Narrative structure in psychosis - Schizophrenia and disruptions in the dialogical self

There is nearly universal acceptance that persons with schizophrenia often experience a profound disruption in their basic sense of self. But what does this disruption in sense of self reflect? Is this the result of an internal catastrophe? If so, where and in what manner did this catastrophe occur? To address these issues this paper will review various perspectives on disruptions of self-experience in schizophrenia as well as literature regarding how sense of self among people in general normally develops out of dialogues both within the individual and between the self and others. Following this we will theorize that the subjective experience of personal incoherence in schizophrenia may reflect a collapse of the ability to maintain ongoing dialogue within the self, specifically arguing that as internal dialogues evaporate, self-experience and personal narrative can devolve into one of three forms: (a) a barren and empty self-organization; (b) internal cacophony; or (c) self constructions dominated by rigid, non-evolving monologues. Lastly, implications for treatment and recovery will be discussed, including the potential usefulness of a focus on interventions that might revitalize clients' internal and external dialogue.