Understanding Functioning in Schizophrenia: A Phenomenological Study in Social Cognition

Understanding Functioning in Schizophrenia: A Phenomenological Study in Social Cognition | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Functioning in Schizophrenia: A Phenomenological Study in Social Cognition Azam Salarhaji, Hossein Karimi Moonaghi, Masoud Kashani-Lotfabadi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6528322/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Sep, 2025 Read the published version in BMC Psychiatry → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Impairments in social cognition are recognized as a key factor contributing to functional disabilities in individuals with schizophrenia. This study aims to explore patients’ lived experiences of functioning within the context of social cognition to gain a deeper and more nuanced understanding of this relationship. Methods: A descriptive phenomenological approach was employed. Ten discharged patients from the largest psychiatric hospital in Khorasan Razavi Province, Iran, were selected using purposive sampling. Data were collected through in-depth, semi-structured interviews and analyzed based on Amedeo Giorgi’s phenomenological method. Results: The analysis identified five overarching themes and 21 subthemes: (1) Restoring Identity Through Employment; (2) The Struggle Between Motivation and Functional Barriers; (3 Living on the Margins of Social Engagement: Cognitive–Emotional Isolation; (4) Dysfunctional Engagement with the Social Environment; and (5) The Family’s Role in Psychosocial Rehabilitation and Identity Reconstruction. Functioning within the domain of social cognition was revealed to be a multifaceted and dynamic process, marked by internal struggles, fluctuating motivation, and sustained social withdrawal. Employment emerged as a vital avenue for rebuilding a sense of self, while the family context acted as both a facilitating and constraining force in the psychosocial recovery journey. Conclusion: Functioning in individuals with schizophrenia reflects an ongoing, adaptive process of identity reconstruction, shaped by internal conflict, cognitive-emotional detachment, and impaired social engagement. Employment and family support are key determinants in promoting functional recovery and personal transformation within the framework of social cognition. Social cognition functioning schizophrenia descriptive phenomenology qualitative research Iran Introduction Schizophrenia is widely recognized as one of the most debilitating psychiatric disorders worldwide ( 1 , 2 ). Despite extensive research, therapeutic progress has remained limited ( 3 ). Over the past three decades, although improvements have been noted in care quality indicators, the global burden of schizophrenia has increased, with both incidence and prevalence showing an upward trend ( 4 , 5 ). In Iran, while the prevalence has remained relatively stable, incidence has risen, and the reported disease burden exceeds the global average ( 6 ). Functional impairment is a core diagnostic criterion in both the DSM-5 and DSM-5-TR ( 7 , 8 ). It generally manifests in two domains: adaptive behavior and interpersonal functioning ( 9 ). These are often conceptualized within two distinct frameworks: real-world functioning (e.g., personal, social, academic, and occupational domains) and functional capacity (i.e., the ability to perform social roles) ( 10 , 11 ). However, the conceptual boundaries of “functioning” remain ambiguous, with overlapping terms—such as social functioning, social adjustment, social impairment, social adaptation, and social competence—frequently used interchangeably ( 12 ). Following the deinstitutionalization movement of the 1960s, enhancing functional capacity to promote socially independent living became a central therapeutic aim for individuals with schizophrenia ( 13 ). Within this context, social recovery has emerged as a key aspect of the broader recovery process, distinct from clinical remission or symptom reduction ( 14 , 15 ). Empirical studies have identified social cognition as a major predictor of functional outcomes ( 16 – 19 ), mediating the relationship between neurocognitive deficits and real-world functioning ( 20 , 21 ). Although social cognition is associated with neurocognition ( 18 ), it exhibits stronger and more independent links to social functioning ( 22 , 23 ). The concept of social cognition was introduced by Penn et al. (1997) as a set of cognitive processes necessary for understanding oneself, others, and social contexts ( 24 ). In 2004, the National Institute of Mental Health (NIMH) formally defined the construct ( 25 ), and in 2006, delineated five core domains: emotion processing, theory of mind, attributional bias, social perception, and social knowledge ( 26 ). Despite these developments, recent studies have continued to highlight persistent conceptual and methodological challenges ( 27 – 29 ). The ongoing lack of clarity in defining and measuring both social cognition and functioning undermines the validity of quantitative research and hampers the design of effective clinical interventions. Although some qualitative studies have explored cognitive deficits ( 30 ), social functioning ( 31 ), and daily participation ( 32 ) among individuals with schizophrenia, no research to date has specifically investigated the lived experience of functioning through the lens of social cognition—either in Western or Iranian contexts. Moreover, most existing literature has prioritized clinicians’ perspectives ( 26 , 33 ). Even when patients' experiences are considered, data are often collected through caregivers ( 34 , 35 ), introducing potential biases and misrepresentation. Descriptive phenomenology provides an appropriate framework for investigating such underexplored and complex phenomena ( 36 , 37 ). Rooted in the philosophy of Edmund Husserl (1970), this approach treats conscious experience as a valid foundation for scientific inquiry ( 38 ). Although the application of phenomenological methods to social cognition remains debated ( 39 ), this perspective acknowledges that social cognition encompasses not only inferential reasoning but also direct and embodied experiences of social interaction ( 40 ). Accordingly, this study aims to explore the lived experiences of individuals with schizophrenia regarding their functioning within the domain of social cognition. It addresses critical conceptual and practical gaps in the literature—particularly within non-Western cultural settings. Methods Study Design This study forms part of a broader research initiative examining the lived experiences of social cognition among individuals with schizophrenia, with a particular emphasis on functioning as a core conceptual dimension. A descriptive phenomenological approach, grounded in the philosophy of Edmund Husserl, was employed. Husserl emphasized the importance of subjective experience in understanding human motivation and introduced the concept of intentionality —the directedness of consciousness toward specific objects, including perception, memory, imagination, emotion, and thought processes (38, 41) . This methodological stance enables researchers to examine patients’ lived experiences without imposing theoretical presuppositions, thereby facilitating the incorporation of their perspectives into clinical care and decision-making (42). To preserve neutrality in interpreting participants’ narratives, the researchers implemented the bracketing process (epoché) to suspend pre-existing assumptions and theoretical biases (43). Given the absence of a universally accepted operational definition of bracketing (44), multiple strategies were employed: deferring the literature review until data analysis was complete (37), avoiding pre-established theoretical frameworks concerning social cognition and functioning (44), explicitly articulating the researchers’ personal and professional experiences prior to data collection (44), and maintaining analytic memos throughout interviews and data analysis (44, 45). These measures were applied consistently during the analytic phase. Although complete bracketing, as conceptualized by Husserl, may remain an aspirational ideal in practice, its implementation significantly contributes to methodological rigor in phenomenological research (44). Considering the inherent complexity of conscious self-reflection regarding social cognition in individuals with schizophrenia (46), the interview guide was developed using open-ended questions. These were informed by Penn et al.’s (1997) conceptualization of social cognition (24), supplemented through expert consultation and a review of relevant terminology (see Table 1). Participants and Setting Participants were purposively selected from the discharge records of a 750-bed psychiatric hospital in Khorasan Razavi Province, northeastern Iran. Inclusion criteria were: A confirmed diagnosis of schizophrenia based on DSM-5 criteria for at least two years; A minimum education level of lower secondary school (equivalent to ninth grade); Clinical stability, defined as fewer than three relapses in the previous five years; A score of 3 or below on all positive symptom items of the Positive and Negative Syndrome Scale (PANSS); Living with first-degree relatives as a proxy for familial support; Age between 18 and 50 years, with illness onset prior to age 35; Sufficient cognitive ability to understand the study and provide informed assent; Provision of informed consent by a legal guardian. Exclusion criteria included: The presence of acute psychiatric symptoms; Cognitive inability to provide consent; Voluntary withdrawal from the study by the participant at any point. Data Collection Data collection was conducted between January 2021 and November 2022 and was extended due to constraints related to the COVID-19 pandemic. In-depth, semi-structured, face-to-face interviews were carried out with participants (see Table 1). Given the cultural sensitivities surrounding mental illness and identity in Iran, the interviewer (AS) initially contacted each participant’s legal guardian. She introduced herself as an academic researcher and clearly explained how the contact information had been obtained from hospital discharge records. Upon securing informed consent from the guardian and being formally introduced to the patient, the participant was invited to participate in the study. This multi-step approach proved essential for establishing trust and reducing apprehension among participants. Seven participants engaged willingly from the outset, while three initially expressed hesitancy but later became actively involved throughout the study. All interviews were conducted by the first author (AS), a psychiatric nurse with a master’s degree and a current PhD candidate, under the supervision of academic mentors (HKM) and expert consultants (HNA, FFH, MKL), all of whom had expertise in psychiatry and qualitative methodology. Drawing upon her clinical experience and academic training, the interviewer cultivated a nonjudgmental and empathetic atmosphere that encouraged honest and meaningful disclosure. Interview times and locations were chosen by participants: seven took place in participants’ homes, two in hospital settings, and one in a public park. Interviews lasted between 90 and 120 minutes. Six participants completed a single session; four required a second session—three for extended discussion and one due to fatigue during the initial interview. No incidents of emotional distress were reported. All interviews were audio-recorded with the participants’ consent and promptly transcribed for preliminary analysis. Data collection continued until thematic saturation was achieved, which occurred after the tenth interview, when no new themes emerged. Data Analysis Data were analyzed using Amedeo Giorgi’s (1933) descriptive phenomenological method (47), comprising four sequential steps: (1) repeated reading of transcripts to gain a holistic understanding; (2) identification and segmentation of meaning units; (3) clustering similar units to extract emergent themes; and (4) synthesis of these themes into a structural description of participants’ lived experiences. The analytical process was carried out concurrently with data collection and was guided by an interdisciplinary team comprising experts in psychiatry (FFH), psychiatric nursing (HNA, AS), psychology (MKL), and qualitative research methodology (HKM). Trustworthiness To ensure the rigor and validity of the findings, this study adhered to the trustworthiness criteria established by Lincoln and Guba (1985), which encompass credibility, dependability, confirmability, and transferability (48). Credibility was enhanced by conducting interviews in a psychologically safe and nonjudgmental environment that encouraged open and authentic sharing. The initial coding and thematic analysis were performed by the first author (AS) and independently reviewed by two academic supervisors (HKM and HNA), thereby reinforcing the accuracy and trustworthiness of the findings. Dependability was strengthened through systematic academic oversight. Transcripts and analytic procedures were presented and critically examined during biannual defense sessions by external faculty members with expertise in psychiatry, phenomenology, and sociology. This external audit ensured methodological consistency and transparency. Confirmability was maintained by keeping detailed analytic memos and reflexive journals throughout the research process. These documents served as tools to monitor potential researcher bias and to uphold objectivity in interpretation and analysis. Transferability was supported through purposive sampling aimed at maximizing variation in participant characteristics—including age, gender, education level, and socio-economic status—to increase the applicability of findings across diverse sociocultural contexts within and beyond Iran’s mental health system. Ethical Considerations The study received ethical approval from the Research Ethics Committee of Mashhad University of Medical Sciences, Iran (Ethics Code: IR.MUMS.NURSE.REC.1398.090). All interviews were conducted in private settings without the presence of family members to ensure confidentiality. Participants were identified using numerical codes to protect anonymity. Prior to participation, the study’s purpose and procedures were clearly explained to both participants and their legal guardians, and written informed consent was obtained from all involved. The study fully complied with the ethical principles outlined in the Declaration of Helsinki. Findings This study involved in-depth, semi-structured interviews with ten individuals diagnosed with schizophrenia (six men and four women), utilizing a descriptive phenomenological approach. Participant demographics are detailed in Table 2. Thematic analysis yielded five overarching themes that collectively capture the lived experience of functioning within the domain of social cognition (see Table 3). The presentation of findings aims to reflect the diversity of participants' lived experiences. Some individuals are represented in multiple themes due to the richness and complexity of their narratives, which provided deeper insights into the phenomenon. To support transparency and analytical depth, a supplementary file is provided containing the full set of verbatim quotations across all themes (see Additional File 1). Theme 1: Restoring Identity Through Employment Participants consistently described employment as a powerful means of reconnecting with positive memories, reclaiming self-worth, fostering social integration, and alleviating psychological distress. However, the pursuit of a restored identity was frequently accompanied by feelings of detachment and loss. This theme encompassed four interrelated subthemes: 1.1 Recalling Past Roles and Competencies Participants reflected on former job roles that had instilled a sense of success, autonomy, and personal fulfillment. These memories served as symbolic anchors to a more capable self, offering hope for identity restoration. “By God’s grace, I got hired and even ranked among the top candidates… Those first ten years of my job were the best days of my life. I really enjoyed life. I was an award-winning employee with creativity medals. I had such strong self-belief. Wherever I went, my work stats outshone the rest. Everyone was happy with my performance.” (P1) 1.2 Employment as a Source of Usefulness and Social Connection Employment provided not only a renewed sense of purpose and personal value but also facilitated interpersonal relationships and visibility within the community. In contrast, unemployment was closely associated with isolation and diminished self-worth. “My boss... he’s the type who calls me if I’m late to work. He says I’m his right-hand man, his ‘Swiss Army knife.’ It makes me feel valued—like I matter.” (P2) “Unemployment hurts more than anything else. Ever since I lost my job, I’ve just been home. I constantly feel like I’m useless, like a broken tool…” (P3) 1.3 Employment as a Psychological Soothing Agent Many participants described employment as therapeutic, helping them manage psychiatric symptoms such as stress, insomnia, and auditory hallucinations. “Working is like a sedative for me. When I work, I sleep better. Just like I enjoy exercising, working feels like exercise to me…” (P10) “When I’m at work, I’m occupied, and I don’t pay much attention to the voices. But if I lose my job and stay home, things get really hard.” (P7) 1.4 A Sense of Disconnection from the Healthier Former Self Although participants longed to reconnect with their more competent and socially active selves, many expressed a deep sense of emotional distance, marked by nostalgia, grief, and a lingering awareness of lost time. “I wish I could go back—be who I used to be. I used to go out more, be in touch with people. But now, things have changed. I’ve lost contact with many. I want those old habits back, but my life feels monotonous now. Time just drags on. I miss the past.” (P5) Theme 2: The Struggle Between Motivation and Functional Barriers Participants described a fluctuating journey in their efforts to regain functional stability. While social and occupational support often ignited motivation and self-confidence, internal barriers—such as emotional fatigue, diminished energy, and low initiative—repeatedly disrupted their progress. This theme comprises three subthemes: 2.1 Support from Others as a Cornerstone of Functioning Participants emphasized that encouragement and belief from others were pivotal in reviving their sense of self-worth and potential. Support was often expressed through mentorship, opportunity, and sustained emotional investment. “My boss sparked my self-confidence—something that had died in me since childhood. Within those few years, I grew by 30–40%. He always believed in me, kept encouraging me. He even taught me things outside work hours. He’d say: ‘You have potential, a bright future.’ That meant a lot to me.” (P1) 2.2 Emotional Fatigue and Declining Drive Despite external support, participants frequently experienced emotional exhaustion and a lack of drive that impeded consistent engagement in daily and occupational roles. “When I worked at the fruit shop, I didn’t have the drive to learn—to think about working independently or building my own future. I just kept working for my dad.” (P3) 2.3 Bright Days, Dark Days: The Nonlinear Path of Recovery Recovery was not experienced as a linear process. Brief moments of hope and momentum were often followed by setbacks, apathy, and renewed despair. “If I have two good days, I get hopeful. I think I can start fresh. But once those two days are over, it’s like five bad days follow—and I give up on everything again.” (P8) Theme 3: Living on the Margins of Social Engagement : Cognitive–Emotional Isolation Participants described their social presence as largely passive and emotionally detached. Social interactions were often perceived not only as challenging but also as emotionally draining, meaningless, or even threatening. Nevertheless, specific environments—particularly work settings and supportive contexts—sometimes enabled gradual re-engagement with social life. This theme includes four subthemes: 3.1 A Quiet Social Identity Rooted in Childhood Many participants traced their tendencies toward social withdrawal to early childhood, describing themselves as quiet observers who felt disconnected from peers. “I was always shy. When we were kids, my cousins played together, but I’d sit with the adults. Guests would come and go—I didn’t care. Even now, I just say hello and that’s it.” (P4) 3.2 Emotional Exhaustion and Preference for Solitude Social interaction was frequently experienced as cognitively and emotionally depleting. Many preferred solitudes as a protective strategy to manage internal overwhelm. “At parties, even if someone talked to me, I’d just nod. I didn’t care what they were saying. I had this strange fatigue—just wanted to be with myself, not pay attention to others. Still feel that way.” (P1) “At work, I may interact once, but then I don’t want to see or talk to them again—man or woman. I just avoid it altogether.” (P7) 3.3 Difficulty Initiating or Sustaining Social Relationships Participants acknowledged significant difficulties in initiating or maintaining interpersonal relationships. Many attributed this to internal barriers and preferred others to take the lead. “I’ve never started a relationship myself—never initiated a friendship. Even if I’m with someone all day, I never begin a conversation. I know I should make the effort, but I just can’t.” (P4) 3.4 Transformative Experiences of Social Reconnection Despite persistent withdrawal, several participants described meaningful transformations in their social skills through experiences such as employment or community engagement. “Since I started working for my boss, people say I’ve become more outgoing, more sociable. I’ve improved in connecting with others.” (P5) “Once I started working in sales, I began to overcome my shyness—I could talk to all kinds of people.” (P4) Theme 4: Dysfunctional Engagement with the Social Environment Participants reported a range of cognitive difficulties—including confusion, reduced attention, memory problems, and general cognitive slowing—during social, academic, and occupational interactions. These impairments hindered effective communication, compromised social roles, and contributed to a sense of disconnection from one’s environment. This theme includes five subthemes: 4.1 Impaired Comprehension of Social Cues Slowed cognitive processing affected participants’ ability to interpret verbal and non-verbal social cues, often leading to misunderstandings and social withdrawal. “I feel like I’ve become extremely slow. I don’t understand what people say anymore. My brain slows down—I hear what they say, but I can’t grasp the meaning. If I understood, I’d laugh or respond, but I just can’t.” (P2) 4.2 Inconsistent Attention During Interactions Sustained attention during conversations or multitasking was reported as difficult, leading to fragmented listening and disengagement. “When someone talks for a long time, I just can't retain what they're saying. I suddenly feel drained, and I lose track of the conversation.” (P10) “I see women who manage both work and home. For me, it’s hard. If I’m working, I can’t also hold a conversation—it overwhelms me.” (P5) 4.3 Memory Loss and Social Disconnection Participants reported cognitive lapses such as memory loss and confusion, which contributed to strained relationships and a profound sense of social disconnection. “Before my wife left, she tried to talk seriously about our situation. She eventually got frustrated and left, saying, ‘You’re not listening. You don’t care.’ I told her I was listening, but when she asked what she’d said—I couldn’t remember.” (P1) “I don’t even recognize my sisters or parents anymore. I’m afraid I’ll get lost if I go out alone. Maybe I’ve just had too much on my mind—I feel like I’ve forgotten everything over the past few years.” (P6) 4.4 Decline in Learning Ability in Work and School Cognitive difficulties such as poor memory retention and slowed learning capacity were described as significant barriers to educational and occupational engagement, often leaving participants feeling inadequate. “I went to several universities, but I dropped out. I started with software engineering, but I only passed two courses. Then I switched to chemistry—that didn’t work either. I wanted to study, but nothing would stick.” (P8) “I couldn’t do any job properly. Even simple math problems I used to solve—I can’t anymore. I wanted to keep studying, but the medication messed with my focus. I couldn’t even read properly.” (P9) 4.5 Declining Accuracy as a Barrier to Job Retention Reduced cognitive precision and attentional decline were commonly cited as reasons for job loss or reassignment to fewer demanding roles. “My company job required a lot of precision. I felt like I was learning too slowly and only doing a fraction of what was expected. Eventually, I was fired. But I managed better with simpler jobs like tiling or manual labor.” (P10) Theme 5: The Family’s Role in Psychosocial Rehabilitation and Identity Reconstruction Participants described their familial relationships as complex and ambivalent. While families often served as essential sources of emotional support, they could also act as sources of psychological strain. Mismatches between family expectations and participants' actual capacities contributed to feelings of guilt, rejection, and a fractured sense of identity. This theme consists of five subthemes: 5.1 Loss of Familial Role and Caregiver Identity Many participants reported being unable to fulfill traditional roles such as parenting or caregiving, leading to emotional distance from their familial identities. “I was so depressed that I worried how my little girl would grow up. My sister raised her—I couldn’t. Even when my grandkids visit, I can’t do anything for them. I can’t even lift them or bring them things.” (P6) “I don’t do most of my tasks myself. My parents tell me what to do—like reminding me to eat or to hurry in the shower. They’re always telling me to be faster.” (P8) 5.2 Conflict Between Family Expectations and Functional Reality Unrealistic familial expectations were described as a source of emotional distress, particularly when they ignored participants' cognitive or emotional limitations. “Whenever I say I can’t help around the house, they say I’m lazy. It makes me cry. They say I do things poorly or slowly—all of it weighs heavily on me. I don’t feel comfortable at home.” (P6) “My dad mostly scolds me for not working. Nowadays, getting a job is hard, and keeping one is even harder. Just thinking about how I can’t earn my own living causes me so much anxiety.” (P4) 5.3 The Dual Role of Family: Support or Pressure Families were perceived as either supportive or pressurizing—some offering encouragement, while others undermined autonomy or disregarded participants' needs. “My sister checks in on me all the time and gives me my medications. My older brother is incredibly kind—he keeps telling me to find a job or finish school so I don’t waste my life.” (P8) “My entire medication routine was disrupted because of my mom. I was following what the doctor prescribed, but I don’t know what she was thinking—she just took them away.” (P9) 5.4 Experiences of Marginalization Within the Family Several participants reported feeling excluded, devalued, or invisible within the family structure, reinforcing a sense of emotional isolation. “I’ve never had a real role in my family or society. I was like a background character in a movie—no one remembers the extras, just the stars. That’s who I was.” (P4) “When I’m watching something, I like, they switch the channel or turn off the TV without telling me. Things like that really upset me.” (P9) “My dad lets my younger brother drive the car, but not me. I feel like they value him more than they do me.” (P3) 5.5 Redefining One’s Role—Despite Limitations Despite limitations, some participants actively sought to reclaim their identity through meaningful roles within the family, particularly as caregivers or emotional anchors. “I may not do much, but I need to be here. If my parents need a doctor’s visit, I’m the one who takes them.” (P10) “I feel like I was reborn at 22. It might sound dramatic, but this is the real me now. I’m constantly busy with my parents’ medical needs.” (P4) Discussion This study employed a descriptive phenomenological approach to explore the lived experiences of individuals with schizophrenia concerning their functioning within the domain of social cognition. The findings suggest that functioning is not merely a behavioral or performance-based construct, but rather a dynamic, multidimensional process rooted in identity formation, emotional meaning, and interpersonal connection. Employment emerged as a central context for self-reconstruction and the reestablishment of social identity—eliciting experiences of self-worth, belonging, hope, and psychological relief, while also evoking nostalgia for a previously healthier state of being. Despite receiving varying levels of support, participants' perceived functioning was frequently hindered by inconsistent motivation, emotional and cognitive fatigue, psychological vulnerability, and core limitations in concentration, memory, and learning. These internal constraints often rendered social interactions challenging or even threatening, contributing to a pervasive sense of psychosocial isolation. The family system played a dual role—providing emotional and practical support on one hand, and imposing pressure through conflicting expectations or the withdrawal of familial roles on the other. In some cases, participants were able to redefine their role within the family, thereby supporting processes of identity restoration and social reintegration. These findings align with Cotter et al. (2019), who identified feelings of inefficacy and social withdrawal as central components of functioning among individuals at high risk for psychosis (49). However, while Cotter and colleagues focused predominantly on internalized stigma and psychological distress, the current study highlights broader contextual influences, including cultural expectations, family dynamics, and employment environments. Similar perspectives are echoed in the work of Cowman et al. (2021) and Javed and Charles (2018), both of whom underscore the critical role of social cognition in psychosocial functioning (17, 50). Taken together, these findings indicate the need to move beyond static, skills-based models of functioning. Instead, a dynamic, socially embedded, and meaning-centered framework is warranted—one that resonates with contemporary occupational therapy theories and recovery-oriented models of care (13, 15, 51). The following section outlines the main themes derived from the phenomenological analysis. Restoring Identity through Employment Participants described employment as a meaningful, restorative, and socially affirming experience—one that contributed to self-recognition, emotional regulation, and reintegration into social life. Reflecting on past professional roles and accomplishments often evoked a temporary resurgence of self-esteem and purpose. However, this process was frequently tinged with nostalgia for previous identities and grief over lost social roles. These findings align with the perspectives of Troubé (2021) and Drake (2021), who conceptualize employment not merely as a structural necessity, but as a narrative tool that restores order, normalcy, and meaning in one's life (52, 53). Similarly, studies by Doroud et al. (2015), Elraz (2018), Chauhan et al. (2022), and Hoier et al. (2024) underscore the role of employment—including in its basic or voluntary forms—as a key mechanism for identity reconstruction (31, 54-56). A distinctive contribution of the present study lies in its differentiation between reconstructing a former identity —as observed in non-Western contexts—and generating a new identity , more commonly reported in Western settings. This distinction emphasizes the critical role of cultural context in shaping recovery trajectories. The Struggle Between Motivation and Functional Barriers Participants portrayed functioning as a nonlinear, unstable process—oscillating between periods of intrinsic motivation and episodes of psychological exhaustion. External support, particularly interpersonal encouragement and flexible opportunities, was identified as essential for restoring self-efficacy. Conversely, internal limitations such as diminished willpower and emotional fatigue consistently hindered sustained performance. This dynamic tension echoes findings from Maddineshat et al. (2022), who emphasized the struggle between aspiration and incapacity among individuals with schizophrenia in Iran (57). Emotional support and adaptable work conditions were highlighted as vital enablers of re-engagement with meaningful roles. These qualitative findings are also reinforced by quantitative evidence from Bechi et al. (2017), Wang et al. (2020), and Ang et al. (2020), who differentiate between functional capacity and real-world performance , pointing to the essential role of contextual and interpersonal factors beyond cognitive ability (11, 58, 59). The convergence of qualitative and quantitative data underscores the necessity of refining both the definition and operationalization of functional indicators in clinical practice and research. Living on the Margins of Social Engagement: Cognitive–Emotional Isolation For many participants, social interaction was described as strenuous, unstable, and anxiety-provoking. Their social identities—shaped from childhood through patterns of withdrawal, silence, and difficulties in initiating or sustaining communication—were not merely expressions of personality, but rather unconscious adaptations to the cognitive and emotional demands of interpersonal engagement. This detachment was often accompanied by a sense of threat, futility, and emotional exhaustion. Nevertheless, participation in supportive environments or occupational settings occasionally facilitated the gradual reestablishment of social connectedness. These patterns align with phenomenological conceptualizations of the "social self." Raballo and Kruger (2011) note that early indicators of vulnerability to psychosis include a weakened sense of social presence and heightened sensitivity in interpersonal contexts (60). These disruptions, which are often rooted in deficits in Theory of Mind (ToM) and emotional decoding (61) , were evident in the participants' narratives, manifesting as withdrawal and cognitive fatigue during social encounters. A recent systematic review by Taban et al. (2024) reinforces this view, emphasizing that community-based mental health services (CBMHS)—including social skills training and ongoing family engagement—can meaningfully reduce psychosocial isolation and enhance interpersonal functioning in individuals with schizophrenia (62). Dysfunctional Engagement with the Social Environment Participants often viewed social environments not as opportunities for growth, but as overwhelming spaces marked by confusion, cognitive overload, and emotional distress. Impairments in memory, attention, and learning hindered their ability to interpret social cues, engage in conversation, and participate in meaningful interpersonal exchanges. These difficulties disrupted their emotional, academic, and occupational functioning and further entrenched a sense of cognitive–emotional detachment. These findings are supported by international evidence. Research by Wright et al. (2019) and Thibaudeau et al. (2021) indicates that deficits in ToM and challenges in decoding emotional and social cues—such as intonation, facial expression, and interactional rhythm—are significant contributors to social withdrawal and perceived rejection (63, 64). The present study highlights how such cognitive limitations act as critical barriers to social participation, educational attainment, and sustained employment for individuals living with schizophrenia. The Family’s Role in Psychosocial Rehabilitation and Identity Reconstruction Participants’ narratives highlighted the dual role of family in their recovery journeys. For some, family functioned as a source of emotional support and served as a platform for reestablishing social roles. For others, however, it became a source of psychological strain—manifested through controlling behaviors, unrealistic expectations, and increasing marginalization within the family unit. These tensions often emerged from a misalignment between the individual’s cognitive-emotional capacities and the social demands imposed by the family, resulting in feelings of anxiety, guilt, or rejection. Nevertheless, several participants were able to redefine their familial identity by assuming secondary roles and responsibilities, thereby restoring a sense of belonging and personal value. From a social psychological perspective, attributional styles significantly influence how support is perceived. When familial support does not align with the individual’s psychological needs, it may be experienced not as nurturing but as an additional source of stress (17). This notion was echoed in participants’ accounts, reinforcing the importance of adapting family support to match the individual's cognitive and emotional readiness. These findings are consistent with studies by Rezaie and Phillips (2020) in Iran and Ma et al. (2023) in China, both of which emphasize the culturally ambivalent nature of family roles in the recovery process (65, 66). Further evidence from McFarlane et al. (2016), Caqueo-Urízar et al. (2017), and Samuel et al. (2020) highlights the critical importance of family involvement in psychosocial rehabilitation (67-69). The distinct contribution of this study lies in its focus on the subjective perception of support versus pressure, interpreted within a culturally situated psychosocial framework—a nuance often underexplored in cross-cultural mental health research. Strengths and Limitations A key methodological challenge in this study was the participants’ difficulty in grasping the concept of social cognition , a limitation also noted by Uchino et al. (2022) (46). Given the absence of a universally accepted definition of this construct, a descriptive phenomenological design was deemed most appropriate. The interview guide was developed based on the conceptual model proposed by Penn et al. (1997), with bracketing techniques integrated according to the methods of Gearing (2004) (24, 44). Although the sample size was relatively small, this aligns with the conventions of phenomenological research, which prioritizes the depth and richness of subjective experience over statistical representativeness. Nevertheless, several sample-specific features—such as participants being in the recovery phase, receiving family support, and presenting with mild symptom severity (as indicated by PANSS)—may constrain the generalizability of findings to other subpopulations. Notably, hesitations expressed by patients and guardians during recruitment highlight potential trust-related barriers, which could limit the applicability of results to individuals with more severe or chronic presentations, including those with paranoia or homelessness. Furthermore, because the study focused specifically on lived experiences within the domain of social cognition, other relevant facets of functional performance may have remained underexplored during interviews. Despite these limitations, the findings offer valuable implications for the development of psychosocial, occupational, and rehabilitative interventions, particularly within sociocultural contexts comparable to the study setting. Conclusion The findings underscore that functioning in schizophrenia is a dynamic and multidimensional phenomenon, situated at the intersection of psychological processes, social relationships, and cultural norms. Functioning should not be construed merely as a measure of cognitive ability or symptom severity; rather, it reflects an individual’s evolving effort to reconstruct identity in the face of internal vulnerabilities and external constraints. Social cognition—encompassing intention recognition, attributional style, and emotional regulation—emerges as a critical determinant of relational quality and everyday social functioning. Furthermore, employment operates not only as a source of economic stability but also as a key arena for self-renewal, belongingness, and role redefinition. Yet, factors such as emotional fatigue, diminished volition, and unresolved family dynamics contribute to the fragility and non-linearity of this reconstruction process. Accordingly, a robust understanding of functioning in schizophrenia must adopt a biopsychosocial lens that integrates identity, relational, and cultural dimensions into clinical frameworks. Practical Recommendations Multidimensional Rehabilitation Approaches Recovery-oriented interventions should extend beyond the enhancement of neurocognitive performance to include identity-based rehabilitation. Interventions that incorporate personal narrative, role restoration, and meaning-making strategies may be more effective in supporting long-term psychosocial recovery (54, 55). Culturally-Informed Family Empowerment Family psychoeducation programs should aim to reduce coercive caregiving styles and instead cultivate supportive, autonomy-promoting dynamics—particularly in collectivist cultures where family influence is profound. Adapting these interventions to sociocultural norms may enhance both relational cohesion and treatment adherence. Access to Meaningful and Adaptive Employment Creating access to flexible, low-demand, or voluntary work opportunities can facilitate re-engagement with routine, social integration, and identity recovery, particularly for individuals in early or fluctuating stages of remission (58, 59). Research Recommendations To further elucidate the complex relationship between social cognition and functional outcomes, future studies should employ mixed-methods designs across diverse cultural contexts. In particular, research is needed to address the rehabilitation needs of marginalized and high-risk populations—such as those with chronic symptoms, experiences of familial estrangement, or housing insecurity—in order to develop more inclusive and targeted models of psychosocial care. Declarations Acknowledgments This article was derived from a PhD thesis in nursing, approved by the Research Department of Mashhad University of Medical Sciences under code 980593. We would like to express our sincere gratitude to the esteemed research department of the university, as well as to the patients, their families, and all individuals who contributed to the execution of this study. Author Contributions AS, HKM, and MKL conceptualized and organized the study. AS conducted the interviews under the supervision of HKM, MKL, and FH. AS, HKM, and HNA carried out data analysis. The preliminary manuscript was prepared by AS and was revised by the other authors. All authors have reviewed and approved the final version of the manuscript. Funding This research was financially supported by the Research Deputy of Mashhad University of Medical Sciences, as well as a grant from author HKM. Data A vailability The datasets gathered and analyzed during this study are not publicly available due to ethical constraints regarding patient data and anonymity. however, they can be obtained upon reasonable request from the corresponding author. Ethics Approval This research forms part of a PhD thesis in nursing, approved by the Ethics Committee of Mashhad University of Medical Sciences under code IR.MUMS.NURSE.REC.1398.090, which is the Internal Review Board (IRB) for this study. Human Ethics and Consent to Participate Informed consent was obtained from both the participants and their legal guardians, assuring them of their right to withdraw from the study at any time and that their information would remain confidential. The principles of the Helsinki Declaration were adhered to throughout this research. Clinical trial number not applicable. Consent for Publication The funding source has approved the publication of this article. Competing Interests The authors declare that they have no conflicts of interest. References Ferrari AJ, Santomauro DF, Herrera AMM, Shadid J, Ashbaugh C, Erskine HE, et al. 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Understanding the differences between Husserl’s (descriptive) and Heidegger’s (interpretive) phenomenological research. Journal of Nursing and Care. 2012;1(5):1-3. Picton CJ, Moxham L, Patterson C. The use of phenomenology in mental health nursing research. Nurse researcher. 2017;25(3):14-8. Willis DG, Sullivan-Bolyai S, Knafl K, Cohen MZ. Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research. Western journal of nursing research. 2016;38(9):1185-204. Gearing RE. Bracketing in research: a typology. Qualitative health research. 2004;14(10):1429-52. Bednall J. Epoche and bracketing within the phenomenological paradigm. Issues in Educational Research 2006;16(2):123-38. Uchino T, Okubo R, Takubo Y, Aoki A, Wada I, Hashimoto N, et al. Perceptions of and subjective difficulties with social cognition in schizophrenia from an internet survey: Knowledge, clinical experiences, and awareness of association with social functioning. Psychiatry and clinical neurosciences. 2022;76(9):429-36. Giorgi A. Phenomenological and psychological research. Pittsburgh: Humanities Press; 1933. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Education for information. 2004;22(2):63-75. Cotter J, Bucci S, Drake RJ, Yung AR, Carney R, Edge D. Exploring functional impairment in young people at ultra-high risk for psychosis: A qualitative study. Early intervention in psychiatry. 2019;13(4):789-97. Cowman M, Holleran L, Lonergan E, O'Connor K, Birchwood M, Donohoe G. Cognitive Predictors of Social and Occupational Functioning in Early Psychosis: A Systematic Review and Meta-analysis of Cross-Sectional and Longitudinal Data. Schizophrenia bulletin. 2021;47(5):1243-53. Hammell KW. Dimensions of meaning in the occupations of daily life. Canadian journal of occupational therapy Revue canadienne d'ergotherapie. 2004;71(5):296-305. Troubé S. Exploration of Everydayness in Schizophrenia: A Phenomenological Approach. Psychopathology. 2021;54(1):18-25. Drake RE, Wallach MA. Employment is a critical mental health intervention. Epidemiology and psychiatric sciences. 2020;29:e178. Doroud N, Fossey E, Fortune T. Recovery as an occupational journey: A scoping review exploring the links between occupational engagement and recovery for people with enduring mental health issues. Australian occupational therapy journal. 2015;62(6):378-92. Elraz H. Identity, mental health and work: How employees with mental health conditions recount stigma and the pejorative discourse of mental illness. J Human relations. 2018;71(5):722-41. Chauhan N, Leeming D, Wattis J. "It's a Big Family Here." Becoming and Belonging in a Service Providing Employment-Related Support for People with Mental Health Problems: An Interpretative Phenomenological Analysis. Community mental health journal. 2022;58(2):277-87. Maddineshat M, Cheraghi F, Ghaleiha A, Khalafbeigi M, Sadeghian E. Facilitators and Barriers of Return to Work in Working People with Serious Mental Illness: A Qualitative Study. Indian journal of psychological medicine. 2022;44(2):120-8. Wang SP, Wang JD, Chang JH, Wu BJ, Wang TJ, Sun HJ. Symptomatic remission affects employment outcomes in schizophrenia patients. BMC psychiatry. 2020;20(1):219. Ang MS, Rekhi G, Lee J. Vocational Profile and Correlates of Employment in People With Schizophrenia: The Role of Avolition. Frontiers in psychiatry. 2020;11:856. Raballo A, Krueger J. Phenomenology of the social self in the prodrome of psychosis: from perceived negative attitude of others to heightened interpersonal sensitivity. European psychiatry : the journal of the Association of European Psychiatrists. 2011;26(8):532-3. Deste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia. Frontiers in psychiatry. 2020;11:524. Taban M, Nooraeen S, Tanha K, Moradi-Lakeh M, Malakouti SK. Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis. BMC psychiatry. 2024;24(1):256. Wright AL, Phillips LJ, Bryce S, Morey-Nase C, Allott K. Subjective experiences of cognitive functioning in early psychosis: a qualitative study. (Psychosis) Psychological, Social and Integrative Approaches. 2019;11(2):1-12. Thibaudeau É, Cellard C, Turcotte M, Achim AM. Functional Impairments and Theory of Mind Deficits in Schizophrenia: A Meta-analysis of the Associations. Schizophrenia bulletin. 2021;47(3):695-711. Rezaie L, Phillips D. Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study. Journal of psychiatric and mental health nursing. 2020;27(6):752-62. Ma M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC psychiatry. 2023;23(1):468. McFarlane WR. Family Interventions for Schizophrenia and the Psychoses: A Review. Family process. 2016;55(3):460-82. Caqueo-Urízar A, Rus-Calafell M, Craig TK, Irarrazaval M, Urzúa A, Boyer L, et al. Schizophrenia: Impact on Family Dynamics. Current psychiatry reports. 2017;19(1):2. Samuel R, S A, Jacob KS. A Qualitative Study Exploring the Lived Experience of Unemployment Among People with Severe Mental Illness. Indian journal of psychological medicine. 2020;42(5):435-44. Tables Table 1: Interview guidelines The interviews were guided by open-ended, phenomenologically grounded questions designed to explore participants’ lived experiences of functioning within the domain of social cognition: When you reflect on your overall functioning in life, how would you describe your experience? Can you recall a specific situation in which you became aware of how you were functioning? How do you think others perceive your ability to function? Have you experienced a moment when someone formed a specific impression of your functioning? Could you describe it? What has your experience of functioning been like during social interactions? Can you describe an instance in which your functioning influenced your communication or relationships with others? Is there anything else you would like to share about your experience of functioning in daily or social life? Follow-up prompts were used to encourage deeper reflection and richer narratives: “Could you elaborate on that?” “What was that experience like for you?” “How did you feel in that moment?” Table 2: Participant Characteristics (n = 10) Coding gender Age (years) Education Level occupation Marital status positive symptoms socio-economic status P1 male 42 Bachelor’s Bank Feedback Divorced Yes Average P2 female 38 9th Grade Tea Server Divorced No Low P3 male 28 9th Grade Unemployed Married No Average P4 male 29 Bachelor’s Master’s Student Single No Average P5 female 35 Associate Degree Knitting (Doll Making) Single No Low P6 female 52 9th Grade Unemployed Married No Low P7 female 32 Bachelor’s Freelance Work Single Yes Low P8 Male 33 Some College Freelance work Single Yes Average P9 Male 25 Associate Degree Unemployed Single No High P10 Male 41 High School Household Chores Single No High Table 3 : The Extracted Themes and Subthemes Themes Subthemes Restoring Identity Through Employment Recalling Past Roles and Competencies Employment as a Source of Usefulness and Social Connection Employment as a Psychological Soothing Agent A Sense of Disconnection from the Healthier Former Self The Struggle Between Motivation and Functional Barriers Support from Others as a Cornerstone of Functioning Emotional Fatigue and Declining Drive Bright Days, Dark Days: The Nonlinear Path of Recovery Living on the Margins of Social Engagement: Cognitive–Emotional Isolation A Quiet Social Identity Rooted in Childhood Emotional Exhaustion and Preference for Solitude Difficulty Initiating or Sustaining Social Relationships Transformative Experiences of Social Reconnection Dysfunctional Engagement with the Social Environment Impaired Comprehension of Social Cues Inconsistent Attention During Interactions Memory Loss and Social Disconnection Decline in Learning Ability in Work and School Declining Accuracy as a Barrier to Job Retention The Family’s Role in Psychosocial Rehabilitation and Identity Reconstruction Loss of Familial Role and Caregiver Identity Conflict Between Family Expectations and Functional Reality The Dual Role of Family: Support or Pressure Experiences of Marginalization Within the Family Redefining One’s Role—Despite Limitations Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6528322","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469273443,"identity":"6dc8bbb6-f142-4f38-b074-5b288abc7561","order_by":0,"name":"Azam Salarhaji","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Azam","middleName":"","lastName":"Salarhaji","suffix":""},{"id":469273444,"identity":"c3576c2e-344e-4cb2-89cc-79e7f97a260c","order_by":1,"name":"Hossein Karimi Moonaghi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBACCSA+wGBwQA4uwkasFmPStIB0JTYQ7TDJ9rMPD90ouJO+dkZ28geGGjsGPukD+LVI86QbHM4xeJa77UbuNgmGY8kMbHwJ+LXIMaQxALUcBmsBeuQAAxsPAYfJ8T8Da0k3u5G7+QPDPyK0SEtAbEkAatkgwdhGhBbJGRBbDLedebtNIrEvmYegFonzacyfc/4cljc7DnTYh292cvI9BLSgggQGBkJ2jIJRMApGwSggBgAAho9BJVeUbmEAAAAASUVORK5CYII=","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Hossein","middleName":"Karimi","lastName":"Moonaghi","suffix":""},{"id":469273446,"identity":"c77fe822-53f5-4787-a22b-20c39e2f661a","order_by":2,"name":"Masoud Kashani-Lotfabadi","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Masoud","middleName":"","lastName":"Kashani-Lotfabadi","suffix":""},{"id":469273447,"identity":"a0a359e3-e53c-4817-87c0-6a25a2ad297d","order_by":3,"name":"Hossein Namdar Areshtanab","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hossein","middleName":"Namdar","lastName":"Areshtanab","suffix":""},{"id":469273449,"identity":"28315abe-91a9-49d6-9aa5-0cd3383db40d","order_by":4,"name":"Farhad Faridhosseini","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Farhad","middleName":"","lastName":"Faridhosseini","suffix":""}],"badges":[],"createdAt":"2025-04-25 11:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6528322/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6528322/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-025-07290-5","type":"published","date":"2025-09-30T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92883926,"identity":"bf79ffae-a998-4144-8b86-f19024e408f6","added_by":"auto","created_at":"2025-10-06 16:11:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1446522,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6528322/v1/7f5ccd20-f896-4877-9466-1f4e8316eec5.pdf"},{"id":84459511,"identity":"bf164af0-3e9e-442a-862c-2c4d5c81eeeb","added_by":"auto","created_at":"2025-06-12 08:38:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34624,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6528322/v1/004698c5ca77a5bd677ae4ab.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding Functioning in Schizophrenia: A Phenomenological Study in Social Cognition","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchizophrenia is widely recognized as one of the most debilitating psychiatric disorders worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite extensive research, therapeutic progress has remained limited (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Over the past three decades, although improvements have been noted in care quality indicators, the global burden of schizophrenia has increased, with both incidence and prevalence showing an upward trend (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In Iran, while the prevalence has remained relatively stable, incidence has risen, and the reported disease burden exceeds the global average (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFunctional impairment is a core diagnostic criterion in both the DSM-5 and DSM-5-TR (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). It generally manifests in two domains: adaptive behavior and interpersonal functioning (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These are often conceptualized within two distinct frameworks: real-world functioning (e.g., personal, social, academic, and occupational domains) and functional capacity (i.e., the ability to perform social roles) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, the conceptual boundaries of \u0026ldquo;functioning\u0026rdquo; remain ambiguous, with overlapping terms\u0026mdash;such as social functioning, social adjustment, social impairment, social adaptation, and social competence\u0026mdash;frequently used interchangeably (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFollowing the deinstitutionalization movement of the 1960s, enhancing functional capacity to promote socially independent living became a central therapeutic aim for individuals with schizophrenia (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Within this context, social recovery has emerged as a key aspect of the broader recovery process, distinct from clinical remission or symptom reduction (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEmpirical studies have identified social cognition as a major predictor of functional outcomes (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), mediating the relationship between neurocognitive deficits and real-world functioning (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Although social cognition is associated with neurocognition (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), it exhibits stronger and more independent links to social functioning (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe concept of social cognition was introduced by Penn et al. (1997) as a set of cognitive processes necessary for understanding oneself, others, and social contexts (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In 2004, the National Institute of Mental Health (NIMH) formally defined the construct (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and in 2006, delineated five core domains: emotion processing, theory of mind, attributional bias, social perception, and social knowledge (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Despite these developments, recent studies have continued to highlight persistent conceptual and methodological challenges (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The ongoing lack of clarity in defining and measuring both social cognition and functioning undermines the validity of quantitative research and hampers the design of effective clinical interventions.\u003c/p\u003e \u003cp\u003eAlthough some qualitative studies have explored cognitive deficits (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), social functioning (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), and daily participation (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e) among individuals with schizophrenia, no research to date has specifically investigated the lived experience of functioning through the lens of social cognition\u0026mdash;either in Western or Iranian contexts. Moreover, most existing literature has prioritized clinicians\u0026rsquo; perspectives (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Even when patients' experiences are considered, data are often collected through caregivers (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), introducing potential biases and misrepresentation.\u003c/p\u003e \u003cp\u003eDescriptive phenomenology provides an appropriate framework for investigating such underexplored and complex phenomena (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Rooted in the philosophy of Edmund Husserl (1970), this approach treats conscious experience as a valid foundation for scientific inquiry (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Although the application of phenomenological methods to social cognition remains debated (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), this perspective acknowledges that social cognition encompasses not only inferential reasoning but also direct and embodied experiences of social interaction (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccordingly, this study aims to explore the lived experiences of individuals with schizophrenia regarding their functioning within the domain of social cognition. It addresses critical conceptual and practical gaps in the literature\u0026mdash;particularly within non-Western cultural settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study forms part of a broader research initiative examining the lived experiences of social cognition among individuals with schizophrenia, with a particular emphasis on functioning as a core conceptual dimension. A descriptive phenomenological approach, grounded in the philosophy of Edmund Husserl, was employed. Husserl emphasized the importance of subjective experience in understanding human motivation and introduced the concept of \u003cem\u003eintentionality\u003c/em\u003e\u0026mdash;the directedness of consciousness toward specific objects, including perception, memory, imagination, emotion, and thought processes\u003cspan dir=\"RTL\"\u003e\u0026nbsp;(38, 41)\u003c/span\u003e.\u0026nbsp;This methodological stance enables researchers to examine patients\u0026rsquo; lived experiences without imposing theoretical presuppositions, thereby facilitating the incorporation of their perspectives into clinical care and decision-making\u0026nbsp;(42).\u003c/p\u003e\n\u003cp\u003eTo preserve neutrality in interpreting participants\u0026rsquo; narratives, the researchers implemented the bracketing process (epoch\u0026eacute;) to suspend pre-existing assumptions and theoretical biases (43). Given the absence of a universally accepted operational definition of bracketing (44), multiple strategies were employed: deferring the literature review until data analysis was complete (37), avoiding pre-established theoretical frameworks concerning social cognition and functioning (44), explicitly articulating the researchers\u0026rsquo; personal and professional experiences prior to data collection (44), and maintaining analytic memos throughout interviews and data analysis (44, 45). These measures were applied consistently during the analytic phase. Although complete bracketing, as conceptualized by Husserl, may remain an aspirational ideal in practice, its implementation significantly contributes to methodological rigor in phenomenological research (44).\u003c/p\u003e\n\u003cp\u003eConsidering the inherent complexity of conscious self-reflection regarding social cognition in individuals with schizophrenia\u0026nbsp;(46), the interview guide was developed using open-ended questions. These were informed by Penn et al.\u0026rsquo;s (1997) conceptualization of social cognition\u0026nbsp;(24), supplemented through expert consultation and a review of relevant terminology (see Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were purposively selected from the discharge records of a 750-bed psychiatric hospital in Khorasan Razavi Province, northeastern Iran.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were:\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eA confirmed diagnosis of schizophrenia based on DSM-5 criteria for at least two years;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eA minimum education level of lower secondary school (equivalent to ninth grade);\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eClinical stability, defined as fewer than three relapses in the previous five years;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eA score of 3 or below on all positive symptom items of the Positive and Negative Syndrome Scale (PANSS);\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eLiving with first-degree relatives as a proxy for familial support;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eAge between 18 and 50 years, with illness onset prior to age 35;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eSufficient cognitive ability to understand the study and provide informed assent;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eProvision of informed consent by a legal guardian.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included:\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eThe presence of acute psychiatric symptoms;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eCognitive inability to provide consent;\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003eVoluntary withdrawal from the study by the participant at any point.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData collection was conducted between January 2021 and November 2022 and was extended due to constraints related to the COVID-19 pandemic. In-depth, semi-structured, face-to-face interviews were carried out with participants (see Table 1).\u003c/p\u003e\n\u003cp\u003eGiven the cultural sensitivities surrounding mental illness and identity in Iran, the interviewer (AS) initially contacted each participant\u0026rsquo;s legal guardian. She introduced herself as an academic researcher and clearly explained how the contact information had been obtained from hospital discharge records. Upon securing informed consent from the guardian and being formally introduced to the patient, the participant was invited to participate in the study. This multi-step approach proved essential for establishing trust and reducing apprehension among participants.\u003c/p\u003e\n\u003cp\u003eSeven participants engaged willingly from the outset, while three initially expressed hesitancy but later became actively involved throughout the study.\u003c/p\u003e\n\u003cp\u003eAll interviews were conducted by the first author (AS), a psychiatric nurse with a master\u0026rsquo;s degree and a current PhD candidate, under the supervision of academic mentors (HKM) and expert consultants (HNA, FFH, MKL), all of whom had expertise in psychiatry and qualitative methodology. Drawing upon her clinical experience and academic training, the interviewer cultivated a nonjudgmental and empathetic atmosphere that encouraged honest and meaningful disclosure.\u003c/p\u003e\n\u003cp\u003eInterview times and locations were chosen by participants: seven took place in participants\u0026rsquo; homes, two in hospital settings, and one in a public park. Interviews lasted between 90 and 120 minutes. Six participants completed a single session; four required a second session\u0026mdash;three for extended discussion and one due to fatigue during the initial interview. No incidents of emotional distress were reported. All interviews were audio-recorded with the participants\u0026rsquo; consent and promptly transcribed for preliminary analysis. Data collection continued until thematic saturation was achieved, which occurred after the tenth interview, when no new themes emerged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using Amedeo Giorgi\u0026rsquo;s\u0026nbsp;(1933)\u0026nbsp;descriptive phenomenological method\u0026nbsp;(47), comprising four sequential steps: (1) repeated reading of transcripts to gain a holistic understanding; (2) identification and segmentation of meaning units; (3) clustering similar units to extract emergent themes; and (4) synthesis of these themes into a structural description of participants\u0026rsquo; lived experiences.\u003c/p\u003e\n\u003cp\u003eThe analytical process was carried out concurrently with data collection and was guided by an interdisciplinary team comprising experts in psychiatry (FFH), psychiatric nursing (HNA, AS), psychology (MKL), and qualitative research methodology (HKM).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrustworthiness\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo ensure the rigor and validity of the findings, this study adhered to the trustworthiness criteria established by Lincoln and Guba (1985), which encompass credibility, dependability, confirmability, and transferability\u0026nbsp;(48).\u003c/p\u003e\n\u003cp\u003eCredibility was enhanced by conducting interviews in a psychologically safe and nonjudgmental environment that encouraged open and authentic sharing. The initial coding and thematic analysis were performed by the first author (AS) and independently reviewed by two academic supervisors (HKM and HNA), thereby reinforcing the accuracy and trustworthiness of the findings.\u003c/p\u003e\n\u003cp\u003eDependability was strengthened through systematic academic oversight. Transcripts and analytic procedures were presented and critically examined during biannual defense sessions by external faculty members with expertise in psychiatry, phenomenology, and sociology. This external audit ensured methodological consistency and transparency.\u003c/p\u003e\n\u003cp\u003eConfirmability was maintained by keeping detailed analytic memos and reflexive journals throughout the research process. These documents served as tools to monitor potential researcher bias and to uphold objectivity in interpretation and analysis.\u003c/p\u003e\n\u003cp\u003eTransferability was supported through purposive sampling aimed at maximizing variation in participant characteristics\u0026mdash;including age, gender, education level, and socio-economic status\u0026mdash;to increase the applicability of findings across diverse sociocultural contexts within and beyond Iran\u0026rsquo;s mental health system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical approval from the Research Ethics Committee of Mashhad University of Medical Sciences, Iran (Ethics Code: IR.MUMS.NURSE.REC.1398.090). All interviews were conducted in private settings without the presence of family members to ensure confidentiality. Participants were identified using numerical codes to protect anonymity.\u003c/p\u003e\n\u003cp\u003ePrior to participation, the study\u0026rsquo;s purpose and procedures were clearly explained to both participants and their legal guardians, and written informed consent was obtained from all involved. The study fully complied with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Findings","content":"\u003cp\u003eThis study involved in-depth, semi-structured interviews with ten individuals diagnosed with schizophrenia (six men and four women), utilizing a descriptive phenomenological approach. Participant demographics are detailed in Table 2. Thematic analysis yielded five overarching themes that collectively capture the lived experience of functioning within the domain of social cognition (see Table 3).\u003c/p\u003e\n\u003cp\u003eThe presentation of findings aims to reflect the diversity of participants\u0026apos; lived experiences. Some individuals are represented in multiple themes due to the richness and complexity of their narratives, which provided deeper insights into the phenomenon. To support transparency and analytical depth, a supplementary file is provided containing the full set of verbatim quotations across all themes (see Additional File 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 1: Restoring Identity Through Employment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants consistently described employment as a powerful means of reconnecting with positive memories, reclaiming self-worth, fostering social integration, and alleviating psychological distress. However, the pursuit of a restored identity was frequently accompanied by feelings of detachment and loss. This theme encompassed four interrelated subthemes:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 Recalling Past Roles and Competencies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reflected on former job roles that had instilled a sense of success, autonomy, and personal fulfillment. These memories served as symbolic anchors to a more capable self, offering hope for identity restoration.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;By God\u0026rsquo;s grace, I got hired and even ranked among the top candidates\u0026hellip; Those first ten years of my job were the best days of my life. I really enjoyed life. I was an award-winning employee with creativity medals. I had such strong self-belief. Wherever I went, my work stats outshone the rest. Everyone was happy with my performance.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Employment as a Source of Usefulness and Social Connection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEmployment provided not only a renewed sense of purpose and personal value but also facilitated interpersonal relationships and visibility within the community. In contrast, unemployment was closely associated with isolation and diminished self-worth.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My boss... he\u0026rsquo;s the type who calls me if I\u0026rsquo;m late to work. He says I\u0026rsquo;m his right-hand man, his \u0026lsquo;Swiss Army knife.\u0026rsquo; It makes me feel valued\u0026mdash;like I matter.\u0026rdquo; (P2)\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Unemployment hurts more than anything else. Ever since I lost my job, I\u0026rsquo;ve just been home. I constantly feel like I\u0026rsquo;m useless, like a broken tool\u0026hellip;\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.3 Employment as a Psychological Soothing Agent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany participants described employment as therapeutic, helping them manage psychiatric symptoms such as stress, insomnia, and auditory hallucinations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Working is like a sedative for me. When I work, I sleep better. Just like I enjoy exercising, working feels like exercise to me\u0026hellip;\u0026rdquo; (P10)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When I\u0026rsquo;m at work, I\u0026rsquo;m occupied, and I don\u0026rsquo;t pay much attention to the voices. But if I lose my job and stay home, things get really hard.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.4 A Sense of Disconnection from the Healthier Former Self\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough participants longed to reconnect with their more competent and socially active selves, many expressed a deep sense of emotional distance, marked by nostalgia, grief, and a lingering awareness of lost time.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I wish I could go back\u0026mdash;be who I used to be. I used to go out more, be in touch with people. But now, things have changed. I\u0026rsquo;ve lost contact with many. I want those old habits back, but my life feels monotonous now. Time just drags on. I miss the past.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 2: The Struggle Between Motivation and Functional Barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described a fluctuating journey in their efforts to regain functional stability. While social and occupational support often ignited motivation and self-confidence, internal barriers\u0026mdash;such as emotional fatigue, diminished energy, and low initiative\u0026mdash;repeatedly disrupted their progress. This theme comprises three subthemes:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Support from Others as a Cornerstone of Functioning\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants emphasized that encouragement and belief from others were pivotal in reviving their sense of self-worth and potential. Support was often expressed through mentorship, opportunity, and sustained emotional investment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My boss sparked my self-confidence\u0026mdash;something that had died in me since childhood. Within those few years, I grew by 30\u0026ndash;40%. He always believed in me, kept encouraging me. He even taught me things outside work hours. He\u0026rsquo;d say: \u0026lsquo;You have potential, a bright future.\u0026rsquo; That meant a lot to me.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Emotional Fatigue and Declining Drive\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite external support, participants frequently experienced emotional exhaustion and a lack of drive that impeded consistent engagement in daily and occupational roles.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When I worked at the fruit shop, I didn\u0026rsquo;t have the drive to learn\u0026mdash;to think about working independently or building my own future. I just kept working for my dad.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Bright Days, Dark Days: The Nonlinear Path of Recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecovery was not experienced as a linear process. Brief moments of hope and momentum were often followed by setbacks, apathy, and renewed despair.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;If I have two good days, I get hopeful. I think I can start fresh. But once those two days are over, it\u0026rsquo;s like five bad days follow\u0026mdash;and I give up on everything again.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 3: Living on the Margins of Social Engagement\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e Cognitive\u0026ndash;Emotional Isolation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described their social presence as largely passive and emotionally detached. Social interactions were often perceived not only as challenging but also as emotionally draining, meaningless, or even threatening. Nevertheless, specific environments\u0026mdash;particularly work settings and supportive contexts\u0026mdash;sometimes enabled gradual re-engagement with social life. This theme includes four subthemes:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 A Quiet Social Identity Rooted in Childhood\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany participants traced their tendencies toward social withdrawal to early childhood, describing themselves as quiet observers who felt disconnected from peers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was always shy. When we were kids, my cousins played together, but I\u0026rsquo;d sit with the adults. Guests would come and go\u0026mdash;I didn\u0026rsquo;t care. Even now, I just say hello and that\u0026rsquo;s it.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2\u0026nbsp;Emotional Exhaustion and Preference for Solitude\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocial interaction was frequently experienced as cognitively and emotionally depleting. Many preferred solitudes as a protective strategy to manage internal overwhelm.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;At parties, even if someone talked to me, I\u0026rsquo;d just nod. I didn\u0026rsquo;t care what they were saying. I had this strange fatigue\u0026mdash;just wanted to be with myself, not pay attention to others. Still feel that way.\u0026rdquo; (P1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At work, I may interact once, but then I don\u0026rsquo;t want to see or talk to them again\u0026mdash;man or woman. I just avoid it altogether.\u0026rdquo; (P7)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Difficulty Initiating or Sustaining Social Relationships\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants acknowledged significant difficulties in initiating or maintaining interpersonal relationships. Many attributed this to internal barriers and preferred others to take the lead.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve never started a relationship myself\u0026mdash;never initiated a friendship. Even if I\u0026rsquo;m with someone all day, I never begin a conversation. I know I should make the effort, but I just can\u0026rsquo;t.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Transformative Experiences of Social Reconnection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite persistent withdrawal, several participants described meaningful transformations in their social skills through experiences such as employment or community engagement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Since I started working for my boss, people say I\u0026rsquo;ve become more outgoing, more sociable. I\u0026rsquo;ve improved in connecting with others.\u0026rdquo; (P5)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Once I started working in sales, I began to overcome my shyness\u0026mdash;I could talk to all kinds of people.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 4: Dysfunctional Engagement with the Social Environment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported a range of cognitive difficulties\u0026mdash;including confusion, reduced attention, memory problems, and general cognitive slowing\u0026mdash;during social, academic, and occupational interactions. These impairments hindered effective communication, compromised social roles, and contributed to a sense of disconnection from one\u0026rsquo;s environment. This theme includes five subthemes:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Impaired Comprehension of Social Cues\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSlowed cognitive processing affected participants\u0026rsquo; ability to interpret verbal and non-verbal social cues, often leading to misunderstandings and social withdrawal.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I feel like I\u0026rsquo;ve become extremely slow. I don\u0026rsquo;t understand what people say anymore. My brain slows down\u0026mdash;I hear what they say, but I can\u0026rsquo;t grasp the meaning. If I understood, I\u0026rsquo;d laugh or respond, but I just can\u0026rsquo;t.\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Inconsistent Attention During Interactions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSustained attention during conversations or multitasking was reported as difficult, leading to fragmented listening and disengagement.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When someone talks for a long time, I just can\u0026apos;t retain what they\u0026apos;re saying. I suddenly feel drained, and I lose track of the conversation.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I see women who manage both work and home. For me, it\u0026rsquo;s hard. If I\u0026rsquo;m working, I can\u0026rsquo;t also hold a conversation\u0026mdash;it overwhelms me.\u0026rdquo; (P5)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Memory Loss and Social Disconnection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants reported cognitive lapses such as memory loss and confusion, which contributed to strained relationships and a profound sense of social disconnection.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Before my wife left, she tried to talk seriously about our situation. She eventually got frustrated and left, saying, \u0026lsquo;You\u0026rsquo;re not listening. You don\u0026rsquo;t care.\u0026rsquo; I told her I was listening, but when she asked what she\u0026rsquo;d said\u0026mdash;I couldn\u0026rsquo;t remember.\u0026rdquo; (P1)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026rsquo;t even recognize my sisters or parents anymore. I\u0026rsquo;m afraid I\u0026rsquo;ll get lost if I go out alone. Maybe I\u0026rsquo;ve just had too much on my mind\u0026mdash;I feel like I\u0026rsquo;ve forgotten everything over the past few years.\u0026rdquo; (P6)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4 Decline in Learning Ability in Work and School\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCognitive difficulties such as poor memory retention and slowed learning capacity were described as significant barriers to educational and occupational engagement, often leaving participants feeling inadequate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I went to several universities, but I dropped out. I started with software engineering, but I only passed two courses. Then I switched to chemistry\u0026mdash;that didn\u0026rsquo;t work either. I wanted to study, but nothing would stick.\u0026rdquo; (P8)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I couldn\u0026rsquo;t do any job properly. Even simple math problems I used to solve\u0026mdash;I can\u0026rsquo;t anymore. I wanted to keep studying, but the medication messed with my focus. I couldn\u0026rsquo;t even read properly.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.5 Declining Accuracy as a Barrier to Job Retention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReduced cognitive precision and attentional decline were commonly cited as reasons for job loss or reassignment to fewer demanding roles.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My company job required a lot of precision. I felt like I was learning too slowly and only doing a fraction of what was expected. Eventually, I was fired. But I managed better with simpler jobs like tiling or manual labor.\u0026rdquo; (P10)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme 5: The Family\u0026rsquo;s Role in Psychosocial Rehabilitation and Identity Reconstruction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants described their familial relationships as complex and ambivalent. While families often served as essential sources of emotional support, they could also act as sources of psychological strain. Mismatches between family expectations and participants\u0026apos; actual capacities contributed to feelings of guilt, rejection, and a fractured sense of identity. This theme consists of five subthemes:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.1 Loss of Familial Role and Caregiver Identity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany participants reported being unable to fulfill traditional roles such as parenting or caregiving, leading to emotional distance from their familial identities.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was so depressed that I worried how my little girl would grow up. My sister raised her\u0026mdash;I couldn\u0026rsquo;t. Even when my grandkids visit, I can\u0026rsquo;t do anything for them. I can\u0026rsquo;t even lift them or bring them things.\u0026rdquo; (P6)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I don\u0026rsquo;t do most of my tasks myself. My parents tell me what to do\u0026mdash;like reminding me to eat or to hurry in the shower. They\u0026rsquo;re always telling me to be faster.\u0026rdquo; (P8)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.2 Conflict Between Family Expectations and Functional Reality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnrealistic familial expectations were described as a source of emotional distress, particularly when they ignored participants\u0026apos; cognitive or emotional limitations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Whenever I say I can\u0026rsquo;t help around the house, they say I\u0026rsquo;m lazy. It makes me cry. They say I do things poorly or slowly\u0026mdash;all of it weighs heavily on me. I don\u0026rsquo;t feel comfortable at home.\u0026rdquo; (P6)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My dad mostly scolds me for not working. Nowadays, getting a job is hard, and keeping one is even harder. Just thinking about how I can\u0026rsquo;t earn my own living causes me so much anxiety.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.3 The Dual Role of Family: Support or Pressure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamilies were perceived as either supportive or pressurizing\u0026mdash;some offering encouragement, while others undermined autonomy or disregarded participants\u0026apos; needs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My sister checks in on me all the time and gives me my medications. My older brother is incredibly kind\u0026mdash;he keeps telling me to find a job or finish school so I don\u0026rsquo;t waste my life.\u0026rdquo; (P8) \u0026ldquo;My entire medication routine was disrupted because of my mom. I was following what the doctor prescribed, but I don\u0026rsquo;t know what she was thinking\u0026mdash;she just took them away.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.4 Experiences of Marginalization Within the Family\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeveral participants reported feeling excluded, devalued, or invisible within the family structure, reinforcing a sense of emotional isolation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve never had a real role in my family or society. I was like a background character in a movie\u0026mdash;no one remembers the extras, just the stars. That\u0026rsquo;s who I was.\u0026rdquo; (P4)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;When I\u0026rsquo;m watching something, I like, they switch the channel or turn off the TV without telling me. Things like that really upset me.\u0026rdquo; (P9)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My dad lets my younger brother drive the car, but not me. I feel like they value him more than they do me.\u0026rdquo; (P3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5.5 Redefining One\u0026rsquo;s Role\u0026mdash;Despite Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite limitations, some participants actively sought to reclaim their identity through meaningful roles within the family, particularly as caregivers or emotional anchors.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I may not do much, but I need to be here. If my parents need a doctor\u0026rsquo;s visit, I\u0026rsquo;m the one who takes them.\u0026rdquo; (P10)\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I feel like I was reborn at 22. It might sound dramatic, but this is the real me now. I\u0026rsquo;m constantly busy with my parents\u0026rsquo; medical needs.\u0026rdquo; (P4)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study employed a descriptive phenomenological approach to explore the lived experiences of individuals with schizophrenia concerning their functioning within the domain of social cognition. The findings suggest that functioning is not merely a behavioral or performance-based construct, but rather a dynamic, multidimensional process rooted in identity formation, emotional meaning, and interpersonal connection.\u003c/p\u003e\n\u003cp\u003eEmployment emerged as a central context for self-reconstruction and the reestablishment of social identity\u0026mdash;eliciting experiences of self-worth, belonging, hope, and psychological relief, while also evoking nostalgia for a previously healthier state of being.\u003c/p\u003e\n\u003cp\u003eDespite receiving varying levels of support, participants\u0026apos; perceived functioning was frequently hindered by inconsistent motivation, emotional and cognitive fatigue, psychological vulnerability, and core limitations in concentration, memory, and learning. These internal constraints often rendered social interactions challenging or even threatening, contributing to a pervasive sense of psychosocial isolation.\u003c/p\u003e\n\u003cp\u003eThe family system played a dual role\u0026mdash;providing emotional and practical support on one hand, and imposing pressure through conflicting expectations or the withdrawal of familial roles on the other. In some cases, participants were able to redefine their role within the family, thereby supporting processes of identity restoration and social reintegration.\u003c/p\u003e\n\u003cp\u003eThese findings align with Cotter et al. (2019), who identified feelings of inefficacy and social withdrawal as central components of functioning among individuals at high risk for psychosis\u0026nbsp;(49). However, while Cotter and colleagues focused predominantly on internalized stigma and psychological distress, the current study highlights broader contextual influences, including cultural expectations, family dynamics, and employment environments. Similar perspectives are echoed in the work of Cowman et al. (2021) and\u0026nbsp;Javed and Charles\u0026nbsp;(2018), both of whom underscore the critical role of social cognition in psychosocial functioning (17, 50).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTaken together, these findings indicate the need to move beyond static, skills-based models of functioning. Instead, a dynamic, socially embedded, and meaning-centered framework is warranted\u0026mdash;one that resonates with contemporary occupational therapy theories and recovery-oriented models of care (13, 15, 51).\u003c/p\u003e\n\u003cp\u003eThe following section outlines the main themes derived from the phenomenological analysis.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eRestoring Identity through Employment\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eParticipants described employment as a meaningful, restorative, and socially affirming experience\u0026mdash;one that contributed to self-recognition, emotional regulation, and reintegration into social life. Reflecting on past professional roles and accomplishments often evoked a temporary resurgence of self-esteem and purpose. However, this process was frequently tinged with nostalgia for previous identities and grief over lost social roles.\u003c/p\u003e\n\u003cp\u003eThese findings align with the perspectives of Troub\u0026eacute; (2021) and Drake (2021), who conceptualize employment not merely as a structural necessity, but as a narrative tool that restores order, normalcy, and meaning in one\u0026apos;s life (52, 53). Similarly, studies by Doroud et al. (2015), Elraz (2018), Chauhan et al. (2022), and Hoier et al. (2024) underscore the role of employment\u0026mdash;including in its basic or voluntary forms\u0026mdash;as a key mechanism for identity reconstruction (31, 54-56).\u003c/p\u003e\n\u003cp\u003eA distinctive contribution of the present study lies in its differentiation between \u003cem\u003ereconstructing a former identity\u003c/em\u003e\u0026mdash;as observed in non-Western contexts\u0026mdash;and \u003cem\u003egenerating a new identity\u003c/em\u003e, more commonly reported in Western settings. This distinction emphasizes the critical role of cultural context in shaping recovery trajectories.\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eThe Struggle Between Motivation and Functional Barriers\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eParticipants portrayed functioning as a nonlinear, unstable process\u0026mdash;oscillating between periods of intrinsic motivation and episodes of psychological exhaustion. External support, particularly interpersonal encouragement and flexible opportunities, was identified as essential for restoring self-efficacy. Conversely, internal limitations such as diminished willpower and emotional fatigue consistently hindered sustained performance.\u003c/p\u003e\n\u003cp\u003eThis dynamic tension echoes findings from Maddineshat et al. (2022), who emphasized the struggle between aspiration and incapacity among individuals with schizophrenia in Iran (57). Emotional support and adaptable work conditions were highlighted as vital enablers of re-engagement with meaningful roles.\u003c/p\u003e\n\u003cp\u003eThese qualitative findings are also reinforced by quantitative evidence from Bechi et al. (2017), Wang et al. (2020), and Ang et al. (2020), who differentiate between functional \u003cem\u003ecapacity\u003c/em\u003e and real-world \u003cem\u003eperformance\u003c/em\u003e, pointing to the essential role of contextual and interpersonal factors beyond cognitive ability (11, 58, 59).\u003c/p\u003e\n\u003cp\u003eThe convergence of qualitative and quantitative data underscores the necessity of refining both the definition and operationalization of functional indicators in clinical practice and research.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eLiving on the Margins of Social Engagement: Cognitive\u0026ndash;Emotional Isolation\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFor many participants, social interaction was described as strenuous, unstable, and anxiety-provoking. Their social identities\u0026mdash;shaped from childhood through patterns of withdrawal, silence, and difficulties in initiating or sustaining communication\u0026mdash;were not merely expressions of personality, but rather unconscious adaptations to the cognitive and emotional demands of interpersonal engagement. This detachment was often accompanied by a sense of threat, futility, and emotional exhaustion. Nevertheless, participation in supportive environments or occupational settings occasionally facilitated the gradual reestablishment of social connectedness.\u003c/p\u003e\n\u003cp\u003eThese patterns align with phenomenological conceptualizations of the \u0026quot;social self.\u0026quot; Raballo and Kruger (2011) note that early indicators of vulnerability to psychosis include a weakened sense of social presence and heightened sensitivity in interpersonal contexts\u0026nbsp;(60). These disruptions, which are often rooted in deficits in Theory of Mind (ToM) and emotional decoding\u003cspan dir=\"RTL\"\u003e\u0026nbsp;(61)\u003c/span\u003e, were evident in the participants\u0026apos; narratives, manifesting as withdrawal and cognitive fatigue during social encounters. A recent systematic review by Taban et al. (2024) reinforces this view, emphasizing that community-based mental health services (CBMHS)\u0026mdash;including social skills training and ongoing family engagement\u0026mdash;can meaningfully reduce psychosocial isolation and enhance interpersonal functioning in individuals with schizophrenia (62).\u003c/p\u003e\n\u003col start=\"4\"\u003e\n \u003cli\u003e\u003cstrong\u003eDysfunctional Engagement with the Social Environment\u0026nbsp;\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eParticipants often viewed social environments not as opportunities for growth, but as overwhelming spaces marked by confusion, cognitive overload, and emotional distress. Impairments in memory, attention, and learning hindered their ability to interpret social cues, engage in conversation, and participate in meaningful interpersonal exchanges. These difficulties disrupted their emotional, academic, and occupational functioning and further entrenched a sense of cognitive\u0026ndash;emotional detachment.\u003c/p\u003e\n\u003cp\u003eThese findings are supported by international evidence. Research by Wright et al. (2019) and Thibaudeau et al. (2021) indicates that deficits in ToM and challenges in decoding emotional and social cues\u0026mdash;such as intonation, facial expression, and interactional rhythm\u0026mdash;are significant contributors to social withdrawal and perceived rejection\u0026nbsp;(63, 64). The present study highlights how such cognitive limitations act as critical barriers to social participation, educational attainment, and sustained employment for individuals living with schizophrenia.\u003c/p\u003e\n\u003col start=\"5\"\u003e\n \u003cli\u003e\u003cstrong\u003eThe Family\u0026rsquo;s Role in Psychosocial Rehabilitation and Identity Reconstruction\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eParticipants\u0026rsquo; narratives highlighted the dual role of family in their recovery journeys. For some, family functioned as a source of emotional support and served as a platform for reestablishing social roles. For others, however, it became a source of psychological strain\u0026mdash;manifested through controlling behaviors, unrealistic expectations, and increasing marginalization within the family unit.\u003c/p\u003e\n\u003cp\u003eThese tensions often emerged from a misalignment between the individual\u0026rsquo;s cognitive-emotional capacities and the social demands imposed by the family, resulting in feelings of anxiety, guilt, or rejection. Nevertheless, several participants were able to redefine their familial identity by assuming secondary roles and responsibilities, thereby restoring a sense of belonging and personal value.\u003c/p\u003e\n\u003cp\u003eFrom a social psychological perspective, attributional styles significantly influence how support is perceived. When familial support does not align with the individual\u0026rsquo;s psychological needs, it may be experienced not as nurturing but as an additional source of stress (17). This notion was echoed in participants\u0026rsquo; accounts, reinforcing the importance of adapting family support to match the individual\u0026apos;s cognitive and emotional readiness.\u003c/p\u003e\n\u003cp\u003eThese findings are consistent with studies by Rezaie and Phillips (2020) in Iran and Ma et al. (2023) in China, both of which emphasize the culturally ambivalent nature of family roles in the recovery process (65, 66). Further evidence from McFarlane et al. (2016), Caqueo-Ur\u0026iacute;zar et al. (2017), and Samuel et al. (2020) highlights the critical importance of family involvement in psychosocial rehabilitation (67-69).\u003c/p\u003e\n\u003cp\u003eThe distinct contribution of this study lies in its focus on the subjective perception\u003cstrong\u003e\u0026nbsp;of\u0026nbsp;\u003c/strong\u003esupport versus pressure, interpreted within a culturally situated psychosocial framework\u0026mdash;a nuance often underexplored in cross-cultural mental health research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA key methodological challenge in this study was the participants\u0026rsquo; difficulty in grasping the concept of \u003cem\u003esocial cognition\u003c/em\u003e, a limitation also noted by Uchino et al. (2022)\u0026nbsp;(46). Given the absence of a universally accepted definition of this construct, a descriptive phenomenological design was deemed most appropriate. The interview guide was developed based on the conceptual model proposed by Penn et al. (1997), with bracketing techniques integrated according to the methods of Gearing (2004)\u0026nbsp;(24, 44).\u003c/p\u003e\n\u003cp\u003eAlthough the sample size was relatively small, this aligns with the conventions of phenomenological research, which prioritizes the depth and richness of subjective experience over statistical representativeness.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNevertheless, several sample-specific features\u0026mdash;such as participants being in the recovery phase, receiving family support, and presenting with mild symptom severity (as indicated by PANSS)\u0026mdash;may constrain the generalizability of findings to other subpopulations. Notably, hesitations expressed by patients and guardians during recruitment highlight potential trust-related barriers, which could limit the applicability of results to individuals with more severe or chronic presentations, including those with paranoia or homelessness.\u003c/p\u003e\n\u003cp\u003eFurthermore, because the study focused specifically on lived experiences within the domain of social cognition, other relevant facets of functional performance may have remained underexplored during interviews.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the findings offer valuable implications for the development of psychosocial, occupational, and rehabilitative interventions, particularly within sociocultural contexts comparable to the study setting.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings underscore that functioning in schizophrenia is a dynamic and multidimensional phenomenon, situated at the intersection of psychological processes, social relationships, and cultural norms. Functioning should not be construed merely as a measure of cognitive ability or symptom severity; rather, it reflects an individual\u0026rsquo;s evolving effort to reconstruct identity in the face of internal vulnerabilities and external constraints.\u003c/p\u003e\n\u003cp\u003eSocial cognition\u0026mdash;encompassing intention recognition, attributional style, and emotional regulation\u0026mdash;emerges as a critical determinant of relational quality and everyday social functioning. Furthermore, employment operates not only as a source of economic stability but also as a key arena for self-renewal, belongingness, and role redefinition.\u003c/p\u003e\n\u003cp\u003eYet, factors such as emotional fatigue, diminished volition, and unresolved family dynamics contribute to the fragility and non-linearity of this reconstruction process. Accordingly, a robust understanding of functioning in schizophrenia must adopt a biopsychosocial lens that integrates identity, relational, and cultural dimensions into clinical frameworks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePractical Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eMultidimensional Rehabilitation Approaches\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eRecovery-oriented interventions should extend beyond the enhancement of neurocognitive performance to include identity-based rehabilitation. Interventions that incorporate personal narrative, role restoration, and meaning-making strategies may be more effective in supporting long-term psychosocial recovery (54, 55).\u003c/p\u003e\n\u003col start=\"2\"\u003e\n \u003cli\u003e\u003cstrong\u003eCulturally-Informed Family Empowerment\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFamily psychoeducation programs should aim to reduce coercive caregiving styles and instead cultivate supportive, autonomy-promoting dynamics\u0026mdash;particularly in collectivist cultures where family influence is profound. Adapting these interventions to sociocultural norms may enhance both relational cohesion and treatment adherence.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n \u003cli\u003e\u003cstrong\u003eAccess to Meaningful and Adaptive Employment\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eCreating access to flexible, low-demand, or voluntary work opportunities can facilitate re-engagement with routine, social integration, and identity recovery, particularly for individuals in early or fluctuating stages of remission (58, 59).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch Recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo further elucidate the complex relationship between social cognition and functional outcomes, future studies should employ mixed-methods designs across diverse cultural contexts. In particular, research is needed to address the rehabilitation needs of marginalized and high-risk populations\u0026mdash;such as those with chronic symptoms, experiences of familial estrangement, or housing insecurity\u0026mdash;in order to develop more inclusive and targeted models of psychosocial care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article was derived from a PhD thesis in nursing, approved by the Research Department of Mashhad University of Medical Sciences under code 980593. We would like to express our sincere gratitude to the esteemed research department of the university, as well as to the patients, their families, and all individuals who contributed to the execution of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAS, HKM, and MKL conceptualized and organized the study. AS conducted the interviews under the supervision of HKM, MKL, and FH. AS, HKM, and HNA carried out data analysis. The preliminary manuscript was prepared by AS and was revised by the other authors. All authors have reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was financially supported by the Research Deputy of Mashhad University of Medical Sciences, as well as a\u0026nbsp;grant\u0026nbsp;from\u0026nbsp;author\u0026nbsp;HKM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eA\u003cspan dir=\"RTL\"\u003evailability\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets gathered and analyzed during this study are not publicly available due to ethical constraints regarding patient data and anonymity. however, they can be obtained upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research forms part of a PhD thesis in nursing, approved by the Ethics Committee of Mashhad University of Medical Sciences under code IR.MUMS.NURSE.REC.1398.090, which is the Internal Review Board (IRB) for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from both the participants and their legal guardians, assuring them of their right to withdraw from the study at any time and that their information would remain confidential. The principles of the Helsinki Declaration were adhered to throughout this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003enot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe funding source has approved the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFerrari AJ, Santomauro DF, Herrera AMM, Shadid J, Ashbaugh C, Erskine HE, et al. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. 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Qualitative health research. 2004;14(5):726-35.\u003c/li\u003e\n\u003cli\u003eSpaulding S. Phenomenology of social cognition. Erkenntnis. 2015;80(5):1069-89.\u003c/li\u003e\n\u003cli\u003eGallagher S, Psychology. In defense of phenomenological approaches to social cognition: Interacting with the critics. Review of Philosophy and Psychology. 2012;3(2):187-212.\u003c/li\u003e\n\u003cli\u003eReiners GM, Care. Understanding the differences between Husserl\u0026rsquo;s (descriptive) and Heidegger\u0026rsquo;s (interpretive) phenomenological research. Journal of Nursing and Care. 2012;1(5):1-3.\u003c/li\u003e\n\u003cli\u003ePicton CJ, Moxham L, Patterson C. The use of phenomenology in mental health nursing research. Nurse researcher. 2017;25(3):14-8.\u003c/li\u003e\n\u003cli\u003eWillis DG, Sullivan-Bolyai S, Knafl K, Cohen MZ. Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research. 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Community mental health journal. 2022;58(2):277-87.\u003c/li\u003e\n\u003cli\u003eMaddineshat M, Cheraghi F, Ghaleiha A, Khalafbeigi M, Sadeghian E. Facilitators and Barriers of Return to Work in Working People with Serious Mental Illness: A Qualitative Study. Indian journal of psychological medicine. 2022;44(2):120-8.\u003c/li\u003e\n\u003cli\u003eWang SP, Wang JD, Chang JH, Wu BJ, Wang TJ, Sun HJ. Symptomatic remission affects employment outcomes in schizophrenia patients. BMC psychiatry. 2020;20(1):219.\u003c/li\u003e\n\u003cli\u003eAng MS, Rekhi G, Lee J. Vocational Profile and Correlates of Employment in People With Schizophrenia: The Role of Avolition. Frontiers in psychiatry. 2020;11:856.\u003c/li\u003e\n\u003cli\u003eRaballo A, Krueger J. Phenomenology of the social self in the prodrome of psychosis: from perceived negative attitude of others to heightened interpersonal sensitivity. European psychiatry : the journal of the Association of European Psychiatrists. 2011;26(8):532-3.\u003c/li\u003e\n\u003cli\u003eDeste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia. Frontiers in psychiatry. 2020;11:524.\u003c/li\u003e\n\u003cli\u003eTaban M, Nooraeen S, Tanha K, Moradi-Lakeh M, Malakouti SK. Effectiveness and cost-effectiveness of community-based mental health services for individuals with severe mental illness in Iran: a systematic review and meta-analysis. BMC psychiatry. 2024;24(1):256.\u003c/li\u003e\n\u003cli\u003eWright AL, Phillips LJ, Bryce S, Morey-Nase C, Allott K. Subjective experiences of cognitive functioning in early psychosis: a qualitative study. (Psychosis) Psychological, Social and Integrative Approaches. 2019;11(2):1-12.\u003c/li\u003e\n\u003cli\u003eThibaudeau \u0026Eacute;, Cellard C, Turcotte M, Achim AM. Functional Impairments and Theory of Mind Deficits in Schizophrenia: A Meta-analysis of the Associations. Schizophrenia bulletin. 2021;47(3):695-711.\u003c/li\u003e\n\u003cli\u003eRezaie L, Phillips D. Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study. Journal of psychiatric and mental health nursing. 2020;27(6):752-62.\u003c/li\u003e\n\u003cli\u003eMa M, Shi Z, Chen Y, Ma X. Recovery journey of people with a lived experience of schizophrenia: a qualitative study of experiences. BMC psychiatry. 2023;23(1):468.\u003c/li\u003e\n\u003cli\u003eMcFarlane WR. Family Interventions for Schizophrenia and the Psychoses: A Review. Family process. 2016;55(3):460-82.\u003c/li\u003e\n\u003cli\u003eCaqueo-Ur\u0026iacute;zar A, Rus-Calafell M, Craig TK, Irarrazaval M, Urz\u0026uacute;a A, Boyer L, et al. Schizophrenia: Impact on Family Dynamics. Current psychiatry reports. 2017;19(1):2.\u003c/li\u003e\n\u003cli\u003eSamuel R, S A, Jacob KS. A Qualitative Study Exploring the Lived Experience of Unemployment Among People with Severe Mental Illness. Indian journal of psychological medicine. 2020;42(5):435-44.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Interview guidelines\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable dir=\"\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 626px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe interviews were guided by open-ended, phenomenologically grounded questions designed to explore participants\u0026rsquo; lived experiences of functioning within the domain of social cognition:\u003c/p\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli dir=\"LTR\"\u003eWhen you reflect on your overall functioning in life, how would you describe your experience?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eCan you recall a specific situation in which you became aware of how you were functioning?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eHow do you think others perceive your ability to function?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eHave you experienced a moment when someone formed a specific impression of your functioning? Could you describe it?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eWhat has your experience of functioning been like during social interactions?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eCan you describe an instance in which your functioning influenced your communication or relationships with others?\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003eIs there anything else you would like to share about your experience of functioning in daily or social life?\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp dir=\"LTR\"\u003e\u003cstrong\u003eFollow-up prompts\u003c/strong\u003e were used to encourage deeper reflection and richer narratives:\u003c/p\u003e\n \u003cul type=\"disc\"\u003e\n \u003cli dir=\"LTR\"\u003e\u003cem\u003e\u0026ldquo;Could you elaborate on that?\u0026rdquo;\u003c/em\u003e\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e\u003cem\u003e\u0026ldquo;What was that experience like for you?\u0026rdquo;\u003c/em\u003e\u003c/li\u003e\n \u003cli dir=\"LTR\"\u003e\u003cem\u003e\u0026ldquo;How did you feel in that moment?\u0026rdquo;\u003c/em\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp dir=\"RTL\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Participant Characteristics (n = 10)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eCoding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003egender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eEducation Level \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eoccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003epositive symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003esocio-economic status\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eBank Feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9th Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eTea Server\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9th Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eAssociate Degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eKnitting (Doll Making)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9th Grade \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eFreelance Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eSome College\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eFreelance work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eAssociate Degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 55px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eHigh School \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eHousehold Chores\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eTable 3\u003cspan dir=\"RTL\"\u003e:\u0026nbsp;\u003c/span\u003eThe Extracted Themes and Subthemes\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003eThemes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eSubthemes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003eRestoring Identity Through Employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eRecalling Past Roles and Competencies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eEmployment as a Source of Usefulness and Social Connection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eEmployment as a Psychological Soothing Agent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eA Sense of Disconnection from the Healthier Former Self\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003eThe Struggle Between Motivation and Functional Barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eSupport from Others as a Cornerstone of Functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eEmotional Fatigue and Declining Drive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eBright Days, Dark Days: The Nonlinear Path of Recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eLiving on the Margins of Social Engagement: Cognitive\u0026ndash;Emotional Isolation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eA Quiet Social Identity Rooted in Childhood\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eEmotional Exhaustion and Preference for Solitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eDifficulty Initiating or Sustaining Social Relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eTransformative Experiences of Social Reconnection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003eDysfunctional Engagement with the Social Environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eImpaired Comprehension of Social Cues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eInconsistent Attention During Interactions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eMemory Loss and Social Disconnection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eDecline in Learning Ability in Work and School\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eDeclining Accuracy as a Barrier to Job Retention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 252px;\"\u003e\n \u003cp\u003eThe Family\u0026rsquo;s Role in Psychosocial Rehabilitation and Identity Reconstruction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eLoss of Familial Role and Caregiver Identity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eConflict Between Family Expectations and Functional Reality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eThe Dual Role of Family: Support or Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eExperiences of Marginalization Within the Family\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eRedefining One\u0026rsquo;s Role\u0026mdash;Despite Limitations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Social cognition, functioning, schizophrenia, descriptive phenomenology, qualitative research, Iran","lastPublishedDoi":"10.21203/rs.3.rs-6528322/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6528322/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Impairments in social cognition are recognized as a key factor contributing to functional disabilities in individuals with schizophrenia. This study aims to explore patients’ lived experiences of functioning within the context of social cognition to gain a deeper and more nuanced understanding of this relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA descriptive phenomenological approach was employed. Ten discharged patients from the largest psychiatric hospital in Khorasan Razavi Province, Iran, were selected using purposive sampling. Data were collected through in-depth, semi-structured interviews and analyzed based on Amedeo Giorgi’s phenomenological method.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe analysis identified five overarching themes and 21 subthemes: (1) Restoring Identity Through Employment; (2) The Struggle Between Motivation and Functional Barriers; (3 Living on the Margins of Social Engagement: Cognitive–Emotional Isolation; (4) Dysfunctional Engagement with the Social Environment; and (5) The Family’s Role in Psychosocial Rehabilitation and Identity Reconstruction. Functioning within the domain of social cognition was revealed to be a multifaceted and dynamic process, marked by internal struggles, fluctuating motivation, and sustained social withdrawal. Employment emerged as a vital avenue for rebuilding a sense of self, while the family context acted as both a facilitating and constraining force in the psychosocial recovery journey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Functioning in individuals with schizophrenia reflects an ongoing, adaptive process of identity reconstruction, shaped by internal conflict, cognitive-emotional detachment, and impaired social engagement. Employment and family support are key determinants in promoting functional recovery and personal transformation within the framework of social cognition.\u003c/p\u003e","manuscriptTitle":"Understanding Functioning in Schizophrenia: A Phenomenological Study in Social Cognition","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-12 08:38:03","doi":"10.21203/rs.3.rs-6528322/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-15T12:15:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T08:28:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T12:24:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232692604443398054167011387307149072912","date":"2025-06-17T12:08:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"303991604146271632353652023138501050234","date":"2025-06-10T08:17:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-10T08:09:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T09:10:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-26T04:06:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-26T04:04:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2025-04-25T10:57:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2e03e77-047d-46a4-9567-59bb939bf6cf","owner":[],"postedDate":"June 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:05:14+00:00","versionOfRecord":{"articleIdentity":"rs-6528322","link":"https://doi.org/10.1186/s12888-025-07290-5","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2025-09-30 15:57:15","publishedOnDateReadable":"September 30th, 2025"},"versionCreatedAt":"2025-06-12 08:38:03","video":"","vorDoi":"10.1186/s12888-025-07290-5","vorDoiUrl":"https://doi.org/10.1186/s12888-025-07290-5","workflowStages":[]},"version":"v1","identity":"rs-6528322","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6528322","identity":"rs-6528322","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}