Meaning, Integration, and the Self in Serious Mental Illness: Implications of Research in Metacognition for Psychiatric Rehabilitation

Objective: It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. Method: Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. Findings: Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. Conclusions and Implications for Practice: Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions. Impact and Implications It is unclear what aspects of subjective forms of recovery in psychosis can be quantified. This article reviews research that suggests that metacognition is a quantifiable process that supports subjective aspects of recovery which enable persons to make sense of and address challenges related to mental illness. It is proposed that the promotion of metacognition may be an active but previously unrecognized element of successful rehabilitative practice.