Meaning-making in psychotic experiences and its impact on meaning in life in first-episode psychosis

Meaning-making in psychotic experiences may affect mental health recovery by influencing the degree to which a person experiences Meaning in Life (MIL). However, how meaning made in such experiences impacts MIL is poorly understood. We aimed to explore how service users engage in meaning-making in their experience of a first-episode psychosis (FEP) (as well as subsequent and current psychotic experiences), and to identify if and how this meaning has influenced their current perspective on MIL.

The study aim was addressed using Interpretative Phenomenological Analysis (IPA). We used purposive maximum variation sampling and conducted semi-structured interviews with 16 members of an epidemiologically complete FEP incidence cohort in the Republic of Ireland. Data analysis was guided by IPA procedures.

We found psychotic experiences both contributed to and eroded MIL but also created memory blanks, blocking the process of meaning-making. Meaning-making in psychotic experiences involved: Living with the impact of psychosis on the self and identity (Survival); Reconnecting with time to move forward in time (Restoring temporality); Navigating agency and powerlessness in chaos (Reclaiming control); Generating Meaning in Life in a vacuum (Presence in absence); and Trying to find a home for psychosis or not needing to (Narrative re-storying).

Findings challenge current meaning-making theory; suggesting that it may not be fully applicable to the lives of people experiencing psychosis. Our data also have implications for the implementation of trauma informed care, the recovery approach in mental health, clinical practice, and research.