The Construction of Self in Diabetics

Gloria Margarita Gurrola Pea, Patricia Balczar Nava, Hiliana Guadalupe Coln
Garatachia
Autonomous University of the State of Mexico
Summary
The objective of this study was to identify the general pattern of construction of self in two
groups of patients diagnosed with type 2 diabetes, of which one displays adherence to
treatment and the other does not.
Through an international non-probabilistic sample, a total of 51 patients over 18 years old
were chosen who did not have complications of the disease. The repertory grid technique
was used to establish the elements and constructs after the analysis of the focus group
content.
The results show that when it comes to the measurement of elevated self-esteem, according
to the correlation between the actual self and the ideal self, both groups show
extremely low self-esteem. In respect to self-comparison with others, understood as a
measurement of self-perceived social isolation, both groups of controlled patients see
themselves as different from others. Lastly, it was discovered that the satisfaction patients
felt with their peers is higher in controlled patients.
It was concluded that suffering from a chronic degenerative illness impacts the value of
self. Self-perceived social isolation can result from patterns of socialization based on food
and drink which is very prevalent in Mexican culture. Satisfaction with peers, including
caretakers, can be related to an adherence to treatment.
Key words: construction of self, diabetes, repertory grid technique
In the Theory of Personal Constructs, Me is a synonym of self or of oneself and is
defined as a construction or personal theory composed of a group of hypotheses on
oneself. This personal theory has the ultimate purpose of making sense of the proceeding
information of oneself and the interaction between one and the others, allowing the person
to organize their experience and maintain a sense of self-consistency throughout different
moments and situations (Botella & Feixas, 1998, p. 94).
The others are everyone else and represent the people in their environment, the people
the individual connects with. The way in which we construct others is intimately related to
the way in which we construct ourselves, as mentioned by Bannister and Agnew (as in
Feixas and Cornejo, 1998), the idea of self is not a concept but a bipolar construct self-no
self. Perceiving others implies an automatic self-comparison which provides information
for the dynamic construction of self.
According to Feixas and Cornejo (1998), human beings manage the construction of self,
making the following differentiations:
The differentiation between me and the idea me. This can be considered a measure
of self-esteem since it reflects the distance perceived by the subject between what
he or she is and what he or she wants to be.

The differentiation between me and the others. The construction of self is

intrinsically related to the construction of others since the processing of the
information about others implies a certain degree of automatic self-comparison. For
example, it is especially relevant that in the study of self the differentiation between
me and the others as an indicator of the central aspect of interpersonal construction,
being the social integration and its counterpart the self-perceived social isolation.
The differentiation between the ideal and the others. This index allows the
understanding of how the subject constructs the other important people in relation to
the ideal me, can be an indicator of the perceived adequacy of the others. A
negative or low correlation can indicate the subjects dissatisfaction with the people
around him or her, attributing his or her symptoms and desperation to them, while a
positive or high correlation suggests the view that the others are good.
This is why, from this perspective, developing and maintaining a sense of self also implies
that the person feels respect for the world in which he or she lives, for rules and for others.
The diagnosis of a chronic degenerative disease like diabetes impacts the sense of self in an
important way since it implies a progressive disorder, during which the patient lives
through a series of physical losses accompanied with a personal sensation of a loss of
control in ones own life and of the future.
Type 2 diabetes is a public health problem which is not exclusive to developing countries
like Mexico. This illness, because of its chronic characteristics, not only causes damage to
physical health, but can affect the mental health of those who suffer from it. A high
incidence of psychological disorders has been documented in the chronically ill (ColungaRodriguez, Garcia, Gonzalez & Salazar-Estrada, 2008), the most common being depression
with the consistent lowering of self-esteem and social isolation, as well as being associated
with a loss of metabolic control, poor adherence to treatment and a lower quality of life.
When it comes to adherence to treatment, it was observed that in adults with type 2
diabetes, a series of social, cognitive and behavioral factors can affect in a positive or
adverse way the adherence to treatment and implies the controlling and self-monitoring of
the levels of glucose in the blood, special diets, exercise, the use of prescribed medicines,
avoiding tobacco, alcohol and other substances, as well as the frequent trips to doctors
appointments (Samaniego & Alvarez, 2006). It could be said that patients with a diagnosis
of diabetes need to makes changes in all areas of their life and, above all, in the
construction of self as an important part of their medical treatment.
The study of processes, structures and cognitive content in health is on the rise given the
recognized importance of these factors in the etyopathology, development, maintenance and
treatment in a large part of the physical health problems. Despite this, one of the areas that
has gained less attention is the subjective construction of self and the problems this causes
for the patients. If we take into account that the subjects activity is measured by his or her
own construction of the same, it seems obvious we must deepen the processes, structures
and contents which form this construction (Feixas & Villegas, 2000). This result is of
particular relevance in the planning and development of intervention since any treatment
process should also be constructed by the subject himself and integrated into his system of
previous construction, since this construction plays a relevant part in the acceptance and
maintenance of therapeutic guidelines for change (Feixas, Saul, Avila-Espada & Sanchez,
2001; Feixas, Saul & Sanchez, 2000). For this reason, the objective of this study is to

compare patterns of construction of self in those patients with type 2 diabetes who adhere
to medical treatment and those who do not.
Method
Participants
With a an international non-probabilistic sample, 51 people with type II diabetes were
chosen, all of which were over 18 years old, with at least one year since being diagnosed
and who did not have complications with the disease at the time of application. The
sample was divided into two groups; the first was composed of 12 women and 5 men
who demonstrated an adherence to treatment. The second group was composed of 19
women and 13 men who did not adequately follow treatment.
Technique
The repertory grid technique proposed by Feixas and Cornejo (1998) was applied, which
is a variation of the Kelly proposal (1955). The repertory grid is an evaluation
instrument of the dimensions and structure of the personal significance which tries to
capture the way in which a person gives meaning to experiences in his or her own terms.
It is a type of structured interview during which the person first chooses the
representative people (elements) of his world or problem, secondly, idiosyncratic
constructs are elicited and its opposites according to the similarities and differences
between people who are important to the subject. Finally, the subjects grade on a scale of
one to seven how close they get to these important people and to himself with each one
of the constructs and its opposites.
The application implies a three phase process:
1) Elicitation of elements: requires a list of interpersonal roles, as well as one or
two elements of self. For this study, the elements were established through an
analysis of focus group content, previously prepared by the participants.
2) Elicitation of constructs: this procedure implies questions of similarity between
elements. For example, which characteristic these two people have in common?
And questions of difference. For example, what is the difference between these
two people? The last one allows the researcher to record the poles of the
constructs on the right lines. For this study the constructs were pre-established
through an analysis of the participant focus group content.
3) Punctuation: the participant assigns a grade from 1 to 7 of each of the elements
taking into account the elicited construct.

Analysis of results
The results were processed in the program entitled Record 2.0, analyzing the
correspondence, which allows the group treatment of the elements and constructs. Among
other measurements, the me-ideal me, me-other and ideal-others were brought up.
Results
The results show that in terms of self-esteem, measured in terms of the correlation MeIdeal Me (>.20) both groups showed low self-esteem, the group of controlled patients
being the one with less self-esteem. With respect to the comparison of the others (>.20) it
can be observed that the group which shows adherence to treatment, showing a lower
correlation to others, see themselves as different from other people. Lastly, it can be
observed that the satisfaction with peers (>.20) is higher in controlled patients (see tables 1
and 2).
Insert table 1
Insert table 2
Discussion
The ideal and the ideal me is defined as the expectations a person has of himself and
his desires, in a way that positively increases his self-evaluation, evaluating for himself and
before others. Self-evaluation can provoke emotions which can be embarrassing and these
depend on the cognitive and social development of the individual (Botella & Feixas, 1998).
In the case of diabetic patients, low self-esteem tends to be related to the feelings of
impotence and inadequacy of bodily functions (Velasco & Sinibaldi, 2001). It is a fact that
this kind of patient will suffer sooner or later from macro or micro-vascular complications
which diminish his physical, psychological and social abilities, producing disabilities,
blindness, mental deterioration, depression and a poor quality of life in general (Alfaro,
Carothers & Gonzalez, 2006), distancing them more and more from the Ideal Me. The
constant presence of depressive symptomatology in diabetic patients (Aceves, 2001) given
the consequences and nuisances of the disease during their activities and interests, directly
influences their positive experiences and indirectly provokes a perception of less control
and personal power.
The perception of it being unfair to suffer from diabetes and their reactions of rage and
hostility tend to generate an intense rejection on the part of the patient towards those who
surround the patient (Simon, 1999) with the consequential distancing and shyness. At the
same time, the loss of bodily functions can make the patient feel different and bring about
isolation and from there the perception of the difference between Me and Others. It is
important to note that an important aspect dealing with the processes of family and social
relationships can represent a determining factor for the adequate management of diabetes is
the pattern of nutrition (Samaniego & Alvarez, 2007). In Mexico, culture determines and
institutes a lifestyle which is opposite to the medical treatment of diabetes (Cardoso, 2006),
since there are many celebrations which are not only an opportunity for socializing and fun,
they are also a part of the close relationship with ones family. The fun and pleasure
generated by these celebrations are unfortunately related to food which is prohibited in the
medical treatment of diabetes since this food is high in carbohydrates, fat and alcohol. If the
patient is trying to take care of his health, he must separate himself from the group to
consume a prescribed diet, challenging the prescribed cultural patterns of socialization,
with can generate antipathy, conflict and cause the subject to miss important experiences
with his social group and particularly with the people who are important to him.

When it comes to the correlation of Ideal-Others, we must take into account that the
treatment of diabetic patients requires personal responsibility and implies the control of
certain skills. It also takes place in a social context in which there are many care-takers
involved who may be perceived as either adequate or inadequate (Simon, 1999). When
patients do not perceive an adequate quality of life or control of the disease, the most
affected dimension is precisely the satisfaction with treatment (Cardenas, Pedraza &
Lerma, 2005) including all those who are involved in the treatment, whether it be the
medical staff or the family. We can disregard the dissatisfaction of the uncontrolled patients
in this study since although they do not follow their treatment, they blame their symptoms
and desperation on the people around them.
In general, we can conclude that suffering from a chronic degenerative illness like type 2
diabetes, impacts the value of self, that self-perceived social isolation of the patients who
adhere to medical treatment can be a response to socialization patterns based on food and
drink which is very common in Mexican culture and the satisfaction with peers, including
care-takers is related to an adherence to treatment.
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