Narrative identity in addictive disorders: a conceptual review.

Narrative identity allows individuals to integrate their personal experiences into a coherent and meaningful life story. Addictive disorders appear to be associated with a disturbed sense of self, reflected in problematic and disorganized self-narratives. In recent literature, a growing body of research has highlighted how narrative approaches can make a dual contribution to the understanding of addiction: on the one hand, by revealing crucial aspects of self structure, and, on the other, by supporting the idea that addiction is a disorder related to unintegrated self-states in which dissociative phenomena and the resulting sense of 'loss of self' are maladaptive strategies for coping with distress. This conceptual review identified the main measures of narrative identity, i.e., narrative coherence and complexity, agency, and emotions, and critically examines 9 quantitative and qualitative studies (out of 18 identified in literature), that have investigated the narrative dimension in people with an addictive disorder in order to provide a synthesis of the relationship between self, narrative and addiction. These studies revealed a difficulty in the organization of narrative identity of people with an addictive disorder, which is reflected in less coherent and less complex autobiographical narratives, in a prevalence of passivity and negative emotions, and in a widespread presence of themes related to a lack of self-efficacy. This review points out important conceptual, methodological and clinical implications encouraging further investigation of narrative dimension in addiction.

Illness and narrative identity: examining past and future life story chapters in individuals with bipolar disorder, diabetes mellitus or no chronic illness.

The purpose of this study was to investigate whether narrative identity challenges are specific to Bipolar Disorder (BD) as a mental illness or a reflection of living with chronic illness. Nineteen individuals diagnosed with BD, 29 individuals diagnosed with Type 1 Diabetes Mellitus (T1DM) and 25 controls without chronic mental or somatic illness identified past and future life story chapters which were self-rated on emotional tone and self-event connections and content-coded for agency and communion themes. Individuals with BD self-rated their past chapters as more negative and less positive, and their chapters were lower on content-coded agency and communion themes compared to T1DM and controls. There were fewer group differences for future chapters, but BD was associated with lower self-rated positive emotional tone and self-stability connections as well as lower content-coded agency and communion themes. The results indicate that narrative identity is affected in individuals with BD above and beyond the consequences of living with chronic illness. This may reflect distinct effects of mental versus somatic illness on narrative identity.

Narrative as active inference: an integrative account of cognitive and social functions in adaptation.

While the ubiquity and importance of narratives for human adaptation is widely recognized, there is no integrative framework for understanding the roles of narrative in human adaptation. Research has identified several cognitive and social functions of narratives that are conducive to well-being and adaptation as well as to coordinated social practices and enculturation. In this paper, we characterize the cognitive and social functions of narratives in terms of active inference, to support the claim that one of the main adaptive functions of narrative is to generate more useful (i.e., accurate, parsimonious) predictions for the individual, as well as to coordinate group action (over multiple timescales) through shared predictions about collective behavior. Active inference is a theory that depicts the fundamental tendency of living organisms to adapt by proactively inferring the causes of their sensations (including their own actions). We review narrative research on identity, event segmentation, episodic memory, future projections, storytelling practices, enculturation, and master narratives. We show how this research dovetails with the active inference framework and propose an account of the cognitive and social functions of narrative that emphasizes that narratives are for the future-even when they are focused on recollecting or recounting the past. Understanding narratives as cognitive and cultural tools for mutual prediction in social contexts can guide research on narrative in adaptive behavior and psychopathology, based on a parsimonious mechanistic model of some of the basic adaptive functions of narrative.

Measuring narrative identity: rater coding versus questionnaire-based approaches.

Narrative identity - how individuals narrate their lived and remembered past - is usually assessed via independent rater coding, but new methods relying on self-report have been introduced. To test the assumption that different methods assess aspects of the same underlying construct, studies measuring similar components of narrative identity with different methods are needed. However, such studies are surprisingly rare. To begin to fill this gap, the present study compared the narrative variables, temporal coherence, causal coherence, and thematic coherence, measured via rater coding of participants' self-generated narratives of the remembered past and via subscales of the self-report measure Awareness of Narrative Identity Questionnaire (ANIQ). The results showed that the ANIQ subscales did not correlate significantly with their corresponding rater-coded dimension, and that the ANIQ subscales were generally unrelated to the other rater-coded dimensions. Furthermore, an exploratory factor analysis demonstrated that the ANIQ subscales loaded together on a factor that did not include any rater-coded variables. The findings suggest that the narrative variables share little empirical overlap when assessed via the ANIQ and rater coding of self-generated narratives.

"I want to lift my people up": Exploring the psychological correlates of racial themes within the life stories of midlife Black Americans.

OBJECTIVE: This study explores how middle-aged Black Americans talk about race, without prompting, while telling their life stories. METHOD: Drawing upon a dataset of lengthy Life Story Interviews (N = 70), we first employed a keyword search to identify race-relevant interview scenes for each participant. Next, we conducted a thematic analysis of these scenes to identify salient racial narrative themes. Finally, we coded race-relevant scenes to examine the psychological correlates of racial narrative themes. RESULTS: We identified 460 total racially themed Life Story Interview scenes, with the number of racially themed scenes ranging from 1 to 17 across participants' interviews. Racial narrative themes included Community of Care, Black Cultural Identity, Multiculturalism, Activism, Encounter with Racism, Systemic Racism, and Racial Reckoning. Quantitative analyses highlight a relationship between racial narrative themes and psychological measures of wisdom and generativity. CONCLUSION: This study offers insight into the ways that race manifests in the life stories of Black Americans and highlights the importance of considering race in the study of narrative identity, and personality, more broadly.

Participants' Experiences of Sex Offender Treatment: Searching for Desisting Narrative Identities.

Life-course criminology has demonstrated the importance of social relationships and life transitions to understand desistance. Yet, individuals convicted of sexual offenses seem to differ in terms of turning points, where treatment is suggested as salient to their desistance processes. Drawing on 13 teller-focused interviews with adult male incarcerated participants in a new Swedish sex offender program, this paper examines the treatment experience and the under-explored aspect of early desistance, as well as the role of society and social relations in the treatment process, through a practice-oriented lens. The thematic analysis suggests participants started developing desisting narrative identities where micro turning points in treatment contributed to offenses being explained and re-integrated into a sense of the self as an acceptable person. The process, which also enabled active responsibility, seemed to be facilitated by a holistic, person-centered treatment environment. Nonetheless, continued desistance requires adequate attention to social support and stigma management post-release.

'I am just a shadow of who I used to be'-Exploring existential loss of identity among people living with chronic conditions of Long COVID.

Identity loss and (re)construction forms a central debate in sociology of chronic illness. Living with chronic/persistent health conditions may raise questions about how disruptions can touch upon and further threaten the very roots of existence, by which people reflexively perceive a coherent and stable sense of 'being-in-the-world'. Whilst medical sociologists have shown interest in 'existential loss' in chronic illness, this question remains largely underexplored. Adopting a qualitative study on Long COVID (LC) as an example, this article illuminates existential identity loss as a deeply painful experience of losing body as a fundamental medium to retain continuity and consistency of one's narratively constructed identity. Interviews with 80 LC sufferers in the UK revealed that living with persistent and often uncertain symptoms and disruptions can cause the loss of biographical resources and resilience, making it difficult to reflexively understand their own being within the world. Their dynamic responses to LC also highlighted how sufferers' longing for a narratively coherent self can profoundly shape the ongoing construction of their identity in chronic health conditions. These insights into the complicated and often hard-to-express existential pain of identity loss can also nurture more holistic understandings of and support for LC and chronic illness more broadly.

Former dementia caregivers' high and low point narratives: what is remembered, and how is it shared?

OBJECTIVES: To characterize core themes conveyed by caregivers when sharing narratives of high and low caregiving points and to describe how caregivers structured these narratives. METHODS: Using consensual qualitative research and thematic analysis, high and low point narratives from 32 former caregivers of persons living with dementia were examined. RESULTS: High point narrative themes involved strengthening relationships with care partners, fulfillment derived from care, lighthearted moments, and fostering the care partners' joy and dignity. Low point narratives involved family conflict and lack of support, personal deficiencies, loss of the caregivers' 'pre-caregiving' life, health system failures, and alienation from their care partner. Across high and low points, caregivers' narratives were structured by three types of narrative elaborations; details unnecessary for factual recall but which enriched narrative sharing. CONCLUSION: Themes across high and low point narratives encompassed relational issues, how caregiving shaped the caregiver's self-efficacy, and factors that made navigating caregiving easier or more difficult. Both high point and low point narration often involved describing positive aspects of caregiving (PAC). Narrative elaborations may be used by former caregivers to engage in deeper evaluation of their caregiving experiences. We consider how psychotherapeutic techniques can help former caregivers reframe maladaptive narratives, supporting their mental health.

Phenomenological Interview and Gender Dysphoria: A Third Pathway for Diagnosis and Treatment.

Gender dysphoria (GD) is marked by an incongruence between a person's biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called "wait-and-see" approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a "third pathway" for the diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients' personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny's conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender.

Making meaning of trauma in psychosis.

Background: Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported. Aim: To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process. Methods: Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis. Results: We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth. Conclusion: The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.

Is It Possible to Allocate Life? Triage, Ageism, and Narrative Identity.

Triage protocols can exclude older patients for the sake of effectiveness and this may be defended as the older have already had their fair share of life, which can mean fair amounts or complete lives. Nevertheless, if life is considered as a narrative, mentioning amounts might be nonsensical. Narratives have a quality of unity; so, life events are fragments whose meanings are dependent on the meaning of the whole. Thus, time units do not represent a reliable measure of the content of life. In addition, people's experience is different from the external flow of time, making its significance relative. Moreover, to compare the completeness of lives qualitatively, it is necessary to have a common cultural understanding, which is improbable to agree on in a modern society. Therefore, basic assumptions of the accounts that refer to fair shares of lives are mistaken, and these accounts do not support age-based rationing.

The Stories We Tell Influence the Support We Receive: Examining the Reception of Support-Seeking Messages on Reddit.

Although social support facilitates coping and recovering from stressful life events, people do not always get the support that they need. Prior research suggests that the way one talks about stressful events to others may influence the support they receive. Given that people are increasingly relying on online communities for social support, this study adopted a person-centered approach (latent profile analysis) to examine how narrative variables related to the motivational themes, emotional content, and organizational structure of randomly sampled support-seeking messages (N = 495) posted on Reddit (r/Anxiety and r/Depression) influenced the quantity (number of comments and post score) and quality (type of support in comments) of support that they received. We identified five distinct narrative profiles of support-seeking posts, which in turn differentially predicted the quality, but not quantity, of social support people received. While commenters provided high levels of emotional support to all forms of posts, we found that coherence was an important determinant of esteem support. A combination of coherence, as well as agency and affective tone, were important determinants of instrumental, informational, and network support. The ways in which one talks about their problems influence the way others support them.

Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis.

BACKGROUND AND HYPOTHESIS: Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN: Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS: CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS: This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.

Obsessions And Compulsions: A Lifespan Perspective.

Freud traced the origin of the obsessional neurosis, which he considered a model condition for psychoanalytic inquiry, to a fixation in the anal phase of psychosexual development. Although many analysts have raised doubts about his account, and while the Sullivanian and Lacanian traditions have proposed alternatives, no approach has accounted for what Freud observed as the dizzying variety of obsessive presentations, which seem to defy a singular explanation. The broader research community has moved on, meanwhile, to genetic, neurological, and cognitive-behavioral explanations of what we now call obsessive-compulsive disorder. I argue that we can best account for the variety of obsessive presentations and meaningfully contribute to this interdisciplinary dialogue by framing obsessive-compulsive symptoms as the result of a disorder of volition, an exaggerated sense of willpower, not tied to any one developmental phase or bodily zone. Such a disorder evolves through the lifespan processes of introjection, identification, and repudiation in relation to an anxious/critical parent or an unpredictable environment. I trace these processes through three major developmental milestones. The implication is that, by looking in depth at how the obsessive person internalizes relationships, psychoanalysis can make a unique contribution to a conversation beyond its own borders.

Family relationships as a source of narrative identity of people with advanced dementia.

BACKGROUND: The growing body of research on narrative identity, while helpful, rarely focuses on people with dementia. In this paper, we explore how individuals living with advanced dementia construct their narrative identities in relation to their family experiences, which play a crucial role in shaping identity as shown by recent studies. METHODS: We conducted a qualitative study using data from 15 semi-structured interviews with people aged 66 to 94 who have advanced dementia. The data were analyzed using a textual-oriented discourse analysis. RESULTS: We identified two discourses-autobiographical and economic-that organize their narrative identities. Through the autobiographical discourse, participants emphasized their sense of belonging within a social group and their role as custodians of family identity. Within the economic discourse, they negotiated their social utility and value, particularly in response to demeaning discourses targeting individuals who do not accumulate wealth. In the structural analysis, we identified two narrative types-looped or unfolding-that depend on their affective experiences related to their family. We especially explored how the repetition of narrative threads by individuals with dementia might indicate a traumatic background rather than just memory disruptions. CONCLUSIONS: This study provides insights into the narrative identities of individuals with advanced dementia, shedding light on the intersection of family experiences and identity formation in this population.

Cognitive dependencies and psychological health correlates of coherence in autobiographical reasoning.

Autobiographical reasoning is a process by which an individual creates a coherent life account. The degree of coherence in autobiographical reasoning has been related to psychological health correlates such as depression and self-esteem in previous studies, but with inconsistent findings. Similarly, the basic psychological processes required to achieve coherence have been previously studied with regard to intelligence, but infrequently, and also with mixed findings. In the present study, we first developed and evaluated a German version of the Awareness of Narrative Identity Questionnaire (ANIQ) as an established measure of self-reported coherence. Second, we tested for cognitive dependencies on intelligence and memory indices. Third, we analysed its associations with psychological health correlates. We assessed a sample of 272 participants and thereof 189 participants again two-weeks later. Results supported the assumptions of the German ANIQ's psychometric qualities (factor structure, test-retest reliability, invariance) and validity (with regard to self-consciousness, self-concept clarity, and written accounts of personal turning points). We found coherence to be independent of intelligence and verbal memory, but partially dependent on figural memory. Coherence was related to depression, positivity, self-esteem, and self-esteem stability, but not to anxiety, substantiating its salutogenic effects.

'It feels like I'm back to being a teacher': A longitudinal trajectory analysis of teachers' experiences during the first 8 months of COVID-19 in England.

BACKGROUND: Understanding teachers' experiences throughout the school closures and reopenings that have characterized large periods of the COVID-19 pandemic provides us with unique insights into what it means to be a teacher during a global public health crisis. AIM AND METHOD: To investigate teachers' narratives of their experiences, we conducted 95 semi-structured interviews with 24 teachers in England across four time points between April and November 2020. We used a longitudinal qualitative trajectory analysis of participants' stories of their high-, low- and turning-points. RESULTS: We derived four themes that were evident at each time point and developed over time. The themes were: (1) growing frustration at uncertainties caused by poor government leadership, (2) expanding concern for pupil learning and well-being, (3) an increasingly labour-intensive and exhausting job and (4) declining pleasure and pride in being a teacher. CONCLUSIONS: The findings shed light on the impact of COVID-19 on the professional identity of these teachers and we propose ways in which teachers can be supported now and in the future.

Being and becoming 'a frail older adult': Meaning-making and resistance through storytelling.

By inquiring into older adults' narrations about their lives in the present, past, and future, this study aims to learn more about home-dwelling older adults' lived experiences of being and becoming "frail". This article is based on a dialogical narrative analysis of interviews with three home-dwelling older adults identified as frail by the home care services. We conducted a series of three interviews with each participant over a period of eight months. Our results demonstrate that while some older adults experience frailty as inevitable and irreversible, others experience it as a transition. Some narrated frailty as a comprehensive experience, while others' narratives were more situational and transitional. Being able to live at home was crucial and moving to a nursing home was associated with the risk of becoming frailer and the loss of valued relations to family and their home. Experiences of frailty were framed and shaped by the past, present, and future. Faith, fate, and previous capacities to overcome adversities were crucial in the older adults' narrations. Older adults' stories provide an opening to diverse and changing experiences of living with frailty. By telling stories about the past, present, and future, older adults can maintain identity, a sense of belonging, and balance in the midst of adversities. By engaging with older adults' stories, health and care professionals can support the older adult in the ongoing process of being and becoming 'a frail older adult'.

Perfection is a sad and lonely place: A study of existential vulnerability in the life stories of persons struggling with perfectionism.

Under what life conditions do individuals turn to perfectionistic striving and ideals as a solution? The present paper examines how people with perfectionism narrate their relationship to our shared existential vulnerability; that we are vulnerable as human beings, and that the ways we relate to this vulnerability have consequences for psychological health. In the present qualitative study, we explored the life narratives told by nine students with perfectionism, drawing on semi-structured life-story interviews. We conducted an explorative-reflexive thematic analysis and identified five themes: 1) Outside-Feeling Alienated, 2) Relating to Chaos, 3) Trying to Control the Painful and Uncontrollable, 4) Islands of Just Being and Positive Contact, and 5) Heading Toward a Balance Between Doing and Being. Their perfectionism can be seen as a way of handling existential vulnerability at a point in their lives where relational resources needed to stay firm in a vulnerable state are lacking. Perfectionistic themes influence their personal identity in the domain of narrative constructions, values, belongingness, and embodiment. Accomplishments were dominant themes in the plots of their narrative self-constructions and values. They felt their "self-made" identities kept others at a distance. However, we also found strivings for a more fulfilling life with broader self-definitions.

Narrative identity does not predict well-being when controlling for emotional valence.

Narrative identity refers to a person's internalized and evolving life story. It is a rapidly growing research field, motivated by studies showing a unique association with well-being. Here we show that this association disappears when controlling for the emotional valence of the stories told and individuals' general experience of autobiographical memory. Participants (N = 235) wrote their life story and completed questionnaires on their general experience of autobiographical memory and several dimensions of well-being and affect. Participants' life stories were coded for standard narrative identity variables, including agency and communion. When controlling for emotional valence of the life story, the general experience of autobiographical memory was a significant predictor of most well-being measures, whereas agency was a predictor of one variable only and communion of none. These findings contradict the claim of an incremental association between narrative identity and well-being, and have important theoretical and practical implications for narrative identity as an outcome measure in interventions.