Elsevier

Comprehensive Psychiatry

Volume 69, August 2016, Pages 53-61
Comprehensive Psychiatry

Self-continuity across time in schizophrenia: An exploration of phenomenological and narrative continuity in the past and future

https://doi.org/10.1016/j.comppsych.2016.05.001Get rights and content

Abstract

Background

Disorders of the self, such as a reduced sense of personal continuity in time, are a core symptom of schizophrenia, but one that is still poorly understood. In the present study, we investigated two complementary aspects of self-continuity, namely phenomenological and narrative continuity, in 27 patients with schizophrenia, and compared them with 27 control participants.

Methods

Participants were asked to identify important past events and to narrate a story from their life that included these events. They were also asked to imagine important events that might happen in their personal future and to build a narrative of their future life. The vividness of these important life events and the proportion of self-event connections in the narratives were used as a measure of phenomenological and narrative continuity, respectively.

Results

Our study showed patients with schizophrenia experienced less vivid representations of personally significant events (p = .02) for both temporal directions (past and future) (p < .001). In addition, their ability to make explicit connections between personal events and self-attributes in life narratives was also impaired (p = .03), but only in the case of past narratives (p < .001).

Conclusions

These results shed new light on the cognitive mechanisms underlying self-disorders in schizophrenia. The clinical and therapeutic implications of these findings are discussed.

Introduction

Disorders of the self are a core and frequent symptom of schizophrenia [1], [2], [3], [4] and probably one of its most intriguing features. Such disorders manifest themselves through a broad range of anomalous self-experiences [2], [5], [6], one of them being a reduced sense of personal continuity, also described as a fragmentation of the self in time. Several theoretical and empirical models [3], [7] have been put forward in an attempt to understand the putative causes of these disorders, which are still poorly understood.

Recent theoretical and empirical work in the field of autobiographical memory and narrative research suggests that self-continuity involves at least two distinct components [8], [9]. The first component, phenomenological continuity, is the experience of self-continuity that is felt through mental time travel, either when mentally re-living past events or when pre-experiencing events that might happen in the future [10], [11], [12]. Mental time travel results in the perception that the present moment is both a continuation of the past and a prelude to the future [13]. It also contributes to the subjective feeling that both past and future selves belong to a unique self in the present. Neuroimaging studies have shown that re-experiencing past events and pre-experiencing future events recruit a common set of brain regions (for a recent meta-analysis; see Ref. [14]), and some of these regions have consistently been associated with self-processing [15], lending support to the view that past and future mental time travel may contribute to the experience of self-continuity across time.

The second aspect of self-continuity, narrative continuity [9], is the sense of personal continuity that arises from the creation of coherent life stories. In this regard, memories of personal events have to be integrated into a coherent life story in order to create narrative continuity [16], [17], [18], which involves autobiographical reasoning processes, such as self-event connections that serve to establish links between personal past events and self-attributes (for instance, “that journey changed many things for me; I understood what is meant by the meaning of life, and since then I am more self-confident”; “When I came back to Vietnam, I realized that in the meantime I had grown away from my own culture”) [19], [20]. In this way, an individual can integrate several, sometimes disparate, aspects of his or her self and reconcile the many selves present over time to produce a continuous and coherent self-view [17], [21], [22].

The idea that phenomenological and narrative continuity are two distinct processes, both contributing to self-continuity, is supported by neuroimaging findings showing that re-experiencing past events and reasoning on their implications for the self recruit distinct brain networks [23]. Existing literature on autobiographical reasoning and self-event connections has focused almost exclusively on self-narratives of past events, but the seminal work by d'Argembeau and collaborators [24] suggests that the ability to reflect on the potential implications of important future events (i.e. self-defining future projections) involves similar processes as those at play when extracting personal meaning from past self-defining events.

Several previous studies have investigated these two aspects of self-continuity in patients with schizophrenia. Some studies provided evidence for an impaired phenomenological continuity, showing that patients had a reduced capacity to re-experience past events [25], [26], [27], [28] and to pre-experience future events [29], [30], [31], [32]. Other studies yielded preliminary evidence for a damaged narrative continuity [33], showing that patients were impaired in extracting personal meaning from important past events [34], [35], [36], [37] and anticipated future events [32]. Importantly, however, none of these previous studies explored the relationship between phenomenological and narrative continuity in schizophrenia. Furthermore, a direct comparison of these two dimensions of self-continuity between the past and the future remains to be performed. The present study aimed to address these issues by investigating both aspects of self-continuity in both temporal directions (past and future), thus allowing for a better identification of the different dimensions that could underlie the reduced sense of self-continuity that characterizes patients with schizophrenia.

Section snippets

Participants

Twenty-seven stabilized outpatients (11 women) were recruited from the Psychiatric Department of Strasbourg's University Hospital. All of them fulfilled the DSM-IV-TR diagnosis of schizophrenia [38]. Patients experiencing a major depressive episode (score higher than 6 on the Calgary Depression Scale for Schizophrenia (CDSS) [39]), and those with an IQ of less than 70 (WAIS-R, [40]) were excluded. All but one of the patients were receiving antipsychotics for at least one year (first generation,

Subjective ratings of memories and future thoughts

Because participants reported 7 past events and 3 future events, only the first 3 past events given by the participants were included in the following analyses in order to ensure a better comparison between past and future events. The results are shown in Table 2. As can be seen, the temporal distance of future events was significantly lower than the distance of past events. There was no difference in temporal distance across groups, and the interaction between group and temporal orientation

Discussion

This study showed that two critical and complementary aspects of self-continuity, namely phenomenological and narrative continuity, are impaired in patients with schizophrenia. The difficulty of patients in constructing vivid representations of personally significant events (thought to reflect phenomenological continuity) was observed for both temporal directions — past and future. The ability to make explicit connections between personal events and self-attributes in life narratives (thought

Conclusion

This study sheds light on disorders of self-continuity in patients with schizophrenia and shows, in particular, that patients have difficulty to construct vivid representations of personally significant events (thought to reflect phenomenological continuity) in both directions of time: past and future. Their ability to establish explicit connections between personal events and attributes of self in life narratives (thought to reflect narrative continuity) is also reduced, but only in past

Acknowledgment

We would like to thank Dr. Hiroshi Kobayashi for helping to rate the life narratives coherence and Gilian Wakenhut for the proof reading.

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