Dimensions of Meaning-Making Among Serious Mental Illness to Inform Mental Health Services, Clinical Practice and Public Policy Approaches in the United States

Abstract

Aim The aim of this study is to examine how contemporary scholarship conceptualizes meaning-making among individuals with serious mental illness (SMI), with particular attention to schizophrenia. The study seeks to identify how meaning making is described, facilitated, and operationalized within therapeutic frameworks, and to analyze gaps in the literature that hold implications for recovery-oriented systems of care and public policy in the United States. Background Recovery has become the central organizing framework in U.S. mental health policy, formalized through SAMHSA’s Ten Principles of Recovery and its Four Dimensions of Recovery. Despite similar recovery models across high-income countries, meaning-making remains inconsistently defined across clinical and academic literature. Historical shifts in mental health care, including deinstitutionalization and neoliberal policy reforms, further shape the structural context in which meaning-making occurs. Methods A systematic review was conducted following PRISMA 2020 guidelines. Searches were performed through the University of Washington Libraries using the terms “schizophrenia and meaning making”, and filtered for peer-reviewed English-language articles published between 2016 and 2026. Fifty-three articles were identified; after applying inclusion and exclusion criteria, focusing on studies involving insight into illness, existential distress, and therapeutic engagement, and ten articles were retained for full review. Articles from low-income countries were excluded to maintain policy comparability across high-income nations with established disability systems. Results Four central themes emerged. 1) therapeutic approaches such as Dignity Therapy, Humanistic Psychiatry, and Open Dialogue Therapy support meaning-making by centering narrative identity, existential reflection, and relational dialogue; 2) meaning-making is nonlinear and deeply shaped by extrinsic supports; familial connection consistently facilitated recovery, while loneliness, stigma, and economic precarity hindered it; 3) studies rarely incorporated recovery policy or structural determinants such as poverty or downward economic mobility despite their documented influence on recovery trajectories; and 4) post-traumatic growth and identity reconstruction were common outcomes, with hospitalization and psychosis often described as traumatic events that disrupted but also reshaped self-understanding. Across studies, recovery was characterized not as symptom reduction but as an existential, social, and narrative process requiring dignity, agency, and opportunities for meaning-making. Policy recommendations rest on best practices for a holistic, integrated study and view of intrinsic and extrinsic support, alongside standardized definitions for what characterizes and facilitates recovery for a more comparable view and for pathways towards policy advocacy.