Abstract
Background: Previous research (Comer, 2014) suggests that persons who experience mental illness suffer a loss of control and choice over their behavior, compared to those without mental illness. Research by Lysaker & Lysaker (2008) suggests this experience may be more pronounced among those with schizophrenia, since the experience of self is commonly inchoate: competing perspectives, one dominant perspective, or emptiness. It was thus hypothesized that (1) persons with mental illness in general compared to those without and (2) persons with schizophrenia compared to those with other mental illnesses would interpret everyday life behavior as reflecting lower levels of control and choice. These were tested within a modified ESM paradigm (DeVries, 1992) over 2 studies. Overall, however, there was a desire to assess the paradigm’s viability in clarifying the relationship between mental illness and everyday life behavioral interpretation.
Methods: For Study 1, 30 (12 adult healthy controls, 10 adolescent healthy controls, and 8 psychiatric outpatients) gave informed consent. They were given a booklet of self-report forms and a programmable watch. When the watch would signal, they were to fill out a page in the booklet. While patterned after the typical ESM study, this task differed by focusing on 1 day (rather than a week) and sampling behavioral interpretations (rather than experiences). For Study 2, 14 (8 psychiatric outpatients with schizophrenia plus other diagnoses, and 6 with other diagnoses but no schizophrenia) gave informed consent; however, subjects participated for an entire week rather than just 1 day (as in Study 1). For both studies, all subjects were debriefed (e.g., general reactions, diagnosis confirmation, and sociodemographics).
Results: For Study 1, as hypothesized, various statistical tests showed that psychiatric outpatients scored lower on control than healthy adolescents who scored lower than healthy adults; however, differences between the 3 groups in degrees of choice were not significant. For Study 2, principal hypotheses were not supported; however, exploratory analyses showed significant differences between variances, with the schizophrenia group having lower variances than the other diagnoses group. Overall, results’ meaning and significance are related to signaling frequency, self-report form items, the specific sample, other interpretive factors (e.g., perspective and description), and the nature of schizophrenia in interaction with other diagnoses.
Conclusion: In conclusion, these results suggest that while ESM studies of the relationship of mental illness with behavioral interpretation in everyday life can be enlightening (e.g., control mean and variance differences), care in how to interpret the results, and in how the ESM paradigm should be modified to improve reliability and validity as a consequence, needs attention.