Relationships Between Occupational Participation and Ontological Security in Persons With Schizophrenia

Participation in meaningful activities (termed occupations) is a central aspect of a healthy life. Many with schizophrenia, however, struggle to maintain participation in meaningful occupations, which can limit wellness and impede recovery-focused occupational rehabilitation efforts. One potential cause of limited occupational function may be that persons with schizophrenia may experience occupational participation as ontologically threatening: work or leisure activities, for instance, may threaten a person's already frail sense of self. Although theory is rich in this area, few studies have systematically explored the experiences of occupational participation as they relate to ontological security (or lack thereof) among persons with schizophrenia. To address this issue, the personal narratives of self and others were collected from 33 veterans with schizophrenia using the Indiana Psychiatric Illness Interview. Through qualitative analyses, we then sought to identify sources of ontic threat and responses to that threat to explore how occupational function and ontic threat relate to each other, and how responses to ontic threat relate to occupational function. Our analyses, guided by constructivist grounded theory, showed that ontological threat stemmed from externally imposed circumstances such as being abused, traumatic events or symptoms, social difficulty, and occupational deprivation. Efforts to restore or establish ontological security included giving up occupations, inauthentic adoption of social rules/scripts, occupational imbalance, and authentic participation in occupations. Future research is needed to explore other factors (e.g., metacognition) that can impact occupational participation and wellness among this population and thus inform occupational rehabilitation efforts.