Social Cognition and Schizophrenia

Social cognition continues to challenge researchers. Whereas general cognition has been reliably and widely studied, social cognition has proven to be more elusive. Substantial controversy and debate still surround the more basic issues, such as finding reliable and valid tools to measure it. There is a striking dearth of information and empirical data on social cognition in schizophrenia, despite the fact that social cognition is markedly impaired in this debilitating illness. Social impairment is a hallmark of schizophrenia that continues to resist various pharmacological, rehabilitative, and psychotherapeutic interventions.

The editors of Social Cognition and Schizophrenia have attempted to avoid the limitations imposed by the scarcity of research on social cognition in schizophrenia by tackling the topic from a different perspective. They asked the following question: How could social cognition in health inform abnormal social functioning in schizophrenia as well as treatment modalities? In the first section of the book, researchers try to answer this question by reviewing studies describing social function in healthy individuals or patients with different neuropsychiatric conditions. They report on several conceptual frameworks and then speculate on how the findings might apply to patients with schizophrenia. Many social and psychological theories exist on the cognitive and social deficits that could underlie the impaired social functioning in schizophrenia.

In the second part of the book, contributors describe therapeutic interventions that have been proposed to address the impaired social performance in schizophrenia. They review the theoretical background of such interventions and the few data that have been published. Even the few studies reported in the book have substantial shortcomings, as the authors themselves acknowledge. It soon becomes apparent in this book that much of the information is repeated in one chapter after the other. This is probably the result of how little is known about social functioning in schizophrenia.

Having decided to describe normal social cognition, the editors could have added a section on the neural correlates of theory of mind and related processes that have been investigated in a number of studies in healthy individuals over the last few years. The medial prefrontal and paracingulate regions, the inferior frontal and orbitofrontal cortices, the superior temporal sulcus and temporal poles, and the amygdala have all been proposed to be part of a neural circuit activated by theory of mind tasks (1, 2). To my knowledge, there have been only two reports on the neural basis of theory of mind in patients with schizophrenia to date: that of Russell et al. (3) and a paper from our group that is to be presented at the 2003 International Congress on Schizophrenia.

In summary, social psychologists, psychiatrists, and other students of schizophrenia might find this book a useful review of social cognition in health and in schizophrenia from a psychological perspective. The lack of empirical data and the abundance of speculations reflect the current state of affairs in this field. At a time when there is increased awareness of the higher specificity of negative symptoms in schizophrenia, it is unfortunate that this field remains underinvestigated. This book should serve as a wake-up call to invest more resources in order to better understand this basic cognitive process in one of the most disabling psychiatric illnesses.