On the Inadequacies of Theory of Mind Explanations of Schizophrenia

Abstract

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 shown that patients adequately represent their own and others’ mental states and use this competence to communicate successfully in naturalistic 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. It is the tenacity with which delusional claims are held that is 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. Questions for further research are whether this incorrigibility is specific to delusions, psychotic symptoms or the condition generally, and why patients are so tenacious in disregarding others’ accounts of their problems.