Chronic Chronicles: Navigating Narrative Identity, Biographical Meaning, and Mental Health in Chronic Illness

Abstract

Chronic illness is an increasingly urgent global issue, affecting nearly one-third of adults worldwide. Beyond biomedical challenges, chronic conditions are strongly linked to elevated rates of mental illness and psychological disorders. Despite this, dominant medical models prioritize physical symptom management over the psychological experiences of illness and the narratives people construct to make sense of it. This study draws on narrative psychology to examine how individuals with chronic illness frame and communicate their illness experiences—and whether these narrative processes relate to mental health. A total of 149 adults with chronic physical conditions wrote and edited two personal illness narratives (a high point and a low point) for imagined audiences either with or without shared illness experience. Narratives were analyzed for lexical change (edit quantity, cosine similarity), typology (Chaos, Quest, Restitution), and emotional themes (e.g., Turmoil, Growth). Contrary to predictions, audience framing had no significant effect on editing behavior or narrative content. However, event type did: low-point narratives were more uniform and emotionally negative, while high points were more diverse and individualized. Most strikingly, narrative type—particularly Quest narratives marked by agency and meaning—predicted greater life satisfaction, even among participants with worse illness severity. Participants with a Chaos–Quest pairing (Chaos low-point, Quest high-point) reported the highest well-being, suggesting that psychological resilience may stem not from denying or erasing suffering, but from narratively integrating it with purpose and agency. These findings position narrative identity not just as a reflection of mental health in chronic illness, but as a potential pathway toward it. Keywords: narrative identity, chronic illness, mental health, audience effect, master narratives