Personal narratives and the pursuit of purpose and possibility in psychosis: directions for developing recovery-oriented treatments

ABSTRACT

Introduction

The experience of psychosis involves changes in an individual’s sense of self and their understanding of others and the world around them. Studying life narratives and narrative identity offers one way to better understand these changes.

Areas covered

Narratives of persons with psychosis display alterations in their themes, structures, and processes. These narratives often portray the person as possessing relatively little sense of agency, without meaningful connections to others, and often describe events in a negative emotional tone. The structure of these narratives often lacks temporal cohesion, unfolding in a disjointed manner. The overall structure and content of narratives further appear to struggle to respond to experience, suggesting that individuals with psychosis may have difficulty incorporating new information into their narrative, leading to a lack of narrative evolution. This body of research illustrates how psychosis reflects the interruption of an unfolding life in which sense of self is compromised and cannot be understood as a collection of symptoms and skill deficits.

Expert opinion

There is a need for treatment to address disruptions in personal narratives among persons with psychosis to promote a sense of purpose, possibility and meaning. As our understanding of psychosis continues to evolve and we emphasize first-person life stories, the authors believe that stigma in providers will decrease and the importance of subjective recovery will be further revealed.

KEYWORDS:

• Agency
• narrative
• identity
• psychosis
• psychotherapy
• recovery
• schizophrenia
• self

Article highlights

• Studying narrative identity is one way to better understand the experience of psychosis as involving changes in an individual’s sense of self and their understanding of others and the world around them.

• In psychosis, life narratives include relatively fewer themes of agency and communion.

• The structure of these narratives often includes a lack of temporal cohesion and a disjointed structure.

• Narratives of persons with psychosis may lack responsivity and ineffectively incorporate new information and experience, resulting in narratives that fail to evolve.

• These disruptions in narrative provide novel treatment targets which may advance recovery and uniquely promote a greater sense of purpose, possibility and meaning in one’s life.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript has not been funded.