Narrative Identity, Metacognition, and Well-Being in Patients With Schizophrenia or HIV

Abstract

It has been proposed that schizophrenia reflects disturbances in personal identity, which include sense of personal agency, sense of belonging within a social group, and metacognition. Less is known about how these different processes are related to one another and to well-being outcomes. To study this, we measured themes of agency and communion in narrative identity in 29 individuals with schizophrenia and 29 individuals with HIV. All participants had previously been assessed on metacognitive abilities using the Indiana Psychiatric Illness Interview (IPII) and completed scales measuring hopelessness and self-esteem. For the present study, themes of agency and communion were coded from the IPII transcripts. Results indicated that participants with schizophrenia had lower levels of agency and communion compared with participants with HIV. More presence of agency and communion themes were related to better metacognitive abilities as well as less hopelessness and higher self-esteem across groups. Agency predicted variance in hopelessness after controlling for metacognitive abilities. The results suggest that although the construction of narrative identity may depend on metacognitive abilities, agency themes predict outcomes beyond metacognition.

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

“…Matching observations from psychiatric rehabilitation of alterations in self-experience in psychosis, a person might appear to have lost a sense of why they should do something they had been doing for years as well as what might come from doing something that is meaningful [ 122 ]. This is also consistent with narrative research, which has found that a sense of purpose is less discernable in the life stories of persons with psychosis [ 41 , 123 , 124 ]. More generally, without a sense of one’s purposes and possibilities to anchor a growing sense of self, the symbolization of self and experience might diminish as found in psychoanalytic accounts of the subjective experience of psychosis [ 125 – 127 ] and match what has been described as a lack of existential agency [ 128 ].…”

“…Metacognition has also been linked to interpersonal functioning [ 33 – 35 ] as well as the processes that support social connections, including empathy [ 36 – 38 ]. Deficits in metacognition also have been linked to self-compassion [ 39 , 40 ] and the richness of personal narrative [ 41 ], as well as being implicated in influencing the association between emotional distress and positive symptoms [ 42 ]. Other studies have found that alterations in metacognition are linked to changes in neurocognition and, in a formal network analysis, metacognition was found to be a central node in a network that included social cognition, neurocognition and symptoms [ 43 ].…”

Personal Narratives as a Predictor of Trait Change and State Fluctuations in Self-Esteem and Life Satisfaction during the Transition from Education to Work

“…Most studies on the link between narrative agency and redemption and self-esteem and life satisfaction examined cross-sectional associations at the trait level. This research has shown that narrative agency correlated positively with self-esteem (Holm et al, 2020;Steiner et al, 2019), but not significantly with life satisfaction (rs = .20 and .16, respectively;Bauer & McAdams, 2004;Grossbaum & Bates, 2002). However, these studies on life satisfaction had limited power (ns= 76 and 49, respectively).…”

An investigation of the concurrent and longitudinal associations between narrative coherence and mental health mediated by social support

“…For instance, there is the idea that the ability to successfully narrate challenges is linked to the ability of how to manage them (Allé et al, 2015). Finally, future community based research could pay more attention to examining possible covariates of narrative coherence, including the role of problems in metacognitive capacity and social isolation (Holm et al, 2020; Lysaker et al, 2021).…”