In this collection of essays on the social cognitive aspects of research
and therapy in schizophrenia, the editors aim to persuade the reader that a
better understanding of schizophrenia can be gained by dealing at the same time
with the cognitive deficits and the social dysfunctions that schizophrenic
subjects exhibit. The underlying idea of all the contributions is that problems
which are present in one dimension of a subject’s cognition (e.g. the
information processing system) might be related to problems that exist in another dimension
(e.g. interpersonal relations). For instance, people might be better at
understanding and resolving interpersonal problems when they have fewer
information processing deficits.

The collection is meant for a broad audience, including clinicians and
researchers interested in schizophrenia, philosophers of mind and
epistemologists. The variety of themes contained in this volume is reflected in
the tripartite division of the contributions. Part I reviews the evidence for
the importance of social cognition in the understanding of schizophrenia. In
Part II, some treatments of schizophrenia that emerge from the social cognitive
model are discussed. In Part III, the editors focus on future directions for
research on schizophrenia from a social cognitive point of view.

In this brief review, I shall concentrate on two papers that appear in
the first part of the collection, that is understandably the most fully
developed. Both papers concern the explanation of some schizophrenic behaviors.
I shall focus on these two papers because I believe that, in the attempt to
explain phenomena like delusions, we can best appreciate how cognitive deficits
can interfere with social skills.

Bentall (in “Social Cognition and Delusional Beliefs” pp. 123-148)
challenges the traditional view of delusions as a mysterious phenomenon. He
argues that they are not sharply distinguishable from ordinary beliefs and that
they can be understood by reference to the context in which the subject forms
and maintains her delusional belief.

Bentall’s model involves six elements: 1) the event in the world that
is responsible for the formation of the delusional belief (realistic element),
2) the subject’s perception of that event, 3) the subject’s selective
attention, 4) the subject’s inferential capacities, 5) the formation of the delusional
belief on the basis of (2), (3) and (4), and 6) the maintenance or revision of
the delusional belief when new evidence becomes available.

What Bentall does in some detail is offer evidence that in the
delusional subject things can go wrong at the level of perception, attention,
inference and maintenance or revision. For instance, while some real experience
of the subject might be the origin of the delusion, the way the subject
perceives the event might be anomalous (factor 2). In Capgras subjects, subjects
who believe that some of their close relatives, or their spouses, have been
replaced by impostors, the capacity to recognize familiar faces is impaired. In
particular, they see the face of their relative or spouse as identical or very
similar to the familiar face, but they feel no affective response to that face.

Let me briefly mention other two examples. In experimental situations,
Cotard subjects, subjects who believe they are dead, attend excessively to
words related to death than subjects who are not affected by this delusion
(factor 3). Most delusional subjects exhibit biases in the evaluation of
evidence (factor 6). In fact, they tend to pay more attention than control
groups to evidence that confirms what they already believe or evidence that has
been presented recently.

I am very sympathetic to Bentall’s idea that delusions "exist on a
continuum with ordinary beliefs and attitudes" (p. 124) and I find his
explanatory model a convincing picture of what can go wrong in delusional
systems. His conclusion is that the formation and maintenance of delusions can
be explained by reference to anomalous experiences, attributional processes,
defective theory of mind, selective attention and ‘impulsive’ evaluation of
evidence. Problems in these domains have been found in delusional subjects,
though some factors might be more crucial to the explanation of one kind of
delusion than another. According to Bentall, it is an open question whether one
or more factors need to be present every time a delusional belief is formed and
maintained.

Although Bentall’s analysis is scrupulous and insightful, as far as I
can see, no much weight is given to the social cognitive framework. The only
clear connection between Bentall’s conclusions and the general theme of the collection
is the hypothesis that delusional subjects might be impaired in their theory of
mind skills, that is, in their capacity to ascribe mental states to other
people. But evidence in favor of this hypothesis has been gathered within the
more traditional approach of information processing.

While Bentall’s paper might be seen as marking the transition between
two research projects, Corcoran’s (“Theory of Mind and Schizophrenia” pp.
149-174) is more radically orientated towards an innovative way of thinking
about schizophrenia. The main claim made in her contribution is that
schizophrenia is characterizable as a failure of theory of mind, or more
precisely, a "disorder of metarepresentation". The schizophrenic
subject has a limited capacity to ascribe mental states (such as beliefs,
desires, intentions, emotions) to herself and others. This capacity is
obviously very important in the everyday context of interpersonal relations, as
it allows the subject to interact with others appropriately in different
situations by predicting their reactions and interpreting what they think and
how they feel by simply looking at their facial expressions or listening to
what they say.

Limitations in this area can be responsible for some phenomena like
thought insertion, poverty of action and delusions of persecution. When a
schizophrenic subject claims that someone has inserted a thought in her mind,
for example, what might have happened is that the subject did not correctly monitor
the production of her own thoughts and ended up ascribing one of her own
thoughts to someone else.

The main body of evidence Corcoran refers to concerns subjects with
negative signs (e.g. abulia, social withdrawal) and paranoid subjects. These
subjects fail tasks in which they are required to infer other people’s
intentions. More specifically, they do not recognize when people ‘drop a hint’.
The task, which is typically failed, consists of a vignette where two
characters, A and B, are having a conversation. One of the characters, B, drops
a heavy hint. The subject has to understand what B really means, even when B’s
intention is not immediately transparent from the literal meaning of the
sentence uttered by B. Paranoid subjects and subjects with negative signs
perform significantly worse than control groups on this task. Other similarly
striking results are obtained in second order false belief tasks and tasks in
which the subject has to understand implicit conversational rules given the
context.

Corcoran’s hypothesis, that in schizophrenia like in autism, theory of
mind skills are seriously impaired, is of great interest for both theoretic
models of schizophrenia and therapeutic purposes. However, at this stage, it is
too early for definite conclusions, since more evidence needs to be gathered.
The new interest in social cognition might offer additional motivation to look
for more evidence that would support Corcoran’s hypothesis.

© 2002 Lisa Bortolotti

Lisa
Bortolotti studied philosophy in Bologna (Italy), London and Oxford (UK)
before starting her PhD at the Australian National University in Canberra. Her
main interests are in philosophy of mind, philosophy of psychology,
rationality, mental illness and animal cognition.

Categories: MentalHealth