Narrative storytelling provides a structure for recounting the past as part of trying to understand the present, offering a way to make sense of what has happened. OCCUPATION AND STORY Stories concern both behavior and experience. They are about someone doing-or trying to do - something, about finding these attempts interrupted in the world, and about the resulting struggle to bring personal meaning, behavior, and opportunity into consonance (Mattingly, 1998). As older patients live with chronic diseases and deteriorations from which they cannot realistically expect to recover, treatment processes become a set of public behaviors and associated private feelings, meanings, judgments, and perceptions. That is, treatment of all sorts comes to rely on the telling and making of stories. As Matthews and colleagues describe (1994), the elder tells stories as a way of coming to terms with the many unfamiliarities of old age by situating them within models that arc culturally and personally acceptable. These stories may explicitly concern coping with disease and injury. They arc just as likely to concern broader themes of lifelong efficacy and powerlessness, of success and failure, of love and loss. Storytelling makes use of words as its primary medium of expression. But there is far more to storytelling than words. Occupation is a powerful means through which elders enact the stories of who they are. Using techniques of occupational storytelling (Clark et al., 1996), elders identify the constellation of existing personal occupations that comes to life as their story-each with its own internal consistency, tensions, and hints for resolution. Once told, the story reverberates. Teller and listener alike recognize themes of consonance. They also recognize dissonance between values held and actual behavior, between meaning held inside and activity demonstrated in the outside world (Hasselkus, 2002). And, through a complementary, creative process of occupational story making, elders learn to transform this story into one mat optimally suits their personal self in the current environment and life stage. That is, the person makes a new occupational story. Eloise's tale illustrates occupational storytelling and story making through a woman in her 90s who learned to cope with the ramifications of a devastating fall. VITAL INVOLVEMENT Erikson and colleagues (1986) clarified the principle that a person develops and exercises a unique identity through vital involvement with the environment. Vital involvement is defined as a person's meaningful engagement with the world outside the self (Kivnick, in press; Kivnick and Kavka, 1999). Vital involvement is purposeful activity-the circular mechanism through which individuals exercise capacities and make contributions of value to the world and to themselves, and through which they are influenced and changed by that world. Old age brings a number of constraints on opportunities for individual vital involvement. Maintaining psychosocial health through old age therefore requires the individual to take full advantage of existing opportunities for vital involvement. The construct of vital involvement may be understood as synthesizing fundamental principles from the disciplines of occupational science (Hocking, 2000; Clark et al., 1996; Jackson, 1996; Wilcock, 1993; Yerxa, 1993) and life-cycle, psychosocial development (Erikson, Erikson, and Kivnick, 1986; Erikson, 1980; 1950; Kivnick, 1991; Kivnick and Murray, 1997; Kivnick and Jernstedt, 1996) into an ongoing process that links person to community (See Figure 1). Occupational science rests on the notions (Yerxa, 1998) that occupation constitutes a personally meaningful chunk of activity, and, therefore, that a person's occupational performance may be understood as the person's expression of a unique self in a specific community environment. With every occupation, in every meaningful activity, the elder expresses who she or he is. …

Helen Q. Kivnick

Category	Quartile
社会学	4
社会学, 老年医学	4

Eloise's Tale: Vital Involvement, Occupation, and Story

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