Volume 23, Issue 3 (Fall 2017)                   IJPCP 2017, 23(3): 336-347 | Back to browse issues page


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Talaei Zadeh S, Panaghi L, Hosseini S M M. The Study of Self-Narration of Patients With Schizophrenia Based on Genette’s Structural Analysis Theory. IJPCP. 2017; 23 (3) :336-347
URL: http://ijpcp.iums.ac.ir/article-1-2631-en.html
1- MSc of Family therapy psychology Department of Family Therapy Psychology, Family Research Institute, Shahid Beheshti University, Tehran, Iran , Email:siavash.talaei2010@gmail.com
2- MD in Community Medicine, Associate Professor Family Research Institute, Shahid Beheshti University, Tehran, Iran.
3- MSc Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
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Extended Abstract
1. Introduction

Schizophrenia is an extremely disabling disorder that affects about 1% of the general population [1]. Patients with schizophrenia are one of the groups that experience traumatic conditions such as negative family environment, stigma, and isolation in addition to their psychotic symptoms. On the other side it seems that humans create narrations in order to cope with these painful experiences and narrate their life stories in a way that gives a new meaning to these experiences and a new perception of the world [2]. Some researchers have conceptualized self as a narration that is constructed and reconstructed throughout life. The self-narration of a person relies on how he understands himself as an individual and how he uses narration in order to give consistency to his life. Narrative approach is a suitable method for investigation of subjective experiences of people specifically those dealing with traumatic events [3]. 
There are a lot of studies about narrations of patients with schizophrenia. However, the majority of these studies is quantitative and relates to the cognitive functioning of these patients [4]. The most important question that these researches try to find out is a cognitive one: is a patient with schizophrenia capable of constructing a narration at all? [5]. Such an approach does not encounter the complexity of the subjective world of a person with schizophrenia and neglects his or her phenomenological perception. Thus the aim of this study is to investigate self-narration of patients with schizophrenia. In this way, the study of main themes and chronological structure of self-narrations of patients has a central importance in this study.
2. Methods
This study is a qualitative and narrative research. The statistical sample consisted of 9 subjects: 5 men and 4 women who were selected through purposive sampling. Sampling volume criterion was saturation. Research instruments used were Mental Status Examination form (MSE), and McAdams Life Story interview. All the nine patients selected had undergone diagnosis for schizophrenia 5 years ago. According to MSE form these subjects were in a stable mental situation and most of their symptoms were controlled. They were capable of abstract thinking and intellectual insight. The Global Assessment Functioning (GAF) score too was in the range of 41-50. 4 subject were outpatient samples and 5 subjects were inpatient samples in a charitable institute for protection of psychiatry patients. 
In the second phase of McAdams Life Story interview was performed. Data structural analysis is done on the basis of Genette theory where time, tone, and mood the three important components of structural data analysis are analyzed [6]. Time criterion includes order, duration, and frequency. Tone criterion relates to how a person narrates his or her life story; Is it a tragic story? A comic story? or an ironic one? The mood criterion consists of point of view and distance. Point of view in a narration can be a first person or third person, and it could also be internal or external point of view. Distance implies the degree of proximity a narrator has to his or her story or how non-empathic and distant narration the narrator is to his or her life.
3. Results
Results showed that the main theme of narrations of patients with schizophrenia was be sacrificed. Narrator always takes the role of a victim and the most important agent that sacrifices the person is the illness. Rejection, insecurity, loneliness, and disappointment are some other important themes in their narrations. With respect to family perception most important components are absence of socio-historical aspects, absence of siblings, absence of interactions with family members, absence of father and overinvolved mother (Table 1). Results show that perception of the family of patients with schizophrenia is a self-centered perception in which various components of family can understand in the light of personal relation of patient with that subject.
In structural analysis three criterion of time, tone and mood were considered. In the criterion of time and specifically order there was no disturbance in the perception of time, but life divides into two major episodes. The first episode is the golden age, the period in which there is no illness. However, clues of a chaos in the future appeared gradually. In the second episode the illness appeared and it impacts all aspects of the person’s life. In duration criterion the narration pattern is positive speed in illness episode, which means that a person with schizophrenia narrates the events in time quickly. The most frequently used word was “mother”. In the mood criterion it should be noted that in most of the narrations the point of view is first person and there is no third person point of view. Furthermore, the point of view always is internal not external. In the distance criterion there is a widespread distance between narrator and narration, e.g. the subject and object and the tone of narration is always cynical, tragic, and desperate.
4. Conclusion
Results showed that the narrations of these patients begin with an unsteady situation in which there are some hints of a great confusion. Sometimes this chaos is simple complex and sometimes a great one. By the way this chaos is usually the schizophrenia disorder that completely affects the narrator’s life. The chaos (schizophrenia) usually appears during adolescence. In most of the narrations the origin of schizophrenia is external to the person and is often resolved by the patient himself, although these resolutions are always ticklish and temporal. Data showed that the self-perception of patients with schizophrenia was self-centered perception and the illness had a critical role in it. This self-centered perception brings to the mind psychoanalytic definition of psychosis as the clinical structure that fixates in the primary narcissistic phase and rejects the whole socio-symbolic world [7]. The absence of a third person point of view too implied on this aspect of psychical life of these patients because third person point of view always considers socio-symbolic factors in the narrations. 
Regarding the role of victim in life stories we can imply the concept of engulfment in other studies. Engulfment is the experience of something to the extent that there is nothing outside of it [8]. The concepts of self-stigma or internalized stigma too are concepts that relate to the role of victim [9]. Rejection, insecurity, loneliness, shame, and guilt were other important themes in their narrations all of which relate to the role of the victim. Regarding the absence of a father and an over-involved mother, we can recount the classical concept of schizophrenogenic mothers who along with a passive and neglectful father create schizophrenia in the child. 
Acknowledgments
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest
The authors declared no conflicts of interest.
 
References
  1. Awad AG, Voruganti LN. The burden of schizophrenia on caregivers: A review. PharmacoEconomics. 2008; 26(2):149-62. doi: 10.2165/00019053-200826020-00005
  2. Geller J. Living with schizophrenia. Occoquan: Wold Federation for Mental Health Publication; 2014.
  3. Gutiérrez-Maldonado J, Caqueo-Urízar A, Kavanagh DJ. Burden of care and general health in families of patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology. 2005; 40(11):899–904. doi: 10.1007/s00127-005-0963-5
  4. Fink B. A Clinical introduction to lacanian psychoanalysis. Cambridge, Massachusetts: Harvard University Press; 2004.
  5. D’Argembeau A, Raffard S, Van der Linden M. Remembering the past and imagining the future in schizophrenia. Journal of Abnormal Psychology. 2008; 117(1):247–51. doi: 10.1037/0021-843x.117.1.247
  6. Crossley N. Intersubjectivity: The fabric of social becoming. Thousand Oaks, California: SAGE; 1996.
  7. Crossley ML. Narrative psychology, trauma and the study of self/identity. Theory & Psychology. 2000; 10(4):527–46. doi: 10.1177/0959354300104005
  8. Raffard S, D’Argembeau A, Lardi C, Bayard S, Boulenger JP, Linden MV der. Narrative identity in schizophrenia. Consciousness and Cognition. 2010; 19(1):328–40. doi: 10.1016/j.concog.2009.10.005
  9. Bennouna-Greene M, Berna F, Conway MA, Rathbone CJ, Vidailhet P, Danion JM. Self-images and related autobiographical memories in schizophrenia. Consciousness and Cognition. 2012; 21(1):247–57. doi: 10.1016/j.concog.2011.10.006
  10. Allé MC, Potheegadoo J, Köber C, Schneider P, Coutelle R, Habermas T, et al. Impaired coherence of life narratives of patients with schizophrenia. Scientific Reports. 2015; 5(1):12934. doi: 10.1038/srep12934
  11. Boulanger M, Dethier M, Gendre F, Blairy S. Identity in schizophrenia: A study of trait self-knowledge. Psychiatry Research. 2013; 209(3):367–74. doi: 10.1016/j.psychres.2013.04.002
  12. Holm T, Thomsen DK, Bliksted V. Life story chapters and narrative self-continuity in patients with schizophrenia. Consciousness and Cognition. 2016; 45:60–74. doi: 10.1016/j.concog.2016.08.009
  13. Vining D, Robinson JC. Concept analysis of illness engulfment in schizophrenia. Archives of Psychiatric Nursing. 2016; 30(3):370–4. doi: 10.1016/j.apnu.2016.01.001
  14. Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Archives of Psychiatric Nursing. 2013; 27(5):231–4. doi: 10.1016/j.apnu.2013.05.002
  15. Esmaeilinasab M, Eskandari H, Borjali A. [The comparison of life narratives between anxious and depressed clients with nonclinical sample (Persian)]. Advances in cognitive sciences. 2005; 7(3):58-64. 
  16. Gholamrezaei M. [The life-stories of Iranian university students who attempted suicide: A structural analysis (Persian)] [MA thesis]. Tehran: Shahid Beheshti University; 2009.
  17. Lyons E, Coyle A. Analysing qualitative data in psychology. Thousand Oaks, California: SAGE; 2007.
  18. Rimmon-Kenansh. Narrative fiction: Contemporary poetics. [H. Abolfazl, Persian trans]. Tehran: Niloofar; 2008.
  19. Tyson L. Critical theory today: A user-friendly guide. [M. Hossein Zadeh, F. Hosseini Persian trans]. Tehran: NegaheEmrouz; 2008.
  20. Mohammadi MH, Abbasi A. [Withstand: The Structure of a Myth (Persian)]. Tehran: Chista Publication; 2002.
  21. Creswell JW. Qualitative inquiry & research design: Choosing among five approach. Thousand Oaks, California: SAGE; 2012.
  22. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Education for Information. 2004; 22(2):63–75. doi: 10.3233/efi-2004-22201
  23. McAdams DP. The psychology of life stories. Review of General Psychology. 2001; 5(2):100–22. doi: 10.1037/1089-2680.5.2.100
  24. Dadsetan P. [Psychopathology transition from childhood to adulthood (Persian)]. Tehran: SAMT; 2007.
  25. Karakaş SA, Okanlı A, Yılmaz E. The effect of internalized stigma on the self esteem in patients with schizophrenia. Archives of Psychiatric Nursing. 2016; 30(6):648–52. doi: 10.1016/j.apnu.2016.02.006
  26. MacDougall AG, Vandermeer MRJ, Norman RMG. Determinants of self-esteem in early psychosis: The role of perceived social dominance. Psychiatry Research. 2016. doi: 10.1016/j.psychres.2016.05.050
  27. Fink B. Fundamentals of psychoanalytic technique. New York: W. W. Norton & Company; 2007.
  28. Sadock B, Sadock V, Pedro R. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Science/Clinical Psychiatry [M. Ganji Persian trans]. Tehran: Savalan; 2015.
Type of Study: Original Research | Subject: General
Received: 2017/01/8 | Accepted: 2017/06/18 | Published: 2017/12/9

References
1. Awad AG, Voruganti LN. The burden of schizophrenia on caregivers: A review. PharmacoEconomics. 2008; 26(2):149-62. doi: 10.2165/00019053-200826020-00005 [DOI:10.2165/00019053-200826020-00005]
2. Geller J. Living with schizophrenia. Occoquan: Wold Federation for Mental Health Publication; 2014.
3. Gutiérrez-Maldonado J, Caqueo-Urízar A, Kavanagh DJ. Burden of care and general health in families of patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology. 2005; 40(11):899–904. doi: 10.1007/s00127-005-0963-5 [DOI:10.1007/s00127-005-0963-5]
4. Fink B. A Clinical introduction to lacanian psychoanalysis. Cambridge, Massachusetts: Harvard University Press; 2004.
5. D'Argembeau A, Raffard S, Van der Linden M. Remembering the past and imagining the future in schizophrenia. Journal of Abnormal Psychology. 2008; 117(1):247–51. doi: 10.1037/0021-843x.117.1.247 [DOI:10.1037/0021-843X.117.1.247]
6. Crossley N. Intersubjectivity: The fabric of social becoming. Thousand Oaks, California: SAGE; 1996.
7. Crossley ML. Narrative psychology, trauma and the study of self/identity. Theory & Psychology. 2000; 10(4):527–46. doi: 10.1177/0959354300104005 [DOI:10.1177/0959354300104005]
8. Raffard S, D'Argembeau A, Lardi C, Bayard S, Boulenger JP, Linden MV der. Narrative identity in schizophrenia. Consciousness and Cognition. 2010; 19(1):328–40. doi: 10.1016/j.concog.2009.10.005 [DOI:10.1016/j.concog.2009.10.005]
9. Bennouna-Greene M, Berna F, Conway MA, Rathbone CJ, Vidailhet P, Danion JM. Self-images and related autobiographical memories in schizophrenia. Consciousness and Cognition. 2012; 21(1):247–57. doi: 10.1016/j.concog.2011.10.006 [DOI:10.1016/j.concog.2011.10.006]
10. Allé MC, Potheegadoo J, Köber C, Schneider P, Coutelle R, Habermas T, et al. Impaired coherence of life narratives of patients with schizophrenia. Scientific Reports. 2015; 5(1):12934. doi: 10.1038/srep12934 [DOI:10.1038/srep12934]
11. Boulanger M, Dethier M, Gendre F, Blairy S. Identity in schizophrenia: A study of trait self-knowledge. Psychiatry Research. 2013; 209(3):367–74. doi: 10.1016/j.psychres.2013.04.002 [DOI:10.1016/j.psychres.2013.04.002]
12. Holm T, Thomsen DK, Bliksted V. Life story chapters and narrative self-continuity in patients with schizophrenia. Consciousness and Cognition. 2016; 45:60–74. doi: 10.1016/j.concog.2016.08.009 [DOI:10.1016/j.concog.2016.08.009]
13. Vining D, Robinson JC. Concept analysis of illness engulfment in schizophrenia. Archives of Psychiatric Nursing. 2016; 30(3):370–4. doi: 10.1016/j.apnu.2016.01.001 [DOI:10.1016/j.apnu.2016.01.001]
14. Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Archives of Psychiatric Nursing. 2013; 27(5):231–4. doi: 10.1016/j.apnu.2013.05.002 [DOI:10.1016/j.apnu.2013.05.002]
15. Esmaeilinasab M, Eskandari H, Borjali A. [The comparison of life narratives between anxious and depressed clients with nonclinical sample (Persian)]. Advances in cognitive sciences. 2005; 7(3):58-64.
16. Gholamrezaei M. [The life-stories of Iranian university students who attempted suicide: A structural analysis (Persian)] [MA thesis]. Tehran: Shahid Beheshti University; 2009.
17. Lyons E, Coyle A. Analysing qualitative data in psychology. Thousand Oaks, California: SAGE; 2007. [DOI:10.4135/9781446207536]
18. Rimmon-Kenansh. Narrative fiction: Contemporary poetics. [H. Abolfazl, Persian trans]. Tehran: Niloofar; 2008.
19. Tyson L. Critical theory today: A user-friendly guide. [M. Hossein Zadeh, F. Hosseini Persian trans]. Tehran: NegaheEmrouz; 2008.
20. Mohammadi MH, Abbasi A. [Withstand: The Structure of a Myth (Persian)]. Tehran: Chista Publication; 2002.
21. Creswell JW. Qualitative inquiry & research design: Choosing among five approach. Thousand Oaks, California: SAGE; 2012.
22. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Education for Information. 2004; 22(2):63–75. doi: 10.3233/efi-2004-22201 [DOI:10.3233/EFI-2004-22201]
23. McAdams DP. The psychology of life stories. Review of General Psychology. 2001; 5(2):100–22. doi: 10.1037/1089-2680.5.2.100 [DOI:10.1037/1089-2680.5.2.100]
24. Dadsetan P. [Psychopathology transition from childhood to adulthood (Persian)]. Tehran: SAMT; 2007.
25. Karakaş SA, Okanlı A, Yılmaz E. The effect of internalized stigma on the self esteem in patients with schizophrenia. Archives of Psychiatric Nursing. 2016; 30(6):648–52. doi: 10.1016/j.apnu.2016.02.006 [DOI:10.1016/j.apnu.2016.02.006]
26. MacDougall AG, Vandermeer MRJ, Norman RMG. Determinants of self-esteem in early psychosis: The role of perceived social dominance. Psychiatry Research. 2016. doi: 10.1016/j.psychres.2016.05.050 [DOI:10.1016/j.psychres.2016.05.050]
27. Fink B. Fundamentals of psychoanalytic technique. New York: W. W. Norton & Company; 2007.
28. Sadock B, Sadock V, Pedro R. Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Science/Clinical Psychiatry [M. Ganji Persian trans]. Tehran: Savalan; 2015.

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