Schizophrenia: from Minimal Self-disturbances to Disrupted Narrative identity

Abstract

Selfhood is experienced at multiple levels in healthy individuals with the minimal, unconscious self providing the building block for self-identity. In control populations, emotional experiences and awareness of physiological sensations play a key role in translating these pre-reflexive bodily processes into an explicit self-awareness integrated in autobiographical memories. The ability to create and recall accurate memories, in turn, is essential to develop a stable sense of identity and acquire adequate social skills. Individuals with schizophrenia routinely demonstrate disturbances in all of the above: weakened sense of self, anomalous bodily experiences, and impaired autobiographic memory. However, not much is known about the embodiment of emotions, a mechanism laying at the intersection of the minimal self and the narrative self, in this population. The onset of self-disturbances in the schizophrenia spectrum is also largely unknown. In Study 1, we used a novel topographical tool to examine embodied emotions in schizophrenia and found that individuals with schizophrenia experience anomalous bodily sensation of emotions. In Study 2, we investigated minimal self-disturbances (interoception), emotional embodiment, and disturbances of the narrative self (autobiographical memory) in a group of individuals at high-risk for schizophrenia. We found impaired interoceptive accuracy and emotional embodiment in high risk individuals, although their autobiographical memory and narrative identity remains intact. Together, our results suggest that self-disturbances appear progressively in schizophrenia, starting with disturbances of the minimal self and evolving to disturbances of the narrative, social self.