tive or authoritarian) and communication styles vary in level of assertiveness. Education also provides greater authoritative credibility. Discussions with health profes- sionals are largely ‘expert’-based associated with immedi- ate imbalances within an authoritative communication relationship. However, personal experience and knowl- edge of the disease and disease state become important in destabilising established power differences in medical practice and enhance feelings of ownership. For example, Winkelman et al. (2005) noted that patients’ realities, their values and priorities, are not reﬂected in medical records and suggested that if patients keep a record of their illness experiences from their own perspective this will enhance their sense of illness ownership. In addition, illness or disease and notions of ownership also reside within family history and expectations concerning illness. Taboos, myths and rituals can inﬂuence communication and act as sources of knowledge and action. Discourses from critical and feminist postmodern per- spectives challenge the traditional biomedical model and question science’s claims of universal truths and draw attention to how scientiﬁc discourse and practices are and should be embedded in a social context. The postmodern- ists critique and question the hegemony of biomedicine and expert knowledge (Tang & Anderson 1999). My expe- rience of diagnosis and the ﬁrst thought of being ‘diseased’ led to a motivated, compulsive and focused investigation of everything that was prostate cancer. This compulsive and determined behaviour led to a largely unintended but more balanced interpersonal relationship with the urologist. While acknowledging his level and breadth of knowledge, it was also a means of establishing a less authoritative and more democratic and collaborative envi- ronment when discussing and in particular in treating the disease. In this instance there was a negotiated acceptance of the characteristics of the disease and its treatment. At the level of physiology, there was also recognition of sci- ence’s claims of a universal but incomplete ‘truth’ to the extent that much remained unknown or problematic. For example, the biopsy could not absolutely verify the extent of the disease other than to conﬁrm that it existed. However, the hegemony of biomedicine and expert knowledge was confronted at the level of the social and personal. Power, responsibility and control are important in con- sidering ownership as it applies to illness (Winkelman et al. 2005). Healthcare professionals are often inaccurate when assessing patients’ preferences for participation in treatment practices. Furthermore, ownership in this context is delegated rather than negotiated. While attempting to consider treatment from the perspective of © 2010 Blackwell Publishing Ltd Identity and ownership the patient, the healthcare provider continues to hold power, control and responsibility. This approach is more one-sided in acute or critical care situations and pervades management of life-threatening illness. Nonetheless, this does not suggest that patients do not or are not able to gain some level of ownership over their illness or disease state. For example, experienced patients have been known to take command in interactions with healthcare profession- als (Åsbring & Närvänen 2004). While doctors and patients varied in their power of discourse, they could and did hold differing views about appropriate levels of respon- sibility or control and shared a desire for inﬂuence (Åsbring & Närvänen 2004). Therefore, ownership is complex and subject to notions of power and responsibil- ity. Existing with and having identity embedded within the illness or disease provides for moments of psychologi- cal vulnerability and losses of personal power. These are often the consequence of ‘not knowing’ and or ‘not under- standing’ the disease. Identity is confronted under these circumstances and one looks to overcome and ﬁght. There is a responsibility largely but not limited to one’s imme- diate sense of self and who you are. Notions of self are constructed and embedded within one’s history and associated social and cultural symbols, artefacts and behaviours. Within this symbolic interac- tionist framework, people interpret situations and take action based upon their view of themselves (Dewar & Lee 2000). The self therefore is not static even though embed- ded within an historical perspective. Changes in how one perceives one’s own identity are a function of the illness or disease states and are encountered continually in every- day life (Kralik et al. 2004). Included in these changes are feelings of increased inadequacy and decreased value and inﬂuence in the community (Lundwall 2002). Learning to live with a critical illness in particular involves a process of shifts in identity as the individual grapples with the changes in the sense of self that existed prior to the illness. Illness can dominate identity and permeate all aspects of life or effect only part of the self (Kralik et al. 2004). These shifts in identity and the struggle for self-preservation involve an ongoing process of negotiation. With prostate cancer, there was the predominately successful attempt to be a part of an everyday ordinary life with an almost unconscious attempt at maintaining an established iden- tity and social roles over the control of symptoms (Townsend et al. 2006). It was not particularly given that it was stigmatising. Prostate cancer can largely avoid the stigmatising process as social meaning attached to behav- iours or individuals due to such factors as a physical defor- mity, mental illness or character blemishes (Joachim & Acorn 2000). Nonetheless, the symptoms of prostate 279