Schizophrenia and Other Psychotic Disorders 549
to prevent me from reaching my destination, and they’ve instructed the transit sys-
tem to delay my train.” People with paranoid schizophrenia are often unwilling to
test the veracity of their beliefs, perhaps believing that such tests would be “rigged”
and the results therefore meaningless.
Similarly, people with schizophrenia who have auditory hallucinations do notgenerally try to discover where the sounds of the hallucinations are coming from.
For example, they don’t check whether the radio is on or whether people are talking
in the hallway. They are less likely to question the reality of an unusual experience
(that is, whether it arises from something outside themselves) and so do not correct
their distorted beliefs (Johns, Hemsley, & Kuipers, 2002).
Negative symptoms can also give rise to unfounded beliefs; specifi cally, peoplewho have negative symptoms are particularly likely to have low expectations of
themselves. Although such low expectations could indicate an accurate assessment
of their abilities, research suggests that this is generally not the case: When cognitive
therapy successfully addresses the negative self-appraisals of people with schizo-
phrenia, their functioning subsequently improves (Rector, Seeman, & Segal, 2003).
This fi nding suggests that the negative self-appraisals are distorted beliefs that be-
came self-fulfi lling prophecies (Beck & Rector, 2005).
Emotional Expression
Another psychological factor is the facial expressions of people with schizophre-
nia, which are less intense than those of people who do not have the disorder
(Brozgold et al., 1998; Kring & Neale, 1996). Moreover, people with schizo-
phrenia are less accurate than control participants in labeling the emotions ex-
pressed by faces they are shown (Penn & Combs, 2000; Schneider et al., 2006).
Part of the explanation for problems related to emotional expression may be
the cognitive defi cits: In general, people with schizophrenia often have diffi culty
recognizing emotions that are conveyed by tone of voice (such as the quaver in
a voice fi lled with fear), facial expression (such as an annoyed frown), or body
language (such as a defensive, withdrawn crossing of the arms; Green, 2001).
Because they cannot “read” nonverbal communication well, they are confused
when someone’s words and subsequent behavior are at odds. People with schizo-
phrenia are likely to miss the nonverbal communication that helps most people
make sense of the apparent inconsistency between what others say and what
they do (Greig, Bryson, & Bell, 2004). In fact, even biological relatives of people
with schizophrenia have problems in understanding other people’s nonverbal
communication (Janssen et al., 2003), which suggests that neurological factors
are involved.
Social Factors in Schizophrenia
We’ve seen that schizophrenia often entails diffi culty in understanding and navi-
gating the social world. We’ll now examine this diffi culty in more detail and also
consider the ways that economic circumstances and cultural factors can infl uence
schizophrenia.
Understanding the Social World
Each of us develops a theory of mind—a theory about other people’s mental states
(their beliefs, desires, feelings) that allows us to predict how they will react in a
given situation. People with schizophrenia have diffi culty with tasks that require
an accurate theory of mind (Russell et al., 2006) and may thus fi nd relating to oth-
ers confusing. Because people with schizophrenia have diffi culty interpreting emo-
tional expression in others, they don’t fully understand the messages people convey.
The symptoms of paranoia and social withdrawal in people with schizophrenia may
be a direct result of this social confusion (Frith, 1992). To a person with schizophre-
nia, other people can seem to behave in random and unpredictable ways. Thus, it
makes sense that he or she tries to come up with an explanation for other people’s
P SNP SNTheory of mind
A theory about other people’s mental states
(their beliefs, desires, and feelings) that
allows a person to predict how other
people will react in a given situation.