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Journal of Occupational Science

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Occupational Identity: Exploring the Narratives of

Three Men Living with AIDS
a b
Brent Braveman & Christine A. Helfrich
a
OTR/L Clinical Assistant Professor, Department of Occupational Therapy , University
of Illinois , Chicago M/C 811, Room 347 1919 West Taylor Street, Chicago , Illinois , USA
Phone: 312 3552656 E-mail:
b
OTR/L Assistant Professor, Departments of Occupational Therapy and Disability
Studies , University of Illinois , Illinois , USA
Published online: 26 Sep 2011.

To cite this article: Brent Braveman & Christine A. Helfrich (2001) Occupational Identity: Exploring the Narratives of
Three Men Living with AIDS, Journal of Occupational Science, 8:2, 25-31, DOI: 10.1080/14427591.2001.9686486

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 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
Occupational Identity: Exploring the
Narratives of Three Men Living with
AIDS Brent Braveman and Christine A. Helfrich
Abstract
The relationship between occupation and identity has
received increased attention in recent years. This article
explores the usefulness of the construct of occupational
identity as measured by the Occupational Performance
History Interview (OPHI-II) in understanding the evolving
narratives of three men living with AIDS who participated in
a vocational rehabilitation program. The narratives of the
three men are described and the impact of AIDS and an
attempt to return to work on each individual’s occupational
identity is discussed. Narrative slopes are presented for each
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of the three men. Directions for future research are
suggested.
Keywords
Occupational identity
Narrative analysis
AIDS
Vocational rehabilitation
Brent Braveman, M.Ed., OTR/L
Clinical Assistant Professor, Department of Occupational
Therapy
Christine A. Helfrich, Ph.D., OTR/L
Assistant Professor, Departments of Occupational Therapy
and Disability Studies
Both of the University of Illinois at Chicago
M/C 811, Room 347
1919 West Taylor Street
Chicago, Illinois, USA.
Phone: 312 3552656
Email: Bbravema@uic.edu
Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
This article will present the narratives of three men to
illustrate the usefulness of the construct of occupational
identity in understanding how individuals see their evolving
lives. (Christiansen,1999; Kielhofner, Mallinson, Forsyth,
& Lai, 2001). This article also explores the usefulness of
the construct of occupational identity in understanding the
evolving narratives of persons with a disability. It explains
how gaining a view of a person’s occupational identity can
complement information gained from traditional
assessment of functional capacities or aptitudes in order
to gain a more holistic view of an individual.
Literature Review
Constructing personal narratives involves the integration
of past, present and future selves. People construct their
own identities by using narrative operations to produce
stories about who they are. Self-stories provide unifying
identities to people’s lives by gathering their past actions
and happenings into a coherent and meaningful story
(Polkinghorne, 1996).
The use of narrative as a method of understanding the
unfolding lives of individuals is well documented. Narrative
analysis is a method of understanding the occupational
choices that people make in an unfolding life (Kielhofner,
1995). Through the narratives of their lives, people
recount their daily occupations, routines, family member
relationships, and the socio-cultural factors that influence
their occupational performance (Larson, 1996). Narrative
interviews can also provide a mechanism for researchers
and therapists to make systematic observations, validate
interpretations about people’s lives and interact and
collaborate with them to create new worlds, new meanings
and new life stories (Hasselkus, 1993; Helfrich &
Kielhofner, 1994; Clark, 1993; Mattingly & Freeman,
1993).
Christiansen (1999), in his Eleanor Clark Slagle Lecture
for the American Occupational Therapy Association,
defined identity as “the person we think we are and the
self we know.” He distinguished identity from self-
concept (the inference we make about ourselves) and self-
esteem (the evaluative aspect of the self-concept).
Kielhofner et al. (2001) use the more specific term
“occupational identity.” They define occupational identity
as “a composite sense of who one is and wishes to become
as an occupational being generated from one’s history of
occupational participation.” Because we are capable as
human beings of relating our past life and current
experiences to our imagined future lives, occupational
25
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
identity serves, then, both as a means of self-definition
and as a blueprint for upcoming action. Preliminary
evidence suggests that constructing one’s identity begins
with self-appraisal and extends toward the more
challenging elements of accepting responsibility for and
knowing what one wants from life (Kielhofner et al.,
2001). Thus it appears that building an occupational
identity begins with self-knowledge of capacities and
interests from past experience and extends to constructing
a value-based vision of who one wants to become. Because
occupational identity incorporates one’s past, present and
anticipated future, it can useful in coming to understand
how an experience such as the onset of a disability is
framed by an individual and how it impacts the view that
one holds of his or her past, current and future imagined
self.
The Occupational Performance History Overview (OPHI-
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II) is a semi-structured interview designed to provide
information about the person’s occupational performance
and life history of persons (Kielhofner, Mallinson,
Crawford, Nowak, Rigby, Henry & Walens, 1998). The
OPHI-II allows exploration of all of the person’s roles,
social contacts and any of the environments in which he
or she operates and has been shown to measure three
underlying constructs (Mallinson, Mahaffey & Kielhofner,
1998). In addition to occupational identity these constructs
include occupational competence (the degree to which a
person is able to sustain a pattern of occupational behavior
that is productive and satisfying) and occupational behavior
settings (the impact of the environment on the subject’s
occupational life). After administration, the therapist
scores the person on each of three sub-scales. The items
of each subscale are arranged within the assessment in
order from less to more of the underlying trait. In the case
of occupational identity the construct as measured by the
OPHI-II ranges from the past items of “felt-effective” and
“found meaning and satisfaction in lifestyle” (lesser
amount of the trait) to the present items of “has interests”
and “identifies a desired occupational lifestyle” (larger
amount of the trait). All of the items for the occupational
identity scale are presented in table 1.
Table 1: Items of the OPHI-II Occupational Identity Sub-
Scale
Occupational Identity
Identifies a desired occupational lifestyle
Has interests
Has personal goals and projects
Has commitments and values
Recognizes identity and obligations
Expects success
Appraises abilities and limitations
Accepts responsibility
Made occupational choices (past)
Found meaning and satisfaction in lifestyle (past)
Felt effective (past)
26 Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
Scoring the OPHI-II also includes writing a short life
history narrative. Writing the life history narrative
facilitates development of an appreciation of the
fundamental nature of the person’s narrative. This
condensed narrative summary reveals the fundamental
nature of the person’s narrative. One strategy included in
this process is plotting a graphic representation of the
person’s narrative indicating the narrative slope— a visual
representation of the ups and downs of the person’s
occupational history. The slope of the narrative illustrates
where a person’s life has been and where it is headed
(Kielhofner et al., 1998). In considering any narrative, it
has two features. First the story unfolds across time.
Second the story relates circumstances and events that get
better (a progressive narrative), stay the same (a stable
narrative) or get worse (a regressive narrative) (Gergen
& Gergen, pgs. 36-58, 1983). Because people draw upon
the past and anticipate the future when trying to make sense
of their circumstances, accurately understanding how
people see the slope of their unfolding narrative can be
instrumental to gaining a perspective on how they may
respond to changes in their circumstances or life story
interpret and participate in daily occupations (Kielhofner
et al., 1998).
This paper presents preliminary results of a study of
occupational identity conducted with 16 men who
completed the Employment Options Program, a research
and demonstration project focused on providing vocational
rehabilitation services to people with AIDS and funded by
the U.S. Department of Education’s Rehabilitation
Services Administration (Grant # H235A980170). The
first author conducted a series of 3 narrative interviews
over a 5-month period with each subject. Each interview
was audio taped and lasted an average of 90 minutes. The
first interview included administration of the OPHI-II and
exploration of the impact of AIDS on the men’s lives
(Braveman, Sen & Kielhofner, pgs 139-162, 2001). A
second interview was conducted as a member check after
the interviews were transcribed. The first two interviews
with each subject were then coded for themes using
traditional content analysis with the unit of analysis being
responses to questions. A third interview was conducted
5 months after the first exploring what progress subjects
had made in their efforts to return to work. Plots of the
subjects’ life histories based on the first two interviews
were shared with the subjects for verification. The
narratives of three of these men will be presented focusing
on how occupational identity may be useful in
understanding how the men saw their evolving stories. The
stories, examples of a progressive, stable and regressive
narrative, will be shared to illustrate the construct of
occupational identity in the context of the narratives. The
narrative slopes for the three men, and indications of when
each individual received their diagnosis of being HIV
positive are presented in Figure 1. Implications for
assessment of occupational identity will be discussed.
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
Figure 1: Narrative Slopes of Jorge, Tom and Mark
Jorge
A ID S
M ark A ID S
T om
A ID S
Tom ○ ○ ○ ○
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Key: Jorge Mark
points below the line are negative.
Jorge: A Progressive Narrative with AIDS as a
Point of Transformation
Jorge, a 47-year old with 14 siblings from Puerto Rico,
has a limited work history, a long history of substance use
and abuse and lives in a small, subsidized apartment
provided by an addictions recovery program. Although he
described himself as “straight-A student” he dropped out
of school and began using marijuana at the age of 14. He
worked in temporary jobs painting houses with long breaks
in between which he attributed to his drug use. At 22, Jorge
moved to Chicago with his mother and sister with plans
for the rest of the family to join them. He began “making
deliveries” for drug dealers for money to bring his family
from Puerto Rico. His drug use escalated: “I kind of lost
my mind on that making money and started using heroin,
you know, snorting heroin, that’s why it get me. I kept doing
it and doing it and making a lot of money but I spend it,
you know the way it is, and laid around and started using
through the veins.” He attributes his HIV infection to
heroin use that also led to homelessness and the loss of
his family including his wife and children.
Jorge describes intermittent employment for the next 15
years including jobs at gas stations, cleaning jobs or
painting with his longest stretch of continuous
employment at a car dealership for 12 months. He enjoyed
that job the most. Despite what might be described as a
“poor” work history, Jorge is proud of his attributes as a
worker. Jorge values structure, order and timeliness. He
is confident about his skills as a worker noting, “I’m the
kind of person that when I start a job I like to finish it.
That’s one thing. You tell me to assemble this for today,
this is the job for today, I have to make it. I make sure the
job is going to be done. You don’t have to be on top of me.
Just give me what I have to do and you can come back
later.”
Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
AIDS=AIDS diagnosis. Points above the line are positive &
Jorge is able to appraise his abilities and current
limitations. Fatigue limits his ability to find temporary
work. He stated, “Many times I want to do temporary work
at these places but I cannot. I don’t feel like it—I say I’ll
go tomorrow.” He is optimistic about his success in efforts
to obtain work and relates his determination in comments
such as, “There’s likely nothing getting in my way. I know
I have to control my thinking and think different, say, “I
have to do this, I want to do this.” “As long as you lay
down in the nighttime, you’re ready in the morning to do
it. An if you’re doing the right thing like getting the
medication and eating good and resting good, you will be
able to get up and accomplish what you want.”
Jorge’s daily life is spent on tasks that he structures for
himself including housework, medical appointments,
attending recovery meetings, and volunteering at a local
center for recovering addicts. He focuses on maintaining
a healthy diet and adhering to his medications recognizing
the role that both these factors play in his health and reflect
his commitment and values related to maintaining his
sobriety. He has increased his contact with his family and
is proud that they recognize the progress that he has made
in his recovery.
He has proudly reestablished a relationship with his four
children stating, “I’ve been talking to them better than
before, our relationship is becoming better. And they love
me, I know that. I love them to death, and it’s unbelievable
the way they love me. I’m thinking about what I did, and
what I didn’t do. You know what I mean? It’s a blessing.”
For the first time since Jorge was a student in Puerto Rico,
he has identified a desired occupational lifestyle that
includes goals for work and becoming fully self-sufficient
and is actively working towards achieving these aims. He
continues to pursue temporary employment but is also
actively searching for and applying for permanent part-
time work.
27
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
Jorge perceives that his life has improved. He sees
acquiring AIDS as the critical turning point that has allowed
him a second opportunity, an “awakening” that has allowed
him to see himself and his life more clearly and enabled
him to establish a meaningful direction for himself. He
views his long period of drug use as a time when he “was
lost” but now plans to use his new found peace and “do
something with his life.”
While Jorge has not yet been successful in his goal of
obtaining permanent employment he continues to move
toward this goal. Rather than interpreting his challenges
as a failure, Jorge has focused on the positive direction
his life has taken. He reflected on his life narrative: “When
I was young, I thought I was living a pure life because I
wasn’t doing anything but natural things. A good life. A
pure life. Then in my 20’s I had a messed up life. In my
30’s, 35 years old I was more messed up, you know, lost.
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Now my 47th birthday, hopefully I will get there and I know
I will because I got what it takes to get there. I think I’m
more spiritual. I find peace. I got the peace I lost. That’s
the way I describe my life and it’s good, it’s better than
ever.”
Jorge anticipated that his narrative would continue to
progress in a positive direction, stating, “It’s heading up.
That’s the way it’s supposed to be. Life doesn’t stop
because you have AIDS. Now is when I’m going to live.
You have to fight with something. Some things you have
to fight against.”
Tom: Life Has Been a Ball: A Stable Narrative
with AIDS as a Backdrop
Tom is a 45-year old white male born and raised with his
brother by his mother and an alcoholic father in Chicago.
When the study began, Tom was unemployed and living in
a studio apartment in Chicago. He describes his father’s
alcoholism as a major negative affect on his early life.
He describes his high school experience as “showing up
and not having a thought in my brain—I just went there.”
After graduation from high school, Tom’s work life was
characterized for 28 years by a lack of specific direction
with a myriad of jobs included working in construction,
four years in the Air Force, managing small department
stores, and working on a pumpkin farm. He has always
been focused on the present with little attention to
planning for the future and “just going along.” Still, he
has felt effective in the past, has found meaning and
satisfaction in his lifestyle, and has made occupational
choices.
As a worker, Tom described himself as a problem solver,
stating, “I cover every base, take care of things before they
become a problem.” His self-descriptions included being
committed to working hard and getting along with others,
and finding the positive in a situation.
Tom described his HIV diagnosis as “a horrible day that
28 Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
was probably the worst in his life.” However, as Tom
describes his life story and the major turning points, AIDS
and his illness experience does not come to the
foreground. Rather, AIDS is woven within his life narrative
with the many other positive and negative events that he
colorfully described.
Tom is able to identify the negative impacts of acquiring
AIDS and accurately appraises his abilities and limitations.
He stated that AIDS “Stops your life—it basically stops it
dead in it’s tracks. It stops it, as you know it. Nothing is
ever the same after that.” While Tom describes AIDS this
way, he also stated that he had gotten started again “big-
time.” In reviewing his story, few of the decisions Tom
has made in regards to his life course have been related to
AIDS.
Significant high and low points throughout his life have
marked Tom’s narrative. He described his life story stating,
“It’s been a ball. I’ve been very lucky. I’ve been very blessed.
I wouldn’t trade it for anything.” Rather than being a turning
point or fulcrum in Tom’s narrative, for Tom AIDS is just
another point in the “roller coaster” he calls life. The
pattern of ups and downs has actually been a stable pattern
throughout his life.
At the beginning of the study, Tom had just moved to
Chicago after voluntarily leaving a job on a pumpkin farm
where he worked for three years. Tom was not overly
concerned about his unemployment, other than the natural
worries about being able to support himself financially.
His desire to return to work related to his identity, “I want
to work because I want to live, I want to feel human again,
and I don’t feel human anymore. Because a normal person
works every day.”
After 7 months, Tom successfully obtained full-time
employment with health benefits. In reflecting on his
period of unemployment Tom demonstrated the typical
“You just go on” attitude that he maintained throughout
the interviews. He stated, “I can’t believe how the past six
months, overall, almost everything—has just gone really
nicely. So it’s kinda like been the smoothest period of my
life. It was one of the best times in my life probably.
Because I had the time to work things out and adjust from
my lifestyle up there (the pumpkin farm), which wasn’t
bad, but it just didn’t work for me.” Tom’s new job as a
receptionist for a community-based social service agency
is another in what has been a pattern of moving from one
position to another in unrelated fields. He described the
job as “a starter job, like kinda re-starting over in what
I’m going to be doing. Because since there’s a really good
chance that I’m going to live 20 or 30 or 40 or 50 more
years who knows? I better be prepared and do something
that I enjoy and that I think I’m capable of doing under
maybe sometimes less than favorable health conditions.”
He is optimistic about this new job and expects success.
He described the daily structure of his life as “just living
a normal life and probably a pretty good life compared to
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
a lot of people” and the fact that he has found a job that he
enjoys is “icing on the cake.” While he expresses relief
at having found a job and the financial security that came
along with it, it was at the same time unremarkable to him.
He stated, “I’m working which is a big load off my
shoulders. But at the same time before it happened
(returning to work) I knew the thing would work out one
way or another.”
As Tom looks forward in time he is able to identify a
desired occupational lifestyle, but as is the case with his
description of most periods in his life, his plans
characteristically lack a specific direction. He has
interests and is able to identify personal goals and projects
such as learning Spanish to aid him in his new job. His
expectation of success remains stable as he anticipates
his narrative moving forward in the future. He stated, “Just
getting better. That’s my intention. You work on things; I
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don’t know what’s going to happen or anything like that.
But I feel I can deal with a whole lot of other things that I
maybe didn’t deal with before. I’m more mature now. It’s
off the page.”
Mark: A Regressive Narrative with AIDS as a
Point of Decline
Mark is a 41-year old male who grew up in the suburbs
and resided in a condominium in Chicago throughout the
study. He lived with his parents throughout high school
and his first year of college. After college Mark began a
job with a communications company in an information
management position. Mark found his work exciting,
describing it as “a very good time in my work life.” He
felt effective and “good at his job” and remained in that
position for three years. During this time Mark met his
partner, and they began to live together and Mark found
meaning and satisfaction in his lifestyle. Approximately a
year later, Mark was assigned to a new job that was positive
until the project he was working on was cancelled. He went
to work for months without anything to do, experiencing
considerable guilt over the situation. Shortly after this
time Mark discovered that he and his partner were HIV
positive. Although Mark was reassigned and his work stress
decreased, he continued to experience stress related to
he and his partner’s health problems. After 5 years at the
same company, Mark left and began a totally different kind
of work with a new set of people and related he “loved it
and did very well”.
While the HIV did not initially affect Mark’s health, his
partner was more severely impacted with his first
hospitalization in 1990. In 1992, Mark began experiencing
extreme fatigue that led to several weeks of missing work
and beginning the process of applying for permanent
disability benefits. Mark’s partner’s health continued to
decline and less than a year after Mark stopped working
his partner died.
Mark describes the next year as a period of isolation and
Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
major depression, which only lifted briefly when Mark
became involved in a local alternative health center. The
next year his health declined, requiring several
hospitalizations. Mark remembered, “I got scared because
I thought—I’m living alone, how am I ever going to cope
with taking care of myself, getting to the doctor, all that
other stuff that I helped my partner with, on my own”. As
Mark made plans to live with his parents, he began Protease
Inhibitor treatment. He rapidly reported feeling better with
increased energy and appetite.
Although his condition improved, Mark’s depression
worsened. He stated, “I was so depressed, I wasn’t sleeping.
I think my depression was—My God, what am I going to
do, I’m getting better—this wasn’t in my plan. I had
deconstructed my entire life—I gave up my job, gave up
my partner—gave up all my social contacts, so if I am
going to live—I’m a mess.”
Mark began counseling and slowly adjusted to the idea of
rebuilding his health and considering he might work again.
However, he felt ambivalent. Returning to work held
positive meaning for him both in terms of the financial
rewards and its relationship to his identity; however, he
was unsure of how to return to work. He stated, “At that
point I was kind of scared about the idea of working again,
because I knew I did not want to go back to my old
company. My memory of that was it was a very stressful
place to be.” Mark explored options with his counselor
including the use of an interest inventory. After exploring
a number of options he attended massage therapy school
and was graduating when this study began.
Two weeks before beginning the study, Mark was
interviewed at a spa where he completed an externship.
He described his performance by saying, “I had an
interview two weeks ago and bombed.” “The idea of
interviewing is nerve racking for me. I get performance
anxiety and when I do have to perform physically, even if
it’s just talking, I screw up because of the anxiety. Before
this interview I could picture myself going to work every
day and doing this job, and being happy doing it. And now,
after the interview, I’m not so sure—I feel like—maybe
this isn’t what I should be doing.” These statements are
reflective of Mark’s decreased expectation of success. He
is able to appraise his limitations but has difficulty
recognizing his abilities.
Five months later, Mark remained stuck in a period of
anxiety unable to make significant progress in any area
despite the optimistic view he expressed earlier; “My
expectation for the future is that I will live with this until
there is no need to live with it anymore. Until something
happens and it will be resolved. That could happen and end
in death, but my outlook is not towards getting sick and
dying anymore. It’s toward staying healthy as long as I can.”
Mark vaguely identifies his desired occupational lifestyle
and associates that with returning to work. “I anticipate
that if I actually do finally get a job and settle into it, it
will increase my self-esteem and self-confidence quite a
29
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
bit. I will be more in control of what’s going on with me,
and more responsible for it. And I think it will help me
feel more normal.” Yet he is unable to work through his
immobilizing anxiety. He is able to identify interests but
inconsistently participates in them.
Mark views AIDS as “having turned his life upside down”,
requiring him to go through a process he describes as
“dismantling his life.” Though he is trying to reconstruct
it, he sees returning to work as a very difficult step with
AIDS as a major roadblock.
In describing his narrative, Mark has not lost all hope and
is reflective on the events that have shaped his life. He
stated, “The metaphor that I think of is being blown in the
wind, a directing force that wants you to be in a certain
place, so it blows you a little to the left and if you go too
far it blows you a little to the right. This isn’t just
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correcting the course, pushing me in a specific direction
but it is developing me. I see it as self-development, all
these things.” He has gained the perspective that he is
involved in an ongoing struggle to maintain a sense of
purpose that he has not yet won. “The sense of purpose I
guess would be my term for work identity.” “So leaving
my job, I had to define myself outside of an occupational
identity. I think that regaining an occupational identity
such as most working people have will help solidify and
stabilize my perception of myself.” For Mark, regaining
his desired occupational lifestyle remains a task for the
future. “So, I think that will help once I redefine that, even
though I’ve chosen what I want that to be, it’s not—I’m
not there yet. Once I’m there I will feel some more self-
confidence.”
Discussion
This paper has presented three life history narratives, those
of Jorge, Tom and Mark. These narratives are examples of
a progressive, stable, and regressive narrative
respectively. All three of these individuals took part in
the same clinical program, the Employment Options
Program, that had the mission of helping people with AIDS
who were unemployed explore options to return to work.
While evaluations in work programs are sometimes limited
to a combination of examination of previous work history
and functional capacities, the Employment Options
Program, and the investigator in this study used the
Occupational Performance History Interview (OPHI-II)
to elicit a life history narrative. By eliciting these
narratives the investigator gained a clearer and richer
understanding of how AIDS resulted in shifts in
occupational identity.
Jorge, who has maintained a self-view as a reliable and
dedicated worker and has been “awakened” by his illness,
views his current condition as a foe that you “fight
against.” Tom lives his life as a “roller coaster”
characterized by ups and downs that are each handled in
turn with AIDS as a backdrop for the events of his life.
30 Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
Mark who has less significant physical difficulties, more
financial resources, and more marketable skills is unable
to break out of the inertia of remaining in place, gazing
into the future, yet unable to move towards it in any real
way. While AIDS has marked turning points for Jorge (in
a positive direction allowing him to become clean and
sober) the major turns in Tom’s life has been less related
to AIDS and more reflective of a lifelong pattern of
occupational choices. AIDS for Mark resulted in his
narrative moving in a negative direction resulting in a
dismantling of his life.
Occupational identity was an especially helpful aid in
understanding the narratives of these three men and the
events that made up their narratives. Contrary to what
might be expected if we were to rely on the evidence
related to prediction of successful return to work alone
(e.g. history of previous employment, job satisfaction etc)
we might anticipate that Jorge was the least likely to be
making real progress towards return to work given his
history of substance abuse, poor work history, and low
educational level. And yet, Jorge has framed his illness as
a positive event resulting in increased occupational
identity characterized by his increased commitment to
stable and permanent involvement in the lives of his
children and family. He also took on personal goals and
projects and identified a desired occupational lifestyle and
a plan to achieve that lifestyle based on a realistic appraisal
of his abilities and limitations. AIDS has significantly
impacted Jorge’s occupational identity in a positive
direction.
Because Tom presented himself to a program designed
specifically for people who had AIDS and wished to return
to work, it would have been reasonable to focus on the
impact of his illness on his functional capacity. Yet it was
only through eliciting his life-history narrative that it
became clear that Tom’s occupational identity had
remained stable throughout his illness and the period of
unemployment that marked his initial involvement in the
Employment Options Program and this study. Tom
expected success in obtaining employment through out
the period of the study and worked diligently resulting in
his success in getting a job that matched his emphasis of
the social relationships within the work setting over the
specific nature of the work. Tom was able to identify a
desired occupational lifestyle and begin to take action to
pursue it. He had personal projects and goals related to
life both within and outside of the context of work. His
movement from one employment situation, through a
period of unemployment to reentry to work did not
significantly change his occupational identity.
Based on Mark’s history of consistent employment, higher
educational level, considerable skill set and stable housing
we might anticipate that Mark would more easily be able
to move forward with his plans to return to work. Yet,
Mark’s inability to carry out his plans or work through his
anxiety is indicative of his weaker occupational identity.
Prior to acquiring AIDS, Mark’s occupational identity was
 Occupational Identity: Exploring the Narratives of Three Men Living with AIDS
grounded in his past successes. He had felt effective, found
meaning and satisfaction and made many occupational
choices in past roles. However, for Mark, AIDS and his
partner’s death became a fulcrum around which his
narrative turned. His “performance anxiety” replaced his
prior expectation of success and feelings of competence
as a worker. He seems unable to draw upon his past
occupational identity as he moves into the future. Instead,
his current experiences of anxiety and disappointment
dominate his regressive narrative.
In summary, Jorge’s narrative represents an individual
whose occupational identity and occupational competence
has become stronger as he has faced the challenge of his
illness. He feels less threatened and has increased
confidence in interacting with the occupational behavior
settings in his life. Tom’s narrative represents an individual
whose occupational identity, occupational competence and
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perception of occupational behavior settings have
remained stable despite living a life with alternating
positive and negative experiences. Finally, Mark’s narrative
represents an individual whose occupational identity has
been weakened by the onset of illness that has changed
his life’s course. He feels less competent about his
occupational performance and feels more threatened by,
and less comfortable in the occupational behavior settings
in his life.
Conclusion
This paper presented three narratives of individuals who
completed the Employment Options program, a vocational
rehabilitation program for people with AIDS. An example
of a progressive, stable and regressive narrative was
provided. The narratives were used to illustrate what the
construct of occupational identity might add to a
traditional work history or standard evaluation of
functional capacity. The narratives provided a context to
illustrate that without understanding the occupational
identity of the three subjects we would not have fully
understood their stories.
The OPHI-II would be a useful tool in further studies of
occupational identity related to individuals with other
illnesses or types of disabilities and/or in regards to other
life roles. We would benefit from exploration of how
occupational identity is impacted by, and impacts
occupational transitions associated with adoption of new
roles or loss of roles such as with retirement,
homelessness or becoming a parent. Studies conducted
with persons both with and without disabilities would be
beneficial in illuminating the relationship between
occupational identity and occupational performance.
Journal of Occupational Science, August 2001, Vol 8, No 2, pp 25-31.
B. Braveman and C. Helfrich
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