It is widely known that people with schizophrenia have difficulty telling a coherent story of their lives and that this is linked to impoverished function. But what specifically has gone wrong in the narratives in schizophrenia? Is it the case that some elements of narrative remain intact in schizophrenia while others are uniquely affected? To address these questions, we qualitatively analyze the personal narratives of three persons with schizophrenia, which have emerged in psychotherapy. Based on this analysis we suggest that narratives in schizophrenia uniquely fail to situate agency within the narrator resulting in a story that is missing an agent-protagonist. While the narratives we present contain coherent accounts of how others are connected to one another, they fail to evolve into a story about the self as an agent that others could associate with the narrator. We speculate that this may reflect neuro-cognitively based difficulties maintaining the internal dialogue that propels agency as well as fears that any emergent subjectivity may be appropriated or objectified by others. Implications for psychotherapy are discussed.

Deficits in the ability to recognize and think about mental states are broadly understood to be a root cause of dysfunction in Borderline Personality Disorder (PD). This study compared the magnitude of those deficits relative to other forms of serious mental illness or psychiatric conditions. Assessments were performed using the metacognition assessment scale-abbreviated (MAS-A), emotion recognition using the Bell Lysaker Emotion Recognition Test and alexithymia using the Toronto Alexithymia Scale among adults with schizophrenia (n = 65), Borderline PD (n = 34) and Substance Use disorder without psychosis or significant Borderline traits (n = 32). ANCOVA controlling for age revealed the Borderline PD group had significantly greater levels of metacognitive capacity on the MAS-A than the schizophrenia group and significantly lower levels of metacognitive capacity than the Substance Use group. Multiple comparisons revealed the Borderline PD group had significantly higher self-reflectivity and awareness of the other's mind than the schizophrenia group but lesser mastery and decentration on the MAS-A than substance use group, after controlling for self-report of psychopathology and overall number of PD traits. The Borderline PD and Schizophrenia group had significantly higher levels of alexithymia than the substance use group. No differences were found for emotion recognition. Results suggest metacognitive functioning is differentially affected in different mental disorders.

Many researchers have hoped vocational rehabilitation might help people with schizophrenia not only to work but also to develop more coherent narratives of their abilities and the boundaries imposed by their condition. This study compared narrative accounts of persons with schizophrenia spectrum disorders (n = 16) generated using the Indiana Psychiatric Illness Interview prior to and 5 months following entry into a vocational rehabilitation program. Results revealed participants with more intact levels of neurocognitive function as assessed with the Wisconsin Card Sorting Test demonstrated significant gains in narrative coherence relative to those with greater levels of deficit (F(1,14) = 6.3, p = .02).

Schizophrenia spectrum disorders often involve a profound diminishment in people's ability to coherently narrate their lives. Unknown is whether narrative difficulties of persons with schizophrenia differ from those with other disabilities, and how they relate to clinical or neurocognitive aspects of schizophrenia. To address both issues, personal narratives were obtained for 25 participants with schizophrenia spectrum disorders and a comparison group of eight legally blind participants and four with major depressive disorders. Flexibility of abstract thought and positive, negative, and emotional discomfort symptoms were assessed among the schizophrenia group. ANCOVA comparing scores on our scale to assess narrative development, controlling for age, found the schizophrenia group narratives significantly more impoverished than the comparison group on multiple dimensions, including self-worth and agency. Neurocognitive impairment and negative symptoms were significant predictors of impoverishment in the schizophrenia group. Results may highlight deficits that could be addressed in psychotherapy or rehabilitation to promote recovery.