Stumbling Into Adulthood: Learning From Depression While Growing Up

Abstract

Depression manifests in distinct ways across the life course. Recent research emphasizes how depression impedes development during emerging adulthood. However, our study—based on 40 interviews with emerging adults from multiple regions in the United States, analyzed following grounded theory—suggests a more complex narrative. Increasing experience with cycles of depression can also catalyze (a) mature perspectives and coping mechanisms that protect against depression’s lowest lows; (b) deeper self-knowledge and direction, which in turn promoted a coherent personal identity; and (c) emergence of a life purpose, which fostered attainment of adult roles, skill development, greater life satisfaction, and enriched identity. Our synthesis reveals how depression during emerging adulthood can function at once as toxin, potential antidote, and nutritional supplement fostering healthy development. Our central finding that young adults adapt to rather than recover from depression can also enrich resilience theory, and inform both social discourse and clinical practice.

Having depression has definitely thrown wrenches in the works of my stumbling entrances into adult life … [but] the ability to assess what’s going on both on and under the surface of my mind and make healthy choices about how to deal with and navigate them has helped and probably will help me, not just with depression, but with less clinical things. … I definitely feel like I’m developing the skills with which to navigate living with depression [and it helps me] navigate living life.

Introduction and Background

In the United States, approximately 16% of adults aged 18 to 24 years report having been diagnosed with depression at some point in their young lives (Strine et al., 2008). A number of epidemiological studies and large-scale surveys have generated data linking depression in adolescence—and during the decade between ages 20 and 30—with a range of other difficulties, including low levels of career satisfaction and educational achievement, additional mental health problems, limited self-esteem, substance dependence or abuse, insufficient social support, and poor self-rated health (Avenevoli et al., 2015; Berry, 2004; Brière et al., 2014; Paradis et al., 2006;Reinherz, Giaconia, Wasserman, et al., 1999).

Growing attention to the specific impact of depression on people in their late teens and twenties corresponds with efforts in the behavioral and social sciences to more carefully delineate “emerging adulthood” either as a distinctive developmental phase (Arnett, 2000, 2007; Berry, 2004), or simply as a protracted period between adolescence and adulthood created by contemporary social and economic conditions (Côté & Bynner, 2008). Changes in industrial society during the second half of the 20th century, such as later average ages for establishing a family and higher rates of high school graduation, have resulted in the transition to adulthood being “drawn out over a span of nearly a decade and consist[ing] of a series of smaller steps rather than a single swift and coordinated one” (Waters et al., 2010, p. 4). Young people are now “largely expected to find their own way into adulthood” (Ritchie et al., 2013, pp. 415–416), rather than to follow predictable, rapid, and direct pathways between school and work and between home of origin and married life (Arnett, 2000; Ritchie et al., 2013). Arnett (2000), who advocates a developmental view, summarized emerging adulthood as a time when

many different directions remain possible, when little about the future has been decided for certain, when the scope of independent exploration of life’s possibilities is greater for most people than it will be at any other period of the life course. (p. 469)

Regardless of whether emerging adulthood is viewed as an essential developmental stage or one caused by changing economic and social conditions, emerging adults are demographically distinct because their life circumstances are more varied than those of either adolescents or adults (Arnett, 2000, 2007; Ritchie et al., 2013; Schwartz et al., 2011). Many live with their families of origin and many do not; many are in school and many are not; many cohabitate with a romantic partner and many do not. Subjectively, when asked on surveys to say whether they have reached adulthood, most respondents in this age range describe themselves neither as adolescents nor as adults, demonstrating they also perceive a distinct period exists between these other two established developmental phases (Arnett, 2000).

Emerging adulthood has also been described as a period of intense self-focus (Konstam et al., 2015) and identity formation. During this time, young adults explore fundamental questions about themselves as individuals, their worldview and convictions, their sexuality, and how to negotiate social relationships. As highlighted by Erikson (1968) and subsequent scholars (Bronk, 2011), identity formation during emerging adulthood is intrinsically entwined with the overlapping process of forming a sense of purpose in life. As Bronk (2011) defines it, identity is “… personally meaningful aims and beliefs as they pertain to a consistent sense of who one is and who one hopes to become.” Purpose, on the contrary, “describes an enduring, personally meaningful commitment to what one hopes to accomplish or work towards in life” (p. 32). Depressive symptoms complicate every life aspiration.

Depressive symptoms complicate every life aspiration. Research suggests that specific traits and circumstances afford young people more or less resilience as they face challenges (Bhullar et al., 2014; Zimmerman et al., 2013). But most applications of resilience theory to young adults with mental illness have focused more on individual protective attributes than on the subjective processes through which individuals negotiate their complicated journey toward clarified identity and life purpose.

Two small qualitative studies, based on semi-structured interviews, suggest some patterns and fertile ground for additional research into the subjective experience of depression among younger adults. The first, with 13 Canadian participants aged 15 to 24 years, suggests that the identification of a mental illness (not limited to depression) is followed first by a sense of loss, then adaptation, and—finally—“recovery” (Leavey, 2009). The second study identified that symptoms of depression overwhelm young adults when facing expectations associated with emerging adulthood and are perceived as impediments to achieving valued life goals. Moreover, an unfortunate cycle existed for many study participants, whereby depression led to relational and work-related disappointments, which were then amplified in meaning because they were experienced as connoting “failure” in the adult life process (Kuwabara et al., 2007, p. 7).

Qualitative investigations into depression in adults of all ages reinforce these age-specific studies, highlighting healing processes after initial onset and illustrating varied ways of coping with the impact of mental illness on perceptions of self (Karp, 1994; Ridge & Ziebland, 2006). Although this work lays useful groundwork for understanding the subjective experience of depression among emerging adults, it offers little insight about the factors, processes, or interpretive lenses that enhance resilience for some young people experiencing depression.

In this article, we address this gap by drawing on data from 40 intensive interviews with 38 respondents in the United States, aged 18 to 29, who identified as having depression. We examine how depression impacted their transition from adolescence to emerging adulthood, and built their capacity to form a coherent identity and find a purpose in life. Our analysis contributes a new perspective to the nascent literature in this area by illustrating that emerging adulthood and experiences of depression do not necessarily negatively reinforce one another. Rather, they can also link together in a feedback loop that enhances coping and resilience. This process does not represent “recovery” in any simplistic sense, but rather a lightening of depression’s proverbial load.

More specifically, our interview data suggest that for a subset of people, emergence out of adolescence can ease the burden of depression and render its cycles easier to bear. Our interviews also highlight how struggles with depression can facilitate deeper self-knowledge, which in turn helps the development of a coherent identity during this transitional life stage. Finally, these narratives describe how attachment to a life purpose formed through struggles with depression can, at least for some young people, catalyze a positive feedback loop that facilitates nascent identity formation, make attainment of adult roles possible, and facilitate skill development as well as a sense of satisfaction with life. To be clear, these potentially positive adaptations do not lessen the suffering and isolation that depression induces. Nonetheless, they allow a subset of emerging adults to come to terms with painful experiences, integrating them into their lives and identities in constructive ways.

After presenting our analysis, we consider implications for resilience theory and its applications to contemporary mental health policy. Our findings suggest that the impact of depression on emerging adults may be best illuminated by leveraging insights from the branch of resilience theory that views resilience as a form of social interpretation and meaning making. Applying this theory to our data suggests that young adults’ adaptations to depression’s cycles can be conceptualized, in many cases, as involving resilience rather than recovery.

Method

Primary data were generated from 40 semi-structured, in-depth qualitative interviews with 38 emerging adults (two respondents were interviewed twice, at their own request, to fill in self-perceived gaps from their initial responses), aged 18 to 29, who identified themselves as having depression. We employed a form of theoretical sampling often called “maximum variation,” designed to produce a diverse sample of interviewees able to describe the widest possible range of individual experiences young adults are having with depression in the United States (Corbin & Strauss, 2014; Coyne, 1997; Herxheimer et al., 2000). Following grounded theory methodology, we iteratively designed interview questions to ask using a semi-structured interview guide, then analyzed and interpreted what we learned from early interviews to revise our guide and build on inductively derived insights (Corbin & Strauss, 2014).

A multidisciplinary team of advisors provided guidance throughout the study, from recruitment through production of a website module highlighting major themes. These advisors consisted of clinicians, participants, an artist with a focus on mental health, and a health experience researcher. The study was approved by the University of Wisconsin–Madison Social and Behavioral Sciences institutional review board (IRB), which also acted as IRB of record for Yale University.

Recruitment and Interviewee Characteristics

Because this study focused on exploring the broadest possible range of experiences, participants were recruited for maximum diversity. We sought to include men, women, and persons with diverse gender and sexual identities representing various self-reported racial categories, ethnicities, social classes, and ages between 18 and 29. We sampled specifically for diversity of geographic region and environment, recruiting participants living in rural, suburban, and urban areas of the West, Midwest, and Eastern regions of the country along with participants who had lived in the South. We also sampled for diversity of family structure; religious background; age of onset and diagnosis; treatment preferences; educational attainment; and experiences with work and career. Recruitment was conducted using ads on Craigslist, fliers, word of mouth, referrals from project advisors, and snowball sampling. To be eligible for the study, participants had to identify as having depression and be at least 18 years old. As recruitment continued, we selectively targeted our efforts and interviewed only those who could diversify our sample. Table 1 summarizes key characteristics of study participants.

Table 1.

Background Characteristics of Participants (N = 38).

Characteristics	Study Sample (%)
Age at interview
18–20	21.1
21–23	31.6
24–26	23.7
27–29	23.7
Age of diagnosis of depression
<15	28.9
15–20	44.7
20+	13.2
No clinical Dx	13.2
Self-reported age of illness presentationa
<15	75.7
15–20	18.9
20+	5.4
Gender
Female	50.0
Male	42.1
Trans	7.9
Sexual orientation
Heterosexual	76.3
Bisexual	15.8
Gay/lesbian	7.9
Race/ethnicityb
White	63.9
African American	20.4
Asian	11.1
Mixed	2.8
Other	2.8
Latino	10.5
Treatment of depression
Meds: On now	39.5
Meds: Ever been on	71.1
Meds: Never been on	26.3
Therapy: Ever had	81.6
Therapy: Never had	18.4
Both: Ever had	65.8
Both: Never had	10.5
Other mental health conditions	47.7

^aN = 37.

^bN = 36.

The Interviews

Interviews were conducted between January and November 2015, in the homes of participants (n = 22) or at a nearby location such as a private room in a library or community center (n = 18). Length of interviews was between 60 and 150 minutes. Potential participants spoke with interviewers on the phone prior to the interview, and received documents describing the study in detail. Informed consent was given in person prior to the start of each interview.

Each interview began by inviting the participant to tell his or her own story about living with depression. Semi-structured questions followed using a guide (see Supplemental Material) created by consulting published literature (e.g., Kuwabara et al., 2007; Leavey, 2009). The original questions addressed pre-diagnosis signs, knowledge, and impressions of depression; receiving a diagnosis; therapy and counseling, medication, and hospitalization; self-help, informal supports, and integrated/holistic approaches; and the impact of depression on school, work, and relationships. (For participants who had not received a clinical diagnosis of depression, questions about treatment focused on their interactions with nonspecialist health care providers and on why they elected to avoid clinical treatment.) Following grounded theory methodology (Corbin & Strauss, 1990), as the study proceeded we added probes to explore emerging topics such as the role of pets, the impact of depression on life purpose and outlook, and how depression affected experiences transitioning to adulthood. Although a number of respondents described other psychiatric diagnoses or emotional problems besides depression, the interviewers focused on explicating experiences with depression; other mental health issues were explored only with respect to how they intersected with or were mediated by depression.

Data Analysis

Audio recordings of the interviews were transcribed verbatim by research assistants or professional transcriptionists. Data were analyzed using a modified grounded theory approach (Corbin & Strauss, 1990, 2014). During Phase 1, or open-coding, all authors used an iterative process to review transcripts and discuss emerging themes. The coding scheme, which included both a priori and newly discovered thematic categories, was continuously revised until data analysis, at version eight, no longer suggested refinements or new codes.

In Phase 2 we employed axial coding, coding text by topic using the constant comparative method to identify subthemes and articulate their conceptual relationships to other topics. This article focuses on a set of interlocking themes derived from our full analysis of transcripts: the effects of depression on transitions to adulthood, the development of a sense of life purpose, and the emergence of adult identity. Specific dimensions of these themes and their relationships to one another, as presented in this article, were developed using both coded data and referral back to the original transcripts. These dimensions were then reviewed and re-reviewed by R.G., M.S., and M.W. to verify “theory-observation” congruence (Corbin & Strauss, 1990), and informed by a thorough review of the literature.

Findings

Challenges Related to Life Transitions

Transitions of any kind can be difficult to manage when depressed (Reinherz, Giaconia, Wasserman, et al., 1999)—and emerging adulthood is characterized by multiple significant changes including new living situations, educational opportunities, careers, and relationships (Arnett, 2000, 2007; Ritchie et al., 2013). Our interviews reflected this reality. Transition challenges were often exacerbated by specific stressors related to leaving childhood such as losing day-to-day parental support and the onset of complex adult responsibilities. These findings, which we have documented more fully elsewhere (Health Experiences Research Network, 2016), elaborate those previously identified in the literature (Kuwabara et al., 2007; Leavey, 2009). Broadly aggregated, they reveal two meta-themes: falling behind, and feeling different.

Falling behind.

Many of our interviewees associated having depression with delays in normative transitions such as leaving home, going to college, or starting a first job. One young man, for example, says depression “stunted my growth in so many ways”; at age 25, he feels he “… could’ve been greater” had his illness not “made me believe I couldn’t. Genuinely believe that I couldn’t.” Feelings of inadequacy about taking on adult roles could also exacerbate depression. As a young woman put it, falling behind

… makes me frustrated because being 29 I should be able to have a degree and have a job, have a car, be able to pay all my bills, have custody of my daughter and be able to live a normal life and I can’t. I really can’t live like everybody wants me to.

Feeling different.

The feeling of being different from peers was often described as beginning before emerging adulthood, and even before depression was recognized or diagnosed. In one female participant’s words, “I have felt different than a lot of my peers for almost as long as I can remember, even in young childhood…. I always had these very deep darker thoughts and when I would ask friends that were my age whether they had ever thought about that, the thought had never crossed their mind.” These perceived differences exacerbated a sense of social isolation. As one interviewee put it, “I didn’t have a lot of kids that wanted to play with me because I felt like they didn’t get me because I was in a different predicament and I didn’t really understand how they were living.”

Delays in advancing through life’s stages and peer-group distancing can erode much of the scaffolding that helps young people negotiate their initial steps into adulthood (Côté & Bynner, 2008; Waters et al., 2010). However, as we show below, emerging adults we interviewed also described how gaining distance from adolescence and developing introspective capacities through struggles with illness altered depression’s grip, producing life-stage-appropriate forms of resilience, growth, and personal development.

Gaining Perspective: Learning to "Ride the Cycles of Depression"

Although age and accumulating experience influence all humans, young adults with depression in our study described a set of distinctive experiences. As they grew toward independence and away from dependencies associated with adolescence, a number of our interviewees described changes in how they cope with cyclical symptoms of depression, including a partial normalization of symptoms that initially felt terrifying, and refinement of their own coping skills hard-earned from past suffering.

Gaining independence.

For some young adults we interviewed, increased independence from homes and communities of origin made things easier with respect to their depression because “… when you are not trapped in the house, when you have more independence, when you are not at the whim of other people … it gets so much better …” Getting a driver’s license and knowing you “could just like get in and drive around” afforded relief for some; as one participant put it, “I’m a 22-year-old adult, I’m gonna go on a drive because I’m feeling sad today.” For others, moving out of their parents’ home, “being around this different environment, and just being able to start over … has made it a lot easier.” As one young woman noted, “Once I moved out of my mom’s house … doors opened up, everything opened up.”

The literature on adolescent depression highlights difficulties teens can have going public with their illness and getting help if their parents are unable or unwilling to facilitate, or if intrafamilial stigma in the form of mistrust, blame, rejection, or avoidance is high (González-Torres et al., 2007; Moses, 2010; Radovic et al., 2015). These factors were salient for many of our participants, who reflected on the relief of moving past the stage of life when they lived at home with parents who did not take constructive action on their behalf because they did not believe the problem was real, because they were struggling with their own mental health or substance abuse issues, or because of a paralyzing fear of stigma (Health Experiences Research Network, 2016).

Experience with depression can make suffering less acute.

Internal changes people experience as they grow up can be even more transformative for their depression than increased independence. Our interviews were replete with testimony about how experience, though no panacea, can in fact be a healer. Although they hadn’t realized this would be so when in the midst of their teen years, improved quality of life was a decided reality for many once they reached young adulthood. As one interviewee summarized,

In the very beginning, it was absolutely chaotic … a jumble of information and feelings and thoughts and emotions and worries. And I had no idea how to … package that up in a manageable way. And, and address it. And I feel like … a lot of younger people with depression are going to go through the exact same thing. And part of that is because being young, you just that’s how your brain works. Your life is like that. It’s very chaotic and it’s … very hard to manage even without depression…. So as you get older, and I hate to say that because that’s what my parents always said, but like, you get older, you get better at managing situations. But there will be a point where things start to just naturally clear up, because your brain develops and you’re able to just process information better, more effectively … and then you can make decisive actions and then you can see the results …

Almost all of our participants described their depression as waxing and waning over time. For some, the cyclical nature of the illness continued to make things harder because awareness of its “bad phase” casts such a long shadow, even when “feeling fine.” Echoing a finding by Karp (1994), some also described how repetition of the cycles can be profoundly demoralizing and exhausting. As explained in detail below, however, for many the capacity to more smoothly “navigate the journey” markedly increased as they got older, gained more experience with and perspective on their own depression, and left adolescence behind.

Realizing that everything is temporary.

A central theme from our interviews is that young adulthood often yields knowledge elusive in adolescence—namely, that even severe depression will abate and, concomitantly, later bouts will be easier to survive because “if you’ve dealt with horrible things in the past and you’ve made it through,” you can “make it through so many more.” One young man described knowing he will eventually get back “to the top of the bell curve,” because though depression “definitely has pits … the only constant is change.” A young woman talked about her increased capacity to manage even very low lows: “When I was younger I thought depression would be the end of me,” she said, “But now that I’m older I realize that it’s something that many people deal with in life and that’s it’s kind of an ongoing battle and that … if you can make it through one day you can make it through … the next round of things …” Other young adults referred even more explicitly to attempted suicide, noting, for example, that if they had been able to see as adolescents that the depth of depression they were feeling at the time “is temporary, everything is temporary,” they would “not have tried.”

For some people, acute ups and downs mellow, with age, to something more akin to chronicity. Their illness is then no longer mysterious and becomes something with which it is possible to become “more comfortable.” As summarized in one participant’s reflections on his progression from “suicidal depression” at age 10 to his current young adulthood,

… what I’ve learned … is that periods of hopelessness are temporary. And that if you wait them out, you normally see a solution that you haven’t thought of before. So sometimes, it is that. Other times … It’s something that you live with. It’s something that you make adjustments to … like … having like a sore shoulder or something. You want to be careful with heavy—lifting heavy objects. You don’t want to hurt yourself but it’s an annoyance, it’s not something that’s taking you out of the game. And that’s what I’m trying to remind myself is that no matter, no matter how bad I feel, it’s almost never actually that bad and if I just keep on doing what I’m doing that I normally turn out OK.

Dread about return of bad times during the good ones can also abate—at least a little—with age. This may mean less time focused on awareness that “the happiness ends.” In the words of one young woman,

I sort of had these ebbs and flows like throughout my childhood and I think a lot people can relate to that … there would be … a bad few months and then a good few months, and then maybe a bad year and then a good couple weeks, but … I spent a lot of those good periods in … this petrification like this feeling … “yeah things are good now, but I can’t really truly enjoy them because I’m still just waiting for the other foot to fall.” So, since, since moving out and since having a lot better outlook on a lot of the things happening to me, I’ve had a lot of an easier time enjoying things and enjoying people … and building new relationships.

Another participant emphasized hard-won perspective about his own ongoing loss of joy, noting that though his illness “… can be debilitating and it can rob a peaceful moment from you and that’s the extra struggle of it that sucks,” he has learned to remember “… that happiness isn’t gone. It’s maybe hiding around a little bit but you can find it again as long as you believe that it’s still there.” The key evolution for him has been learning to exhaust himself less in the “up” part of his cycle, so as not to “cave in” during the “down” part. Success with this renders his illness “… something that I work around … rather than something that occasionally comes in and fucks the shit up.”

Suffering as integral to life and joy.

Finally, a number of participants came to feel, with time, that cycles of depression informed their philosophical view of life. “Life has its ups and downs,” said one young woman, and this is necessary because “… if it was all flat, you’re not living … That beeping machine in the hospital goes up and down for a reason, [and] … to feel the good you have to feel the bad.” For another interviewee, growing older meant gaining new perspective about suffering:

When I was in my teenage years whenever something good would happen to me it always seemed like something terrible would also follow …, the way I look at it now is that it’s not necessarily a bad thing because … you can’t be happy forever, because then … you wouldn’t exactly know what happy is.

People we interviewed also described how depression-induced suffering rendered them more empathetic. One pathway to empathy was through sympathy for one’s own “depressed self,” learning over time to “have more compassion for myself.” Another route toward empathic understanding was through more awareness of other people’s suffering. One interviewee, for example, describes that

… despite the fact that [depression] has made my life a lot more difficult … it also affords me a great deal of empathy, a great deal of sensitivity, a great deal of understanding that someone who hasn’t struggled with something like this might not have … if you come into this world and you are more sensitive, you see more or you hear more. You’re a noticer—whether it’s the dew on some rose petals or it’s the immense suffering of the people in front of you.

A synthesis of emerging adults’ descriptions of how they learn to live with depression during the transition to adulthood is depicted in Figure 1. As they recounted their histories and envisioned their futures, many participants acknowledged that cycles of depression have been and are likely to remain part of their lives. Most of this subset found that, with time, the low points in each successive cycle sank less far toward despair before curving back upward. This is partly a result of increased self-awareness (as suggested by the arrow in Figure 1 just below the curve), and partly because accrued perspective prevents repeated triggers such as feeling different or falling behind (see boxes in the figure) from pulling the curve so far down, while increased independence and sense of command pull it back up.

Figure 1.

Learning to ride the cycles of depression in young adulthood.

Self-Knowledge and Identity: "Stuff Gets a Lot More Clear as You Get Older"

Developing a viable sense of self.

Our interviewees described emotional awareness as one of several valued forms of self-knowledge that depression helped—or sometimes forced—them to cultivate. Struggles with the illness led to reflection on “trigger points” or how to cope with being “exceedingly emotionally sensitive.” The resulting introspection, analysis of self, and monitoring of behaviors led for many to deepened self-understanding. As one young man put it, emphasizing benefits that emerged through earlier struggles with depression,

… stuff gets a lot more clear from the beginning as you get older …, the stakes are a lot higher … I’m happy that I’m aware now…. It’s like well when stuff gets real…. I’ll know how to deal with it … I’m aware enough in my emotions … most people aren’t aware of their emotions, honestly, like 90% of people aren’t aware of their emotions.

This acquired capacity to observe and monitor changes in emotional tenor is critical for being “able to recognize … symptoms when they start to emerge and [developing] … coping mechanisms to navigate my life …” Another interviewee observed that through depression “… I grew as a person because I understand myself better as I think about these trigger points and reflect on my life.”

Leaving adolescence behind also helped some with self-acceptance and self-esteem in general, and acceptance of depression-related struggles in particular. These findings offer additional perspective on summaries in the existing literature documenting the damaging, self-perpetuating nature of low self-esteem for depressed young adults (e.g., Reinherz, Giacona, Hauf, et al., 1999). “I think I have more compassion for myself,” noted one interviewee. Another noted,

When I was younger I just felt stupid, I felt like my feelings weren’t valid … and now I’m in a place where I could really identify … like I do struggle with things and that’s okay. But there’s a way I could struggle that’s helpful not hurtful to myself and to my relationships.

Other participants emphasized how getting older made them less reliant on the opinions of others, and able to build their self-esteem in new ways and to discover that it is possible to “survive without other people’s validation.” Increased self-knowledge also made it easier to reject normative definitions of what it means to be a young adult; as one young woman put it, being normal is “… not the goal here. I don’t want to be told that I’m normal. I want to figure out more of me, I want to figure out, you know, why I do stuff.” Here our findings echo emerging developmental neuroscience, which has documented diminishment in adults of the strong influence peers exert during adolescence (e.g., Smith et al., 2015).

Finally, more self-knowledge made it possible for some to contextualize depression as one part of a broader emotional repertoire. Depression makes life feel “really shitty” sometimes, but also increases capacity to be “really kind and giving and caring” and “a sensitive person.” As one participant noted,

I think so often we are talking about depression and anxiety as though it’s only a negative…. But you know, we all have these different ranges. I’m a person when it comes to …, the analogy about a piano, I play all the keys. I have very high highs and I have very low lows.

Enriched identity.

Depression overshadowed or obstructed the process of establishing an adult identity for many participants in our study. A subset, however, found that over time their illness experiences played a substantial role in the development of a more mature, satisfying sense of self. For these young adults, depression caused grave suffering, but also has a “silver lining” because it “built character and … kinda put things into perspective.” Our participants’ oft-repeated observation that “what doesn’t kill you makes you stronger”—the paradox of being “fragile but very, very strong”—acted as an umbrella for some notable subthemes.

A number of young adults expressed pride in their identity as someone who had survived and learned from depression. As one put it, “[depression] … has definitely contributed greatly to who I am, it has made me thankful, it has made me proud and I feel very accomplished having gone through something as life-threatening as that and making it to now.” Another described her mental illness as “a mutant power” that undergirds multiple aspects of her personality. Some referred explicitly to feeling more mature than their peers. “I’ll feel a lot more accomplished than some of my peers … [when] graduating from the university,” said one young man, looking ahead to the upcoming completion of this milestone, “[J]ust all of this will make that feel just so much more worthwhile and like I’ve accomplished so much …” Another said she believes her peers are missing a “deeper understanding of the world because to them, everything is rainbows, unicorns, and sunshine.” Her depression has taught her, however, that “… it’s not, and it makes you appreciate the times that are rainbows, unicorns, and sunshine because you know that the other days are very, very far from that.”

Pathways to Survival, Meaning, and Thriving: "Creating My Own Purpose in Life"

Life purpose has been defined as including three dimensions: clear intention to progress toward specific aims in life, personal commitment of time and other resources in service of such aims, and dedication to a cause beyond oneself (Bronk, 2011; Bundick, 2011; Damon et al., 2003). Many young adults we interviewed offered vivid descriptions of their own experiences with these processes, and how engagement in them was an essential aspect both of coping with their cyclical mental illness and of forming a coherent adult identity. Our participants described several distinct (though interrelated) kinds of life purpose—each of them deeply connected to past experiences with depression, and to development of an adult life that builds on rather than repudiates this reality.

Empathy and helping others

Being of help to other people was the “cause beyond self” most often named by our participants as the root inspiration undergirding commitment to work toward specific goals. One young man, who had been raised in a religious household but moved away from religious practice in his own life, put it this way: “While I no longer believe in God … forging connections and understandings with as many people as possible in as many degrees as possible to as deep level as possible is something that gives my life a great deal of meaning.” A young woman echoed a similar connection between serving others and life meaning:

I don’t think that we’re here to just, you know, take in, take in all the pleasures and just pass on to the next life or back into the dirt or whatever. I, I do think that we all [uh] serve, you know, [uh] serve a purpose to, to help others or to just get our message out. [Uh] I think if we were only here to observe, then life probably wouldn’t be as long as it is because, you know, I mean there’s only so much you can see and then it’s like, what’s left?

Narratives from some of our participants highlighted a circular relationship, or positive feedback loop, between dedication to helping others and alleviation of depression’s symptoms. As one summarized, tying the importance of purpose directly to his ability to manage depression,

I believe there’s a purpose in this Earth for me … having structure like that takes me out of my own head and puts me into a deepened, greater being, a greater purpose to help myself and others instead of just pulling the covers over my head and saying this is it, this is all life has to offer.

A second interviewee also described helping other people as the “sole reason we are here,” emphasizing that “… what suffering from depression and everything else has taught me is to help other people, is to teach other people and to learn as much about it as I can, so that I can help myself and others.”

One young woman’s narrative provides detail about all aspects of the feedback loop—how depression leads to greater empathy, increased empathy to “creating something good” by helping others, and the actualization of purpose to feeling better.

So depression gives me that drive to get something out. It gives me a strength and an understanding towards others because I know what it feels like to be fragile. I know what it feels like to be on the verge of killing yourself or on the verge of harming yourself. So I’m more capable of being sympathetic. And it helps me deal with my friends who have depression. It helps me understand them better and they seem to be drawn to my energy and positivity because that’s something that a lot of people with depression don’t have. And that’s the reason I have it, that’s the reason I project it, is because I understand that so many people just don’t have it. So it’s helped me realize where others might need help and where I need help and how that can fit together … I saw it for myself. I saw that I could create something that was good. I saw that I could benefit people’s lives. People have told me that I was a positive influence on them or that I saved them from this feeling of isolation or I provided them friendship when nobody else really did. So I kind of see that I can help people, that I’m contributing something. And that, in turn, helps me value myself and-and be nicer to myself. So that, and-and give myself a break. So that I can continue to be good. And that in and of itself is a bit of a self-feeding cycle as well.

For another participant, dedication to family constituted a powerful life purpose that kept her—along with others in our study—from falling prey to depression’s darkest sides. Her goal, she says,

… that I’ve had to help keep me going through each day is you know, take care of my family. So that’s the main rock that I go through … And so being dedicated to, continuing to be a role model and continuing to help my family in whatever ways that I can is what has occupied myself.

Embracing adult roles.

A second category of life purpose described by our participants was embracing adult roles such as developing a meaningful career or becoming a parent. Successfully identifying a professional direction and developing talents accordingly provided many interviewees with a practical as well philosophical focus— one that also served, in many cases, to counterbalance depression. One woman, for instance, was motivated to consistently use an antidepressant, because “It was important to me that I be able to maintain this image of myself as an ambitious, professional, hard-working person.” Another discusses how being taken on as an intern taught her to see things through to the end, and thus to develop a skill. “I never felt like I was lazy when I was depressed but I felt like I was taking up space, like I wasn’t doing anything,” she explained. But now “… I’m doing something again and I’m contributing something which is I guess like career, future career. I, I don’t feel like a waste of space anymore if that makes sense.”

For some, life purpose helping others combined with commitment to a career path, creating a trajectory similar to that described just above yet distinct because of the professional element. Like a number of other interviewees, one young woman found that depression made her more genuine, compassionate, and capable of creating a “safe space” for others. And she sees these qualities as essential to being a “better therapist” in her own career. “Clients can see me as more reliable,” she reflected. “I think as a therapist it’s important to have your own experiences.” At the same time, her dedication to work in the helping professions helped her take her life and studies more seriously, no longer wanting to be “that person” who would be “truant.”

Another young woman describes how damaging lack of purpose was to her mental health before she found her way to a counseling career, and how decisively things shifted when she set a path for herself and joined the helping profession.

I did not feel like I had a, a purpose back then. And so, if you don’t have a purpose, then, of course, why does anything matter and so that really just perpetuated that cycle of not caring. But so now my purpose has more shifted to I’m in the helping profession, I’m able to help people especially people with depression. I, I have clients who the majority of them are depressed and to see those symptoms in someone … it can really take you back sometimes if you, if you think about it too long. But I just feel for them so much and I just want to help and that’s, that’s my purpose…. [E]specially as the stigma is starting to go away. It’s more okay to ask for help like I should have and so just being there for other people to call on for help has been very meaningful.

Many young adults we interviewed described connections between their depression and a drive toward creativity which then cohered into a life purpose built around art. One interviewee explained that though her depression can make it hard to concentrate on work at times, it also makes her more introspective, informs how she “explores cool subject matters … [like] an animation or a drawing or whatever,” and has “benefits working in an artistic field.” Another meditated on how depression gives him access to emotional dimensions of theater work that would otherwise not be available.

[Depression] has also given me this unique perspective that I have that nobody else does with which I can tap into certain stories and certain characters and certain moves and tease them out of their actors, out of myself if I’m acting or other actors if I’m directing, out of designers and out of anyone who works on a show. It gives me this ability to engage with the art I want to make on an emotional level that I don’t think I would be able to access if I weren’t drawing from this pain in my past.

A career at home, parenting, can also provide a transformational purpose in life. One participant talks about how when she became pregnant, she grew much more “ … aware about the consequences of my actions, how you know I was more aware of my body of my thoughts, because I wanted to be better for this child you know.” She goes on to describe how dedication to the purpose of not passing on depression and its attendant negative outlook and dark thoughts motivated her toward a series of consistent actions.

So I made a very conscious effort, I was going to be more positive, I was going to eat better, I was going to go to counseling, I was going to do anything that I could to just be a more positive person so that she would never have and deal with what I had.

Depression-Infused Identity

Finally, some participants explicitly linked life purpose and identity, describing a generative, cyclical relationship between the two. In one participant’s formulation, struggles to overcome depression forced him to

… sit back and create [my] own philosophies on things, and thus to … believe that I create my own purpose in life. That I, that nothing’s really dictating what’s going to happen to me, that I’ve made all of these decisions that … I chose personally a lot of these things to do in my life that have bettered my life.

As a result, his identity is forming as someone with autonomy, who has “… the chance to make your own choices and really determine your future.”

Interviewee #30, like many others, found a depression-infused purpose in life being supportive of and empathic with other people. At the same time, her own struggles remain an integral part of who she is. She summarized how her sense of self evolved to include both needing and giving help like this:

I can be someone who struggles with and survives with this and deals with this and I can, you know, be someone who can be supportive. Actually no, that phrasing isn’t very helpful. Let me think, let me try again. I can, I can just hold both spaces, because I think that I’ve been on both sides of the table in many instances. I’ve many times been on the side of the table where you know, I’m holding someone else’s pain and I’m here to compassionately listen and be very attuned, but other times I need someone to hold that space for me, that safety, that nurturing and that compassion. And I think being able to accept that …

Depression’s positive influence on life purpose and identity in no way nullified, however, the excruciating process of achieving it. As one noted,

[Depression] makes you more capable of handling things, [but] it’s a silver lining on a very huge, very dark cloud…. The strength to endure incredible hardships is impressive, but I think anybody would prefer to not have to endure those hardships in the first place. Knowing that you’re capable was maybe more of a consolation prize.

Another elaborates a similar point:

I can easily imagine someone with depression … thinking, “what the fuck do you mean silver lining? This is an awful thing.” But I do think there is value to the perspective that I have felt things that made me feel really bad, things that happened to me that still sometimes make me feel really bad, but all that history and all that painful stuff in my present still makes me the person I am today. And on the whole, I am happy with the person that I am today …

Another facet of increasingly mature identity highlighted by our participants was flexibility. In another’s words,

I’m not trying to get rid of it any longer. I simply view it as an aspect of myself that I need to be aware of and work with. I kind of view depression like the weather. If it rains, I can’t really be upset about it. I simply have to wear a coat. And I have to be prepared for where my depression takes me sometimes. And I have to just understand that I need to give myself a break sometimes. But it’s not something that I think can be solved or cured. It’s just my perspective in life sometimes.

As we have shown, our interviewees described deeper self-knowledge and life skills borne of struggles with depression as facilitating development of a coherent identity—a process mediated by enhanced empathy, a viable sense of self, and a clearer connection to life purpose. Figure 2 captures this dynamic schematically, reflecting the multiple life stage processes described in our interviews. Individuals did not always track within a single stream, but evolved a sense of self that integrated insights and experiences from two or more. We explore the implications of this complex process of development and integration in more detail—as well as illustrate how it facilitates a distinct form of resilience among emerging adults—in the “Discussion” section.

Figure 2.

Multiple pathways to a depression-infused identity in young adults.

Discussion

Our findings reveal that for a substantial subset of emerging adults in our sample who were also depressed as adolescents, the transition from certain forms of helplessness and dependence characteristic of mid teenage years, toward greater autonomy and new horizons in later teens and twenties, eased the burden of depression. Our analysis suggests that increased age and experience, even while still a young person in a changeable stage of life, can yield new capacity to manage cycles of an illness that during adolescence felt cataclysmic. In some cases, they also point the way toward a distinct sense of identity and/ or specific life purpose that become guide stars through the murky, difficult process of becoming an adult.

Depression can—and frequently does—make growing up harder, delaying certain normative life-transitions like graduation, marriage, or entry into structured career paths. Emergence into adulthood can also exacerbate the negative impact of depression, reducing access to forms of social support previously available from family. Both these troubling experiences and the more optimistic interpretations that young people can often draw from them intersect as a more complex and interpretively rich conception of resilience in this age group.

Our discussion here therefore begins by exploring the significance of our findings about various pathways to the “depression-infused identity” shown in Figure 2. We then consider how resilience theory both illuminates and is extended by this analysis at the intersection where depression and emerging adulthood meet. We finish our discussion by considering some implications for contemporary social discourse.

Depression as Catalyst for Personal Development

Our findings about purpose, self-knowledge, and identity echo elements of one earlier study’s summary of adaptation and recovery processes for mentally ill young adults who “… compared with their typical peers … had to advance through the lifecycle stages more rapidly” (Leavey, 2009, p. 122). The suffering and alienation experienced by many young people with depression does form a sort of crucible—one in which their emerging sense of self can be forged and tempered. Our findings add to the existing literature, however, by suggesting some hitherto unrecognized pathways for this process— pathways that take us beyond conventional representations of suffering as a catalyst for strength to look instead at implications for adult identity formation.

First, by creating social distance between the person with depression and peers, depression takes away the “easy path” of conformity followed by so many adolescents (Moses, 2010). With this option stripped away, emerging adults must construct conceptions of self in a more autonomous way. As we have shown, initial efforts to do so may prove faltering or misguided. However, over time, they can bear precious fruit in the form of enhanced personal agency, which in turn can induce greater subsequent reflection, and—eventually—a deeper form of self-knowledge than might be possible to gain while simply conforming.

Second, as we have described, experiences with depression can stimulate greater empathy for other people’s suffering. Past research suggests that empathy during adolescence and early adulthood predicts pro-social attitudes and behaviors later in life (Allemand et al., 2015). Altruistic motivations can give positive meaning to life. In this way, emotional consequences of depression can provide a potent jump-start for some aspects of mature personal identity.

Finally, a sense of life purpose may be fostered in multiple and mutually reinforcing ways by various sequelae of depression. It is well-established that life purposes can emerge from suffering (Frankl, 1984; Kashdan & McKnight, 2013). Moreover, social isolation induced by depression may give rise to greater self-reflection, which further fosters the emergence of a well-defined sense of personal purpose (Bundick, 2011). Descriptions offered by the emerging adults we interviewed suggest these processes can occur even during tumultuous periods of rapid transition and in the midst of uncertainty about the future. Our interviews also illustrate that identification as a person living with depression can yield its own distinct form of life purpose—for example, through dedication to promoting the well-being of people with mental illness, becoming a “stigma buster,” or otherwise facilitating the health of others. This, in turn, can create a positive feedback loop which eases the burden of depression.

Not all young adults will follow all three of these paths toward enhanced identity. As Figure 2 conveys in graphical terms, the pathways most relevant to particular individuals depend in part on the trajectory of their own emerging senses of self. Even those who reported having a relatively less developed sense of self could nonetheless “feel” their way toward greater empathy with the suffering of others, and thus toward a form of identity deeply connected to empathic capacity (the left-most pathway in Figure 2). By contrast, participants in our study who could envision and embrace adult roles, such as parenting or a defined career, were sometimes able to incorporate the lessons they had learned coping with depression into their emerging sense of life purpose and identity (the right-most pathway in Figure 2).

Resilience Theory, Depression, and Emerging Adulthood

The findings summarized in this article may serve to illuminate a number of psychosocial theories, including labeling theory (Thoits, 2011) and various approaches to conceptualizing identity formation (Bronk, 2011). Our focus here, however, is on implications for resilience theory, both because that theoretical construct has been most frequently applied to the study of at-risk youth (Wright & Masten, 2015; Zimmerman et al., 2013) and because it has been repeatedly used to inform mental health interventions (Backer et al., 2015; Lennon et al., 2016), as well as social policy directed to young people and their families (Noyes, 2016).

Applying resilience theory to emerging adults.

A number of scholars explore how multiple social and psychological factors interact to shape resilience (e.g., Ungar & Theron, 2019). For the sake of simplicity here, however, we consider three distinct conceptual threads evident in resilience theory since it first emerged from its phenomenological roots during the 1980s: (a) trait-based models that link resilience to particular attributes of the individual, family, or social context; (b) process-based models that focus primarily on resilience as “something we do” rather than “something we have”; and (c) interpretive models that focus on how key actors make sense of their personal experiences in light of their social context (Aranda et al., 2012, p. 552). Although elements of all three threads were evident by the end of the 20th century (Richardson, 2002), the interpretive thread remains the least fully developed and least often applied to empirical studies of health and illness (Aranda et al., 2012; Wang et al., 2015).

A subset of the experiences described by young adults in our study can be categorized as forms of coping and learning consonant with process-based models of resilience (Lennon et al., 2016). However, a number of our respondents evidenced an arguably interpretivist form of resilience by transforming the meaning of depression from a disability into a form of empowerment that— though they would never have chosen it—now sits at the core of their sense of adult self and differentiates them from many of their peers. The rich narratives recounted in our interviews poignantly illustrate privately experienced “competing and conflicting forms of embodied subjectivity”—suffering, growth, and an evolving sense of self. Taken as a whole, these narratives also describe a “relationally and collectively lived” ethos of emerging adults using the experiences they have already had with depression to define their own life purposes and identities within a particular culturally defined life stage. Together, these insights from our interviews flesh out an interpretivist version of resilience which emphasizes “a reflexive self, generated relationally, whose subjectivity is negotiated through embodied, affective and historically and culturally situated biographies” (Aranda et al., 2012, p. 554).

Exploration of deep forms of identity transformation have largely been absent from the resilience literature as it has been applied to health and illness. Conceptualization of transformation has been largely focused on processes such as “steeling” or “inoculation,” documenting how moderate exposure to stressors can build up an individual’s capacity to cope with subsequent exposures to those same burdens in the future (Wright & Masten, 2015; Zimmerman et al., 2013). As our analysis above reveals, the transformative processes described in some of our interviews involved development of a depression-infused adult identity rather than merely a toughening of one’s existing self. This emerging identity at times drew upon creative or imaginative expressions of selfhood—for example, as a “stigma buster” or “someone who plays all the keys of the piano.” Similar conceptions of personal growth have been explored in some past studies of resilience and culture, but rarely applied to health or health care (Lee & Lee, 2016).

Relevance for other chronic health conditions.

Resilience frameworks have been used to illuminate the impact of a variety of health conditions that begin in childhood or adolescence (Cousins et al., 2015; Hilliard et al., 2012; Pembroke et al., 2017). We believe two aspects of experiences with depression itself—perhaps in contrast to many physical illnesses or injuries—are fundamental to the adaptive processes we describe in this article (see Figures 1 and 2). The first is that it is identity-defining, because it can reshape people’s relationships with their inner sense of self (Karp, 1994; Ridge & Ziebland, 2006). This renders depression more difficult to “externalize” in ways that sustain identity as distinct from the condition. The second is that symptom severity is often cyclical, which allows emerging adults iterative periods of reflective distance during which they can gain critical forms of self-awareness. To the extent that other chronic illnesses mimic these features of depression, it may be that their intersection with emerging adulthood results in patterns of adaptation similar to those described in this article. However, we expect that many early-onset conditions do not incorporate either or both of these features.

Implications for Social Discourse and Policy

The complex conceptualization of how depression and personal development can intersect during emerging adulthood we describe above has implications for how we describe and address depression among young adults. Two of these implications stand out as particularly consequential for refining contemporary social discourse and policy with respect to emerging adults’ experiences with depression.

Resilience with rather than recovery from depression.

When the existing literature touches on how individuals can find it easier to live with depression over time, authors rely almost exclusively on a recovery lexicon. Leavey (2009), for example, describes how emerging adults accept and adjust to mental illness (including but not limited to depression) as an adaptation process, which she calls “recovery.” Other research identifies elements of resilience, such as the ability to weather adversity, that moderated depression symptoms in young adults and, over time, promoted more consistent or effective coping (Carbonell et al., 2002). Ridge and Ziebland’s (2006) study of adult experiences with depression found that “disintegration of the façade of self” could lead to “profound shifts in the way that people felt about themselves,” and eventually facilitate integration of depression as meaningful and even potentially beneficial (pp. 1044–1045). Karp (1994) has a “career” framework for depression across the life span, which he categorizes as “coming to grips with an illness identity” and “getting past it” (pp. 22, 24).

The representation of these constructive responses as forms of “recovery” explicates “how people give meaning to recovery following depression” (Ridge & Ziebland, 2006). This framing is not surprising. Advocates and policy makers in many countries have, over the past two decades, made the case that everyone can, with appropriate treatment, recover from any form of mental illness— thereby seeking to reduce stigma for these conditions and increase public investments in treatment (Frese et al., 2001; Palmquist et al., 2017; Tanenbaum, 2006).

Although the recovery trope dominates contemporary social and policy discourse, the resilience literature has long recognized that recovery and resilience are far from synonymous. To be sure, many past studies have emphasized quantifiable distinctions, most often the divergent trajectories of adaptation and homeostasis following the onset of a health threat (Bonanno, 2005). But other distinctions—potentially more consequential in emerging adulthood—can also be seen through the more interpretivist lens we explore just above.

Our interviews with young adults included descriptions of personal development, such as enhanced coping skills and growing comfort with social interactions, which are also identified in the recovery literature. But the broader developmental dynamics embedded in these narratives were not, for the most part, consistent with a recovery narrative. “Recovery” suggests that those in question have put depression’s impact in the past—that they have “gotten past it” (Karp, 1994; Lieberman et al., 2008). Almost all young adults interviewed for our study, however—including those currently not depressed or experiencing only mild symptoms—anticipated that cycles of depression would remain part of their lives in future.

The distinction between resilience and recovery is more than semantic. If one aspires to “recover,” the re-emergence of symptoms represents a form of relapse. As depression remains stigmatized, relapse can also be experienced as a shameful “lapse” in character, betraying lack of will-power, lack of consistent follow-through with treatment, or lack of mature judgment (Thoits, 2011). By contrast, when people learn to expect they can live full and complete lives even in the context of their depression, the re-emergence of low mood may feel more like a return-visit from an unwanted yet familiar acquaintance. The “down” parts of depression’s cycles are never welcome, but over time they may become accepted and no longer connote shame, discredit, or personal failure. These cycles thereby no longer exert as much downward pressure on people’s lives, as suggested in Figure 1, depicting the experiences of transitioning to adulthood while living with depression.

Limitations

Our findings must, of course, be understood in light of certain methodological limitations. Our sample was self-selecting because we only considered for inclusion people who responded to our recruitment efforts. Although we interviewed a substantial number of participants who were actively depressed or still cyclically struggling, our sample was likely skewed away from people with most severe current manifestations. The fact that we could not include those who succeeded in committing suicide means that we did not hear from people most likely to offer narratives counter to the conclusion that growing up can make depression easier. Furthermore, although forms of resilience that we identified in this study may well be consequential for suicidal ideation (Matel-Anderson et al., 2019), our sample was too small and inappropriately constituted to fully explore these potential manifestations.

We also want to emphasize that many of our findings about how emerging adulthood can ease contextual pressures and augment buffers may be limited to the subset of people whose depression began during childhood or adolescence—a group that was plausibly overrepresented in our sample (see Table 1). The impact of social context and social capital (ranging from the negative effects of community-level stigma to the positive impact of family-and community-based support) certainly merits additional study, using a larger sample size and methods appropriate for investigating these phenomena. Finally, it is possible that as participants recounted their experiences they constructed narratives subject to attribution bias by overemphasizing positive personal agency and downplaying negative events (Ross, 1977).

Conclusion

Depression exacts a heavy toll on emerging adults. High rates of suicide for affected people in this age group underscore the depth of suffering it can cause and remind us never to regard the illness lightly. At the same time, the narratives explored in this article highlight how changes in life circumstance brought in by the tides of time, combined with accumulated experience riding depression’s cycles, can render the illness easier to cope with—at least for some—as adolescence becomes more distant and full adulthood nearer. Experiences with depression can also catalyze a “fast track” for the development of adult identity and purpose.

Our sampling methods make it unwise to extrapolate prevalence from our findings. But the positive pathways illuminated here were not unusual in our sample: Roughly three quarters of our interviewees described at least one dimension of such pathways in their personal accounts.

We believe the enriched framework for understanding interactions between emerging adulthood and depression we offer here is useful in several ways. Clinicians who work with emerging adults can better understand what forms of resilience to look for and scaffold. Researchers interested in building on our findings can test them with larger cohorts; for example, future studies might determine how subsets of people (perhaps stratified by class, race, or community environment) respond to barriers and buffers as they progress through emerging adulthood. Perhaps most importantly, the insights offered by these narratives can help other young adults—and those who care for and about them—to appreciate a broader range of possibilities for depression’s postadolescent trajectory.

As one interviewee noted, “I think [it] takes time for everyone to learn [and adapt to] their own personal limits.” In the words of another, depression is “… always a journey … [but it’s] a journey that I’m getting more comfortable with, like easier to navigate.” If these emerging adults’ stories of acquired perspective and capacity to live with their illness can help “someone out there who is going through the same issue that I am going through,” if these stories could “stop them from doing something self-destructive,” then the fondest self-stated aspirations of those who bravely told their stories for this project will be met.

Author Biographies

Rachel Grob, MA, PhD, is director of National Initiatives and Clinical Professor at the Center for Patient Partnerships, Senior Scientist at the Department of Family Medicine and Community Health, and Investigator at the Health Innovation Program, University of Wisconsin-Madison. She is a qualitative and mixed-methods researcher devoted to eliciting diverse narratives about health and health care, and using them to inform system change. She is on the national steering committee for the Health Experiences Research Network.

Mark Schlesinger, Ph.D. is Chair of the Department of Health Policy and Management, Professor of Health Policy, a fellow of the Institution for Social and Policy Studies at Yale University and past editor of the Journal of Health Policy, Politics and Law. He studies patient experience and patients’ responses to problematic medical encounters, including ways of enhancing the scope, clarity, and influence of patient voice. Dr. Schlesinger is on the national steering committee for the Health Experiences Research Network.

Meg Wise, MLS, PhD, is a qualitative researcher focusing on how people develop resilience in the face of chronic or life-threatening illness. Recently retired from the Sonderegger Research Center, she remains an affiliate at the Center for Patient Partnerships and the Health Experiences Research Network (HERN) at the University of Wisconsin-Madison.

Nancy Pandhi MD, MPH, PhD is associate professor and Vice Chair of Research at the University of New Mexico Health Sciences Center Department of Family and Community Medicine. She is a practicing family physician and mixed methods health services researcher. She serves on the Health Experiences Research Network (HERN) National Steering Committee.