were ups and





downs in my mental health. I had a good period between the beginning of the nineties

until 1993, when I wasn’t afraid to go out, wasn’t afraid of people, and felt real good.

There is a conspicuous gap between the 40 years of his life taken up by his mentalillness, almost 66% of it, and the very small place it is allotted in his narrative,only 12.5%.

Dmitry’s attitude towards his illness changed according to the life events he wasdescribing. The illness became marginal when he experienced success and morecentral when he failed. In the open part of the interview he spoke mainly of success,presenting the identity of a hero and barely relating to his illness. This is how hedescribed the onset: “When I was 16, I had a fight with someone and was kni-fed . . . since then I’ve been ill.” While Dmitry grappled with a psychiatric illness for67% of his life, it was allotted only 15% of his narrative.

Being identified as mental health patients seemed to threaten the other identitiesthe respondents chose to present. In this way, efforts to disguise and hide theirillness and avoid contact with other patients could be construed as a coping strat-egy. However, there were situations when respondents chose to expose their illness,especially when it conferred some advantage.

Slavik, for instance, felt that the National Insurance stipend and state rentassistance were invaluable and that, thanks to them, he was less occupied witheconomic survival than his healthy brother and other immigrants:

I get more than my brother, who finished his studies . . .Economically, he can barely

support himself. He couldn’t find work and now only just manages to earn some

money. But me . . . I have the pension and also earn a thousand shekels from my

supported employment. It’s easier, because the State helps. And I live in a hos-

tel . . . and don’t always have to think about how to manage.

In some cases the respondents perceived the social stigma of being mentally ill as acollateral advantage. Embracing the stigma offered certain protections and enabledsome of them to get away with otherwise unacceptable behavior. This mechanismseemed mostly unconscious and may be associated with respondents’ history ofgovernment-sanctioned persecution and consequent feelings of suspicion towardsthe State (Remennick, 2007).

Arie related that after his hospitalization, during his military service in the FSU,he felt free because he could always explain away his behavior by the illness.Yaakov applied a similar strategy. He proudly reports a violent incident he wasinvolved in and the advantage of being mentally ill because the police could notpress charges against him:

Not long ago I had a problem: I argued with a shopping mall security guard. The

police were called and at some point they grabbed me and began to beat me. They

tried to calm me down, but I resisted, which is why they hit me and wanted to charge

me for attacking police officers. But everything calmed down when I told them I had





been hospitalized in a psychiatric facility. Actually, I didn’t tell them, I told the

lawyer, who added documents concerning my health including certificates verifying

that I was not fit to stand trial. Did you ever see something like this [removes docu-

ment from wallet and shows interviewer]?

When he got into trouble with the law, Yaakov made use of the “mentally ill” labelto obtain immunity.

Discussion

The results of the present study suggest that individuals with SMI from the FSUreconstruct multiple identities in their narratives. The present findings suggest thatthe creation of multiple identities may help them construct a coherent life narrativeand preserve positive self-perception in the face of the crises and transitions theyencounter. Alongside their multiple context-dependent identities, a clearly defined“meta-identity” emerges in their narratives—that of immigrants from the FSU.This identity may help prevent the respondents’ illness from affecting their self-perception so they can retain a healthy identity.

Following immigration to Israel, the sense of belonging to the educated andcultured elite may have protective value, as it did in the USSR, and counterbalancethe loss of social status and experiences of discrimination (Rapoport & Lomsky-Feder, 2002). In addition, as it did in their homeland, work also has a significantmeaning in the construction of the respondents’ personal identities(Markowitz, 1993).

Our data suggest that the difficulties and transitions the Soviet Jews coped within the USSR enabled them to structure their identity as heroes. Like other religions,Judaism was banned in the USSR; religious practices were forbidden, and anti-Semitism was widespread. The abuse of psychiatry practiced in the USSR until theend of 1980s (van Voren, 2009) created a commonality between Zion dissidents andthe mentally ill, as both groups risked psychiatric hospitalization. Thus amongdissidents being labelled “mentally ill” became a symbol of heroism in the fightagainst the regime. This heroic self-perception appeared to protect the respondents’self-image in a context of very limited supportive interpersonal ties.

The present findings are congruent with findings from other studies on JewishFSU immigrants in Israel, Germany, and the USA, which indicate this group’stendency to adopt multiple cultural identities, mainly Russian, Jewish, and a newmainstream identity (Ben-Rafael et al., 2006; Horenczyk, 2000; Persky & Birman,2005). The opportunity to construct several identities and adapt claimed identitiesto specific situations seems to help these immigrants preserve a positive self-perception (LaFromboise et al., 1993). Respondents appear to move between thedifferent identities and, in different contexts (Bhabha, 1994), present the one thataffords them the maximal emotional or instrumental gain. They may attribute theirrejection by society not to their psychiatric situation, but rather to cultural disson-ances or other difficulties typical of the encounter of normative immigrants with





a new society (Pedersen, 1995). Similarly, they may attribute their problems in thelabor market, which were likely related to their illness, to their status as immi-grants. At the same time, respondents’ suspicious attitude towards authority andthe establishment (Remennick, 2007) encouraged them to exploit the collateraladvantages of being labeled “mentally ill,” such as State-proffered economic assist-ance and some immunity from judicial prosecution that mentally healthy immi-grants do not have.

The findings of the present study suggest that whereas normative immigrantsretain their Jewish-Russian identity while gradually acquiring a new Israeli identity(Ben-Rafael et al., 2006), immigrants who cope with SMI are less successful inintegrating into Israeli society. Their life stories tell of being rejected by Israelisociety and, in the terms of Berry (1997, 2001), they adopt the strategy of segre-gation and preserve their heritage identity. However, contrary to Berry’s assump-tion, and in line with the multicultural theory that explores the adaptationprocesses of immigrants from a subjective, contextual perspective (Rudmin,2009), this strategy is not necessarily harmful. Our findings suggest that FSUimmigrants may spare themselves the more painful experience of being rejectedbecause of their mental illness by focusing on their rejection by the host society dueto their immigrant status.

The present findings can be discussed not only from the perspective of accul-turation, but also with reference to the theory of dimensions of personal identity(Arredondo & Glauner, 1992). This theory aims to illuminate intrapsychic pro-cesses of individuals who cope with a double stigma. It submits three dimensionsthat affect identity formation: (a) an ecological dimension including variables ofinborn characteristics, such as gender, race, ethnicity, innate or acquired physicaland mental illnesses; (b) a sociopolitical dimension of acquired variables, such aseducation, occupation, religion practice, geographic location; and (c) a historicaldimension encompassing global events that shape human cognition.

Mental illness may disrupt the continuity of a life story and is often thought tonarrow an individual’s identity, suppressing dimensions that were significant in thepast (Yanos et al., 2010). However, the results of the present study do not supportthis assumption; in their life stories, our respondents underscored the dimensions ofidentity they could control (education, occupation, and immigration toIsrael—Dimension [2]) and related to sociohistorical events in their lives (theSoviet abuse of psychiatry, the disintegration of the USSR —Dimension [3]) inorder to construct a multidimensional identity. This allowed them to minimize therole of their mental illness (Dimension [1]), over which they had no control, andthus limit its negative effect on their self-perception. Their feelings of belonging tothe intelligentsia and of having a profession buttressed their positive sense of selfand of efficacy in the face of disrespect and discrimination from native Israelis andsocial stigma against persons with SMI (Corrigan & Kleinlein, 2005).

Contrary to the assumption of risk associated with a double stigma (Kidd et al.,2011), the present findings raise the possibility that the multitude of transitionsexperienced by the respondents enabled them to minimize their illness and





construct a positive, even heroic self-perception based on ethnic and culturaldimensions. As Jews, the respondents were accustomed to their minority statusin their homeland; later, as immigrants, they became accustomed to their minoritystatus in Israel. It is possible that because of these experiences, they may be moreresilient in the face of being stigmatized as “mentally ill.”

It is important to keep in mind, however, that respondents’ tendency to flattenthe theme of mental illness in their narratives does not necessarily mean that theydo not feel ill; it could alternatively represent an avoidance strategy vis-a-vis apainful and embarrassing issue. When one does not identify with the category ofmentally ill, one does not experience the associated decrease in self-esteem and thusattains some protection from social stigma (Warner, Taylor, Powers, & Hyman,1989). There is evidence that this pattern of sealing-over is not unique to immi-grants from the FSU and characterizes the strategies of many people who arecoping with mental illness (McGlashan, 1987; Tait, Birchwood, & Trower, 2003).

As suggested by Kleinman (1980), it is important to examine the choice ofcoping strategy by the psychiatric patients within a cultural and socioeconomiccontext. It is plausible that the common cultural background of the interviewer andthe respondents contributed to the adoption of the sealing-over style in the presentresearch, as it is not generally deemed acceptable in Russian culture to revealnegative feelings and mental difficulties (Polyakova & Pacquiao, 2006).Moreover, this strategy may be especially adaptive in a context of immigration;studies indicate that the wider social context and the everyday adjustment difficul-ties that immigrants encounter often lead them to understate their emotional crises(Ekblad, Abazari, & Eriksson, 1999).

The results of this study also suggest that mental health practitioners shouldrecognize the centrality of the experience of immigration and acculturation in thelives of their immigrant patients. This understanding may guide interventions andhelp practitioners establish working alliances by recognizing the role of theirpatients’ immigration experience in the formation of their identity, rather thanfocusing exclusively on their illness.

In terms of policy, the results suggest that service providers need to study thecultural profile of immigrant patients and build instruments and programs thattake their unique needs into consideration. Similarly, the findings support theapplication of innovative rehabilitation interventions that combine cognitive andnarrative psychotherapy and help alleviate self-stigmatization among persons withSMI (Yanos, Roe, & Lysaker, 2011). In the course of such interventions, stigmaticattitudes are challenged and an attempt is made to broaden patients’ narratives byattributing new interpretations of their lives that include dimensions of identity notdominated by the illness.

The postmodern perspective recognizes multiplicity in narratives and identitiesand asserts that each story reflects, and at the same time constructs, a selectedaspect of identity according to the context in which it is told, the audience towhich it is addressed, and the purpose the narrator assigns to it (Mishler, 2004).Thus in the present study the narratives do not reflect the full identity of the





respondents but rather those elements they chose to relate in the context of theresearch. The small number of respondents prevents the present research frombeing directly generalized to all FSU immigrants with SMI or to other immigrationgroups and settings. The fact that respondents were mostly male indicates that ourdata set likely underscores issues associated with male immigrant identity andmasculinity, while themes related to the experience of female immigrants may beunderrepresented in the narratives collected. In future research, a sample moreheterogeneous in terms of gender and more homogeneous in terms of age andtime of onset of the illness may produce a richer picture.

This is a pilot study that offers a glimpse into the experience of FSU immigrantswith psychiatric disorders in Israel and raises many questions: What cultural valuesand norms guide the process of identity formation among immigrants from othercultures and among other minority groups in Israel? What personal and culturalassets may be harnessed for the rehabilitation process of individuals with SMI fromdifferent ethnic groups? Does the process of “normalization” revealed in this studyoccur in other immigration settings? Future large-scale research is needed in orderto answer these questions and obtain a more comprehensive understanding of thejunction between mental illness and migration. Quantitative methodologies mayalso be applied in order to substantiate and elaborate on the findings of the presentstudy.

Funding

This research received no specific grant from any funding agency in the public, commercial,or not-for-profit sectors.

Acknowledgments

The authors wish to thank the participants for their valuable contributions to this study. The

authors also thank Dr. Gabriela Spector-Mersel and three anonymous reviewers for theirhelpful comments and suggestions.

References

Alasuutari, P. (1997). The discursive construction of personality. In A. Lieblich, &

R. Josselson (Eds) The narrative study of lives (pp. 1–20). Thousand Oaks, CA: Sage.Arredondo, P., & Glauner, T. (1992). Personal dimensions of identity model. Boston, MA:

Empowerment Workshops.

Bar-Yosef, R. W. (1968). De-socialization and re-socialization: The adjustment process ofimmigrants. International Migration Review, 2, 27–43.

Ben-Rafael, E., Lyubansky, M., Gluckner, O., Harris, P., Israel, Y., Jasper, W., & Schoeps,

J. (2006). Building a diaspora: Russian Jews in Israel, Germany, and the USA. Leyden,MA: Brill.

Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: AnInternational Review, 46(1), 5–34.

Berry, J. W. (2001). A psychology of immigration. Journal of Social Issues, 57(3), 615–631.





Bhabha, H. K. (1994). Between identities. In R. Benmayor, & A. Skotnes (Eds) Migrationand identity: International yearbook of oral history and life stories (Vol. 3, pp. 183–189).Oxford, UK: Oxford University Press.

Bhugra, D., Leff, J., Mallet, R., Morgan, C., & Zhao, J.-H. (2010). The Culture and IdentitySchedule a measure of cultural affiliation: Acculturation, marginalization and schizo-phrenia. International Journal of Social Psychiatry, 56(5), 540–556.

Birman, D., Trickett, E. J., & Buchanan, R. M. (2005). A tale of two cities: Replication of astudy on the acculturation and adaptation of immigrant adolescents from the formerSoviet Union in a different community context. American Journal of Community

Psychology, 35, 83–101.Central Bureau of Statistics. (2010). Statistical abstracts of Israel. Jerusalem, Israel: Author.Corrigan, P. W., Green, A., Lundin, R., Kubiak, M., & Penn, D. L. (2001). Familiarity with

and social distance from people who have serious mental illness. Psychiatric Services,

52(7), 953–958.Corrigan, P. W., & Kleinlein, P. (2005). The impact of mental illness stigma. In P.

W. Corrigan (Ed.) On the stigma of mental illness (pp. 11–33). Washington, DC:

American Psychological Association.Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness.

Clinical Psychology: Science and Practice, 9, 35–53.

Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self-stigma of mental illness:Implication for self-esteem and self-efficacy. Journal of Social and Clinical Psychology,25, 875–884.

Davidson, L. (2003). Livening outside mental illness: Qualitative studies of recovery in schizo-

phrenia. New York, NY: New York University Press.Ekblad, S., Abazari, A., & Eriksson, N. (1999). Migration stress-related challenges asso-

ciated with perceived quality of life: A qualitative analysis of Iranian refugees and

Swedish patients. Transcultural Psychiatry, 36(3), 329–345.Elias, N., & Lemish, D. (2011). Between three worlds: Host, homeland, and global media in

the lives of Russian immigrant families in Israel and Germany. Journal of Family Issues,

20(10), 1–29.Erikson, E. (1968). Identity, youth, and crisis. New York, NY: W. W. Norton.Estroff, S. E. (1989). Self, identity, and subjective experiences of schizophrenia: In search of

the subject. Schizophrenia Bulletin, 15(2), 189–196.Gergen, K. J., & Gergen, M. M. (1988). Narrative and the self as relationship.

In L. Berkowitz (Ed.) Advances in experimental social psychology (Vol. 21, pp. 17–56).San Diego, CA: Academic Press.

Gordon, M. M. (1964). Assimilation in American life: The role of race, religion, and nationalorigins. New York, NY: Oxford University Press.

Grinberg, L., & Grinberg, R. (1984). A psychoanalytic study of migration: Its normal and

pathological aspects. Journal of the American Psychoanalytic Association, 32(1), 13–38.Horenczyk, G. (2000). Conflict identities: Acculturation attitudes and the immigrants’ con-

struction of their social worlds. In E. Olshtain, & G. Horenczyk (Eds) Language, identity,

and immigration (pp. 13–30). Jerusalem, Israel: Magnes Press.Jurcik, T., Chentsova-Dutton, Y. E., Solopieieva-Jurcikova, I., & Ryder, A. G. (2013).

Russians in treatment: The evidence base supporting cultural adaptations. Journal ofClinical Psychology, 69(7), 774–791.





Kacen, L. (2010). Analysis of life stories’ titles [Hebrew]. In L. Kacen, & M. Krumer-Nevo(Eds) Qualitative data analysis (pp. 299–315). Beer-Sheva, Israel: Ben-Gurion Universityof the Negev Press.

Kidd, S. A., Veltman, A., Gately, C., Chan, J., & Cohen, J. N. (2011). Lesbian, gay, andtransgender persons with severe mental illness: Negotiating wellness in the context ofmultiple sources of stigma. American Journal of Psychiatric Rehabilitation, 14, 13–39.

Kirkpatrick, H. (2008). A narrative framework for understanding experiences of people withsevere mental illnesses. Archives of Psychiatric Nursing, 22(2), 61–68.

Kleinman, A. M. (1980). Patients and healers in the context of culture. Berkeley: University

of California Press.LaFromboise, T., Coleman, H. L. K., & Gerton, J. (1993). Psychological impact of bicul-

turalism: Evidence and theory. Psychological Bulletin, 114, 395–412.Lally, S. J. (1989). Does being in here mean there is something wrong with me? Schizophrenia

Bulletin, 15(2), 253–265.Lavretsky, H. (1998). The Russian concept of schizophrenia: A review of the literature.

Schizophrenia Bulletin, 24(4), 537–557.

Leipzig, C. (2006). When Russians come to therapy. The American Journal of FamilyTherapy, 34(3), 219–242.

Lerner, Y., Kertes, J., & Zilber, N. (2005). Immigrants from Soviet Union, 5 years post-

immigration to Israel: Adaptation and risk factors for psychological distress.Psychological Medicine, 35(12), 1805–1814.

Levav, I., Kohn, R., Flaherty, J. A., Lerner, Y., & Aisenberg, E. (1990). Mental healthattitudes and practices of Soviet immigrants. Israel Journal of Psychiatry and Related

Sciences, 27, 131–144.Lieblich, A., Tuval-Mashiach, R., & Zilber, T. (1998). Narrative research: Reading, analysis

and interpretation. Thousand Oaks, CA: Sage.

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Beverley Hills, CA: Sage.Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma

as a barrier to recovery: The consequences of stigma for the self-esteem of people with

mental illnesses. Psychiatric Services, 52(12), 1621–1626.Markowitz, F. (1993). A community in spite of itself: Soviet Jews emigres in New-York.

Washington, DC: Smithsonian Institution Press.

McAdams, D. P. (1993). The stories we live by: Personal myths and the making of the self.New York, NY: William Morrow.

McAdams, D. P., Josselson, R., & Lieblich, A. (Eds). (2006). Identity and story: Creative selfin narrative. Washington, DC: American Psychological Association.

McGlashan, T. H. (1987). Recovery style from mental illness and long-term outcome.Journal of Nervous and Mental Disease, 175, 681–685.

Mirsky, J. (2009). Mental health implications of migration: A review of mental health com-

munity studies on Russian-speaking immigrants in Israel. Journal of Social Psychiatryand Psychiatric Epidemiology, 44(3), 179–187.

Mirsky, J., & Kaushinsky, F. F. (1989). Migration and growth: Separation individuation

process in immigrant students in Israel. Adolescence, 24, 725–740.Mirsky, J., Kohn, R., Levav, I., Grinshpoon, A., & Ponizovsky, A. M. (2008). Psychological

distress and common mental disorders among immigrants: Results from the Israeli-basedcomponent of the World Mental Health Survey. Journal of Clinical Psychiatry, 69,

1715–1720.





Mishler, E. G. (1986). The analysis of interview-narratives. In T. R. Sarbin (Ed.) Narrativepsychology: The storied nature of human conduct (pp. 233–255). New York, NY: Praeger.

Mishler, E. G. (2004). Historian of the self: Restoring lives, revising identities. Research in

Human Development, 1, 101–121.Pedersen, P. (1995). The five stages of culture shock: Critical incidents around the world.

Westport, CT: Greenwood Press.

Persky, I., & Birman, D. (2005). Ethnic identity in acculturation research: A study of mul-tiple identities of Jewish refugees from the former Soviet Union. Journal of Cross-CulturalPsychology, 36(5), 557–572.

Phinney, J. S.,Horenczyk,G., Liebkind,K.,&Vedder, P. (2001). Ethnic identity, immigration,and well-being: An interactional perspective. Journal of Social Issues, 57(3), 493–510.

Polkinghorne, D. E. (1991). Narrative and self-concept. Journal of Narrative and LifeHistory, 1, 135–154.

Polyakova, S. A., & Pacquiao, D. F. (2006). Psychological and mental illness among elderimmigrants from the former Soviet Union. Journal of Transcultural Nursing, 17, 40–49.

Rapoport, T., & Lomsky-Feder, E. (2002). “Intelligentsia” as an ethnic habitus: The incul-

cation and restructuring of intelligentsia among Russian Jews. British Journal ofSociology of Education, 23(2), 233–248.

Remennick, L. I. (2007). Russian Jews on three continents: Identity, integration, and conflict.

New Brunswick, NJ: Transaction.Riessman, C. K. (1993). Narrative analysis. Newbury Park, CA: Sage.Ristner, M., Ponizovsky, A. M., Kurs, R., & Modai, I. (2000). Somatization in an immigrant

population in Israel: A community survey of prevalence, risk factors, and help-seeking

behaviour. American Journal of Psychiatry, 157, 385–392.Roe, D. (2005). Recovering from severe mental illness: Mutual influences of self and illness.

Journal of Psychosocial Nursing and Mental Health Services, 43(12), 34–40.

Roe, D., & Davidson, L. (2005). Self and narrative in schizophrenia: Time to author a newstory. Journal of Medical Humanities, 31, 89–94.

Rosenthal, G. (1993). Reconstruction of life-stories: Principle of selection in generating

stories for narrative interviews. In R. Josselson, & A. Lieblich (Eds) The narrativestudy of lives (pp. 59–91). Newbury Park, CA: Sage.

Rudmin, F. W. (2009). Constructs, measurements and models of acculturation and accul-

turative stress. International Journal of Intercultural Relations, 33, 106–123.Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or

bidimensional? A head-to-head comparison in the prediction of personality, self-identity,and adjustment. Journal of Personality and Social Psychology, 79, 49–65.

Schwartz, S. J., Montgomery, M. J., & Briones, E. (2006). The role of identity in accultur-ation among immigrant people: Theoretical propositions, empirical questions, andapplied recommendations. Human Development, 49, 1–30.

Shor, R. (2006). When children have problems: Comparing help-seeking approaches ofIsraeli-born parents and immigrants from the former Soviet Union. InternationalSocial Work, 49(6), 745–756.

Spector-Mersel, G. (2011). Mechanisms of selection in claiming narrative identities: A modelfor interpreting narratives. Qualitative Inquiry, 17(2), 172–185.

Strauss, A., & Corbin, J. (1994). Grounded theory methodology: An overview. In N.K. Denzin, & Y. S. Lincoln (Eds) Handbook of qualitative research (pp. 273–285).

Thousand Oaks, CA: Sage.





Tait, L., Birchwood, M., & Trower, P. (2003). Predicting engagement with services forpsychosis: Insight, symptoms and recovery style. British Journal of Psychiatry, 182,123–128.

van Voren, R. (2009). Political abuse of psychiatry – An historical overview. SchizophreniaBulletin, 36(1), 33–35.

Warner, R., Taylor, D., Powers, M., & Hyman, J. (1989). Acceptance of the mental illness

label by psychotic patients: Effects on functioning. American Journal of Orthopsychiatry,59, 398–409.

Yanos, P. T., Roe, D., & Lysaker, P. H. (2010). The impact of illness identity on recovery

from severe mental illness. American Journal of Psychiatric Rehabilitation, 13(2), 73–93.Yanos, P. T., Roe, D., & Lysaker, P. H. (2011). Narrative enhancement and cognitive

therapy: A new group-based treatment for internalized stigma among persons withsevere mental illness. International Journal of Group Psychotherapy, 61, 577–595.

Evgeny Knaifel, MA, is a PhD candidate at the Spitzer Department of Social Work,Ben-Gurion University of Negev, Israel. His research interests lie in the areas ofmental health and immigration in the context of psychiatric rehabilitation andcultural adaptation of immigrants with mental illness and their families.

Julia Mirsky, PhD, is a clinical psychologist, an Associate Professor in the SpitzerDepartment of Social Work, Ben-Gurion University of the Negev, Israel, andChair of this department. She specializes in psychological aspects of migrationand issues in cultural competence and culturally informed service delivery. Dr.Mirsky served on national committees and as a consultant on issues related toimmigrants, immigrant children and adolescents. She has been involved in inter-national research projects and has published widely on her subject in internationalprofessional periodicals.




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