Specifying Interactional Markers of Schizophrenia in Clinical Consultations

Abstract

Schizophrenia is a serious mental illness affecting approximately one per cent of the population. Despite major advances in brain-imaging techniques since the naming of schizophrenia more than a hundred years ago, the basic character of the illness remains poorly understood. An influential theory of schizophrenia proposes that it can be explained by an inability to understand and reason about the mental states of others. In particular, an inability to correctly infer the mental states of others is believed to give rise to delusions and other psychotic symptoms. Our recent research has, however, shown that, in general, patients with schizophrenia adequately represent their own and others’ mental states and use this competence to communicate successfully in social interaction. In talk with delusional content, patients recognize that others do not agree with their delusional claims and are not persuaded by the justification they provide for these claims. Importantly, they recognize their own and others’ discomfort at the disagreement this causes. However, they do not revise their claims and the tenacity with which delusional claims are held can be striking. This is all the more interesting given their ability to appreciate and respond appropriately to others’ mental states and their evident discomfort in the face of others’ disagreement. The questions are: (1) Is this incorrigibility specific to talking about delusions and other psychotic symptoms or is it a general problem? And (2) Why are patients so tenacious in disregarding others’ accounts of their problems?