Quand la cohérence narrative fait défaut : analyse de récits autobiographiques dans la schizophrénie

Abstract

ObjectivesLife narratives of patients with schizophrenia offer unique material to explore patients’ subjective experience related to their illness, in particular the alteration of self observed in schizophrenia. Material and methodsWe used two protocols to collect life narratives of patients with schizophrenia and control subjects. A validated coding method to analyze life narratives enabled us to distinguish three kinds of life story coherence: temporal, causal-motivational and thematic. ResultsThe temporal coherence of narratives is mildly impaired in patients, in particular when narratives are collected using a more structured method. However, causal-motivational and thematic coherence are severely 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. ConclusionThis study provides new understanding of the cognitive deficits underlying self-disorders in patients with schizophrenia. Clinical perspectives ensuing from these results and aiming at improving narrative coherence in schizophrenia are discussed.