Variable causes of social dysfunction in schizophrenia: The interplay of neurocognitive, personal, and intersubjective factors

Abstract

Schizophrenia exerts its devastating effects mostly by causing a profound and poorly understood inability to function, affecting different aspects of everyday life from daily activities to a lack of social contacts, unemployment, and the consequences of stigmatisation. In empirical studies, social dysfunction is defined as a social performance measure, commonly based on the principles of cognitivism, and usually evaluated in laboratory and everyday settings. In schizophrenia, it is thought to be caused by cognitive dysfunction, related to brain dysfunction. From a medical perspective, schizophrenia is understood as a neurodevelopmental disorder resulting in a pattern of disconnection between important brain areas. Nevertheless, measures of neurocognition do not explain the expected amount of variance in social functioning. Other explanatory models of social dysfunction include structural functionalism, symbolic interactionism, and clinical phenomenology. Phenomenological accounts relate to the classical tradition in psychopathology, which describes schizophrenia as being marked by a certain “Gestalt”, which is in turn recognised as a distinctive and pervasive change in an individual’s self-experience and attunement to the surrounding world, thus emphasising the subjective experience of others. In the present paper, we intend to empirically explore the dilemma concerning the causes of social dysfunction in schizophrenia and to show how the comprehension, gained via a neuroscientific approach to a complex brain phenomenon can be meaningfully expanded by adding insights from different explanatory models. These models need to be operationalised so that all the data can be incorporated into a comprehensive statistical analysis.