Exploring a lay Gestalt of schizophrenia? A Danish background population’s explanations on why and how first-episode schizophrenia patients’ narratives were intuitively sensed as contextually inappropriate

Background: Recent continental-phenomenological psychiatry emphasizes pragmatics or social and contextual inappropriateness as a core disorder of schizophrenia, which is potentially relevant to early identification and treatment. Objective: However, there are hardly any studies that examine the background population’s sensitivity to inappropriateness in schizophrenia, even if “common” people, from a pragmatic perspective, are likely to be highly sensitive to cultural-conventional norms, including (in)appropriateness. Method: One empirical evaluation of contextual (in)appropriateness in 10 narratives from first-episode schizophrenia patients and healthy controls, respectively, found that when a phenomenologically informed Danish population (n=157 high-school students; mean age, 18.5) was “blinded” to the control–patient status – that is, “anonymous” narratives of the wordless picture story Frog, Where Are You? – they consequently evaluated patient narratives as more inappropriate than appropriate and control narratives as more appropriate than inappropriate (significant with 0.007). Aiming to explore a potential pattern recognition, distinguishing patient from control narratives, the present study systematizes and discusses salient explanations from lay “experts” who almost consequently (80% to 100%) evaluated patient narratives as inappropriate and control narratives as appropriate (n=63 of 157). Results: Explanations of inappropriateness concerned affective aspects (about how the patient felt or how the evaluators felt reading the narrative), formal aspects (about pauses, fluency, and brevity), and aspects about sense making (from lack of understanding to nonsense and strangeness).The background population may be sensitive to affective and formal inappropriateness, but only lay experts emphasize the lack of sense in the patients’ narratives. Conclusion: Further studies might benefit from investigating whether early referrals from family, friends, or schoolteachers of their own accord thematize such inappropriateness aspects, and whether questionnaires targeting inappropriateness could be developed and used in the early identification of young people at risk.