MemoryMental healthSchizophrenia

Schizophrenia: What can we learn from patients’ autobiographical stories?

Affiliations : Associate Professor (maître de conférences) at Scalab, Université de Lille, France

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Summary: Tell me the story of your life. You can probably narrate it quite coherently, even if it would take quite a while. Read this article to find out how individuals with schizophrenia’s autobiographical narratives might play into their identity disorder and memory coherence.

“Despite the “usual” voices, alien thoughts and paranoia, what scared me the most was a sense that I had lost myself, a constant feeling that my self no longer belonged to me. […] I feel that my real self has left me, seeping through the fog  toward a separate reality, which engulfs and dissolves this selft. It has nothing to do with the suspicious thoughts or voices; it is purely a distorted state of  being. The clinical symptoms come and go but this nothingness of the self is permanently there.” (Clara Kean, “Silencing the Self: Schizophrenia as a Self-disturbance – Schizophrenia Bulletin, 2009).

Background: Our sense of identity is rooted in autobiographical memory

Identity disorders are among the earliest descriptions of schizophrenia (Kraepelin, 1919) and are still considered central to schizophrenic symptomatology today. However, due to their heterogeneity and complexity, they remain poorly understood. 

Personal identity is rooted in our autobiographical memory -the ability to remember personally experienced events- which plays a fundamental role in the construction of a sense of identity and its maintenance over time (Conway & Pleydell-Pearce, 2000). 

Methods: Life story to evaluate the sense of identity in schizophrenia through narrative coherence

In order to better understand identity disorders, we conducted a study focusing on the life story of people with schizophrenia (Allé et al., 2015). The life narrative, through its construction and narration, makes it possible to contextualize past personal events in the identity development of its narrator by creating a sense of coherence, unity and continuity through the passage of time. It corresponds to the most complex and integrated level of identity in autobiographical memory.

The experimental method we used (Köber et al., 2015) has made it possible to analyze the narrative coherence of these personal narratives on three levels: temporal, causal-motivational, and thematic. While temporal coherence makes it possible to account for the chronology of the narrator’s life story, causal-motivational coherence reflects identity development in its changes and evolution, and thematic coherence reflects identity in its stabilization.

Results: Alteration of motivational and thematic coherence in people suffering from schizophrenia

By comparing a group of 27 people suffering from schizophrenia with a control group (without any psychiatric or neurological disorder), our study showed that temporal coherence was weakly diminished while causal-motivational and thematic coherence were strongly altered in the narratives of people suffering from schizophrenia. These results reflect the difficulties of people suffering from schizophrenia to understand and explain how events experienced in the past have shaped their identity, and to integrate these events into a coherent narrative that accounts for the continuity of their identity despite the passage of time.

Our study showed that the difficulties highlighted in people suffering from schizophrenia were linked, on the one hand, to their executive deficit and, on the other hand, to their subjective feeling of personal coherence. This offers evidence that the alteration of narrative coherence in schizophrenia is linked to the patients’ cognitive disorders. Moreover, it is interesting to observe that the subjective feeling of coherence which is an indicator of health and wellbeing (Antonovsky, 1985), was strongly linked to the narrative coherence of the life story. 

Take home message

The alteration of the narrative coherence of autobiographical narratives in schizophrenia could be one of the mechanisms behind these patients’ identity disorders in their narrative dimension. Numerous studies have highlighted the key role of autobiographical narrative coherence in maintaining or restoring mental health (Adler, 2012; Lodi-Smith et al., 2009). In light of the results of the present study, the deficient processes involved in the coherent construction of the autobiographical narrative could be the subject of targeted therapeutic interventions in order to help people suffering from schizophrenia to restore meaning to their life course and take a further step towards recovery (Koenig-Flahaut et al., 2012). 

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