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Disability and Self:
Critical Factors in 
Positive Adjustment 
After the Onset of 
Disability in Emerging 
Adulthood

NATALIE CHRISTENSEN



102  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

DISABILITY AND SELF

ABSTRACT

9LZPSPLUJ �̀�ZLSM�LɉJHJ �̀�HUK�ZVJPHS�Z\WWVY[�HYL�RL`�MHJ[VYZ�PUÅ\LUJPUN�
adjustment following the onset of chronic disability. The presence or 
HIZLUJL�VM�[OLZL�MHJ[VYZ�PUÅ\LUJLZ�[OL�HɈLJ[LK�WLYZVU»Z�WLYJLW[PVUZ�VM�
ZLSM��WLYJLW[PVUZ�I`�V[OLYZ��HUK�V]LYHSS�SPML�ZH[PZMHJ[PVU�HUK�JVUÄKLUJL�
in their ability to achieve goals. This article assesses data collected 
from an open-ended interview with a single participant, D, organized 
I`�[OLTH[PJ�HUHS`ZPZ��0[�ÄUKZ�[OH[�+�Z�YLZPSPLUJ �̀�ZLSM�LɉJHJ �̀�HUK�ZVJPHS�
Z\WWVY[�Z`Z[LT�ZPNUPÄJHU[S`�PUÅ\LUJLK�OLY�TPUKZL[�HUK�H[[P[\KL�[V^HYK�
life after being diagnosed with Multiple Sclerosis (MS). The author 
L_WSVYLZ�OV^�[OLZL�MHJ[VYZ�^LYL�PUÅ\LUJLK�I`�[OL�TPJYV���TLZV���
and macro-contexts in which D existed, focusing particularly on the 
context of her relationships with others. The paper concludes with 
recommendations for future research.



COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   103   

NATALIE CHRISTENSEN

O ver 1 billion people live with some form of disability and 
that number is increasing (World Health Organization, 
2021). Some reports suggest that 15% of adults ages 60 
and older report at least one functional limitation (Infurna & 

Wiest, 2016), while an estimated 5% of working Americans experience a 
short-term disability each year (Council for Disability Awareness, 2021). 
Research indicates the life stage in which one develops a disability 
TH`�PUÅ\LUJL�[OLPY�KL]LSVWTLU[HS�[YHQLJ[VY �̀�ZPUJL�PUKP]PK\HSZ�MHJL�
KPɈLYLU[�YLZWVUZPIPSP[PLZ�HUK�WYPVYP[PLZ�[OYV\NOV\[�[OL�SPML�JV\YZL��(Z�
discussed by Lachman (2004), in emerging adulthood, individuals are 
generally healthy and therefore focused on milestones related to their 
career and personal life. Emerging adulthood is characterized as a time 
when young adults explore their newfound freedom and solidify their 
identities (Arnett, 2000). Developing a physical disability during emerging 
adulthood disrupts normative developmental trajectories and creates 
a stark contrast between life experiences gathered as an able-bodied 
person and life experiences following the onset of disability.

;OL�KL]LSVWTLU[�VM�H�KPZHIPSP[`�UV[�VUS`�PUÅ\LUJLZ�OV^�H�WLYZVU�]PL^Z�
themselves, but also impacts their interactions with others and with 
society at large. Ableism is a tangible experience for many people 
with disabilities who may experience judgment and marginalization. 
Experiences of ableism can vary depending on the severity of 
symptoms, the individual’s own attitudes and perceptions, and the 
visibility of an individual’s disability. People with visible disability 
symptoms may be more likely to experience overt ableism, as their 
JVUKP[PVUZ�HYL�KPɉJ\S[�VY�PTWVZZPISL�[V�OPKL��*VUKP[PVUZ�JOHYHJ[LYPaLK�
by recurring-remitting symptomatology, such as Multiple Sclerosis (MS), 
HYL�\UPX\L�PU�[OH[�[OL`�OH]L�H�ZWLJ[Y\T�VM�Z`TW[VT�ZL]LYP[ �̀�4:�PZ�
an incurable neurodegenerative disease in which the body’s immune 
system attacks the myelin sheath, resulting in diverse and unpredictable 
manifestations of symptoms. An individual may be able to pass as 
able-bodied at times, depending on where they happen to be on the 
spectrum at that time. The choice to disclose or conceal disability 



104  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

JHU�OH]L�WYHJ[PJHS�HUK�WZ`JOVSVNPJHS�JVUZLX\LUJLZ�[OH[�PUÅ\LUJL�H�
person’s daily experiences (Nario-Redmond, 2020).

Studies by Fong et al. (2006) and Dalmonte et al. (2004) found that 
a “positive outlook, maintenance of social relationships, and an 
ability to adapt to the environment are critical to maintaining well-
being” (Ploughman et al., 2012, p. 7). The purpose of this study is to 
KLTVUZ[YH[L�OV^�H�WLYZVU�Z�YLZPSPLUJ �̀�ZLSM�LɉJHJ �̀�HUK�ZVJPHS�Z\WWVY[�
Z`Z[LT�PUÅ\LUJL�IV[O�OV^�[OL`�]PL^�[OLTZLS]LZ�HUK�[OLPY�HIPSP[`�[V�
thrive and achieve their goals after the onset of a physical disability.

LITERATURE REVIEW
ABLEISM

(ISLPZT�PZ�KLÄULK�HZ�WYLQ\KPJL�HUK�KPZJYPTPUH[PVU�IHZLK�VU�WO`ZPJHS�
HUK�TLU[HS�KPZHIPSP[`�JSHZZPÄJH[PVU��5HYPV�9LKTVUK���������5HYPV�
9LKTVUK��������PKLU[PÄLZ�HISLPZT�HZ�HɈLJ[P]L�LTV[PVUZ�VY�H[[P[\KPUHS�
reactions, behavioral actions or practices, and cognitive beliefs and 
stereotypes that go beyond general negativity. There are nuances and 
degrees to which these three forms can manifest, and ableism exists at 
the internal, interpersonal, and institutional levels. 

Internalized ableism incorporates ableist attitudes, beliefs, and practices 
in the minds of individuals who identify as disabled. This form of 
internalized oppression has been found to contribute to mental health 
concerns, including anxiety, depression, isolation, and feelings of 
inferiority (Jóhannsdóttir et al., 2022).

RESILIENCY AND MULTIPLE SCLEROSIS

After experiencing stress or trauma, some people adjust positively 
and establish a stable developmental trajectory; others respond 
maladaptively (Herrman et al., 2011). An individual’s ability to recover 
MYVT�Z[YLZZ�JHU�HɈLJ[�KL]LSVWTLU[�HUK�PUÅ\LUJL�OLHS[O�V\[JVTLZ��
7SV\NOTHU�L[�HS��KLÄUL�YLZPSPLUJL�HZ�¸[OL�HIPSP[`�[V�HJOPL]L��YL[HPU��VY�
regain a level of physical or emotional health after illness or loss, which 
is associated with successful coping and ‘bouncing back’ in spite of 

DISABILITY AND SELF



COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   105   

substantial adversity” (2020, p. 2769). Studies on the ability to maintain 
independence, adaptive lifestyle habits, social participation, and overall 
OLHS[O�YLSH[LK�X\HSP[`�VM�SPML�[OYV\NO�Z`TW[VT�THUHNLTLU[�Z\NNLZ[�[OH[�
resilience promotes healthy aging with MS (Ploughman et al., 2020).

Higher psychological resilience is associated with better physical 
function in people with MS and with fewer neurological symptoms 
(Jakimovksi et al., 2022). Studies report a lifetime prevalence of 
depression in people with MS of up to 50%, and the development of 
depression is closely linked to coping style, positive adjustment, and 
resilience factors (Ploughman et al., 2020). Social connection closely 
PU[LY[^PULZ�^P[O�[OL�JVUJLW[�VM�YLZPSPLUJ`!�NYLH[LY�ZVJPHS�Z\WWVY[�PZ�
associated with greater resiliency and more adaptive coping strategies 
in people with MS (Jakimovksi et al., 2022).

SELF-EFFICACY

:LSM�LɉJHJ`�YLMLYZ�[V�HU�PUKP]PK\HS»Z�ZLUZL�VM�JVU[YVS�V]LY�[OLPY�
achievements and their capacity to respond to challenges and meet 
NVHSZ��+PZHIPSP[`�ZLSM�LɉJHJ`�PZ�H�WLYZVU»Z�ILSPLM�[OH[�[OL`�JHU�THUHNL�
their disability to achieve their goals (Amtmann et al., 2012). There are 
ZL]LYHS�^H`Z�PU�^OPJO�ZLSM�LɉJHJ`�ILSPLMZ�PTWHJ[�ILOH]PVY��PUJS\KPUN�
the actions an individual chooses to take, as most opt for behaviors that 
result in feelings of competency and accomplishment. These beliefs 
HSZV�PUÅ\LUJL�WLYZL]LYHUJL�HUK�WLYJLP]LK�Z[YLZZ�SL]LSZ��(T[THUU�L[�HS���
�������0UKP]PK\HSZ�^P[O�OPNOLY�SL]LSZ�VM�ZLSM�LɉJHJ`�VM[LU�KLTVUZ[YH[L�
SV^LY�SL]LSZ�VM�HU_PL[`�HUK�KLWYLZZPVU��^OPJO�JHU�WVZP[P]LS`�PUÅ\LUJL�
their outlook and adjustment to life following a diagnosis (Tan-Kristanto 
& Kiropoulos, 2015). 

(KKP[PVUHSS �̀�HU�PUKP]PK\HS»Z�SVJ\Z�VM�JVU[YVS�PUÅ\LUJLZ�OV^�[OL`�WLYJLP]L�
life events. People with an external locus of control attribute events and 
JVUZLX\LUJLZ�[V�MVYJLZ�V\[ZPKL�VM�[OLTZLS]LZ��Z\JO�HZ�V[OLYZ»�HJ[PVUZ��
while those with an internal locus of control feel that their actions are 
the catalysts for events. A health locus of control (HLC) refers to the 
perception individuals have of their options for symptom management 

NATALIE CHRISTENSEN



106  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

and disease control (Wilski et al., 2019). The degree to which an 
PUKP]PK\HS�MLLSZ�YLZWVUZPISL�MVY�[OLPY�KPZHIPSP[`�JHU�HɈLJ[�OV^�[OL`�
choose to cope with the limitations they experience.

SOCIAL SUPPORT

Social support is associated with better psychological well-being, 
reduced stress levels, and improved emotional well-being and 
perception of happiness and success (King et al., 2000). Jensen et al. 
(2014) found that perceived social support is associated with subjective 
well-being in people with physical disabilities. The corollary is that there 
is a strong association between lack of social support and depression. 
Individuals with physical disabilities are at a higher risk of lacking 
perceived social support, as their mobility may be impaired and, as a 
result, their ability to engage with a broader community is limited. The 
type of social support people receive, whether from friends, family, or 
ZPNUPÄJHU[�V[OLYZ��OHZ�H�KPɈLYLU[PHS�PTWHJ[�VU�KLWYLZZPVU�SL]LSZ"�MYPLUK�
support plays the largest role (Jensen et al., 2014). The importance of 
MYPLUK�Z\WWVY[�PUKPJH[LZ�[OL�PUÅ\LUJL�VM�[OL�IYVHKLY�ZVJPHS�LU]PYVUTLU[�
on perceptions of self and happiness, demonstrating how essential 
having a diverse support system is to positive adjustment after an 
adverse life event.

METHODS

D is a 56-year-old heterosexual, cisgender, white female from New York 
^OV�KL]LSVWLK�4:�H[�����;OPZ�Z[\K`�HPTZ�[V�L_WSVYL�[OL�PUÅ\LUJL�[OH[�
developing a disability in emerging adulthood has on an individual’s 
perception of themselves and their ability to live a fully-realized life and 
HJOPL]L�[OLPY�NVHSZ��/H]PUN�SP]LK�^P[OV\[�[OPZ�KPZHIPSP[`�MVY�H�ZPNUPÄJHU[�
portion of her early life, as well as having experienced periods of 
YLTPZZPVU�HUK�ÅHYL�\WZ��+�OHZ�\UPX\L�PUZPNO[�PU[V�[OL�ZWLJ[Y\T�VM�4:��
;OPZ�YLZLHYJO�MVJ\ZLZ�VU�[OL�PUÅ\LUJL�VM�YLZPSPLUJ �̀�ZVJPHS�Z\WWVY[��
HUK�ZLSM�LɉJHJ`�VU�+»Z�WLYJLW[PVU�VM�OLY�HIPSP[PLZ�ILMVYL�HUK�HM[LY�OLY�
diagnosis and into middle adulthood.

DISABILITY AND SELF



COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   107   

The student researcher arranged to interview D in person at her home. 
The student researcher made it clear before and throughout the 
interview that the participant could stop at any time and that D was 
\UKLY�UV�VISPNH[PVU�[V�HUZ^LY�X\LZ[PVUZ�^P[O�^OPJO�ZOL�KPK�UV[�MLLS�
comfortable. The interview lasted approximately two hours and was 
recorded and transcribed via the Otter app on the researcher’s phone. 
;V�WYV[LJ[�+»Z�JVUÄKLU[PHSP[ �̀�[OLZL�YLJVYKPUNZ�^LYL�KLSL[LK�\WVU�
completion of the research paper. She was informed of her rights and 
signed an informed consent document indicating that she understood 
[OL�PU[LY]PL^»Z�JVU[L_[��YLX\PYLTLU[Z��HUK�V\[JVTL��8\V[LZ�MYVT�[OL�
interview were organized using thematic analysis into topics related to 
self-perception, perception by others, resiliency, and social support. This 
study received IRB approval prior to publication.

RESULTS
IMPACT OF DISABILITY ON SOCIAL SUPPORT

Numerous protective factors were present in D’s childhood, including 
a strong sense of community, growing up in a middle-class family, 
OH]PUN�HJJLZZ�[V�X\HSP[`�LK\JH[PVU��HUK�ILPUN�^OP[L�PU�H�OVTVNLUV\Z��
conservative town. Concurrently, she experienced certain risk factors, 
particularly within her family dynamics. D shared that her role in the 
family, even as a child, was the peacemaker and “perfect child” who 
THKL�OLY�WHYLU[Z�WYV\K�HUK�OLSWLK�[V�TP[PNH[L�[OL�JVUZLX\LUJLZ�VM�
her sibling’s maladaptive behaviors. Growing up with a brother who 
struggled with substance abuse and undiagnosed bipolar disorder, she 
ILJHTL�MHTPSPHY�^P[O�[OL�KPZHISPUN�LɈLJ[Z�VM�TLU[HS�HUK�WO`ZPJHS�PSSULZZ�

When discussing her parents’ devastation over her diagnosis, she 
L_WYLZZLK�MLLSPUNZ�VM�N\PS[!�¸0�MLS[�H^M\S��0»T�UV[�[OL�VUL�[OH[�IYPUNZ�
heartache into their life.” She experienced a transition from being an 
independent emerging adult to an emerging adult who relied heavily on 
the support of others. This sense of guilt carried over to other important 
relationships in D’s life, including that with her husband. She recalled 
her fears of becoming dependent on her husband at only 24, thinking at 
the time, “Oh no, he’s going to have to take care of me, like I’m an old 

NATALIE CHRISTENSEN



108  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

woman." Despite fears of being a burden, D shared that her husband 
HUK�THYYPHNL�HKHW[LK�X\PJRS`�[V�SPML�HM[LY�OLY�KPHNUVZPZ!�¸4`�O\ZIHUK�
became even more devoted. He looked out for every detail, every detail 
that would make my life better and easier.”

Relocating far from home as an emerging adult, D found herself away 
MYVT�MHTPS`�HUK�MYPLUKZ��/V^L]LY��ZOL�X\PJRS`�LZ[HISPZOLK�JVUULJ[PVUZ�
[OYV\NO�OLY�O\ZIHUK»Z�^VYR��ÄUKPUN�H�JVOVY[�VM�`V\UN�HK\S[Z�PU�ZPTPSHY�
situations as transplants to the area.

I had just gotten married here in New York and immediately moved 
V\[�[V�3VZ�(UNLSLZ��:V�0�KPKU�[�OH]L�H�^OVSL�NYV\W�VM�NVVK�MYPLUKZ�
VY�HU`�MHTPS �̀�)\[�L]LY`VUL�MYVT�T`�O\ZIHUK�Z�JVTWHU`�^LYL�
RPUK�VM�TPZÄ[Z�ILPUN�V\[�[OLYL��OH]PUN�UV�MHTPS �̀�:V�^L�OHK�H�NVVK�
social support system.

She explained that her friends in California became skilled at adapting 
to her needs to the point that she experienced very few perceived 
limitations during that period. Her disability became integrated into the 
IHJRKYVW�VM�OLY�ZVJPHS�YLSH[PVUZOPWZ�^P[OV\[�KLÄUPUN�OLY��;OPZ�^HZ�THKL�
especially clear as she described how her friends responded to her new 
limitations.

;OL`�YL�Q\Z[�SPRL��VO��^L�SS�JHYY`�`V\�\W�[OL�OPSS��>LSS��`V\�RUV �̂�
[OLYL�Z�UV�OHUKPJHWWLK�HJJLZZ�OLYL��0»SS�[OYV^�`V\�V]LY�T`�
ZOV\SKLY��:V�`LHO��PU�[OH[�YLZWLJ[��P[�^HZU�[�H�Z[PNTH¯;OL`»K�ZH`�
KVU�[�^VYY �̀�>L�SS�NL[�`V\�[OLYL�

Despite acknowledging the crucial role social support played in D’s 
perception of her limitations, she was highly resistant to becoming 
PU]VS]LK�^P[O�[OL�IYVHKLY�4:�KPZHIPSP[`�JVTT\UP[ �̀�:OL�L_WSHPULK�
that she felt the disability community represented a “pity party” she 
JV\SK�UV[�HɈVYK�[V�NL[�PU]VS]LK�PU��0U�OLY�V^U�^VYKZ��¸6\[�VM�ZPNO[��
out of mind.” D expressed that she felt no need to be involved with 
the community because she could get any information about her 
condition from her doctor or online, without hearing about other 
people’s problems. Coming from a family that believed highly in taking 

DISABILITY AND SELF



COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   109   

responsibility for one’s problems without outside help may have helped 
shape this attitude toward her disability.

SELF-PERCEPTION AND DISABILITY

+�Z�WYPVYP[PLZ�H[�KPɈLYLU[�Z[HNLZ�PU�OLY�SPML�L]VS]LK�^P[O�OV^�ZOL�
perceived herself and her abilities, roles, and goals. Due to the 
relapsing-remitting nature of her MS, there were periods when she 
could live life essentially as an abled person and disconnect from her 
KPHNUVZPZ��/V^L]LY��K\YPUN�Z`TW[VT�ÅHYL�\WZ��ZOL�JV\SK�UV[�PNUVYL�[OL�
very real limitations that she was experiencing. She was also frustrated 
with herself for not having the capacity to do everything she wanted. 
0UP[PHSS �̀�HUK�MVY�X\P[L�ZVTL�[PTL��ÅHYL�\WZ�^LYL�JOHYHJ[LYPaLK�I`�ZWPRLZ�
in internalized ableist thoughts; D felt she was being denied the full 
experience of emerging adulthood. However, these attitudes would 
shift as she developed adaptive coping mechanisms and began to 
accept life as it was. D expressed that as a young adult, she struggled 
with comparing her experiences with those of her peers. Watching her 
JVOVY[�HK]HUJL�[OLPY�JHYLLYZ�^HZ�KPɉJ\S[��LZWLJPHSS`�PU�JVUQ\UJ[PVU�
with her health challenges. When D lost her job due to her symptoms, it 
ZPNUPÄJHU[S`�PTWHJ[LK�OLY�ZLSM�WLYJLW[PVU!�¸0�^HZ�PUJYLKPIS`�KPZHWWVPU[LK�
with myself because I worked so hard to get where I was, and I had 
to leave it because of this stupid disease… I felt badly about myself 
because of that.”

D expressed that she was also forced to confront the reality of her 
JVUKP[PVU�^OLU�OLY�KVJ[VY�WYLZLU[LK�HU�\S[PTH[\T!�IL�H�SH^`LY�VY�IL�H�
mom. At this point, she had to reassess her goals and aspirations and 
recognize that she could not do everything. She cited this as another 
turning point in her acceptance that the real limitations imposed upon 
her by MS restricted some life paths. However, D took this as an 
opportunity to reevaluate her priorities and recognize that she valued 
starting a family over having a career. After the birth of her daughter, D 
had to again come to terms with her capabilities as she initially struggled 
to reconcile her new role as a mother with her physical limitations.

NATALIE CHRISTENSEN



110  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

;OLYL�^LYL�[OPUNZ�0�JV\SKU�[�KV�^P[O�T`�KH\NO[LY�^OLU�ZOL�^HZ�
a baby. Like I could never give her a bath by myself. Those kinds 
of things…got to me, but then I hired a nurse to come and take 
her for a couple hours here and there. And she did all the things 
0�JV\SKU�[�KV��HUK�0�Q\Z[�OHK�[V�IL�VRH`�^P[O�[OH[�ILJH\ZL�[OLU�0�
could do other things… So that made it not so bad. It was just 
part of how we lived.

;OL�L_WLYPLUJL�VM�HNPUN�HSZV�PUÅ\LUJLZ�H�WLYZVU»Z�WLYJLW[PVU�VM�
themselves. While D’s chronological age is 56, it is important to 
consider her biological age when discussing her perception of self. As 
H�UL\YVKLNLULYH[P]L�KPZLHZL��4:�Z[YVUNS`�HɈLJ[Z�IPVSVNPJHS�HNPUN�HUK�
physical deterioration, and D expressed concerns over both physical 
and cognitive decline as she ages and the disease progresses. When 
asked about considerations when planning for the future, she explained 
that she is much more practical about her capabilities now.

Well, now I have to absolutely face that if I stay in the physical 
condition I am in right now, there are things I won’t be able to do. 
For example, we are most likely taking the retirement cruise of 
V\Y�SPML[PTL�SVUN�ILMVYL�T`�O\ZIHUK�PZ�YL[PYPUN¯0[�Z�UV[OPUN�^L�
planned on doing, but you know what? I might not be able to do  
P[�UL_[�`LHY��6Y�L]LY��YPNO[&�:V�0�T�Q\Z[�YLHSPZ[PJ�HIV\[�P[�

;OLZL�JVUJLYUZ�OH]L�HɈLJ[LK�OV^�+�HWWYVHJOLZ�SPML�HUK�WLYJLP]LZ�
[OL�VWWVY[\UP[PLZ�HɈVYKLK�[V�OLY��+L]LSVWPUN�H�WYHNTH[PJ�]PL^�VM�OLY�
situation has been an empowering coping mechanism from the onset of 
her MS.

SELF-EFFICACY

D’s experiences and decisions since she developed MS are 
JOHYHJ[LYPaLK�I`�H�Z[YVUN�ZLUZL�VM�ZLSM�LɉJHJ`�HUK�HU�PU[LYUHS�SVJ\Z�
VM�JVU[YVS��^OPJO�NYLH[S`�PUÅ\LUJLK�OV^�ZOL�WLYJLP]LK�OLYZLSM�HUK�OLY�
VWWVY[\UP[PLZ��:OL�L_WYLZZLK�[OH[�ZOL�MYLX\LU[S`�MHJLK�[OL�KLJPZPVU�[V�
either give into despair or forge ahead. D shared that after her mother 

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COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   111   

received a cancer diagnosis, her mother essentially decided life  
was over.

From the day they gave her her diagnosis, not a positive word 
passed her lips. Everything was miserable. Everything was terrible. 
Everything was awful. Even good things that happened…I never 
wanted that, and I thought, ‘I got through all these years with the 
disease without becoming bitter.’

At a critical turning point in her life, D adopted a mindset that 
deliberately looked for the positive aspects of life because she viewed 
it as a decision within her control, demonstrating her strong sense of 
ZLSM�LɉJHJ �̀�;OPZ�TPUKZL[�VM�WLYZL]LYHUJL�[OYV\NO�HK]LYZP[ �̀�TVKLSLK�
by her father as he managed her brother’s struggles and family 
responsibilities, came to play a crucial role in how she tackled the 
challenges she faced as an emerging adult.

RESILIENCY AND DISABILITY

¸0�[OPUR�[OH[�Z�WYVIHIS`�[OL�ILZ[�[OPUN�`V\�JHU�KV��1\Z[�THRL�P[�H�WHY[�VM�
OV^�`V\�SP]L�¹�;OPZ�ZPTWSL�Z[H[LTLU[�I`�+�YLÅLJ[Z�H�WYVMV\UK�Z[YLUN[O�
and resiliency that characterizes her experience with MS from her 
diagnosis up to the present day. Throughout the interview, D made many 
comments about refusing to let her diagnosis “ruin [her] attitude.”

I saw when my mother was so depressed and negative, what it 
did to the people around her, and I never wanted to do that to 
T`�MHTPS`�HUK�MYPLUKZ��(UK�[Y\[OM\SS �̀�P[�Z�IL[[LY�[V�OH]L�H�NVVK�
attitude, and people want to make themselves miserable by 
seeing only the negative.

D’s experience watching her mother battle cancer strengthened her 
already existing resiliency. Some of D’s response may be rooted in 
the interpersonal role that she took on within her family from a young 
age, that of the dependable child who rose to meet challenges head-
VU��>OLU�HZRLK�[V�PKLU[PM`�OLY�Z[YLUN[OZ��+�YLÅLJ[LK�VU�ZVTL�VM�[OL�
characteristics that informed her perspective on disability and adversity.

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112  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

0�[OPUR�0�T�]LY`�WYHNTH[PJ��(UK�0�[OPUR�[OH[�OLSWZ�H�SV[��@V\�OH]L�[V�
be practical. How can I make this better? You try it. Does it make 
it better? Maybe, maybe not. But you tried to make it better. And if 
P[�ZPTWS`�JHU�[�IL�KVUL��`V\�TV]L�VU�

D’s resilience manifests through a strong sense of practicality. Her ability 
to bounce back after setbacks and challenges is integral to who she is, 
shaped in part by her self-determination.

HISTORICAL CHANGES AND SOCIAL INSTITUTIONS

+�HSZV�YLÅLJ[LK�VU�[OL�IYVHKLY�ZVJPHS�JOHUNLZ�ZOL�^P[ULZZLK�V]LY�[OL�
WHZ[�[OYLL�KLJHKLZ��>OLU�+�^HZ�ÄYZ[�KPHNUVZLK��[OLYL�^LYL�SPTP[LK�
treatment options for MS, and she jumped on the opportunity to be a 
¸N\PULH�WPN¹�MVY�L_WLYPTLU[HS�TLKPJH[PVUZ��>OPSL�YLÅLJ[PUN�VU�KPZHIPSP[`�
accommodations and treatments for MS now, compared to when she 
was diagnosed, D expressed gratitude for the changes over the past 
decades.

I think in the last 20 or 30 years it has been an amazing period of 
time for disabled people, with the ADA rules being enforced and 
WLVWSL�ILJVTPUN�TVYL�H^HYL��:V�0�[OPUR�P[�Z�H�IL[[LY�^VYSK�[OHU�
���`LHYZ�HNV�^OLU�0�^HZ�ÄYZ[�KPHNUVZLK¯PM�0�OHK�ILLU����HUK�
SP]PUN�PU�[OPZ�RPUK�VM�^VYSK��TH`IL�0�^V\SKU�[�OH]L�OHK�[V�THRL�
[OH[�KLJPZPVU�VM�º0�T�KPZHISLK�»�VY�º0�T�UV[�KPZHISLK�»�:V�0�[OPUR�P[�Z�
really wonderful.

It is evident that societal perceptions of people with disabilities have 
shifted positively since D’s diagnosis, as have the accommodations and 
VWWVY[\UP[PLZ�HɈVYKLK�[V�[OLT��;OL�HJJLZZPIPSP[`�VM�W\ISPJ�ZWHJLZ�^HZ�
HSZV�PKLU[PÄLK�HZ�H�^H`�PU�^OPJO�[OPUNZ�OH]L�ILJVTL�¸L_WVULU[PHSS`�
better” since her diagnosis. The increasing accommodations provided to 
her through her urban environment and the development of accessibility 
tools, such as her electronic gait stimulator and her portable wheelchair, 
have made it easier to maintain her current mobility and allow her more 
freedom.

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COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   113   

EXPERIENCES WITH ABLEISM

The complex interactions between achievement and disability 
WLYJLW[PVU�HYL�YLÅLJ[LK�PU�+»Z�[OV\NO[Z�VU�OV^�V[OLYZ»�VWPUPVUZ�OH]L�
PUÅ\LUJLK�OLY�SPML��7LVWSL�Q\KNL�+�HZ�LP[OLY�HISLK�VY�KPZHISLK�IHZLK�
on the severity and visibility of her symptoms, meaning that at times 
she could “pass” as able-bodied even if it took a physical or mental 
toll to do so. Overall, D expressed that she is far less concerned with 
the perception of others than when she was younger and still coming 
to terms with her new reality. Having to constantly decide between 
disclosing her condition or maintaining an abled persona characterized 
much of D’s early period with MS. 

(M[LY�OLY�KPHNUVZPZ��+�JVU[PU\LK�^VYRPUN�H[�H�*HSPMVYUPH�SH^�ÄYT��OPKPUN�
her diagnosis from her bosses and coworkers as she recognized there 
were potential repercussions to disclosing her disability status. D 
recounted how she was forced to share her diagnosis after deteriorating 
to the point that her symptoms became visible. When her MS caused 
OLY�[V�YLX\PYL�H�JHUL�HUK�^LHY�HU�L`LWH[JO��ZOL�^HZ�HZRLK�[V�SLH]L�
her position. In this instance, the ableist perception of others directly 
resulted in limited career opportunities.

D shared that as she has gotten older and her disease has progressed, 
ZOL�OHZ�UV[PJLK�HJ\[L�KPɈLYLUJLZ�PU�PU[LYHJ[PVUZ�^P[O�HJX\HPU[HUJLZ�HUK�
strangers. D described feeling largely unbothered by the thought of how 
WLVWSL�ZLL�OLY��KLZWP[L�YLJVNUPaPUN�[OH[�V[OLYZ»�WLYJLW[PVUZ�PUÅ\LUJL�
how they interact with her. Now, the choice to disclose her condition is 
no longer an option; symptoms such as a persistent limp provide visual 
indicators. Responses to her disability are often characterized by ableist 
attitudes, whether they manifest as pity, discomfort, or dismissal. She 
emphasized how frustrating it can be when someone reduces her to 
OLY�KPZHIPSP[ �̀�+�HSZV�YLÅLJ[LK�VU�OV^�ZOL�YLZWVUKZ�[V�V[OLY�WLVWSL»Z�
reactions now compared to when she was younger. 

;OL�`V\UNLY�TL�WYVIHIS`�^V\SK�OH]L�JHYLK��)\[�UV �̂�0�KVU�[�JHYL�
if someone says, ‘Oh, what is that,’ and they kind of push it, and 

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114  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

0�[LSS�[OLT��º6O��`V\�RUV �̂�4\S[PWSL�:JSLYVZPZ�»�0[�YLHSS`�KVLZU�[�
matter to me what they say. What are you gonna do? 

Rather than shying away from increasing visible indication of impairment 
over the years, D has embraced the realities of life with MS. Not only 
did she share her gratitude for mobility aids such as her walker and 
wheelchair, she also described her assortment of “fabulous canes, 
VUL�MVY�L]LY`�V\[Ä[�¹�+�YLÅLJ[LK�[OH[�^OPSL�ZOL�JHUUV[�JVU[YVS�^OL[OLY�
people are aware of her disability, it is up to her to decide how she 
responds to them.

DISCUSSION 

Study of the factors that contribute to positive adjustment after the 
onset of disability is a crucial area of research that is only becoming 
more relevant, as more and more people are experiencing disability and 
living with their conditions for many years. As people with MS age, their 
expectations and priorities evolve with the progression of the disease. 
According to Ploughman et al. (2012), many people diagnosed with MS 
MLLS�[OH[�WO`ZPJHS�SPTP[H[PVUZ�PUÅ\LUJL�[OLPY�X\HSP[`�VM�SPML�SLZZ�[OHU�[OL`�
HɈLJ[�ZVJPHS�HUK�LTV[PVUHS�M\UJ[PVUPUN��>L�JHU�JVUJS\KL�[OH[�YLZPSPLUJ �̀�
ZLSM�LɉJHJ �̀�HUK�ZVJPHS�Z\WWVY[�HSS�JVU[YPI\[L�[V�HU�PUKP]PK\HS»Z�ZLUZL�
of agency and control over their condition and promote positive 
adjustment.

D’s inner strength and belief in her ability to live a fully realized life 
helped her positively adjust to life with a disability and maintain an 
HKHW[P]L�KL]LSVWTLU[HS�[YHQLJ[VY �̀�0UMVYTLK�I`�OLY�WHYLU[Z��ILSPLMZ�
HUK�ILOH]PVYZ�HUK�OLY�SV]LK�VULZ��Z\WWVY[��OLY�TPUKZL[�JOHYHJ[LYPaLK�
OLY�ZLSM�WLYJLW[PVU�HUK�OLY�LɈVY[Z�[V�YLHJO�OLY�NVHSZ��;OYV\NOV\[�[OL�
interview, D expressed beliefs in resilience and resistance to despair. 
Without this sense of control over how she responded to adversity, D 
TH`�OH]L�MV\UK�P[�TVYL�KPɉJ\S[�[V�JVWL�^P[O�OLY�KPHNUVZPZ��WHY[PJ\SHYS`�
in the early stages. As Ploughman et al. (2012) proposed, D experienced 
a transition from denial to acceptance to self-advocacy. This transition 
was not always linear, as MS’s relapsing-remitting nature caused her 

DISABILITY AND SELF



COLUMBIA SOCIAL WORK REVIEW, VOL. XXI  |   115   

to vacillate between denial and acceptance even as she learned to 
advocate for herself. 

Individuals do not exist within a vacuum, and it is essential to look at 
the broader social contexts in which they exist. The development of 
KPZHIPSP[`�HɈLJ[Z�HU�PUKP]PK\HS»Z�SPML�[YHQLJ[VY`�[OYV\NO�[OL�PU[LYKLWLUKLU[�
lives of that individual and the people with whom they have 
relationships. D’s diagnosis of MS had a profound impact on herself and 
on dynamics with her parents, husband, and larger social network. D 
relied on the support of friends and family members while navigating life 
^P[O�4:��:VJPHS�Z\WWVY[�WVZP[P]LS`�PUÅ\LUJLZ�VUL»Z�ZLSLJ[PVU�VM�JVWPUN�
skills, social life, sense of empowerment, and reduction in loneliness 
(Forouzan et al., 2013). The importance of this support is underscored 
by the numerous references D made throughout the interview to the 
network of friends and family that emerged to help her manage MS.

+»Z�L_WLYPLUJLZ�^P[O�4:�^LYL�HSZV�PUÅ\LUJLK�I`�[OL�PU[LYZLJ[PVU�VM�OLY�
identities and positionality. Multidisciplinary research has consistently 
PUKPJH[LK�ZPNUPÄJHU[�OLHS[O�KPZWHYP[PLZ�IL[^LLU�^OP[LZ�HUK�YHJPHS�
ethnic minorities, with minority and socioeconomically disadvantaged 
populations up to three times as likely as other groups to experience 
disability at older ages (Schoeni et al., 2005). However, research has 
PUKPJH[LK�[OH[�THU`�VM�[OLZL�KPɈLYLUJLZ�HYL�SPURLK�[V�KPZWHYP[PLZ�
in income and education rather than biological distinctions (Fuller-
Thomson et al., 2009). As a middle-class woman, D had access to 
LHYS`�JHYL��(S[OV\NO�ZOL�L_WLYPLUJLK�ÄUHUJPHS�JVUJLYUZ�YLSH[PUN�[V�
her inability to work, she was at a lower risk of falling into poverty. She 
was fortunate enough to understand the healthcare options available 
[V�OLY�HUK�[V�JVUULJ[�^P[O�WPVULLYZ�PU�[OL�4:�ÄLSK�^OV�MHJPSP[H[LK�OLY�
involvement with novel treatments as they became available.

LIMITATIONS

It must be noted that the data provided through this interview 
YLWYLZLU[�H�ZPUNSL�WLYZVU�Z�L_WLYPLUJL��;OL�YLZ\S[PUN�PU[LYWYL[H[PVUZ�
may not accurately describe the experiences of other persons with 

NATALIE CHRISTENSEN



116  |  COLUMBIA SOCIAL WORK REVIEW, VOL. XXI 

disabilities, even those who also developed MS at a young age. Due 
to the subjective nature of disability, caution must be exercised when 
attempting to extrapolate one individual’s experience to a broader 
WVW\SH[PVU��;OLYL�PZ�H�WVZZPIPSP[`�[OH[�[OL�WOYHZPUN�VM�ZVTL�X\LZ[PVUZ�
may have led D in a particular direction, even though open-ended 
X\LZ[PVUZ�^LYL�\ZLK��(KKP[PVUHSS �̀�KH[H�HUHS`ZPZ�^HZ�JHYYPLK�V\[�I`�H�
ZPUNSL�PUKP]PK\HS�^P[OV\[�JVSSHIVYH[PVU�^P[O�V[OLYZ��/V^L]LY��L]LY`�LɈVY[�
was made to ensure that conclusions regarding the roles of resiliency, 
ZLSM�LɉJHJ �̀�HUK�ZVJPHS�Z\WWVY[�PU�+»Z�L_WLYPLUJL�VM�KPZHIPSP[`�^LYL�
rooted in evidence drawn from relevant, peer-reviewed research.

FUTURE RESEARCH DIRECTIONS

-\[\YL�YLZLHYJO�KPYLJ[PVUZ�TH`�L_WSVYL�[OL�PUÅ\LUJL�VM�KPɈLYLU[�[`WLZ�
of social support on an individual’s experience, investigating whether 
[OLYL�HYL�KPɈLYLU[PHS�LɈLJ[Z�IHZLK�VU�[OL�ZV\YJL�VM�Z\WWVY[��(KKP[PVUHSS �̀�
researchers may be interested in studying how positive internal 
[YHP[Z��Z\JO�HZ�YLZPSPLUJ`�HUK�ZLSM�LɉJHJ �̀�JHU�IL�J\S[P]H[LK�[OYV\NO�
interventions. Developing programs that encourage the adoption 
of health-promoting attitudes and behaviors may allow healthcare 
WYVMLZZPVUHSZ�[V�WYV]PKL�PTWVY[HU[�ZJHɈVSKPUN�MVY�JVWPUN�TLJOHUPZTZ�
TV]PUN�MVY^HYK��;OLZL�PU[LY]LU[PVUZ�JV\SK�ZPNUPÄJHU[S`�PTWHJ[�OV^�
people with MS view themselves, their capabilities, and their life 
trajectory.

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