Posted: April 29th, 2018

Recognising Individual Experiences and Self-Identity in Schizophrenia

Recognising Individual Experiences and Self-Identity in Schizophrenia

Schizophrenia is a complex and heterogeneous disorder that affects various aspects of a person’s life, including their sense of self. The sense of self, or the sense of who one is as an individual and in relation to others, can change throughout one’s life due to various factors and events. However, experiencing psychosis and being diagnosed with schizophrenia can have a profound impact on one’s sense of self, leading to changes in how one perceives oneself, relates to others, and makes sense of one’s experiences. These changes can be understood in different ways, depending on the theoretical and empirical perspectives adopted by researchers and clinicians. In this paper, we aim to review some of the main approaches to studying identity changes in schizophrenia, and to highlight the implications for practice and research.

One way of understanding identity changes in schizophrenia is to regard them as characteristics of psychosis, or as manifestations of altered or disordered self-experience. This perspective is based on the phenomenological tradition that views schizophrenia as a disorder of the self, where the person loses the sense of being the agent and owner of their thoughts, feelings, and actions. According to this view, identity changes are seen as intrinsic to the psychotic experience, such as feeling detached from oneself, having a fragmented sense of self, or experiencing a loss of self-boundaries. Some researchers have argued that these identity changes are useful in identifying psychosis, and have proposed specific measures to assess them, such as the Examination of Anomalous Self-Experience (EASE) or the Self-Disorders Scale (SDS). These measures aim to capture subtle and subjective aspects of self-disturbance that may precede or accompany the onset of psychosis.

Another way of understanding identity changes in schizophrenia is to regard them as consequences of altered cognitive functioning, or as reflections of impairments in memory, metacognition, and social cognition. This perspective is based on the cognitive-behavioral tradition that views schizophrenia as a disorder of information processing, where the person has difficulties in encoding, storing, retrieving, and integrating information. According to this view, identity changes are seen as resulting from deficits in autobiographical memory, self-knowledge, and theory of mind. Some researchers have argued that these identity changes are related to poor functioning and quality of life in schizophrenia, and have proposed specific interventions to enhance them, such as cognitive remediation or cognitive-behavioral therapy. These interventions aim to improve cognitive abilities and skills that are relevant for developing and maintaining a coherent and positive sense of self.

A third way of understanding identity changes in schizophrenia is to regard them as consequences of internalized stigma, or as reflections of negative beliefs and attitudes that the person adopts from society. This perspective is based on the social-psychological tradition that views schizophrenia as a disorder of social interaction, where the person faces discrimination and rejection from others. According to this view, identity changes are seen as resulting from stigma-related processes, such as stereotype threat, self-stigma, or anticipated discrimination. Some researchers have argued that these identity changes are related to low self-esteem and hopelessness in schizophrenia, and have proposed specific interventions to reduce them, such as psychoeducation or peer support. These interventions aim to increase awareness and acceptance of one’s condition, and to foster empowerment and recovery.

A fourth way of understanding identity changes in schizophrenia is to regard them as consequences of lost roles and relationships, or as reflections of disruptions in one’s social network and life course. This perspective is based on the sociological tradition that views schizophrenia as a disorder of social structure, where the person experiences role transitions and losses due to their illness. According to this view, identity changes are seen as resulting from social isolation, marginalization, or exclusion. Some researchers have argued that these identity changes are related to loneliness and depression in schizophrenia, and have proposed specific interventions to restore them,
such as vocational rehabilitation or family therapy. These interventions aim to increase social participation and support, and to facilitate role recovery and adaptation.

A fifth way of understanding identity changes in schizophrenia is to regard them as reflections of personal growth, or as indications of resilience and coping in the face of adversity. This perspective is based on the positive psychology tradition that views schizophrenia as a disorder with potential for recovery and well-being, where the person can learn from their experiences and find meaning and purpose in their lives. According to this view, identity changes are seen as resulting from personal reflection, transformation, or integration. Some researchers have argued that these identity changes are related to optimism and satisfaction in schizophrenia, and have proposed specific interventions to promote them,
such as narrative therapy or mindfulness-based therapy. These interventions aim to enhance personal agency and autonomy,
and to foster self-compassion and acceptance.

In conclusion, identity changes in schizophrenia are complex phenomena that can be understood from multiple perspectives. Each perspective offers a different lens through which to examine how people with schizophrenia see themselves as individuals and in relation to others, and how they make sense of their experiences. These perspectives have important implications for practice and research, as they suggest different ways of assessing, intervening, and evaluating identity changes in schizophrenia. A comprehensive and integrative approach that considers the strengths and limitations of each perspective, and that respects the individual experiences and preferences of people with schizophrenia, may be the most beneficial for enhancing their sense of self and well-being.

References

– Conneely, M., McNamee, P., Gupta, V., Richardson, J., Priebe, S., Jones, J. M., & Giacco, D. (2021). Understanding identity changes in psychosis: A systematic review and narrative synthesis. Schizophrenia Bulletin, 47(2), 309-322. https://doi.org/10.1093/schbul/sbaa124
– Moe, A. M., & Docherty, N. M. (2014). Schizophrenia and the sense of self. Schizophrenia Bulletin, 40(1), 161-168. https://doi.org/10.1093/schbul/sbt121
– Lysaker, P. H., & Lysaker, J. T. (2010). write my essay pro uk writings Schizophrenia and alterations in self-experience: A comparison of 6 perspectives. Schizophrenia Bulletin, 36(2), 331-340. https://doi.org/10.1093/schbul/sbn077
– Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. Schizophrenia Bulletin, 29(3), 427-444.
– Stanghellini, G., & Lysaker, P. H. (2007). The psychotherapy of schizophrenia through the lens of phenomenology: Intersubjectivity and the search for the recovery of first and second person awareness. American Journal of Psychotherapy, 61(2), 163-179.

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