Illness disrupts more than the body; it disrupts meaning. It unsettles the taken-for-granted flow of daily life, casting doubt on one’s identity, expectations and relationships. This is beyond biology. It imposes a biographical disruption: an interruption in the story a person tells about themselves, their purpose and their place in the world. This disruption propels the individual into a liminal state, where they no longer fully belong to the life they knew, nor have they arrived at a stable new one. The body becomes a threshold between a past self and an unknown future.

What is Biographical Disruption?

Coined by sociologist Michael Bury in 1982, the term biographical disruption describes what happens when chronic illness radically interrupts a person’s life, their narrative. There is a ‘before’ and there is an ‘after’. Before illness, people tend to assume a stable trajectory: health is the norm, the body is reliable, the future is predictable – plans can be made. Illness breaks this continuity. It forces individuals to question who they are, what they can do, how others see them. Identity becomes uncertain, as does the future: plans now in doubt, if not abandoned.

This is about dealing with loss, as well as change. Biographical disruption involves grief for a version of the self that may no longer be accessible. A once-independent person may now need assistance; a previously confident worker may be unable to return to their profession. Life becomes fragmented, and the task of making sense of it, of constructing a new narrative, can be slow, painful and deeply personal.

The In-Between State

This experience of being “between selves” aligns with the concept of liminality, as presented in previous articles. Liminality describes the transitional phase in rites of passage: the moment when one is no longer who they were, but not yet who they will become.

In the context of illness, liminality is not a symbolic ritual, it is lived experience. The person is caught between the old self and an uncertain new identity. Time feels strange: the past feels remote, the present becomes thick with uncertainty and the future is a blank. Social roles dissolve. Relationships may shift, often uncomfortably so. The world, once familiar, feels alien.

The Body as Threshold

When illness arrives, the body changes from a transparent background to an overwhelming foreground. What was once silent now screams. Pain, fatigue, manifestations of symptoms and limitations make the body feel unfamiliar. It feels like a betrayal sometimes. This alienation from the body intensifies the biographical rupture. The self is disrupted, not only mentally and socially, but physically.

The body is now something that the person can no longer trust. It is an estrangement. And this is a key part of both biographical disruption and liminality. The body becomes a site of ambiguity, a threshold through which one must pass but cannot ignore.

Social Dislocation and Silence

Illness often leads to social isolation. The former roles the person had: parent, colleague, friend, all become harder to fulfil. The disruption is not only internal, but interpersonal. Others may respond with pity, discomfort or even absence. Conversations grow awkward and relationships drift.

This compounds the liminal state. They are no longer fully integrated into the world of wellness, but not fully embraced by a new identity either. The ill body becomes both a symbol and a reality of marginalisation.

This experience is especially stark for those with chronic illnesses or a disability. There is no return to “normal”, the life before. There is only a renegotiation of what life can be. Yet society tends to favour stories of recovery or tragedy. These are narratives with neat endings. Chronic ambiguity and uncertainty do not fit with this.

The Unrecognised Liminality of Chronic Illness

People living in chronic liminality often say they feel unseen. They are pressured to “get better” or hide their symptoms. Cultural narratives offer little space for enduring uncertainty or quiet suffering. Media representations swing between invisibility and spectacle, rarely capturing the steady endurance of those living in ongoing biographical disruption.

This unacknowledged liminality creates a second level of suffering: not just from illness, but from misrecognition. People feel like they exist between categories: neither fully well, nor visibly ill. Their experience is liminal not only within themselves, but socially as well.

Culture and the Meaning of Illness

How biographical disruption and liminality are experienced is shaped by culture. In some societies, illness is understood as a spiritual imbalance, a communal event, or a moral test. In others, it is framed as a personal misfortune or even failure. These meanings affect how people interpret their symptoms, seek care and narrate their experiences.

Clinicians who overlook these cultural contexts risk missing the full story. A patient’s silence might be misread as denial; their metaphors dismissed as confusion. But such expressions are often deeply embedded in cultural and symbolic frameworks. When someone says “It feels like a shadow sitting on my chest”, they are not avoiding clarity, they are offering it in their own language and in how they visualise it.

Clinical Practice as Liminal Work

To respond ethically to biographical disruption, healthcare must become a space where liminality is recognised and respected. Clinicians must see not just the body in distress, but the person in transition.

This means asking different questions in consultations:

-            What has changed in your life since this began?

-            How has this affected the way you see yourself?

-            What would feeling whole mean for you now?

These are not diversions from clinical care, they are deepening it. They invite the patient’s whole self into the room.

When clinicians make room for uncertainty, metaphor, memory and silence, the clinical encounter becomes not just a site of diagnosis, but one of witnessing and accompaniment. Healing, in this space, is about redefinition and not so much about resolution.

Holding the Space Between

When the body becomes a threshold, what people often need most is recognition and not only intervention. They need care that understands the liminal nature of illness, that honours the uncertain and the in-between.

Biographical disruption is a chapter of profound transformation. If healthcare professionals can hold that space with patience and presence, they may begin to practise a healthcare that is not only clinically effective, but deeply human.

Thank you for reading,

Mark Gibson

Leeds, United Kingdom, May 2025