Besides symptoms: unheard narratives in research on schizophrenia.

Sir,

We wish to draw attention to a recently published article in your journal on insight and depression in schizophrenia.[1] While this article reconfirms the findings of several studies that have examined the relationship between insight and depression in persons suffering from schizophrenia, it has implications for research and practice that sorely need highlighting. Multiple quantitative studies have demonstrated a link between insight and depression in schizophrenia.[2] However there is a dearth of qualitative studies that give voice to the experiences of persons grappling with a major psychiatric diagnosis and coming to terms with its personal meaning and implications in one's life. We wonder whether we are at times losing the persons in the symptoms, diagnoses and clinical markers in our research. As an exception to this trend we wish to remind the readers of an important article[3] that illustrated different ways in which grief and mourning may be related to schizophrenia. A conceptual model of psychological recovery (beyond symptomatic and functional recovery) from schizophrenia and other major psychiatric illnesses has been proposed to take into consideration consumer accounts and guide clinical training and practice[4] but culturally grounded research from within the country on psychological recovery is scarce.

Of course, ‘poor insight may protect against depression in the early stages of recovery from schizophrenia’ as mentioned by the authors. Further, the emergence of insight and onset of depression can heighten suicidal risk and hence indicates the need for regular monitoring of depressive symptoms and clinical management. We need to stay aware that depressive symptoms can also signal the emergence of processes related to grieving and psychological recovery. A de-contextualized, de-individualized, impersonal research account of the association between quantitative indices of insight and depression can help in bringing up the recurrent patterns seen across persons but it fails to do sufficient justice to the stories of struggles, triumphs and losses of our clients. Researching narratives underlying insight and depression in schizophrenia has manifold implications. It can unravel complexities that remain masked behind correlations, such as individual differences in ways of adapting to a major illness, and throw light on felt needs of clients for disclosures and listeners in health care settings as well as intrapersonal, interpersonal and contextual factors that facilitate or impede the process of psychological recovery. A narrative based understanding of the process of recovery has implications for practitioners as it urges them to be in tune with the experiential realities of the persons besides their symptomatic and functional recovery and support the process of psychological recovery. Narrative based research can also aid the psychotherapists and counselors in developing intervention plans to facilitate meaning making, regaining a sense of mastery and worth and rediscovering meaningful engagement with life and hope in persons coping with schizophrenia.