Narrative Analysis of Depressed Patients’ Experiences of Personal Worthlessness

Abstract

This study aimed to analyze depressed patients’ narratives of personal worthlessness and to explain the emotional, relational, and meaning-making patterns through which this experience is constructed. This qualitative study was conducted using a narrative analysis approach. The participants were 22 patients with major depressive disorder who had referred to counseling and psychological service centers in Tehran, Iran. They were selected through purposive sampling. Inclusion criteria were having a clinical diagnosis of depression by a psychiatrist or clinical psychologist, reporting persistent feelings of personal worthlessness, being able to participate in an in-depth interview, and providing informed consent. Data were collected through semi-structured interviews and continued until theoretical saturation was achieved. All interviews were audio-recorded, transcribed verbatim, repeatedly reviewed, and analyzed using NVivo software. The analytic process included initial coding, narrative reconstruction, constant comparison, theme development, and organization of participants’ accounts into major narrative categories. The analysis revealed four main categories: “erosion of self-image and the narrative of failure,” “internalized blame and harsh self-judgment,” “feeling like a burden and withdrawal from relationships,” and “blocked future and loss of meaningful striving.” Participants described worthlessness not merely as a negative thought but as a pervasive self-narrative that connected the past with failure, the present with shame, and the future with hopelessness. Their accounts showed that personal worthlessness was intensified through self-criticism, perceived social comparison, emotional isolation, and the inability to imagine a valued future self. The findings suggest that personal worthlessness in depression is a multilayered, narrative, and relational phenomenon shaped by self-criticism, shame, interpersonal disconnection, and a disrupted sense of future. Therapeutic work with depressed patients should therefore move beyond symptom reduction and address reconstruction of self-narratives, development of self-compassion, reduction of internalized blame, and restoration of personal value within meaningful relationships.