Abstract
Self-narratives of patients have received increasing interest in schizophrenia since they offer unique material to study patients’ subjective experience related to their illness, in particular the alteration of self that accompanies schizophrenia. In this study, we investigated the life narratives and the ability to integrate and bind memories of personal events into a coherent narrative in 27 patients with schizophrenia and 26 controls. Four aspects of life narratives were analyzed: coherence with cultural concept of biography, temporal coherence, causal-motivational coherence and thematic coherence. Results showed that in patients cultural biographical knowledge is preserved, whereas temporal coherence is partially impaired. Furthermore, causal-motivational and thematic coherence are significantly impaired: patients have difficulties explaining how events have modeled their identity, and integrating different events along thematic lines. Impairment of global causal-motivational and thematic coherence was significantly correlated with patients’ executive dysfunction, suggesting that cognitive impairment observed in patients could affect their ability to construct a coherent narrative of their life by binding important events to their self. This study provides new understanding of the cognitive deficits underlying self-disorders in patients with schizophrenia. Our findings suggest the potential usefulness of developing new therapeutic interventions to improve autobiographical reasoning skills.
Highlights
The clinical and experimental literature devoted to self-disorders in schizophrenia has mainly considered aspects of the minimal self
This study provides an experimental assessment or objectification of what psychiatrists have been observing clinically for many decades, that is, patients displayed a dramatic reduction of autobiographical reasoning skills, which are essential to create and maintain coherence in life narratives despite autobiographical disruptions and changes
This impairment was correlated both with patients’ executive dysfunction and with the overall reduction of the subjective sense of coherence experienced by patients
Summary
The clinical and experimental literature devoted to self-disorders in schizophrenia has mainly considered aspects of the minimal self. The life narrative has been considered the best suited format for ego identity, because it serves to create a sense of personal coherence, unity, continuity and purpose in one’ life across change. A second aspect is temporal coherence that reflects narrator’s ability to identify when and in what order events took place and that allows the listener to understand the chronology of the life narrative. In this study we investigated possible impairments in the narrative framework and in causal-motivational and thematic coherence of life narratives of patients with schizophrenia. Based on the above-mentioned studies, we expected to find specific impairment of autobiographical reasoning and of causal-motivational and thematic coherence of patients’ life narratives, which in turn may be related to executive dysfunction[23,24] and a deficit of general self-representation[12,17]. We did not make predictions regarding temporal coherence, considering the contradictory results of previous studies showing either a preserved temporal organization of autobiographical memory clusters[14,19] or a reduced chronological coherence within memories of patients with schizophrenia[24]
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