Recovering a sense of self in schizophrenia.

Abstract

Diverse theoretical orientations on psychopathology, including the most recent phenomenological and neuroscientific approaches, consistently have viewed a core component of schizophrenia to be the loss, or distortion, of a person's sense of self as an effective agent in a shared, social world. How such a sense of self becomes lost or distorted and the questions of whether or not, and if so, how it can be recovered have received considerably less attention. These questions are taken up in the present paper. A review of a substantial body of longitudinal research, enhanced by a growing trove of recovery narratives, provides ample evidence that many people recover a sense of self over time. Based on a review of this qualitative literature, this contribution describes the components and processes involved in the gradual reconstruction of an effective sense of social agency. Processes of reconstructing a sense of self begin with acceptance and an instillation of hope, which together provide a foundation for rediscovering one's efficacy in seemingly small but concrete ways that then are incorporated into a sense of social identity as a worthwhile member of one's community. Implications of such an understanding for recovery-oriented practice are considered.