S104. WHAT OF THE MINIMAL SELF? IDENTITY, SUBJECTIVITY, AND THE LIMITS OF SELF-DISORDERS IN FIRST EPISODE PSYCHOSIS

Schizophrenia spectrum conditions have been linked to alterations in self-experience from some of their earliest descriptions. These alterations include disruptions in self-awareness, agency/volition, and distortions of personal identity more generally, and are thought to apply to both a “minimal” and “narrative” self. The notion of schizophrenia-spectrum illnesses as being rooted in self-disorders (SD) continues to receive broad theoretical and empirical support, including from studies of first episode psychosis (FEP). Here, we examine the subjective experience of disruptions in self-identity within a cohort of FEP service users, while critically engaging with the SD literature. We discuss findings from a three year-long ethnographic study examining meanings and experiences of psychosis within an early intervention program in Toronto, Canada. Combining participant observation over the study period with formal and informal open-ended, serial interviews of service users, family members, and clinic staff (n=31 formal interviews; n=10 informal interviews), a reflexive, interpretivist analysis of the data was undertaken. Emerging themes developed through individual interviews were triangulated against subsequent interviews, informal conversations, and through member-checking in an iterative process. Contact with the health care system frequently served as a fulcrum or pivot point in participants’ narratives of mental distress. And while most participants described significant shifts in identity, a sense of narrative continuity remained. Shifts in self and identity, related to many domains captured by the literature on anomalous self-experience, were frequently linked to bodily or corporeal experiences of psychosis. Participants’ particular subjectivities as well as intersubjective experiences informed the quality and nature of psychotic experiences themselves, such that self, psychosis, and society were interwoven; cause and effect were entangled rather than discrete. Relating our data to feminist, postcolonial, and disability studies scholarship concerning the concept of “self,” we critique the emphasis placed by the SD literature on individual psychopathology as explanatory of disturbances in self-experience, examining the limitations of current approaches to SD research. In so doing, we shed light on the complex interplay between biological, interpersonal, cultural, and structural aspects of self-experience within FEP.

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