Insight and Personal Narratives of Illness in Schizophrenia

Abstract

Insight in schizophrenia tends to be assessed as the degree to which one possesses specific knowledge. It therefore often fails to account for the fact that awareness of illness is an inextricable part of a personal narrative and may be incoherent or incomplete for many different narrative reasons. Accordingly, we have developed a means of eliciting narratives of illness: the Indiana Psychiatric Illness Interview, and a method for rating the coherence of those narratives: the Narrative Coherence Rating Scale. In this article we describe these methods and present data on their reliability and validity in a study of the illness narratives of 33 outpatients with schizophrenia or schizoaffective disorder. Results suggest our measures possess sufficient internal consistency and good to excellent interrater reliability. Additionally, as predicted, our measures of narrative coherence were significantly correlated with traditional measures of insight and with measures of cognitive impairment and hopelessness gathered earlier.

Being Interrupted: The Self and Schizophrenia

“…Considered as a whole, the disruption in sense of self that accompanies schizophrenia has been characterized in terms of enduring agony (Searles 1965;Robbins 1993), or a sense of isolation and rejection (Bassman 2000;Lysaker and Bell 1995) that is qualitatively distinct from existential uncertainties about fate or role (Lysaker and Lysaker 2002;Sass 1992;Selzer and Schwartz 1994). Persons with schizophrenia may also experience a fragmentation of self where aspects of themselves no longer cohere or are not embedded in an intelligible history (Eigen 1986;Frosh 1983;Holma andAaltonen 1997;Laing 1978;Lysaker et al 2002;Rosenfeld 1954).…”

“…Persons with schizophrenia may also experience a fragmentation of self where aspects of themselves no longer cohere or are not embedded in an intelligible history (Eigen 1986;Frosh 1983;Holma andAaltonen 1997;Laing 1978;Lysaker et al 2002;Rosenfeld 1954). Moreover, these profound alterations in self-conception are entwined with altered experience of the world (Holma and Aaltonen 1995).…”

“…Could disruptions in internal conversation affect self-experience in a manner that parallels the reports and observations detailed above regarding schizophrenia? In a previous paper (Lysaker and Lysaker 2002) we have suggested as much.…”

Language and hope in schizophrenia-spectrum disorders

“…The Indiana Psychiatric Illness Interview (IPII; Lysaker et al, 2002) is a semi-structured interview that asks participants to tell the story of their lives in as much detail as possible.…”

Trauma, Dissociation and Synthetic Metacognition in Schizophrenia

“…The Indiana Psychiatric Illness Interview -IPII) (Lysaker et al, 2002) is a semistructured interview which is conceptually divided into five sections. At first, after establishing contact investigated persons are asked to tell the story of their lives as detailed as possible.…”