Week 3 Discussion

Addiction Research and Theory

April 2009; 17(2): 152–167

Alcohol and the self: An interpretative phenomenological analysis of the experience of addiction and its impact on the sense of self and identity

PNINA SHINEBOURNE & JONATHAN A. SMITH

School of Psychology, Birkbeck University of London, London, UK

(Received 3 February 2008; accepted 3 June 2008)

Abstract This article presents an in-depth study illuminating how experiences of addiction and accompanying feelings, thoughts and expressions appear to the participant in the context of her life. It focuses on the participant’s engagement with alcohol as an experience of flux and instability and how it impacts on her sense of self. The study reports data from semi-structured interviews with a female participant, analysed using interpretative phenomenological analysis (IPA). The results are considered in relation to relevant literature, including research on addiction and recovery, works on self and identity and theory and use of metaphor. It is suggested that IPA provides an opportunity to build up a rich picture of subjective-felt experience, and thus to contribute to existing psychological research a subjective perspective not often addressed in psychological accounts of addictive behaviour.

Keywords: Identity, self-concept, interpretative phenomenological analysis, qualitative methods, addiction, metaphor

Psychological perspectives on addiction comprise a broad range of theoretical and

experimental approaches including behavioural, cognitive, neuroscience, social, treatment

research and interventions (for overviews, see, for example, West 2006; Gifford and

Humphreys 2007).

Although research on addiction has been dominated by quantitative methodologies

(Neale et al. 2005), there is a growing interest in the use of qualitative methods (Rhodes and

Moore 2001; Nichter et al. 2004). Neale et al. (2005) contended that qualitative methods

‘proved very valuable in demystifying drug and alcohol use and replacing stereotypes and

Correspondence: P. Shinebourne, School of Psychology, Birkbeck University of London, London WC1E 7HX, UK.

E-mail: [email protected]

ISSN 1606-6359 print/ISSN 1476-7392 online � 2009 Informa Healthcare USA, Inc. DOI: 10.1080/16066350802245650

myths about addiction with more accurate information that reflects the daily reality of

substance users’ lives’ (pp. 1586–87). Rhodes and Moore (2001) present qualitative

methods as ideally suited to describing the ‘lived experience’ of drug users from participants’

perspectives. Smith (1998) was concerned to use a research approach which ‘preserves the

uniqueness of the experience from the sufferer’s point of view’ (p. 213). He selected

a phenomenological approach which, in his view, is ‘the research approach most likely to

elicit data concerning the lived experience of an individual’ (p. 214). Larkin and Griffiths

(2002) make a case for psychology to address issues of subjective experience in accounting

for addictive behaviour using qualitative methods. They used interpretative phenomen-

ological analysis (IPA) in their research on the subjective experiences of addiction and

recovery in a residential addictions treatment centre.

This article is concerned with illuminating how experiences of addiction and

accompanying feelings, thoughts and expressions appear to the participant in the context

of her life. It focuses on the participant’s engagement with alcohol as an experience of flux

and instability and how it impacts on her sense of self. The study reports data from semi-

structured interviews with a female participant, analysed using IPA. By focusing in more

depth on the specific experience of a person in relation to addiction, this study builds on the

small number of qualitative studies published to date and contributes to our understanding

of the impact of experiences of addiction on a person’s sense of self.

Interpretative phenomenological analysis is considered a particularly relevant method for

this study as it aims to give voice to, and examine in detail the personal lived experience of

participants and how participants make sense of their experience (Smith 2004). IPA is also

interpretative in recognizing the role of the researcher in making sense of the experience of

participants. Smith refers to ‘double hermeneutics. The participant is trying to make sense of

their personal and social world; the researcher is trying to make sense of the participant

trying to make sense of their personal and social world’ (p. 40). IPA is also informed by the

theoretical perspective of symbolic interactionism (Smith 1996) which is concerned with the

construction of meaning within both the social and the personal world of individuals. IPA

has been used to examine a wide range of psychological topics, e.g.: understanding feelings

of anger (Eatough and Smith 2006); experience of stigma of people living with chronic

fatigue syndrome (Dickson et al. 2007); HIV positive women’s experiences of partner

relationships (Jarman et al. 2005); identity change during pregnancy (Smith 1999). For

a review of work using IPA, see Brocki and Wearden (2006) and Reid et al. (2005). We

believe IPA methodology can make a valuable contribution to psychological understanding

of the experience of addiction as it provides an opportunity to build up a rich picture of the

subjective-felt experience of engagement with alcohol, embedded in the world of the

participant.

The depth, richness and texture of the participant’s account provided an opportunity

to carry out a detailed idiographic case study. An idiographic approach aims for an in-

depth understanding of a particular individual, not possible in nomothetic research

studies which focus on aggregated data and do not provide access to specific explorations

of the particular individuals (Smith et al. 1995; Smith 2004). As Smith and coworkers

point out, idiographic studies consider the individual on his/her own terms, thereby

emphasizing the importance of the individual as a unit of analysis. Thus, they suggest

that ‘a commitment to an idiographic psychology is obviously closely linked to the

rationale for case-studies’ (ibid., p. 63). Smith (2004) suggests that a detailed analysis of

a single case would be justified when one has a particularly rich or compelling case.

A detailed single case study offers opportunities to learn a great deal about the particular

person and their response to a specific situation, as well as to consider connection

Alcohol and the self 153

between different aspects of the person’s account. At the same time, it is also the case, as

Smith (2004) contends, that ‘the very detail of the individual also brings us closer to

significant aspects of a shared humanity’ (p. 43).

Radley and Chamberlain (2001), considering the analogy between the medical case and

case studies in psychology and social science, contend that in medical cases ‘all patients are

cases, in the sense that they are illustrations of a disease category and yet unique in how they

are affected by the disease’ (p. 323). The unique aspects of the case come into being through

the particulars of the presentation made by the patient, and as a ‘double narrative: the

patient’s story is encapsulated and retold in the physician’s account’ (p. 328). Radley and

Chamberlain argue for the specific relevance of the case study to health psychology. In their

view, the case is central to issues concerning health, illness and healing: ‘suffering, as

understood through the study of the case, is irreducible to an object, resists being bounded as

a variable and is ultimately significant because of this elusive status’ [italic in original]. In effect,

all researcher’s communications about health and illness are premised upon the retention,

refinement or the reconstruction of case-understanding’ (p. 331).

Method

Participant

The participant is referred to as Alison. Her name was changed to safeguard confidentiality.

At the time of the interview, Alison was 31, single, and had been attending a day centre for

women with problems of alcohol for about 8 months.

Data collection

Alison was one of the four women attending the day centre for women with problems of

alcohol who agreed to be interviewed for a larger study of women’s experiences of addiction

and recovery. The detailed, rich account of Alison’s narrative provided the material for this

study. The team manager at the centre was approached by email and a meeting was

arranged. Permission to interview was granted with the conditions that the interview would

last about an hour and that the interviewer would inform staff about any concerns if the

participant became upset or anxious during the interview. The study had ethical approval

and Alison signed a consent form. The interviews were conducted at the day centre, in

a quiet room separate from the main area. The aim of the interview was to capture a rich and

detailed description of Alison’s experiences with alcohol and what these experiences meant

to her. An interview schedule was constructed to guide the interview, but the process

remained flexible to enable following up interesting possibilities emerging during the

interview. Three semi-structured interviews with Alison were carried out over a period of 4

weeks, which resulted in 3 h of data. Following the first interview, the first author listened to

the recording and noted down specific questions which could be followed up in greater

detail. In the second and the third interviews, the original questions were introduced again

with specific probes (e.g. Last week you said several things about control . . . would you like

to say some more about what control means to you?). As the material from of the subsequent

interviews elaborated on the same areas, it was integrated in the overall thematic analysis.

The interviews were recorded and later transcribed verbatim.

154 P. Shinebourne & J. A. Smith

Analysis

IPA provides flexible guidelines which can be adapted by researchers in accordance with

their research aims (Smith et al. 1999). The analysis followed several stages: The first stage

consisted of reading the whole transcript a number of times to become immersed in the data.

During reading notes or comments which appear significant or interesting were recorded.

The second stage involved returning to the transcript to transform the initial notes into

emerging themes or concepts taking care not to lose the connection between the

participant’s own words and the researcher’s interpretations. The third stage consisted of

examining the emerging themes and clustering them together according to conceptual

similarities. The clusters were given a descriptive label which conveys the conceptual nature

of the themes in each cluster. As the clusters of themes emerged the transcript was checked

to ensure that the connection with what the participant has actually said was maintained.

In the final stage a table of themes was produced. The table shows the structure of major

themes and subthemes. An illustrative data extract is presented alongside each theme,

followed by the line number, so that it is possible to return to the transcript and check the

extract in context. As Eatough and Smith (2006) suggest, ‘for the researcher, this table is

the outcome of an iterative process in which she/he has moved back and forth between the

various analytic stages ensuring that the integrity of what the participant said has been

preserved as far as possible. If the researcher has been successful, then it should be possible

for someone else to track the analytic journey from the raw data through to the end table’

(p. 120). The table of themes provides the basis for constructing a narrative account of the

interplay between the participant’s account of her experience and the interpretative activity

of the researcher. The narrative account contains relevant extracts in the participants’ own

words, not only to enable the reader to assess the pertinence of the interpretations, but also

to retain the voice of the participant’s personal experience.

Three superordinate themes were identified in the analysis: self in relation to alcohol, self

in relation to others and self in recovery. This article reports on the first superordinate

theme, self in relation to alcohol, and the three interrelated subthemes comprising it (see

Appendix). First, it presents an account of how Alison feels and experiences her engagement

with alcohol as an experience of flux, oscillation and instability, often expressed through

using vivid metaphors. Second, we explore how Alison experiences the process of

transformation into another personality when she is drunk, and the meaning Alison

attributes to the experience. Finally, we examine how Alison perceives herself as a multitude

of conflicting parts and how this is reflected in her ambivalence about alcohol.

Results

The experience of the self as drunk

In this section we examine how Alison presents her engagement with alcohol as an

experience of flux, oscillation and instability. We introduce the analysis with an extract

which presents some of the main features of Alison’s engagement with alcohol. It also vividly

illustrates how Alison turns to metaphors to describe her experience, a feature frequently

repeated during the interview:

Some big wave, you know, you just get caught with it, that’s what it used to be like, this kind of like

helpless feeling, just having to go and get drunk almost, you know, not even particularly wanting

to, just feeling like there’s no other way when you are in that situation.

Alcohol and the self 155

. . .

I was very much at sea, really, and, I didn’t feel grounded . . . just this flux and thought, when am

I ever going to go on land . . . and even if you were sitting on the beach, you know, you’d get caught

back in, I suppose, and now, now I feel very much like I’m not just on the beach but I’m in a hut

somewhere, I can go down to the water when I want and occasionally maybe like give in to it now

and again to see what comes up.

The metaphors used here capture Alison’s engagement with alcohol as an experience of flux,

of oscillation, instability, being lost at sea, not grounded, helplessly caught back by the wave

when attempting to pause in the constant flux engulfing her. As a contrast to the fluid imagery

underscored by the presence of alcohol (itself a liquid), a desire for stability and safety is

expressed in metaphors of being grounded, on land, on the beach, in a hut. The water

presenting at once both the risk of being engulfed and at the same time the horizon of

possibility, the allure of excitement in exploring what comes up in giving in to the wave.

The use of metaphors here and throughout the interview reveals emotional and

imaginative nuances in Alison’s relationship with alcohol. These metaphors encapsulate

what emerges throughout in the interview as a key to the dilemma at the heart of Alison’s

ambivalence about alcohol, constantly hovering between what she symbolizes here in the

metaphoric expressions of ‘sea’ and ‘land’ (see section on the use of metaphors below).

In the following extract Alison is using the figure of a ‘spiral’ to describe the process of her

escalating drinking as turns of mood when she is becoming drunk:

I’d suddenly feel like in a bad mood and depressed even before I started drinking, so I’d have to

drink more than everyone else at the start just to feel happy around people and from there it would

just spiral and spiral . . .

On the way to getting drunk I enjoyed it but it was very short lived because I used to drink so

much right at the start and I was sort of remembering falling into this kind of lull of contentment,

I suppose for a while, and suddenly feel, oh, I feel better now, I feel alright I can actually talk and

be sociable and be the person everyone wants me to be and be happy and, you know, do all that,

entertain everyone . . . and then beyond that stage I never knew how I was.

Initially alcohol is seen as an enabler, providing a route from feeling in a bad mood and

depressed, to enjoyment, contentment and sociability. Although she says that it is a short-

lived enjoyment, she seems to be giving in to the spiral which ensues, the metaphoric

expression ‘lull’ suggesting a sense of foreboding, a temporary calm before an inevitable

upsurge and transformation into an altered stage of unknowing (‘beyond that stage I never

knew how I was’). The images of the spiral and the lull indicate recurrent, perpetual

movement, analogous to the image of the wave and the flux above. There seems to be no

settled point of rest in Alison’s life, as discussed further below.

Alison portrays being drunk as an experience of loss, loss of control, losing consciousness

(blackouts), losing memory, not knowing. Elsewhere Alison describes other negative effects

such as being sick, dizzy, having hangovers and feeling she has damaged her brain. Yet, at

the same time the experience of being drunk is described in positive terms as unlocking

creativity, energizing, exciting:

I suppose its some feeling creative, you know, some feelings of like fun and excitement, I suppose

and kind of maybe being, you know unlocking some sort of artistic feeling . . . creative and

energetic, you know, and interesting.

At this point of the interview Alison is animated, playful and exuberant, in contrast to the

tone of passivity and helplessness in earlier extracts which carry the negative weight of the

156 P. Shinebourne & J. A. Smith

experience of drinking. Using the metaphoric expression ‘unlocking’, alcohol is described as

a key, a gateway to creativity. Yet the experience of exuberance is intertwined with its

counterpart, a sense of the inevitability of the ensuing descent:

But there is always the crash down as well, that’ a kind of problem that I always had before, you go

so high up that inevitably the next day I would just come crashing down and just be so kind of

I guess, to carry on the image, you know, you’d be like washed up and deplete and just feeling very

empty and, you know, very tearful and self-remorseful and,you know, reprimanding yourself and

almost expecting that you are always like just feeling of like guilt and anxiety you have done

something wrong.

There are several points of interest in this extract. In the first instance, Alison’s use of the

metaphor of the downward crash sharply contrasts with the sense of fun and excitement

generated in the experience of drinking. There is also a sense of repetition (‘problem that

I always had before’), mirroring the experience of getting caught in the perpetual movement

of the waves described earlier. In addition, this extract also demonstrates how Alison is using

metaphors creatively, teasing out another possible meaning implicated in the image of the

wave (‘washed up’). At the end of the extract she acknowledges the guilt and negative moral

judgement of herself. The sense of guilt is further discussed in the subtheme perception of the

self below.

I created such a character for myself

In this section we focus on exploring Alison’s mode of dealing with the duality and

ambivalence of her experiences with alcohol. Alison presents herself as a multitude of parts,

referring frequently to ‘part of me’, with different parts holding conflicting perspectives and

culminating in creating a separate character. In the following extract, Alison describes the

process of her transformation into a metaphoric personality she created for herself,

becoming another character through her drinking:

I would like change personality almost and become like I’m I don’t know, like a showgirl,

I suppose, so I would start performing . . . it was just almost like my body was taking over

a character from vaudeville . . . I was that character everyone loved, that person, so I suppose I got

caught in a trap of being like that, and having to drink so much in order to get to that person I did

not know sober.

Alison describes her experience when she is drunk as entering into an altered state. She

seems to have little recollection of what has happened, stating that ‘I did not know what

I was doing’. The ‘showgirl’ and her ‘normal’ self are described as occupying two separate

domains of experience and there is a sense of tension and conflict between them. Alison

appears caught in a trap, compelled to act out the person that her friends love. However,

having to drink so much in order to access that person presents a conflict with her effort to

reduce her drinking. In trying not to be ‘that person’ Alison is becoming aware of parts of the

self being lost. In the following data extract there is a sense of struggle: on the one hand

Alison says she is trying not to be that person but at the same time there is sense of loss:

I created like such a character for myself and something I am still trying to kind of not be, it’s

really difficult . . . if I try to be like really moderate and try to be myself, like people don’t

understand it, and they don’t want that.

I: What is that ‘my self’?

Alcohol and the self 157

A: I am really quite quiet and contemplative.

I: And how do you feel about these two selves?

A: . . . there’s a part of me that enjoys being entertaining and what not but I would like to be more

in touch with that part rather than only being able to access it through alcohol and currently, kind

of feeling the loss of that character because I can’t get in touch with it because I’m not drinking

that much

There is a sense that Alison is missing the other person ‘it’s just sad for me ‘cause I feel like

I can’t, I can’t reach her’. She says that sometimes she drinks deliberately in attempting to

invoke the other character, and she seems curious to discover and understand her other

personality, ‘I don’t understand who this person is, who is she? what is she? is it me, is it

someone else?’ The interviewer continues by exploring Alison’s perception of that other

person:

I: What do you like in that person?

A: Just completely free expression, not worrying about what anyone thinks, not worrying about

probably perceived limitations I feel I have with my body . . . it’s about kind of feeling totally in my

body and totally expressing myself through my body.

I: How does it feel in your body?

A: I know at the time the glimpses I had into it, it feels amazing to kind of connect immediately

through the music and do something that I feel I know at the time I feel is exactly like the right

thing to do.

In Alison’s account, the ‘other’ personality offers her an opportunity to be free from

constraints, to express freely though her body some aspects of herself which she attributes to

another agency. Using the metaphor of a vessel, Alison creates a narrative describing her

sensations of her body opening up to spirits visiting her body when she is drunk. She

portrays the spirits as pockets of energy attracted to people who can play host to them:

They are probably attracted to you and in some way there’s something that you can give them and

you can play hostess to them . . .

I: What can you give them?

A: Probably just expression . . . like old cabaret dancer probably that died before her time or

something like that, you know you’re kind of giving a performance and, allow them to have that

performance

The significance of giving a performance to a dancer who died before her time is illuminated

when Alison is searching for an explanation/understanding:

Because it has been suppressed for so for so long you know, I think it’s probably growing up,

I mean we were all dancers [Alison and her sisters] . . .., stop stop stop stop all the time you know,

constantly being told to stop.

I: You were brought up in this way?

A: Oh yeah yeah very, very catholic ahm, it’ like my mum was a school teacher . . . as a child we had

to be perfect, be seen to be really in control all the time

It seems that in evoking her ‘other’ person through her drinking, Alison is giving expression

to the self that was suppressed in her childhood. In Alison’s narrative her childhood family

appears split, with ‘half of them are actually alcoholics’ and the other half ‘extremely

abstemious’. Elsewhere in the interview Alison describes herself as an insecure child,

precariously hovering between being scared of mother and desire for mother’s approval, and

the enticing possibilities of gregarious enjoyment, as manifested in the presence of hedonistic

158 P. Shinebourne & J. A. Smith

aunts and an alcoholic grandfather. Searching for an explanation of her drinking, Alison is

making an explicit link to her childhood as she perceives a possible attempt to recapture the

missed experiences. She describes how she learned to split her experiences in parts, hiding

much of what was going on in her life from her parents, ‘I told them the parts I thought, you

know, they would approve of’. It appears that Alison’s adult sense of self is still dominated by

the experience of conflicting parts and separate personalities and this is further explored in

the next section.

Perception of the self

In this section we focus on Alison’s perception of herself as a multitude of conflicting parts

and perspectives. Responding to the interviewer’s question inviting her to reflect on what

kind of person she considers herself to be, Alison suggests she is a ‘mixture of water and fire,

a little bit of all but mainly water and fire’:

A part of me is like kind of water type it is quite kind of spiritual and go with the flow and just

having like fluidity . . . and the fire just being passionate, and you know and desiring a lot of things,

a lot of things for yourself and having that kind of impulsive nature as well, at times I can be quite

like childish and impulsive and that’s kind of fire, ‘cause I can be like, a can be a bit ground, you

know the less I kind of drink the more grounded I actually feel and that’s for me is quite kind of

solid and long lasting

In this extract Alison is using the metaphors of the elements to describe how she perceives

herself. Sensations and feelings associated with water and fire dominate her self-image.

The allusions to water resonate with the metaphors of fluidity discussed above. The passions

associated with fire are expressed through the extrovert showgirl performer, the self

indulgent ‘little show-off child’, and in the attraction to risk, that ‘part of me that kind of

I love the not knowing, and I love the feeling of flowing along’.

In the following extract Alison portrays herself in constant flux, constantly evolving,

changing from day to day, yet realizing that ‘probably sometimes it’s good but probably

sometimes it can be detrimental’ as she feels that:

There needs to be more like a centre to me that needs to be some more consistency, something

that is kind same no matter what out there, you know, I’m working on that, but I feel from one day

to the next I really do change and there’s not yet a real core and there’s not, there’s not anything

about me that’s sort of unchanging and all of that has to do with the fact that I am exploring things

now, evolving now

The self as depicted here mirrors the sense of the constant flux and instability invoked in the

fluid metaphors discussed earlier. The tension between the conflicting parts presents

a dilemma for Alison in her attempts to cope with her alcohol problem. On the one hand, she

admits there is ‘part of me that really loves the kind of chaos and this sort of abyss’,

associated with alcohol life style. Yet she recognizes that ‘it feels a part of me but it does not

really feel the whole me, it does not feel like kind of sober me’. The tension and conflicting

attitudes give rise to feelings of guilt and remorse following being drunk as she acknowledges

there is also that ‘part of me just feels courage to be cleansed’:

I suppose part of this guilt surrounding alcohol and stuff is that to me it’s poisonous, which is in

a way, but it shouldn’t be, you shouldn’t feel that bad about it but I still do, I think part of, part of

my feeling is trying just have a completely a cleansing process you know

Alcohol and the self 159

Using the contrasting metaphors ‘poison’ and ‘cleansing’ in this extract, Alison is revisiting

the dilemma at the heart of her fluctuating positions and ambivalence about alcohol. On the

one hand she recognizes that with her drinking she was ‘on a road to destruction’ and she

seems open to ‘cleanse’ herself. On the other hand, she still appears to be emotionally

engaging with the creative, exciting and playful aspects of drinking.

Discussion

In this section we build on some of the observations already made by examining them

through a theoretical lens. First we consider various perspectives on the experience of

multiplicity of the self. This is followed by examining how the use of metaphors can

contribute to understanding the participant’s experience and its meaning.

Multiple selves

One of the most striking features of the preceding analysis is the way in which Alison

presents herself as a multitude of parts, referring frequently to ‘part of me’, with different

parts holding conflicting perspectives. In her narrative Alison describes her multiple selves as

‘my other personality’ and ‘the showgirl’. She experiences the changes as ‘character switch’

taking place as she is ‘transformed to another character’.

Similar accounts have been described as dissociative experiences (e.g. Spanos 1994;

Lilienfeld et al. 1999; Merckelbach et al. 2002; Kihlstrom 2005; Seligman and Kirmayer

2008). In the psychiatric/clinical psychology paradigm (as specified in the Diagnostic and

Statistical Manual, DSM-IV, American Psychiatric Association, 1994) dissociative

disorders include a wide variety of syndromes whose common core is an alteration in

consciousness that affects identity and memory. Kihlstrom (2005) maintains that the

appearance of dissociative disorders as a separate category in DSM ratified their status as

major forms of psychopathology. However, the issue remains controversial, in particular

considering the dissociative identity disorder (Kihlstrom 2005; Lilienfeld et al. 1999;

Shaffer and Oakley 2005) in which an individual appears to possess and manifest two or

more distinct identities. Advocates of this view contend that ‘following severe abuse or

other traumatic events, individuals dissociate or ‘compartmentalize’ their subjective

experience into alternate personalities (‘alters’) as a means of coping with the emotional

pain of the trauma’ (Lilienfeld et al. 1999, p. 507). However, evidence from studies on

dissociative experiences in people with drug or alcohol problems remains contradictory

(Langeland et al. 2002; Somer 2003; Schäfer et al. 2007).

Seligman and Kirmayer (2008) maintain that the association between dissociative

expriences and trauma is predominantly a Euro-American conception as understood in

the psychiatric perspective. In contrast, dissociative experiences in many socio-cultural

contexts ‘seem to be associated with the expression of alternative selves or identites that

were not created in the context of trauma’ (p. 41). From a social-psychological

perspective, dissociative identity disorders are considered as socially constructed, context

bounded phenomena (Spanos, 1994), consisting of ‘rule-governed and goal-directed

experiences and displays of multiple role enactments that have been created, legitimized,

and maintained by social reinforcement’ (Lilienfeld et al. 1999, p. 507). In this view it is

possible to understand dissociative experiences as metaphors for emotional states

(Merckelbach et al. 2002). For example, Seligman and Kirmayer (2008) note that

160 P. Shinebourne & J. A. Smith

even in the dominant culture, dissociate states are increasingly accessed through drugs

and music. In their view, ‘dissociation allows individuals to suspend their normal self

with its accompanying social constraints and enables them, therefore, to express novel,

even normally forbidden, desires, feelings and behaviours that they experience as – and

that others attribute to – some agency other than the self’ (p. 42).

Alison describes her other personality as a construction, stating, ‘I created such

a character’, which she understands as ‘an aspect of my personality that’s repressed’.

From this perspective it is possible to consider the ‘showgirl’ character as a tool for accessing

and expressing emotions that may have been previously unexpressed, unexplored, or even

unrecognized, in a way analogous to the use of metaphors (see discussion on the use of

metaphors later in the article).

The notion as self as multiple was discussed by William James (1902), who

distinguished between I and Me (Hermans 1996). The continuity of the I manifests

itself in a ‘sense of personal identity’ and a ‘sense of a sameness’ and a feeling of

having an existence separate from others. The Me, the self-as-known, is the empirical

self that incorporates all that a person can call one’s own, including one’s body,

clothes, house, relationships, etc. James also considers the notion of a divided self,

a sense of ‘two parallel and discordant thoughts that emerge as selves’ (Gray 2005,

p. 124), which James described as experienced when comparing the current sense of

self to a desired one. James’ notion of the divided self resonates with Higgins’ (1987)

self-discrepancy theory. In Higgins’ conceptualization the different domains of self-

related beliefs may be conflicting or incompatible. The self is conceptualized as multiple

and multifaceted in Markus and Nurius (1986) notion of possible selves, the self one

would like to be or is afraid of becoming, and in Markus and Wurf (1987) theory of

the dynamic self-concept. As Hermans’ (1996) contends ‘these selves, providing images

of desired or undesired end states, motivate individual behaviour. These selves also

provide an interpretative and evaluative context for the current self. In this approach,

the self-concept is considered a system of affective-cognitive structures (also called

schemas or theories) about the self that lends coherence to the individual’s self-relevant

experiences’ (p. 33).

Another aspect of a multiple self-manifested in Alison’s account is a constantly

changing ‘dynamic’ self, constantly evolving, in constant flux. Her account of the self in

movement resonates with the existential perspective in philosophy, as described by

Kierkegaard (1980): ‘Every moment that a self exists, it is in a process of becoming, for

the self . . . does not actually exist, but is simply that which ought to come into existence’ (p. 30). Kierkegaard portrayed the self as a continually evolving process, yet he

recognized that there is a need for finding some resolution: ‘in so far, then as the self

does not become itself, it is not itself; but not to be itself is precisely despair’ (ibid.).

Similarly, in Alison’s account there is a sense of the self in constant flux as she is

‘flowing along with things’. At the same time she recognizes that ‘it can be detrimental’

because ‘there needs to be more like a centre to me that needs to be some more

consistency’. For Kierkegaard the way out of despair was in faith. It seems that Alison

too is attracted to a spiritual dimension, ‘wanting to have that kind of life, you know,

clean pure simple’.

In William James account of conflicting selves there is recognition of a necessary

choice: ‘I am often confronted by the necessity of standing by one of my empirical selves

and relinquishing the rest. Not that I would not, if I could be both handsome and fat

and well dressed and a great athlete . . . But to make any one of them actual, the rest must more or less be suppressed. So the seeker of his truest, strongest, deepest self must

Alcohol and the self 161

review the list carefully, and pick out the one on which to stake his salvation’ (James

1890, p. 310). Yet the act of choosing among several possible selves is also an experience

of loss: ‘In the very act of murdering the vanquished possibility the chooser realizes how

much in that instant he is making himself lose’ (p. 1141). At the time of the interview

Alison is ‘feeling the loss of that character’. She ‘I can’t get in touch with it because I’m

not drinking that much’.

According to James, sustaining a unified sense of self requires intense experiences,

such as spiritual revelation, whether religious or non-religious (Gray 2005). James’

writings have had significant influence on the conception of Alcoholics Anonymous

(Finlay 2000; Gray 2005) and its emphasis on spiritual transformation. The changes that

members of AA and other 12-step fellowships undergo have been described as

a transformation of identity (e.g. Cain 1991; Swora 2004), a terminology that impacted

on the literature on addiction and recovery. The path to and away from addiction has

often been described as a transformation or change in identity and developing a new

sense of self. (e.g. Biernacki 1986; Kellogg 1993; Larkin and Griffiths 2002; McIntosh

and McKeganey 2000, 2001).

McIntosh and McKeganey (2001) describe the need to repair a ‘spoiled identity’ and

a desire for a new identity and a different life-style, as central to their participants’ accounts.

They suggest that ‘the key to the recovery process lies in the individual coming to an

understanding that his or her damaged sense of self has to be restored together with

a reawakening of the individual’s old identity and/or the establishment of a new one’

(McIntosh and McKeganey 2000, p. 1503). Koski-Jännes (2002) contends that recovery

from addiction ‘involves profound changes in a person’s self concept, values and

orientations in life’ (p. 184). In Biernacki’s (1986) account, deciding to stop using drugs

takes place when the addict identity conflicts with other identities important for the person in

ways which are unacceptable to him/her.

This resonates with the findings of the studies by Weisz (1996) and Downey et al.

(2000) which suggest that perception of dissonance, discrepancies and conflicts

between substance use, valued identities and self-standards can constitute an effective

motivator for changing addictive behaviours. Miller and Rollnick (2002) contend that

most people who seek help already perceive significant discrepancy between

motivations. Yet they are ambivalent, caught in an approach-avoidance conflict.

Following Festinger’s (1957) theory of cognitive dissonance, they believe that change is

motivated by a perceived discrepancy between current behaviour and important

personal goals and values.

The discrepancies between expressed intentions and actual behaviour are manifested in

Orford’s (2001) account of the deep ambivalence and conflict which go hand in hand with

the development of addiction. In Orford’s conceptualization, engaging in a common activity,

such as drinking, smoking, gambling, drug taking, eating, may become excessive in the

person’s own view or by the definition of others. People who develop an ‘excessive appetite’

may try to keep away from sources of temptation, however, if they put themselves or find

themselves in tempting situations, ‘then inclination becomes relatively stronger and stronger

and resolve becomes more and more difficult to maintain’ (p. 263). At this stage a balance

between incentives and disincentives may develop into a state of ‘avoidance-approach’

ambivalence and conflict, whereby anticipation of pleasurable indulgence may be mixed

with uncomfortable anxiety.

In Alison’s case, dissonance and conflict about alcohol is experienced at the time of the

interview: ‘Right now I am still in major stages of doubt about stuff’. Her experience

resonates with the attitudinal ambivalence about alcohol identified in the studies by De

162 P. Shinebourne & J. A. Smith

Visser and Smith (2007) and Orford et al. (2002) which consider the paradoxical effects of

alcohol which can produce positive or negative effects at different stages, even in a single

drinking event. As De Visser and Smith (2007) point out, many of the motives identified in

their study of young men’s ambivalence towards alcohol could be considered either as an

incentive or a disincentive.

In Alison’s attempts to control her alcohol use there is a sense of continuing struggle: On

the one hand she is motivated to seek help towards recovery as she is ‘scared of the blackouts

and all the rest of it’, but at the same time she describes the experience of alcohol as creative,

energizing and exciting. On the one hand she states ‘part of my feeling is trying just have

a completely a cleansing process’ but at the same time there is ‘a part of me that really loves

the kind of chaos and this sort of abyss’.

How does the use of metaphors illuminate aspects of experience and feelings?

The duality inherent in metaphors as tools for expressing one domain of experience in terms

drawn from another domain, seems particularly apt for describing Alison’s experiences of

the self as multiple. Indeed, one of the striking features emerging from the interviews with

Alison is her frequent turning to metaphoric expressions and evoking her other personality.

As suggested above, it is possible to understand dissociative experiences as metaphors for

emotional states. How may a focus on metaphor contribute to understanding the

participant’s experience and its meaning?

While classical theory of metaphor regards metaphors as ‘inessential frills’ (Ortony 1993,

p. 2), a linguistic substitution in which one word can stand for another in an unequivocal

way. In contrast, Lakoff (1993, p. 203) contends that ‘the locus of metaphor is not in

language at all, but in the way we conceptualize one mental domain in terms of another’.

Lakoff and Johnson (1980) believe that ‘metaphor is one of our most important tools for

trying to comprehend partially what cannot be comprehended totally: our feelings, aesthetic

experiences, moral practices and spiritual awareness’ (p. 193). In their view, ‘metaphorical

imagination is a crucial skill in creating rapport and in communicating the nature of

unshared experience’ (p. 232).

Similarly, Radley and Chamberlain (2001) and Kirmayer (1992) highlight the function of

metaphor in expressing and communicating experience in the context of health psychology

and medicine. In this view, suffering and the experience of illness may be presented

metaphorically rather than literally, precisely because it is not fully specifiable and cannot be

communicated through description alone. Metaphoric expressions are particularly

significant in this context as Lakoff and Johnson (1980) contend that metaphors are

grounded in bodily experience and constructed in the context of social situations or

scenarios (Lakoff 1987).

Kirmayer (1992, p. 335) suggests that ‘metaphors are tools for working with experience. A

metaphor expresses something that the body knows how to do, a way of working with or

transforming a concept’. As a tool of communication ‘metaphors provide ways of acting on

our representations, or of making presentations to others, that transform the conventional

representation, unpack new meanings, open up the situation’ (ibid.). Alison’s use of

metaphors can be considered as analogous to the ‘showgirl’ character she created as a means

to acting out and expressing suppressed aspects of her experience. Similarly metaphors can

provide a safe bridge for articulating novel expressions of feelings and experiences.

Using metaphoric expressions opens up possibilities for richly textured communication.

Metaphors convey ‘visual and tactual imagery [that] adds a more vivid level of

Alcohol and the self 163

understanding. Also due to the different layers of sensory and informational meanings,

metaphors are more likely to evoke an experiential response in the listener than the relaying

of an adjective alone. Furthermore, metaphors can more accurately capture the quality of an

emotion than an adjective or an emotional label’ (Levitt et al. 2000, p. 23).

Understanding of the potential of metaphors to illuminate experience is supported by

empirical studies exploring metaphoric expressions in psychotherapy. Both conventional and

novel metaphors were found to have profound experiential impact and experiential meaning

for clients and therapists alike (e.g. Angus and Rennie 1988, Levitt et al. 2000). Levitt et al.

(2000) have found that metaphors were most frequently used when the clients were assessing

or analysing their experience. In their view ‘these high proportions may point to the basic

structure of therapy as a meaning-making task and to the use of the metaphor as congruent

with this purpose’ (ibid). Lyddon et al. (2001) contend that ‘metaphors may be useful tools for

helping clients access, as well as symbolize, emotions that may have been previously

unexpressed, unexplored, or even unrecognized’ (pp. 270–271). They believe that using

metaphors may enable clients to indirectly express feelings that might be too painful to address

directly. In this way, metaphors may function as a ‘safe bridge’ to work with the ambivalence

between the part of the client that wants to change and the part that does not.

Cirillo and Crider (1995) identified four kinds of metaphorical communication in therapy:

Making an implied comparison to capture a complex emotional theme; expressing multiple

meanings simultaneously to bridge disparate themes, as a metaphor tends to have several

connotations; providing a new perspective on an experience through a metaphoric

expression and using a novel metaphor to create or reveal something new or facilitate self

discovery. Following their constructivist perspective they take a ‘fluid view of metaphors’

(p. 518) whereby meaning is constructed in the process of dialogical interaction between

speakers and contexts.

While the foregoing discussion refers to explorations of metaphoric expressions in

psychotherapy and to interactions between client and therapist, they indicate similar

possibilities for focusing on metaphors in qualitative research interviews. Alison’s use of

metaphors reveals emotional and imaginative nuances in her perception of and reflection on

her experiences, perhaps not accessible directly, perhaps providing a ‘safe bridge’ to work

with the ambivalence inherent in her predicament.

Conclusion

The results of the present study capture the dynamic and finely nuanced texture of Alison’s

sense of self through her engagement with alcohol, in ways not possible with quantitative

investigations. The qualitative approach of IPA can be seen as complementing and

illuminating quantitative studies, through building up a detailed picture of the subjective-felt

experience, particularly called for in an investigation of an individual’s sense of self,

embedded in the context of an individual’s sense of being in the world. As discussed above,

not many previous studies in this field give voice to subjective accounts and personal

experiences. By focusing on a single case, we have been able to provide a detailed nuanced

account of the participant’s experience of alcohol. The reader is then able to engage in the

process of considering this case in relation to their professional and personal experience as

well as the relevant literature we have discussed here. In addition, as Smith (2004) contends,

that ‘the very detail of the individual also brings us closer to significant aspects of a shared

164 P. Shinebourne & J. A. Smith

humanity’ (p. 43). We suggest that qualitative approaches such as IPA can make a valuable

contribution to furthering our understanding of experience and its meaning.

Declaration of interest: The authors report no conflicts of interest. The authors alone

are responsible for the content and writing of the article.

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166 P. Shinebourne & J. A. Smith

Appendix – Table of themes (Including an illustrative extract for each theme and

line number/s)

Superordinate theme 1 – self in relation to alcohol

The experience of the self as drunk

Metaphoric expressions of the experience of being drunk

Big wave 449

Escalating drinking

It would just spiral and spiral 25

The harmful experience of being drunk

Having blackouts, memory loss 15

The high and the low of the drinking experience

Creative and energetic and interesting 498

Washed up and deplete 502

Ambivalence and dilemmas

If only I could get to that without so much alcohol 488

I created such a character for myself

The self changing through drinking

Having to drink so much in order to get to this person 44–5

The process of becoming the other self

My body was taking over a character 40

Feeling the other self

Feeling totally in my body 1052

The porous body

When you are drunk you are open to spirits visiting your body 475

The self as a process of becoming

From one day to the next I really do change 1110

Perception of the self

Metaphors expressing perception of self

Mixture of water and fire 809

Positive appraisals of self

Quiet and contemplative 66

Negative appraisals of self

I can’t really assert myself 1015

Moral judgements of self

Guilt and anxiety you have done something wrong 504–5

Alcohol and the self 167