The narrative self in schizophrenia and its cognitive underpinnings

Ines Adornetti and Francesco Ferretti

1 Introduction: schizophrenia as a disorder of the self

Although more than a century has passed since schizophrenia was first documented as a peculiar set of disorders with the description of dementia praecox by Kraepelin, its aetiology, essential symptomatology', and natural course remain elusive. Indeed, despite the availability of criteria established for diagnostic identification, such as those included in the latest editions of Diagnostic and Statistical Manual of Mental Disorders (APA, 2013)1 and the International Classification of Disease (ICD-11),2 schizophrenia is still a broad clinical syndrome defined by reported subjective experiences (symptoms), loss of functions (behavioural impairments), and variable patterns of course (Jablensky, 2010). If on the one hand scholars are faced with a variety of phenotypic expressions, on the other hand almost everyone agrees that a disturbance in the sense of self is a universal feature characterizing the lives of persons with schizophrenia (e.g., Lysaker and Lysaker, 2002, 2010; Sass and Parnas, 2003; Kean, 2009; Henriksen and Nor-dgaard, 2014; Davidson, 2020).

Since the time of Kraepelin (1919) and Bleuler (1911), schizophrenia has been associated with specific alterations in the dimension of personal identity. Although dedicating little space to self-experience, Kraepelin acknowledges that abnormalities in this dimension are a central aspect of the disorder. He writes that “dementia praecox consists of a series of states, the common characteristic of which is a peculiar destruction of the internal connection of the psychic personality” (1919: 3). In his revision of Kraepelin’s work, Bleuler (1911) closely ties this disorder to a loss of, or alteration in, persons’ basic sense of self. In Dementia Praecox and the Group of Schizophrenia, the Swiss psychiatrist explains that he replaced the expression ‘dementia praecox’ with the term ‘schizophrenia’ because of the importance of the splitting of the different psychic functions. He states that, “If the disease is marked, the personality loses its unity; at different times, different psychic complexes seem to represent the personality” (9) and highlights that persons with schizophrenia struggle to recognize themselves as subjects of their own experiences and agent of their own actions. These phenomena are particularly evident, for example, in individuals suffering from thought insertion as they believe that some of the thoughts that they experience are not their own. As an illustration of this, consider the following first-person accounts:

I look out the window and I think that the garden looks nice and the grass looks cool, but the thoughts of Eammon Andrews come into my mind. . . . He treats my mind like a screen and flashes his thoughts onto it like you flash a picture.

(Mellor, 1970: 17, reported in O’Brien and Opie, 2003: 107)

Another impressive example illustrating the dissolution of the first-person perspective in schizophrenia is provided by Elyn Saks (2007) in her autobiography The Center Cannot Hold: My Journey through Madness. She writes:

And then something odd happens. My awareness (of myself, of him, of the room, of the physical reality around and beyond us) instantly grows fuzzy. Or wobbly. I think I am dissolving. I feel - my mind feels - like a sand castle with all the sand sliding away in the receding surf.

(Saks, 2007: 12)

After Kraepelin and Bleuler, the idea that schizophrenia involves the experience of a fragile and instable sense of identity has been acknowledged by authors from a wide range of disciplines, including (but not limited to) existential psychiatry (e.g., Laing, 1978), psychoanalysis (e.g., Freud, 1957; Frosch, 1983), and phenomenology (e.g., Minkowski, 1987; Blankenburg, 2001; Sass and Parnas, 2002). For example, within the framework of existential psychiatry, Laing (1978) describes persons with this disorder as fundamentally alienated and as experiencing disrupted relations with the world and themselves. As an illustration, the author provides the following speech sample of a person with schizophrenia:

These thoughts go on and on, I am going over the border. My real self is a way down - it used to be just at my throat but now it has gone down further. I’m losing myself. It’s getting deeper and deeper. I want to tell you things, but I’m scared. My head is full of thoughts, fears, hates, jealousies. My head can’t grip them; I can’t hold onto them.

(Laing, 1978: 151, quoted in Lysaker and Lysaker, 2010: 333)

Further examples of first-person accounts illuminating the alterations of the self in schizophrenia are offered by Frosch (1983), in the context of a psychoanalytic description of the disorder, and by Stanghellini (2004) within a phenomenological perspective.

I become everything I experience to a point where it ultimately resolves into a state of considering myself the universe. I can open myself completely. My mind withdraws from anything that is directly dangerous to my body. ... It means my sense of identity is expanded and there is no longer a me.

(Frosch,1983: 261, quoted in Lysakerand Lysaker, 2010: 334)

I feel lifeless. I have this ‘feeling of vagueness’ especially at sunset hours. I see colors as brighter. All sensations seem to be different from usual and to fall apart. My body is changing, my face too. I feel disconnected from myself, from my muscles, as if they were cropped up in an outer space. ... It also occurs that in this state I get lost when I stay with others. What I lack is the common thought. I have nothing to share with them. In this way, the others become incomprehensible and scaring.

(Stanghellini, 2004: 126, quoted in Lysakerand Lysaker, 2010: 336)

Recently, the disturbances in self-experience characterizing schizophrenia have drawn the attention of cognitive scientists (e.g., Frith, 1992; Gallagher, 2000; Jeannerod, 2009; Cermolacce et al., 2007). This interest can be traced back to a more general theoretical orientation that has emerged over the past two decades characterized by a convergence in the topics of research and methods of cognitive sciences and psychiatry (e.g., Di Francesco et al., 2016). On the one hand, cognitive psychologists and cognitive neuroscientists, in an attempt to shed light on the functioning of human mind, have progressively tried to model various forms of psychopathology. On the other hand, psychiatrists have gradually taken interest in the methodologies and assumptions of the cognitive sciences in order to elaborate patterns of explanation of mental disturbances in compliance with knowledge about processing systems (Cratsley and Samuels, 2013). In this chapter, we explore the alterations in the dimension of the self in schizophrenia within the conceptual framework of cognitive sciences. Specifically, we employ the conceptual tools and empirical findings of cognitive sciences to investigate a specific aspect of the alteration of personal identity in schizophrenia: the relationship between the unity of the self and narrative. We suggest this approach is very effective to discuss one of the main issues characterizing such a relationship: whether narrative depends on language - and therefore whether the unity of the self depends on narrative language. Analysing the proprieties and the cognitive systems involved in narrative processing, we propose that the ability to tell stories, rather than on language, relies on cognitive devices (those constituting the ‘narrative brain’) operating at a deeper level than the devices that process linguistic information. To corroborate this view, we take into account the defining features of narrative and the cognitive architectures involved in their processing. Against the standard view according to which the narrative self depends on the proper functioning of language, we propose that the structure of narrative discourse is a surface effect of a deeper process that acts primarily on the way the sequences of thoughts are organized, rather than on the way thoughts are expressed. In the light of these considerations, we propose that the disturbances characterizing the construction of the narrative self in schizophrenia have to be attributed primarily to cognition, rather than language.

2 The narrative self in schizophrenia

As mentioned previously, in recent years, a growing number of studies have been investigating the phenomena characterizing the sense of self in both healthy individuals and pathological populations from a perspective aiming to integrate philosophical models with the data coming from cognitive sciences (e.g., Bermúdez, 1998; Gallagher, 2000; Zahavi, 2005; Musholt, 2015; Di Francesco et al., 2016; Marraffa and Paternoster, 2016). Against this background, a major tendency has been that of assuming minimal forms of self as the foundation of more advanced and organized forms (e.g., Gallagher, 2000; Gallagher and Zahavi, 2015; Prebble et al., 2013). In this regard, summarizing a long theoretical tradition dating back to William James (1950), Gallagher, and Zahavi have identified two specific forms of selfhood: the minimal self and the narrative self (Gallagher, 2000; Gallagher and Zahavi, 2015; Zahavi, 2010, 2014). The minimal self pertains to what is accessible to immediate self-awareness: it is “a consciousness of oneself as an immediate subject of experience, unextended in time” (Gallagher, 2000: 15). The main aspects of the minimal self are ascribable to the context of motor action and involve the senses of ownership - the sense that it is my body that is moving - and agency - the sense that I am the originator or the source of the action. Within this framework, phenomena such as delusions of control or thought insertions affecting people with schizophrenia are interpreted as involving problems with the sense of agency, as patients make mistakes about the agency of various bodily movements (Gallagher, 2000). Indeed, individuals who show these symptoms wrongly attribute their experience to other people as regards agency (they state that someone else caused the action); with respect to ownership, they instead are capable of correctly selfattributing the experiences (they recognize that they themselves are the ones who undergo the action). Within this framework, it is also suggested that the presence of a minimal self is independent of the possession of linguistic and conceptual abilities. Conversely, according to Gallagher, linguistic capacities are required for the more elaborate levels of selfhood, such as the narrative self. The narrative self is the dimension of the self that is extended in time - the dimension providing a sense of continuity and coherence to the self across time (Baerger and McAdams, 1999). Gallagher (2000: 15) defines it as “a more or less coherent self (or self-image) that is constituted with a past and a future in the various stories that we and others tell about ourselves”. In other words, from this perspective, the temporal dimension of the self is a product of narrative language: without the ability to tell stories, it is not possible to have a self that is extended in time.

A growing body of investigations has been analysing the life stories of patients with schizophrenia (e.g., Gallagher, 2003; Phillips, 2003; Raffard et al., 2010; Allé et al., 2015; Allé et al., 2016; Holm et al., 2016), which are supposed to shed light on the process constituting the individual’s narrative self. Indeed, the construction of a coherent life narrative by integrating personal past, present, and future in a story is thought to reflect self-continuity over time (McAdams, 1996), namely the feeling of being the same person across time, despite life’s many changes (Habermas and Kober, 2014). To construct a global coherent life story, it is necessary to establish temporal order of events, explaining causal connections between those events and evaluating how events have influenced the self (Habermas and Bluck, 2000; Holm et al., 2016). Research has shown that processes of this kind are disrupted (to various degrees) in schizophrenia. In this regard, consider the following case history reported by Phillips (2003) illustrating an impoverished and fragmented self-narrative in a man, Mr. B, with long-standing chronic schizophrenia. Mr. B experienced his first schizophrenic breakdown in his early 20s after he got married and became a father for the first time. Over the years, he struggled to work despite repeated psychotic collapses (i.e., hallucinatory and delusional experiences) and hospitalizations. Gradually, Mr. B assumed a disabled status and remained at home for most of two decades, limiting himself to doing minor household chores. The situation worsened when Mr. B suddenly decided to stop taking his medication. This decision caused a crisis in the home leading his wife to institute divorce proceedings and forcing Mr. B to return to his parents’ house. Phillips (2003) narrates that on a few occasions he asked Mr. B about his view of his self, but he replied by laughing and telling him not to ask senseless questions. The psychiatrist describes the self-narrative of his patient in the following way:

Mr. B has always . . . been unable to present a coherent life narrative or sense of self. . . . The dimension of constructed or fictive self is occasional, unpredictable, fragmented, at times delusional, and not very coherent. It contains the burning at the stake, the various moments at which the illness started, and the frequent, imagined accusations toward his wife. It does not involve the projection of an imagined future that connects with the present and past in a constructive and hopeful manner. The integration of future into his narrative has always been minimal. When he thinks about it, he imagines a future in which he will be living on the street, or more positively, in which he will simply be living comfortably in a hospital. His efforts to locate a self that is not that of the mentally ill man take the form of occasional pathetic denials of his illness and the insistence that he is more himself off the medication, whatever the devastations that occur in that state. . . . With his fragmented and impoverished self-narrative, Mr. B presents a self that is barren and minimally unified.

(Phillips, 2003: 329)

These observations have been corroborated in subsequent experimental studies that have systematically investigated the features of life narratives in people with schizophrenia. Allé and colleagues (2015), for example, analysed the life stories and the ability to integrate and connect personal memories into a coherent narrative in 27 stabilized outpatients with schizophrenia and 26 healthy participants. The life narratives were elicited through an experimental protocol drawn up by Habermas and de Silveira (2008). Participants were asked to remember the seven most important events in their lives and to write them down on cards. Then, they had to narrate their life story in 20 minutes, explaining how they had become the persons they are today. Participants were also asked to date the memories. Analyses were conducted on many parameters. For the aims of our argument, the most important of them were the indicators of causal-motivational, thematic, and temporal coherence. Causal-motivational coherence refers to arguments relating to personal change and includes descriptions of how events determine other events and influence one’s personality evolution. Thematic coherence is supported by arguments which explain an action with reference to an enduring personality trait; it is a way of knowing what is stable in the narrator’s life across several life themes. Eventually, temporal coherence reflects the narrator’s ability to locate events chronologically across the course of the story. The results revealed that indicators of causal-motivational, thematic, and temporal coherence were significantly lower in the group of patients compared to controls. Specifically, “Patients with schizophrenia made fewer comments on changes that occurred throughout their life and to explain how these events have influenced the person they are today, which was reflected in a reduced global causal-motivational coherence” (Allé et al., 2015: 7). As for temporal coherence, patients produced a significantly higher number of anachronies (i.e., deviations from the temporal order of events) compared to the control group, making it more difficult to understand the temporal locations of the memories.

These findings are in line with the results of other studies showing that persons with schizophrenia are impaired in the ability to connect past experiences to the current self and to extract meaning from their memories (D’Argembeau et al., 2008; Dimaggio et al., 2012; Raffard et al., 2009; Raffard et al., 2010; Allé et al., 2016; Malek et al., 2019). In an investigation by Raffard and colleagues (2010), 81 outpatients with schizophrenia were asked to respond to a questionnaire that concerned the descriptions of‘self-defining memories’, namely exemplar selfnarratives of events that according to the individuals give essence to their sense of identity (Singer and Salovey, 1993). The self-narratives were analysed with respect to different indicators: meaning-making (what the individual learns or understands from the event), self-event connections (points in the stories where the narrator binds some aspect of the event to some aspect of the self), and narrative coherence. The latter indicator was coded along three dimensions: context, which concerned information such as time, location, and characters involved in the event; chronology, i.e., the temporal order of the narrative; theme, which was evaluated with reference to the extent to which the subject maintained the topic throughout the narrative, developed the topic, made causal connections, elaborated the details, and inserted personal evaluations. The results revealed that patients with schizophrenia made fewer meaning-making (see also Berna et al., 2011) and selfevent connections than the control groups composed of 50 healthy individuals.

Moreover, patients produced narratives that were less coherent, i.e., less contextualized, less temporal ordered, and thematically less developed than those of the controls, thus corroborating the view that persons with schizophrenia exhibit a specific impairment in the ability to create coherent narratives of their lives by linking together important events to their self.

The observations made so far allow us to stress a significant aspect characterizing the narrative self in schizophrenia. The reduced coherence of patients’ life stories appears to be the product of a twofold difficulty: on the one hand, schizophrenic patients show an inability to temporally organize the events that contributed to determine their personal identity; on the other hand, they are not able to extract meaning from these events or reflect on how they have contributed to shaping their subjectivity. That said, the next step is to determine whether the difficulty in constructing a coherent temporally extended self is the result of language impairments, narrative impairments to be exact, or not. In other words, the next move is to evaluate whether the deficit in storytelling in schizophrenic patients might be considered the product of a deeper impairment relating to the ability to structure (causally and temporally) the sequences of events constituting a narrative.

From the considerations made so far and from the empirical findings discussed, we have highlighted the key role of narrative in the construction of the self. In doing so, we are in line with the standard view of cognitive sciences. However, differently from this view, we propose an alternative hypothesis to account for such a role. Scholars adhering to the standard view suggest that narrative is a product of language and, therefore, the alterations in the dimension of the self in individuals with schizophrenia are strongly connected to alterations in language use (e.g., Gallagher, 2000, 2003). According to an alternative hypothesis, the disorders of the self in schizophrenia largely reflect dysfunctions in cognitive processes that underlie both narrative and language (Cosentino, 2011; Cosentino and Ferretti, 2015). As is evident from these considerations, investigating these issues means not only explaining the disturbances of the self in schizophrenia, but more generally providing an account of how human beings construct their own subjectivity and how and why narrative plays a pivotal role in such a process. Although the debate is far from being conclusive, in this chapter we adhere to a hypothesis alternative to the standard view.

3 'Delinguisticizing' the narrative self

As mentioned previously, when delineating the notion of the narrative self, Gallagher (2000) adheres to the view according to which language represents the core constituent of human identity. The author suggests that human beings have a sense of a coherent and continuous self because they have language; more specifically, because they have the ability to tell stories. In his words: “We use words to tell stories, and in these stories we create what we call our selves” (19). In supporting such a view, which has a long philosophical and psychological tradition, Gallagher follows the account of human subjectivity elaborated by Daniel Dennett (1991).

According to Dennett, personal identity must be interpreted as a centre of narrative gravity: human beings cannot prevent themselves from inventing their selves; once they have become language users, humans are trapped in the web of language and begin assembling their own stories, which end up controlling their creators. As the author writes:

And just as spiders don’t have to think, consciously and deliberately, about how to spin their webs, and just as beavers, unlike professional human engineers, do not consciously and deliberately plan the structures they build, we (unlike professional human storytellers) do not consciously and deliberately figure out what narratives to tell and how to tell them. Our tales are spun, but for the most part we don’t spin them; they spin us. Our human consciousness, and our narrative selfhood, is their product, not their source.

(Dennett, 1991: 418)

This quotation offers many points for reflection. For example, from it emerges the idea that the narrative self is not real, but an empty abstraction, given that our narrative selfhood is the product of the stories we tell. In fact, from Dennett’s perspective, the individual self can be considered as a movable and abstract point where the various narratives that the subject tells about herself, or that others have told about her, meet up. Although this eliminative view deserves a more in-depth analysis, we intend to focus our discussion on another point characterizing Dennett’s account of human subjectivity. Specifically, we want to stress that this perspective is based on a more general idea of the relationship between narrative and language, an idea according to which language represents a necessary condition (both logically and temporally) for the ability to tell stories. This idea is a major tenet of the constructivist perspective of narrative (Bruner, 1990, 1991; Dautenhahn, 2002; Hutto, 2009), of which the psychologist Jerome Bruner is the main representative. In line with culturalist constructivism, according to Bruner, the ability to tell stories has to be viewed as the result of forms of social apprenticeship characterizing the individual’s development within a social group. Internal cognitive systems are not relevant for narrative competence; all that matters is this process of internalization of social and cultural factors.

The issue of the relationship between narrative and language is the key point to clarify our hypothesis on the connection between self and narrative. In order to state that narrative is the product of language, it is necessary to identify the properties characterizing the narrative dimension and ask whether they are reducible to language abilities or not. Although scholars of narratology have different opinions about the nature and number of these properties, there is convergence, however, on the fact that ‘global coherence’ is one of the main features of a narrative. Such a property is relevant to our argument because, as we have already seen, schizophrenic patients have difficulties in the construction of coherent life narratives. If we take global coherence as a litmus test to study the relationships between language, narrative, and construction of the self, the first step is that of investigating the nature of this property; more in detail, the first move is asking whether global coherence can be reduced to the functioning of linguistic systems or not. The possibility of accounting for the role of narrative in the construction of the self depends on the way we answer this question.

The studies attesting the irreducibility of coherence to linguistic cohesion allow us to corroborate the independence and autonomy of narrative from language. As we have already seen, the coherence of a narrative depends, at least in part, on the speaker’s ability to maintain thematic unity and to establish causal and temporal connections between the events constituting a story. According to a prominent tradition within linguistics, the coherence of a narrative or a discourse depends on the grammatical and lexical linear relations between adjacent sentences, that is to say on cohesion between pairs of consecutive statements (e.g., Bublitz, 2011; Danes, 1974; Halliday and Hasan, 1976). As in the following text where the sentences are connected through lexical items (in italics):

After the forming of the sun and the solar system, our star began its long existence as a so-called dwarf star. In the dwarf phase of its life, the energy' that the sun gives off is generated in its core through the fusion of hydrogen into helium.

(Berzlanovich, 2008: 2)

Although cohesive relations (grammatical and lexical) have an important role in the expression and recognition of coherence relations, theoretical arguments (Giora, 1985) and empirical findings (for a discussion, Adornetti, 2015) show that cohesion between consecutive sentences is not a necessary or sufficient condition for the coherence of utterances in the flow of speech. In this regard, a crucial distinction is that between global and local coherence. Global coherence refers to the relationship between the content of a verbalization with that of the general topic of conversation; local coherence concerns the conceptual links between individual sentences or propositions that maintain meaning in a text or narrative discourse (Glosser and Deser, 1990). While local coherence is made possible by cohesion relationships, global coherence is independent from linguistic devices (it is independent from cohesion). Schizophrenic patients represent a prototypical example in this regard. In spite of being able to process the lexical and syntactical aspects of individual sentences, these patients have problems in coherently connecting sentences during the flow of discourse (e.g., Marini et al., 2008). Because of this, their narratives can be affected by several kinds of impoverishment, which include derailment - sudden switching of topic with no obviously apparent logic or segues, tangentiality — oblique or irrelevant reply to questions, and loss of goal -failure to follow a chain of thought through to its natural conclusion (e.g., Andreasen, 1979; Frith, 1992; Kuperberg, 2010; McKenna and Oh, 2005; Pauselli et al., 2018). Consider the following example of schizophrenic derailment:

Then, I always liked geography. My last teacher in the subject was Professor August A. He was a man with black eyes. I also like black eyes. There are also blue and gray eyes and other sorts, too. I have heard it said that snakes have green eyes. All people have eyes.

(Bletiler, 1911)

Although in this text the sentences are locally coherent because they are connected through lexical cohesion (in italics), at the global level the discourse lacks coherence: it is not possible to recognize a central topic unifying the sentences constituting the text. For that, it has been suggested that the derailment of the discourse in schizophrenic patients does not depend on poor linguistic abilities (it is not a language disorder in a strict sense) but represents the surface expression of deeper cognitive deficits (Kuperberg, 2010; Stirling et al., 2006, Boudewyn et al., 2012; for a different perspective on schizophrenic language, see Cardella, 2017).

That said, if coherence is primarily a property of the cognitive dimension (a property relating to the way humans represent reality) and only secondarily a linguistic manifestation, then it makes sense to argue that narrative has only an indirect and secondary effect on the construction of the self: the causal processes that allow a narrative to act as a connection tool for the construction of the narrative seifare the systems that process global coherence, which is a property referable to the cognitive level. The verification of this hypothesis passes through the identification of the cognitive systems at the basis of the processing of global coherence; above all, such verification depends on the fact that these systems, although involved in narrative processing, are autonomous and independent from language functioning. How to prove this hypothesis? The first thing to say is that the narrative dimension implies different processing systems and that global coherence is not a property that can be reduced to the functioning of a single cognitive device (for a discussion, see Ferretti, 2021; Ferretti and Adornetti, 2020). For space reasons and given the importance of the time factor in the construction of coherent self narratives, in this chapter we only focus on the systems that govern the ability to project in time. Our hypothesis is founded on two argumentative steps: the idea that the systems underlying the projection in time have a role in the construction of the self; the idea that these systems have a role in the processing of narrative discourse. Providing empirical foundation for this hypothesis means stating that the role of narrative in the construction of the self is a by-product of processing systems not specific for language. As such, it turns out to be a significant point to investigate the relationship between language and schizophrenia.

4 Mental time travel and self-continuity

One of main cognitive systems that allows humans to represent time is Mental Time Travel (MTT) (Tulving, 1985, 2005; Suddendorf and Corballis, 2007), the device underlying the ability to project into past and future. MTT is composed of two subsystems: episodic memory (EM), which is responsible for remembering past events (Tulving, 1985, 2005), thus contributing to important aspects of autobiographical memory; episodic future thinking (EFT) (Atance and O’Neill, 2001), which allows envisioning possible future personal experiences. Several lines of investigation have shown that EM and EFT are strongly connected to each other. Studies on individuals with acquired amnesia revealed that these patients are unable to project themselves into personal past and exhibit an equivalent deficit in imagining future personal experiences (Klein et al., 2002; Tulving, 1985). These observations go hand in hand with neuroimaging research that found that many of the same brain regions - medial temporal and frontal lobes, posterior cingulate, and retrosple-nial cortex, as well as lateral, parietal, and temporal areas - are active both when remembering the past and when envisioning the future (e.g., Addis et al., 2007; Hassabis et al., 2007).

For our argument, it is important to highlight that the cognitive system underlying the human ability to mentally project in time evolved independently from language. In fact, comparative studies have shown that non-human animals, such as great apes, corvid, and rats, can to a greater or lesser extent remember past episodes and anticipate future needs (e.g., Clayton and Dickinson, 1998; Mulcahy and Call, 2006; Lu et al., 2012; Kano and Hirata, 2015). For example, a study by Kano and Hirata (2015) conducted with chimpanzees and bonobos revealed that these primates exhibit quite detailed memory for single events and an investigation by Mulcahy and Call (2006) attested foresight abilities in bonobos and orangutans. That precursors of MTT are present in animals that cannot talk (the fact that MTT is autonomous from the proper functioning of verbal abilities) allows us to advance the hypothesis that language abilities are not a necessary condition (logically or temporally) for the functioning of this cognitive system. Since it is our claim that MTT has a crucial role both in the construction of important aspects of the self— those providing a sense of continuity across time - and in the processing of significant properties of narrative discourse - global coherence - the fact that such a system is independent from language opens the way to the possibility of ensuring a cognitive foundation for these two processes.

To disentangle the role of MTT in the construction of self, it is important to clarify the meaning of the term ‘episodic’ characterizing its two subcomponents: episodic memory and episodic future thinking. In fact, this term denotes one of the most remarkable features of MTT: its subjective character. Tulving (2005) suggests that the ability to travel mentally in time implies a form of autonoetic consciousness, the consciousness involving explicit memory that requires self-awareness. From this view, EM and EFT are responsible for an individual’s awareness of his or her existence and identity in time, from the personal past to the personal future.

This means that the process of MTT does not merely reflect the extraction of a specific meaning or knowledge, which depends on semantic memory (the memory that deals with general knowledge of one’s environment, such as facts and rules); rather, it also involves the retrieval of one’s personal episodes, as well as the generation of potential future ones (Schacter and Addis, 2007). As Tulving (2005: 9) states: “mental time travel allows the ‘owner’of episodic memory (‘self’), through the medium of autonoetic awareness, to remember one’s own previous ‘thought- about’ experiences, as well as to ‘think about’ one’s own possible future experiences”. Similarly, according to Buckner and Carroll (2007), MTT can be defined as a process of “self-projection”, namely as a shift of perception from the immediate environment to an alternative and imagined one, with the imagined event referenced to oneself. For this, it has been suggested that the two mechanisms constituting MTT are crucial for self-continuity as they are responsible for forming a ‘diachronic unit’ (Prebble et al., 2013). Indeed, being able to recall personal memories or anticipate possible personal future events allows individuals to form representations of themselves as unique beings who exist with meaningful continuity over time.

Some investigations have highlighted that in schizophrenic patients there are abnormalities in the neural circuits typically associated with MTT, among which are the ventromedial prefrontal cortex, the precuneus, and the hippocampus (For-nara et al., 2017). In support of this, behavioural studies have revealed that persons with schizophrenia show reduced ability to both retrieve specific events from their personal past and imagine possible scenarios that might happen in their personal future (e.g., Cuervo-Lombard et al., 2007; Danion et al., 2007; D’Argembeau et al., 2008; Raffard et al., 2013; Chen et al., 2016; Lyons et al., 2016; For-nara et al., 2017; Yang et al., 2018; Malek et al., 2019). It has been shown that patients with schizophrenia recall fewer autobiographical memories, namely memories involving information related to the self, than control participants (Elvevag et al., 2003) and that these memories lack contextual details and are less specific (i.e., referring to events that occurred at a particular time and place and lasted less than a day) compared to control groups (Berna et al., 2016). Similarly, they suffer from difficulties in imagining future events (D’Argembeau et al., 2008; Chen et al., 2016). D’Argembeau et al. (2008) found that patients not only recalled fewer specific past events than healthy controls but were also more impaired in generating specific future events. For example, they exhibited difficulties when asked to describe general situations or emotional states that could potentially be associated with specific events such as feeling guilty about something or feeling relaxed. More recently, these results have been confirmed by Potheegadoo and colleagues (2013) and Wang and colleagues (2017). Interestingly, the authors of these two investigations also showed that during MTT, schizophrenic patients are inclined to adopt an observer perspective (seeing the event from the outside as an observer) rather than a field perspective (seeing what happens through the individual’s own eyes), which suggests self-impairment. Indeed, the fact that patients assume field perspectives less frequently than participants of the control groups may reflect “a weakened sense of the individual of being an actor of his past events, and hence to a reduced sense of self” (Potheegadoo et al., 2013: 88).

From these considerations some important data emerge for the purposes of our argument. The first is that the processing of the time factor is based on systems that are autonomous and independent from those governing language processing and that such systems have important effects on the processes underlying the construction of the narrative self. The second point is that the abilities made possible by these systems - projecting oneself in time — are severely compromised in schizophrenia. Showing that the deficits in the representation of time affect the construction of the self in schizophrenia is a first important result for the purposes of our hypothesis: if MTT is largely independent from language, then deficits characterizing the temporal dimension of the self in schizophrenia do not depend on language. That said, there is one last point that has to be addressed: showing that the impairments in MTT also have an impact on narrative processing.

5 Mental time travel and narrative processing

Accumulating investigations reveal that the processes responsible for remembering the past and envisioning the future are also involved in the production of coherent narratives (for a discussion, see Corballis, 2017; Ferretti and Adornetti, 2020). Relevant in this regard are studies conducted on individuals with autism spectrum disorder (ASD) and amnesic patients with damage to the hippocampus. Like schizophrenic patients, a growing number of investigations report that also persons with ASD have impairments both in episodic memory (e.g., Crane and Goddard, 2008) and in projecting themselves into the future (e.g., Lind and Bowler, 2010; Marini et al., 2016). Recently, it has been suggested that these impairments are also responsible for some of the narrative difficulties often reported in this clinical population (Ferretti et al., 2018; Marini et al., 2019). In a study by Ferretti and colleagues (2018), children with ASD were administered a task aimed at assessing EFT: they were asked to imagine themselves in a possible future scenario (e.g., a snowy landscape) and to choose an item they would take with themselves (i.e., a coat) anticipating a potential future need (Atance and Meltzoff, 2005). Thereafter, participants were asked to generate episodes of a narrative discourse along two conditions: future generation and past generation. In the future generation task, the children were administered coloured drawings that portrayed the beginning of a story and were asked to continue it. In the past generation condition participants saw coloured pictures that depicted the end of a story and had to describe what was likely to have happened earlier. The performance of the children with ASD was compared to that of a group of children with typical development. The results revealed that an impairment in the ability to project themselves into the future also affected the generation of coherent fictional stories. Indeed, from the findings, it emerged that EFT skills were impaired only in a subgroup of children with ASD and that such a subgroup performed significantly worse on the narrative production task than both ASD participants with good EFT skills and participants with typical development. In particular, the subgroup of children with ASD with impaired EFT produced narratives that were globally less coherent than those generated by the other groups. According to the authors, these results allow supporting the view that

the ability to tell stories relies on cognition more than cognition relies on language. In this sense, it is certainly true that, through stories, humans can extend themselves in the time and space dimensions, but it is primarily true that without time navigation capabilities, humans could never have had the ability to tell stories.

(Ferretti et al., 2018: 13)

Relevant for our argument are also the studies on amnesic patients with damage to the hippocampus, a brain structure embedded deep in the temporal lobe, which has been proposed as one of main neural substrates of mental time travel (e.g., Maguire et al., 2016). Although linguistic functions such as lexical and grammatical processing are mainly unimpaired in these patients (e.g., Kensinger et al., 2001), recent research suggests that hippocampal disruption affects qualitative aspects of language production, particularly when creating detailed and complex narratives that unfold over time (e.g., Duff et al., 2009; Race et al., 2015; Hilverman et al., 2016). For example, a study by Race and colleagues (2015) showed that the hippocampus is involved not only in the generation of coherent fictional narratives (i.e., verbal narratives about pictures), but also in the production of discourse about future and past events, namely when participants had to imagine specific personal events about the future (e.g., winning the lottery) and recall specific personal events about the past (e.g., graduation ceremony). From the results it emerged that amnesic patients’ descriptions of the past and future were reduced in higher level measures of linguistic integration, such as global coherence. As discourse coherence reflects the degree to which the speaker stays on topic and develops a global theme using causal linkages and elaborations, these results suggest that the hippocampus plays a critical role in the creation of narrative context by structuring linguistic elements around temporally specific details. Findings of this kind are particularly interesting to shed new light on the narrative deficits affecting patients with schizophrenia. Indeed, there is evidence that not only are these patients characterized by structural abnormalities in the hippocampus (Kalus et al., 2004; Hanlon et al., 2011), but also that such abnormalities (i.e., decreasing in volume) are linked to some of their discourse production impairments (Spalletta et al., 2010).

6 Conclusions

In this chapter, we have suggested that construction of the self that is extended in time is largely the result of a process governed by narrative. Following this thesis, it is possible to consider the difficulty of schizophrenics in the construction of a unitary self as a disorder largely linked to narrative deficits. Considerations of this type, which are the standard hypothesis in cognitive science, are widely shared in the contemporary debate. Although we share the main tenet of hypothesis - the idea that narrative plays a central role in the construction of the self - we diverge from the standard view with respect to the way of explaining ‘how’ and ‘why’ narrative has such a role. To this aim, we have investigated the nature of narrative and the functioning of the systems underlying the processing of the narrative dimension. From this analysis, it has emerged that narrative is independent from language and that the ability to tell stories relies on cognition more than on language. From the point of view of cognitive architectures, in fact, we have shown that the systems that process the narrative dimension - mental time travel - despite having a strong impact on language functioning, evolved in contexts different from that of linguistic communication. From the point of view of properties, we have stressed that global coherence governs the construction of temporal and causal sequences of events at the level of thought, before that of the expression of thought. From these considerations, a new way of conceiving the relationship between narrative and the construction of the self emerges. If for the proponents of the standard view the role of narrative depends almost exclusively on language (given that narrative capacity is the apical development of linguistic competence), from our point of view narrative is first and foremost the product of cognitive systems not specific for language. In a perspective of this kind, studies on the disorders of the self in schizophrenia also acquire new light. If narrative is a by-product of the role played by the systems that process the causal and temporal sequence of events, then the difficulties of constructing a self that is extended in time by individuals with schizophrenia is a process largely independent from language. The narrative deficits of schizophrenics are a surface effect of what happens on a deep cognitive level. In a perspective of this type, the study of such deficits turns out to be a useful test for analysing, in addition to the processes of the construction of the self, also the nature of narrative and, in this way, the proper nature of human language.

Authors contribution

For the specific constraints of the Italian Academy, we specify that Ines Adornetti wrote Sections 1, 2, 3, and 4; Francesco Ferretti wrote Sections 3, 5, and 6.


  • 1 According to the DSM-5, a diagnosis of schizophrenia can be made if two (or more) of the following symptoms are present for a significant portion of time during a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. At least one of the symptoms occurring in the one-month period must be delusions, hallucinations, or disorganized speech.
  • 2 According to the ICD-11, schizophrenia is characterized by multiple disorders, such as thinking disturbances (e.g., delusions, thought disorganization), perception (e.g., hallucinations), self-experience (e.g., the experience that one’s feelings, thoughts, or behavior are controlled by an external force), cognition (e.g., impaired attention, social cognition), volition (e.g., loss of motivation), affect (e.g., blunted affect), and behavior (e.g., bizarre or purposeless). Psychomotor disturbances may be also present. Core symptoms are persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control. A diagnosis of schizophrenia is made when symptoms have persisted for at least one month.


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