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Exploring Self-Defining Memories in Schizophrenia

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Exploring Self-Defining Memories in Schizophrenia MEMORY, 2009, 17 (1), 26Á38 Exploring self-defining memories in schizophrenia Ste´ phane Raffard University of Geneva, Switzerland, and Hoˆpital La Colombie`re CHU Montpellier, and INSERM U-888, France Arnaud D’Argembeau University of Lie`ge, and Belgian Fund for Scientific Research (FRS-FNRS), Belgium Claudia Lardi University of Geneva, Switzerland Sophie Bayard Hoˆpital Gui de Chauliac CHU Montpellier, and INSERM U-888, France Jean-Philippe Boulenger Hoˆpital La Colombie`re CHU Montpellier, and INSERM U-888, France Martial Van Der Linden University of Geneva, Switzerland, and University of Lie`ge, Belgium Previous studies have shown that patients with schizophrenia are impaired in recalling specific events from their personal past. However, the relationship between autobiographical memory impairments and disturbance of the sense of identity in schizophrenia has not been investigated in detail. In this study the authors investigated schizophrenic patients’ ability to recall self-defining memories; that is, memories that play an important role in building and maintaining the self-concept. Results showed that patients recalled as many specific self-defining memories as healthy participants. However, patients with schizophrenia exhibited an abnormal reminiscence bump and reported different types of thematic content (i.e., they recalled less memories about past achievements and more memories regarding hospitalisation and stigmatisation of illness). Furthermore, the findings suggest that impairments in extracting meaning from personal memories could represent a core disturbance of autobiographical memory in patients with schizophrenia. Keywords: Schizophrenia; Self-defining memories; Specificity; Meaning making; Autobiographical memory. Among the many cognitive deficits encountered phical memory, notably because its impairment in patients with schizophrenia, researchers have could constitute an important step in the com- increasingly turned their attention to autobiogra- prehension of this pathology (Cuervo-Lombard Address correspondence to: Ste´phane Raffard, University Department of Adult Psychiatry, Hoˆ pital La Colombie`re, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France. E-mail: [email protected] # 2008 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business http://www.psypress.com/memory DOI:10.1080/09658210802524232 SELF-DEFINING MEMORIES IN SCHIZOPHRENIA 27 et al., 2007; D’Argembeau, Raffard, & Van der recollect memories, to identify them as related to Linden, 2008; Danion et al., 2005; Elvevag, Kerbs, one’s own personal past, and to link them to one’s Malley, Seeley, & Goldberg, 2003; Neumann, goals and desires allows the construction of a Blairy, Lecompte, & Philippot, 2007; Riutort, coherent personal narrative oriented to the pre- Cuervo, Danion, Peretti, & Salame, 2003; Wood, sent and the future. In agreement with this view, Brewin, & McLeod, 2006). The central idea of Addis and Tippett (2004) demonstrated that this approach is that one’s sense of self depends impairments in autobiographical memory for on memories of one’s past experiences and the childhood and early adulthood events in patients capacity to consciously remember these experi- with Alzheimer disease are related to changes in ences (Conway, 2005). Bleuler (1911) argued that the strength and quality of identity. the central defect or abnormality in schizophrenia There is substantial evidence that autobiogra- was best described as a disturbance of continuity phical memory is impaired in patients with of the self, resulting from an initial splitting schizophrenia. First, they generate fewer auto- ‘‘zerspaltung’’ of its unity. More recently in his biographical memories compared to normal par- phenomenological analysis of schizophrenia, ticipants (Elvevag et al., 2003) and they have Blankenburg (1991) stressed the disturbance of difficulties in recalling specific autobiographical the temporal dimension of the self as the core memories; that is, memories for unique episodes feature of the pathology. These theoretical pro- that occurred at a specific time and place positions resulted from clinical observations that (Cuervo-Lombard et al., 2007; D’Argembeau patients with schizophrenia frequently experience et al., 2008; Danion et al., 2005; Neumann et al., perplexity concerning their identity, which can 2007; Riutort et al., 2003; Wood et al., 2006). take the form of derealisation, depersonalisation, Second, they exhibit an abnormal reminiscence or disorganisation (Liddle, 1987). The representa- bump, which peaks earlier than in healthy in- tion of self as an entity extended in time is closely dividuals (Cuervo-Lombard et al., 2007). In related to the ability to remember one’s personal healthy individuals the reminiscence bump is past and ability to project oneself into the future characterised by an increase in recall of autobio- (Wheeler, Stuss, & Tulving, 1997). A recent study graphical memories of events that occurred at the showed that patients with schizophrenia present age of 10 to 30 (Conway, 2005; Conway & Rubin, difficulties in generating specific mental images of 1993). As proposed by Conway (2005), most their personal past and future (D’Argembeau memories from this period are those of ‘‘self- et al., 2008), thus providing evidence for distur- defining’’ experiences, which play a critical role bances of the temporal dimension of the self in for the development and consolidation of the self schizophrenia. (Conway, 2005). Whereas controls have a pre- The relationship between autobiographical dominant memory for events occurred at the age memories and the self has been detailed in recent of 21 to 25, as the sense of self fully developed, models of autobiographical memory (Conway, participants with schizophrenia exhibited a gap 2005; Conway & Pleydell-Pearce, 2000; Conway, concerning the reminiscence bump, which oc- Singer, & Tagini, 2004). Conway and Pleydell- curred at the age of 16 to 25 when identity is Pearce (2000) have argued that autobiographical not fully constituted and achieved. As memories memories are transitory mental constructions from the reminiscence bump have a privileged generated from episodic memories and concep- relation to the self and are highly accessible, they tual autobiographical knowledge. In this model represent self-representations providing con- the construction of autobiographical memories is straints on what the self can currently be, and influenced by the individual’s goals and self- what it might become in the future (Conway, images and, reciprocally, self-images are 2005). Thus, an abnormal reminiscence bump in grounded in memories for personal experiences schizophrenia, peaking in the 16- to 25-year (Conway, 2005; Conway et al., 2004). The self and period for patients vs the 21- to 25-year period memories have to form a coherent system, in for healthy individuals, could lead to impairments which beliefs and knowledge about oneself are in the ability to construct and organise a coherent supported by memories of past experiences. A and stable identity (Cuervo-Lombard et al., coherent sense of self is constructed in terms of 2007). narratives; that is, through the various stories that Using the remember-know-guess paradigm it we and others tell about ourselves (Gallagher, has also been found that patients with schizo- 2000). In other words, the ability to consciously phrenia report fewer Remember responses and 28 RAFFARD ET AL. more Know responses than controls, thus demon- identity. Self-defining memories can also play strating impairments of conscious recollection of mood-regulation and directive functions for the personal events in schizophrenia (Cuervo-Lom- self (Bluck & Gluck, 2004; Pillemer, 2003). First, bard et al., 2007; Danion et al., 2005; Riutort healthy (non-depressed) individuals use self-de- et al., 2003). Furthermore, Danion et al. (2005) fining memories for mood-regulation purposes, a observed that healthy individuals showed an process called mood memory repair. This process increasing proportion of Remember responses consists of maintaining positive moods and re- associated with temporal details (‘‘when’’) as pairing negative moods by retrieving positive the memories became more recent (especially memories (the mood-incongruent effect; Joor- for events experienced after the age of 19), mann & Siemer, 2001; Josephson, Singer, & whereas patients with schizophrenia did not. Salovey, 1996; Rusting & DeHart, 2000). Second, According to the authors, these results suggest self-defining memories provide life lessons that that schizophrenia is characterised by a disrupted assist individuals in optimal adjustment and sense of self over time, with this disruption personal growth. This dimension of meaning becoming worse in late adolescence when symp- making consists of taking the additional step of toms of schizophrenia typically emerge. ascribing meaning to memories by extracting Although it is now well established that auto- lessons about the self, important relationships, biographical memory is impaired in schizophrenia or life in general (Singer & Blagov, 2000Á2001; in terms of specificity and conscious awareness, Thorne, McLean, & Lawrence, 2004). Therefore, little is known about how people with schizo- memories affect the self through the process of phrenia construct their sense of self from auto- meaning making and the incorporation of life biographical memories. Indeed, previous studies lessons into a personal story. This capacity to on autobiographical
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