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Abstract
It has been proposed that certain psychotic symptoms associated with schizophrenia reflect a deficit in the ability
to appreciate other people's mental states (Frith, 1992). This notion is tested using a newly devised task examining
the capacity to infer intentions behind indirect speech. The findings support the notion that some patients with
schizophrenia have difficulties with tasks requiring 'theory of mind' skills and that this deficiency is symptom specific.
The findings are discussed with reference to the cognitive skills which may be involved in the performance of tasks
requiring social inferences.
Keywords: Social Inference; Theory of mind; (Schizophrenia)
I. Introduction
autism. Indeed, Forster et al. (1991)provide evidence to show that chronic negative feature schizophrenia is often associated with childhood social
difficulties particularly in men. Other epidemiological studies (e.g. Jones et al., 1994) have demonstrated asocial inclinations in children later to be
diagnosed as schizophrenic. This would suggest an
early developmental disruption as has been postulated for childhood autism (Wing and Gould,
1979). That children with autism are particularly
poor at inferring the beliefs and intentions of other
people is well documented and supported by thorough and convincing experimental evidence
(Baron-Cohen et al., 1985, 1986; Frith, 1989;
Perner et al., 1989).
electric shocks or were pretending. Results demonstrated that while paranoid patients were more
accurate in their decisions about the genuine stimuli, normal controls were more accurate in their
decisions concerning the simulated stimuli. The
author explained this rather curious finding by
arguing that while the paranoid patients were more
sensitive to the genuine stimuli because of a processing bias, the normal controls were more sensitive to the simulated material because they were
'more accepting of stereotyped social presentation'.
Finally, Cutting and Murphy (1990) examined
the appreciation of social knowledge in patients
with schizophrenia, manic psychosis and depression. Two sets of multiple choice questions were
given to the subjects. One tested knowledge of
how people tend to act in social situations. The
other examined knowledge of non-social events or
objects. It was found that the schizophrenics performed the former task more poorly than either
of the other two groups. This was seen as reflecting
the 'social naivet6' of the subjects with schizophrenia. The authors considered two possibilities to
explain this social naivete. The first is that the
patients perform this task poorly as a result of
their lack of experience of and exposure to such
situations. The second suggestion is that poor
social judgements are an intrinsic feature of schizophrenia or, at least, of a subgroup of these patients.
It is this latter view which the authors favoured.
Clearly then there are implications from the
previous literature that patients with schizophrenia
have difficulty with situations where theory of
mind is required. A test of the hypothesis that
deficits in mental state inference are central to
certain symptoms of schizophrenia is therefore
long-awaited.
This paper reports findings on a simple social
inference task examining the comprehension of
indirect speech. As we have outlined above, Frith's
model makes clear predictions about the performance of patients with different kinds of symptoms
on tasks which require theory of mind skills. We
expecl poor performance from patients with negative features (poverty of speech, flattening of
affect), patients with incoherent speech, and
patients delusions of reference and delusions of
persecution. Patients with passivity experiences
2. Methods
3. Results
Table 1
The demographic details of the subject groups
Group
Schizophrenic patients
Psychiatric controls
Normal controls
n (m: f)
55 (38: 17)
14 (8:6)
30 (20: 10)
Age
31.8 (8.9)
46.7 (18.0)
31.2 (10.0)
Employment
(% employed)
22
50
30
Education
(% achieving:)
Estimated IQ
Degree
O-Level
13
28
23
75
72
73
98.2 (10.3)
105.3 (14.3)
107.1 (11.3)
Schizophrenic
patients (n = 55)
Controls (n =44)
Difference
15.6 (3.9)
98.2 (10.3)
0.49 (p < 0.001)
18.3 (1.6)
106.5 ( 12.1 )
0.08 (ns)
t(97)=4.2, p<0.0001
t(97) = 3.7, p < 0.0001
0.08 (ns)
4. Discussion
Table 3
Performance on the hinting task and estimated IQ in the symptom subgroups
Group
Hints
IQ
Rank observed
Predicted
l:
2:
3:
4:
5:
6:
7:
8:
10
3
23
7
4
8
14
30
12.8 (4.5)
12.7 (5.7)
15.4 (3.6)
18.6 (1.7)
16.5 (2.6)
18.0 (2.6)
18.6 (1.6)
18.1 (1.6)
96.6 (12.8)
95.0 (6.2)
96.6 (9.6)
103.1 (14.6)
101.5 (4.0)
100.0 (7.5)
105.3 (14.3)
107.1 (11.3)
8
7
6
1.5
5
4
1.5
3
8
7
6
5
2.5
2.5
2.5
2.5
negative
incoherent
paranoid
passivity
other
remission
psychiatric controls
normal controls
10
Negative features
It has been argued that patients with chronic
negative schizophrenia show evidence of poor
childhood social functioning (Forster et al., 1991).
The ability to infer the beliefs and intentions of
others is acquired in early childhood according to
the cognitive developmental literature (Leslie,
1987). Thus, the poor performance of patients
with negative features on this simple, social inference task may reflect a failure early in development
which prevented them from ever acquiring normal
'theory of mind' abilities.
Paranoid delusions and related positive features
In contrast to patients with negative features,
there is no evidence of poor childhood social
functioning in those with paranoid symptoms. It
would seem that these patients develop their schiz-
Incoherent speech
These patients performed the hinting task very
badly. However, more patients must be tested
before this result can be considered reliable.
Passivity experiences
The final piece of evidence which supports the
idea that a theory of mind deficit is symptom
specific comes from the performance of the patients
with passivity phenomena, such as delusions of
control. According to the model, these patients
have a representational disability involving the
monitoring of their own intentions to act (Frith
and Done, 1989). It is intriguing that these patients
were perfectly capable of inferring the intentions
of others from indirect speech in the present study.
This suggests that these two skills are dissociable.
Patients in remission
Patients who were symptom free at the time of
testing showed normal performance on the hinting
task. This observation suggests that mentalizing
ability is a state rather than a trait variable that is
closely tied to symptomatology.
4.3. Towards a neuropsychological model of
mentalizing abilities
In a recent positron emission tomography (PET)
study of the comprehension of new metaphors
compared to the comprehension of true/false functional sentences, Bottini et al. (1994) demonstrated
selective activations of prefrontal (BA 8 and 46),
precuneus (BA 31), middle temporal gyrus
(BA 21) and anterior and posterior cingulate
11
5. Conclusions
The argument for symptom specific difficulties
in the ability to infer what is going on in the minds
of other people is supported by the results of
performance on a task examining the comprehension of indirect speech. There appears to be a
hierarchy in the expressed severity of this deficit
consistent with Frith's (1992) model. These problems can be understood in terms of dysfunctional
episodic long term memory and inferential abilities. The breakdown of this skill in this manner is
compelling given that there is increasing evidence
to suggest that both memory and frontal functioning are typically impaired in schizophrenia.
We are currently studying the performance of
schizophrenic patients on a number of other tests
which examine the ability to infer mental states in
other people. It is hoped that this will more clearly
demonstrate the specific nature of the deficit in
relation to the symptoms of schizophrenia.
Acknowledgements
Our deepest thanks go to Dr. Sabine and Dr.
Weller of St. Ann's Hospital, London; Dr. Dolan
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Appendix I
Example. One of the ten hinting task items
Paul has to go to an interview and he's running
late. While he's cleaning his shoes he says to his
wife, Jane: 'I want to wear that blue shirt, but its
very creased.'
Question: What does Paul really mean when he
says this?
Extra information: Paul goes on to say: 'Its in
the ironing basket.'
Question: What does Paul want Jane to do?
References
Abramson, L.Y., Seligman, M.E.P. and Teasdale, J.D. (1978)
Learned helplessness in humans: Critique and reformulation.
J. Abnorm. Psychol. 78, 40-74.
Ammons, R.B. and Ammons, C.H. (1962) Quick Test.
Psychological Test Specialists: Missoula, MT.
Baddeley, A., Thornton, A., Chua, S.E. and McKenna, P.
Delusions and the construction of autobiographical memory.
In: D. Rubin (ed.), Autobiographical Memory (in press).
Baron-Cohen, S., Leslie, A.M. and Frith, U. (1985) Does the
autistic child have a theory of mind? Cognition 21, 37-46.
Baron-Cohen, S., Leslie, A.M. and Frith, U. (1986)
Mechanical, behavioural and intentional understanding of
picture stories in autistic children. Br. J. Dev. Psychol.
4, 113-125.
Beck, A.T. (1976) Cognitive Therapy and the Emotional
Disorders. International Universities Press, New York.
Bottini, G., Corcoran, R., Sterzi, R., Schenone, P., Paulesu,
E., Scarpa, P., Frackowiak, R.S.J. and Frith, C.D. (1994)
The role of the right hemisphere in the interpretation of
figurative aspects of language. Brain 117, 1241-1253.
Cohen, J.D. and Servan-Schreiber, D. (1991) Context, cortex
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