KARNILOWICZ cancer can be threatening to identity particularly when involved with incontinence and damaged sexual function. Diagnosis is also principally disruptive and epiphanic as a moment or point of change. Diagnosis often prompts major life changes. The change can be within or arise from events beyond an individual’s control and can be viewed as fate, luck, chance or unexpected opportunity (Thomson et al. 2002). Epiphanies can represent opportunities and hazards (King et al. 2003) and may be regarded as positive (Whittemore & Roy 2002) or negative. Among Denzin’s (1989) four types of epiphanies described as major, cumu- lative, illuminative and relived, cumulative, epiphanies are linked with chronic illness or disease state as the self is dynamically, continually and progressively reconsti- tuted throughout the prolonged experience of illness (Frank 1995) or disease. Reassessment of identity in this instance lies at the core of illness narrative as epiphanies are pivotal life-changing experiences altering a person’s fundamental meaning structures (Wainwright & Turner 2004). Nonetheless, while seeking precise knowledge of the disease state in terms of its characteristics and its trajec- tory and path, the initial diagnosis provides limited infor- mation. Instead, it unintentionally serves to lessen personal control. In this circumstance, control is with the practitioner although there is meaning in the experience of suffering with the condition (Williams & Koocher 1998). Diagnosis is especially psychologically powerful when it is totally unexpected. Hindsight enabled me to rationalise the increasingly regular need to urinate. However, there was little else that caused concerns of any sort. Consequently, the diagnosis of the probability of having cancer impacted severely. The prominent rational cognitions were confronted by confusion and disbelief. However, while my diagnosis was a surprise, others may legitimise their existing conditions through the diagnosis e.g. multiple sclerosis (Grytten & Maseide 2006). The sub- sequent attempt to cope may be in the form of self- management to order, control and discipline their lives or alternately to minimise, tolerate, accept or ignore all that cannot be mastered (Kralik et al. 2004). Among the forms of self-management or mastery is to ‘intellectualise’ the condition in order to alleviate anxiety (Abram 1980). Social support is also crucial in contending with the disease state and serves as a key mediating factor in the emergence of acceptance and control of illness (Edwards et al. 2007). The extent of trust is also an important element within the cultural and social environment. Trust is based upon the extent to which others (e.g. the healthcare professional or specialist) are able to assist in times of need and distress 280 and is related to hope, perseverance and empathy (Wright 2004). Trusting the expertise, views, opinions and direc- tions of the practitioner facilitates choice and one’s aware- ness of self. However, trust becomes problematic with chronic illness or disease state given the common absence of a clearly deﬁned recovery point (Lee & Poole 2005). Consequently, there is a lack of agency (Diehl et al. 2004) in that the person with the illness or disease is unable to assert one’s self, to experience competence, achievement, power and mastery in their environment. Under these circumstances, establishing psychological ownership is problematic and in some instances may be considered beyond one’s reach. Self-care behaviours are integral in re-establishing ownership through monitoring symptoms, adhering to treatment regimens and engaging in activities that promote health (Regan-Smith et al. 2006). In my case, walking and exercising were integral in this process. It was activity in an arena that I could control within the added and presumed assumption of an associated physical and psychological beneﬁt. S U M M A R Y A N D C O N C L U S I O N S Self-identity is often the subject of greatest change when confronted with an epiphanic experience. It requires one to assess and reassess life and can be confronting as it may also be rewarding. Experiencing a serious illness or being subjected to a life-threatening disease is one of these moments. The effects of the illness may be debilitating and confronting and the illness process often requires one to gain control over its effects by assuming some level of ownership. This does not occur in all instances and a person may choose to have an important other e.g. spouse, medical specialist, to take over this role. However, this role as constructed through social interaction and associ- ated cultural factors may be problematic. This is particu- larly the case with the medical practitioner and specialist interaction with the person experiencing the disease or illness. Psychological ownership while personal is a socially shared or collective reality that does not retain meaning separated from relationship with others. For example, Beveridge et al. (2006) concluded that diabetes appears to be socially owned. Healthcare professionals need to further embrace the psychological effects of illness and to be aware of and create the psychosocial-cultural environment best suited for enabling the development of a patient’s positive self- identity within psychological ownership. Under these cir- cumstances, the positioning of an individual’s level of illness or disease ownership is dependent on time, situa- tion and negotiation. It is the product of discourse and © 2010 Blackwell Publishing Ltd