Skip to main content

Advertisement

SpringerLink
Log in

Theory of mind, social development, and psychosis

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

The difficulty in interpreting other people’s mental states found in children with autism and in people affected by schizophrenia may be explained in terms of a unique mental process called Theory of Mind. The paper discusses the main operational issues of such a peculiar aspect of social cognition, the Theory of Mind, and its implication in schizophrenia, including a review of its related neural structures. Theory of Mind abilities may be a relevant aspect of social interaction involving people affected by schizophrenia, and they need to be further investigated in clinical research.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Premack D, Woodruff G: Does the chimpanzee have a theory of mind? Behav Brain Sci 1978, 4:515–526.

    Article  Google Scholar 

  2. Wimmer H, Perner J: Belief about beliefs: representation and constraining functions of wrong beliefs in young children’s understanding of deception. Cognition 1983, 13:103–128.

    Article  PubMed  CAS  Google Scholar 

  3. Baron-Cohen S, Leslie AM, Frith U: Does the autistic child have a "theory of mind"? Cognition 1985, 21:37–46.

    Article  PubMed  CAS  Google Scholar 

  4. Bowden EM, Beeman MJ: Getting the right idea: semantic activation in the right hemisphere may help solve insight problems. Psychol Sci 1998, 9:435–440.

    Article  Google Scholar 

  5. Nauta WJH: Connections of the frontal lobe with the limbic system. In Surgical Approaches in Psychiatry. Edited by Laiten LV, Livingston KE. Baltimore: University Park Press; 1973:303–314.

    Google Scholar 

  6. Stuss DT, Benson DF: Emotional concomitants of psychosurgery. In Advances in Neuropsychology and Behavioral Neurology. Edited by Heilman KM, Satz P. New York: Guilford Press; 1983:111–140.

    Google Scholar 

  7. Stuss DT: Self, awareness and the frontal lobes: a neuropsychological perspective. In The Self: Interdisciplinary Approaches. Edited by Strauss J, Goethals GR. New York: Springer-Verlag; 1991:255–278.

    Google Scholar 

  8. Fink GR, Markowitsch HJ, Reinkemeier M, et al.: Cerebral representation of one’s own past: neural networks involved in autobiographical memory. J Neurosci 1996, 16:4275–4282.

    PubMed  CAS  Google Scholar 

  9. Wheeler MA, Stuss DT, Tulving E: Toward a theory of episodic memory: the frontal lobes and autonoetic consciousness. Psychol Bull 1997, 121:331–354.

    Article  PubMed  CAS  Google Scholar 

  10. Levine B, Black SE, Cabeza R, et al.: Episodic memory and the self in a case of isolated retrograde amnesia. Brain 1998, 121:1951–1973.

    Article  PubMed  Google Scholar 

  11. Craik FIM, Moroz TM, Moscovitch M, et al.: In search of the self: a positron emission tomography study. Psychol Sci 1999, 10:26–34.

    Article  Google Scholar 

  12. Keenan JP, McCutcheon B, Freund S, et al.: Left hand advantage in a self-face recognition task. Neuropsychologia 1999, 37:1421–1425.

    Article  PubMed  CAS  Google Scholar 

  13. Shammi P, Stuss DT: Humor appreciation: a role of the right frontal lobe. Brain 1999, 122:657–666.

    Article  PubMed  Google Scholar 

  14. Alexander MP, Stuss DT, Benson DF: Capgras syndrome: a reduplicative phenomenon. Neurology 1979, 29:334–339.

    PubMed  CAS  Google Scholar 

  15. Brazzelli M, Colombo N, Della-Sala S, et al.: Spared and impaired cognitive abilities after bilateral frontal damage. Cortex 1994, 30:27–51.

    PubMed  CAS  Google Scholar 

  16. Damasio AR: Descartes’ Error: Emotion, Reason and the Human Brain. New York: Grosset-Putnam; 1994.

    Google Scholar 

  17. Damasio AR: The Feeling of What Happens: Body and Emotions in the Making of Consciousness. New York: Harcourt Brace; 2000.

    Google Scholar 

  18. Adolphs R, Tranel D, Damasio H, et al.: Fear and the human amygdala. J Neurosci 1995, 15:5879–5891.

    PubMed  CAS  Google Scholar 

  19. Channon S, Crawford S: Problem-solving in real-life-type situations: the effects of anterior and posterior lesions on performance. Neuropsychologia 1999, 37:757–770.

    Article  PubMed  CAS  Google Scholar 

  20. Rogers RD, Everitt BJ, Baldacchino A, et al.: Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology 1999, 20:322–339.

    Article  PubMed  CAS  Google Scholar 

  21. Rogers RD, Own AM, Middleton HC, et al.: Choosing between small, likely rewards and large unlikely rewards activates inferior and orbital prefrontal cortex. J Neurosci 1999, 20:9029–9038.

    Google Scholar 

  22. Stuss DT, Picton TW, Alexander MP: Consciousness, selfawareness and the frontal lobes. In The Frontal Lobes and Neuropsychiatric Illness. Edited by Salloway S, Malloy P, Duffy J. Washington, DC: American Psychiatric Press; 2001.

    Google Scholar 

  23. McDonald S: Pragmatic language skills after closed head injury: ability to meet the informational needs of the listener. Brain Lang 1993, 44:28–46.

    Article  PubMed  CAS  Google Scholar 

  24. Kaczmarek BL: Neurolinguistic analysis of verbal utterances in patients with focal lesions of frontal lobes. Brain Lang 1984, 21:52–58.

    Article  PubMed  CAS  Google Scholar 

  25. Siegal M, Carrington J, Radel M: Theory of mind and pragmatic understanding following right hemisphere damage. Brain Lang 1996, 53:40–50.

    Article  PubMed  CAS  Google Scholar 

  26. Winner E, Brownell H, Happé F, et al.: Distinguishing lies from jokes: theory of mind deficits and discourse interpretation in right hemisphere brain-damaged patients. Brain Lang 1998, 62:89–106.

    Article  PubMed  CAS  Google Scholar 

  27. Happé F, Brownell H, Winner E: Acquired "theory of mind" impairments following stroke. Cognition 1999, 70:211–240.

    Article  PubMed  Google Scholar 

  28. Stuss DT, Gallup GG, Alexander MP: The frontal lobes are necessary for "theory of mind". Brain 2001, 24:279–286. Patients with limited focal frontal and nonfrontal lesions were tested for visual perspective taking and detecting deception. Frontal lobe lesions impaired the ability to infer mental states in others, with dissociation of performance within the frontal lobes. Lesions throughout the frontal lobe, with some suggestion of a more important role for the right frontal lobe, were associated with impaired visual perspective taking. Medial frontal lesions, particularly right ventral, impaired detection of deception. The former may require cognitive processes of the lateral and superior medial frontal regions; the latter may require affective connections of the ventral medial frontal with amygdala and other limbic regions.

    Article  Google Scholar 

  29. Siegal M, Surian L: Sources of performance on theory of mind tasks in right hemisphere-damaged patients. Brain Lang 2001, 78:224–232.

    Article  PubMed  Google Scholar 

  30. Rowe AD, Bullock PR, Polkey CE, et al.: "Theory of mind" impairments and their relationship to executive functioning following frontal lobe excisions. Brain 2001, 124:600–616.

    Article  PubMed  CAS  Google Scholar 

  31. Goel V, Grafman J, Sadato N, et al.: Modeling other minds. Neuroreport 1995, 6:1741–1746.

    Article  PubMed  CAS  Google Scholar 

  32. Fletcher PC, Happé F, Frith U, et al.: Other minds in the brain: a functional imaging study of "theory of mind" in story comprehension. Cognition 1995, 57:109–128.

    Article  PubMed  CAS  Google Scholar 

  33. Brunet E, Sarfati Y, Hardy-Baylé MC, et al.: A PET investigation of the attribution of intentions with a nonverbal task. Neuroimage 2000, 11:157–66.

    Article  PubMed  CAS  Google Scholar 

  34. Gallagher HL, Happé F, Brunswick N, et al.: Reading the mind in cartoons and stories: an fMRI study of "theory of mind" in verbal and nonverbal tasks. Neuropsychologia 2000, 38:11–21.

    Article  PubMed  CAS  Google Scholar 

  35. Calarge C, Andreasen NC, O’Leary DS: Visualizing how one brain understands another: a PET study of theory of mind. Am J Psychiatry 2003, 160:1954–1964.

    Article  PubMed  Google Scholar 

  36. Gallagher HL, Frith CD: Functional imaging of theory of mind. Trends Cogn Sci 2003, 7:77–83. The authors stress the importance of functional imaging to isolate brain regions specific to the "ToM" ability. The review discusses the functional significance of three cerebral areas (anterior paracingulate cortex, the superior temporal sulci, and the temporal poles bilaterally) consistently activated in association with ToM tasks.

    Article  PubMed  Google Scholar 

  37. Gopnik A, Meltzoff A: Words, Thoughts and Theories. Cambridge: MIT Press; 1997.

    Google Scholar 

  38. Surian L: Perché la Teoria della Mente è modulare. Sistemi Intelligenti 2001, 13:31–51.

    Google Scholar 

  39. Leslie AM: Pretense and representation: the origins of "theory of mind". Psychol Rev 1987, 94:412–426.

    Article  Google Scholar 

  40. Fodor JA: A theory of child’s theory of mind. Cognition 1992, 44:283–296.

    Article  PubMed  CAS  Google Scholar 

  41. Marraffa M: Teoria della Mente: dai modelli teorici alla psicopatologia cognitiva. Sistemi Intelligenti 2001, 1:3–15.

    Google Scholar 

  42. Leslie AM: Core architecture and domain specificity. In Mapping the Mind: Domain Specificity in Cognition and Culture. Edited by Hirschfeld L, Gelman S. Cambridge, UK: Cambridge University Press; 1994.

    Google Scholar 

  43. Baron-Cohen S: How to build a baby that can read minds: cognitive mechanisms in mind reading. Curr Psychol Cogn 1994, 13:1–40.

    Google Scholar 

  44. Baron-Cohen S: Mindblindness: An Essay on Autism and Theory of Mind. Cambridge: MIT Press; 1995.

    Google Scholar 

  45. Stich S, Nichols S: Folk psychology: simulation or tacit theory? In Folk Psychology: The Theory of Mind Debate. Edited by Davies M, Stone T. Oxford, UK: Blackwell; 1995.

    Google Scholar 

  46. Damasio H, Grabowski TJ, Tranel D, et al.: Neural correlates of naming actions and of naming spatial relations. Neuroimage 2001, 13:1053–1064.

    Article  PubMed  CAS  Google Scholar 

  47. Symons D: On the use and the misuse of Darwinism in the study of human behavior. In The Adapted Mind: Evolutionary Psychology and the Generation of Culture. Edited by Barkow JH, Cosmides L, Tooby J. New York: Oxford University Press; 1992.

    Google Scholar 

  48. Perner J: Understanding the Representational Mind. Cambridge: MIT Press; 1991.

    Google Scholar 

  49. Ekman P: Telling Lies: Clues to Deceit in the Marketplace, Politics, and Marriage. New York: Norton & Co; 1985.

    Google Scholar 

  50. Castelfranchi C, Poggi I: Bugie, finzioni, sotterfugi: per una scienza dell’inganno. Roma: Carocci; 1998.

    Google Scholar 

  51. Cosmides L, Tooby J: Cognitive Adaptations for Social Exchange. The Adapted Mind: Evolutionary Psychology and the Generation of Culture. Edited by Barkow JH, Cosmides L, Tooby J. New York: Oxford University Press; 1992.

    Google Scholar 

  52. Adenzato M: L’approccio della psicologia evoluzionistica allo studio dell’architettura cognitiva umana. Il caso dell’inganno. Sistemi Intelligenti 2001, 1:53–75.

    Article  Google Scholar 

  53. Chance MRA, Mead AP: Social behavior and primate evolution. Symp Soc Exp Biol 1953, 7:395–439.

    Google Scholar 

  54. Humphrey NK: The social function of intellect. In Growing Points in Etiology. Edited by Bateson PPG, Hindle RA. Cambridge, UK: Cambridge University Press; 1976.

    Google Scholar 

  55. Bryne RW, Whiten A: Machiavellian Intelligence: Social Expertise and the Evolution of Intellect in Monkeys, Apes, and Humans. Oxford, UK: Oxford University Press; 1988.

    Google Scholar 

  56. Smith PK: The cognitive demands of children’s social interactions with peers. In Machiavellian Intelligence: Social Expertise and the Evolution of Intellect in Monkeys, Apes, and Humans. Oxford, UK: Oxford University Press; 1988.

    Google Scholar 

  57. Brothers L: The social brain: a project for integrating primate behavior and neurophysiology in a new domain. Concepts Neurosci 1990, 1:27–51.

    Google Scholar 

  58. Brothers L: Neurophysiology of social interactions. In The Cognitive Neurosciences. Edited by Gazzaniga M. Cambridge: MIT Press; 1994.

    Google Scholar 

  59. Damasio AR: Descartes’ error and the future of human life. Sci Am 1994, 271:144–149.

    Article  PubMed  CAS  Google Scholar 

  60. Chater N, Oaksford M: Deontic reasoning, modules and innateness: a second look. Mind Lang 1996, 11:191–202.

    Google Scholar 

  61. Adolphs R, Tranel D, Damasio AR: Dissociable neural systems for recognizing emotions. Brain Cogn 2003, 52:61–69.

    Article  PubMed  Google Scholar 

  62. Wellman HM: The Child’s Theory of Mind. Cambridge: MIT Press; 1990.

    Google Scholar 

  63. Povinelli DJ, Preuss TM: Theory of mind: evolutionary history of a cognitive specialization. Trends Neurosci 1995, 18:418–424.

    Article  PubMed  CAS  Google Scholar 

  64. Frith CD, Corcoran R: Exploring "theory of mind" in people with schizophrenia. Psychol Med 1996, 26:521–530. The authors describe mentalizing ability in 46 symptomatic schizophrenia patients and 44 non-symptomatic controls. Subjects heard six stories and simultaneously were shown simple cartoon pictures depicting the action sequencing occurring in the stories. All the stories involved false belief or deception, so that it was necessary to infer the mental states of the characters in order to understand their behavior. Patients with paranoid delusions were impaired on the questions concerning mental states. Patients with behavioral signs (ie, negative features or incoherence) were also impaired on the mental state questions, but this difficulty was associated with memory impairments. These results are consistent with the hypothesis that certain of the positive symptoms of schizophrenia reflect impairment in the ability to infer the mental states of others.

    Article  PubMed  CAS  Google Scholar 

  65. Mazza M, De Risio A, Roncone R, et al.: Deficit cognitivi nelle sindromi schizofreniche: studio dei processi di mentalizzazione. Psichiatria e Psicoterapia Analitica 1999, 18:256–264.

    Google Scholar 

  66. Frith CD: Theory of mind in schizophrenia. In The Neuropsychology of Schizophrenia. Edited by David AS, Cutting JC. Hove, UK: Lawrence Erlbaum; 1994.

    Google Scholar 

  67. Surian L: Children’s ambiguous utterances: a re-examination of processing limitations on production. J Child Lang 1995, 22:151–169.

    Article  PubMed  CAS  Google Scholar 

  68. Jahanshahi M, Frith CD: Willed actions and its impairments. Cogn Neuropsychol 1998, 15:483–533.

    Article  Google Scholar 

  69. Mazza M, De Risio A, Surian L, et al.: Selective impairments of theory of mind in people with schizophrenia. Schizophr Res 2001, 47:299–308.

    Article  PubMed  CAS  Google Scholar 

  70. Good D: Repair and cooperation in conservation. In Computers and Conversation. Edited by Luff P, Gilbert N, Frohlich D. London: Academic Press; 1956:133–150.

    Google Scholar 

  71. Diamond MD: The ability of schizophrenics to modify responses in an interpersonal situation. J Consult Psychol 1956, 20:441–444.

    Article  PubMed  CAS  Google Scholar 

  72. La Russo F: Sensitivity of paranoid patients to nonverbal cues. J Abnorm Psychol 1978, 87:463–471.

    Article  Google Scholar 

  73. Cutting J, Murphy D: Schizophrenic thought disorders: a psychological and organic interpretation. Br J Psychiatry 1988, 152:310–319.

    Article  PubMed  CAS  Google Scholar 

  74. Frith CD: The Cognitive Neuropsychology of Schizophrenia. Hove, UK: Lawrence Erlbaum Associates; 1992.

    Google Scholar 

  75. Corcoran R, Mercer G, Frith CD: Schizophrenia, symptomatology and social inference: investigating "theory of mind" in people with schizophrenia. Schizophr Res 1995, 17:5–13.

    Article  PubMed  CAS  Google Scholar 

  76. Corcoran R, Frith CD: Conversational conduct and the symptoms of schizophrenia. Cogn Neuropsychiatry 1996, 1:305–318.

    Article  Google Scholar 

  77. Langdon R, Michie PT, Ward PB, et al.: Defective self and/or other mentalising in schizophrenia: a cognitive neuropsychological approach. Cogn Neuropsychiatry 1997, 2:167–193.

    Article  Google Scholar 

  78. Sarfati Y, Hardy-Baylé MC, Besche C, et al.: Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips. Schizophr Res 1997, 25:199–209.

    Article  PubMed  CAS  Google Scholar 

  79. Drury VM, Robinson EJ, Birchwood M: Theory of mind skills during an acute episode of psychosis and following recovery. Psychol Med 1998, 28:1101–1112.

    Article  PubMed  CAS  Google Scholar 

  80. Doody GA, Gotz M, Johnstone EC, et al.: Theory of mind and psychoses. Psychol Med 1998, 28:397–405.

    Article  PubMed  CAS  Google Scholar 

  81. Pickup GJ, Frith CD: Theory of mind impairments in schizophrenia: symptomatology, severity and specificity. Psychol Med 2001, 31:207–220.

    Article  PubMed  CAS  Google Scholar 

  82. Pilowski T, Yirmiya N, Arbelle S, et al.: Theory of mind ability in children with schizophrenia, children with autism and normally developing children. Schizophr Res 2000, 42:145–155.

    Article  Google Scholar 

  83. Hardy-Bayle MC, Sarfati Y, Passerieux C: The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization. Schizophr Bull 2003, 29:459–471.

    PubMed  Google Scholar 

  84. Herold R, Tenyi T, Lenard K, et al.: Theory of mind deficit in people with schizophrenia during remission. Psychol Med 2002, 32:1125–1129.

    Article  PubMed  CAS  Google Scholar 

  85. Penn DL, Corrigan PW, Bentall RP, et al.: Social cognition in schizophrenia. Psychol Bull 1997, 121:114–132.

    Article  PubMed  CAS  Google Scholar 

  86. Penn D: Emotion perception and social functioning in schizophrenia. In Comprehensive Treatment of Schizophrenia: Keio University, International Symposia for Life Sciences and Medicine, vol 8. Edited by Kashima H, Falloon IRH, Mizuno M, et al. Tokyo: Springer; 2002:54–62.

    Google Scholar 

  87. Corcoran R, Frith CD: Autobiographical memory and theory of mind: evidence of a relationship in schizophrenia. Psychol Med 2003, 33:897–905.

    Article  PubMed  Google Scholar 

  88. Mazza M, De Risio A, Tozzini C, et al.: Machiavellianism and theory of mind in people affected by schizophrenia. Brain Cogn 2003, 51:262–269.

    Article  PubMed  Google Scholar 

  89. Fiske ST: Social cognition. In Advanced Social Psychology. Edited by Tesser A. New York: McGraw-Hill; 1995:149–193.

    Google Scholar 

  90. Adolphs R: The neurobiology of social cognition. Curr Opin Neurobiol 2001, 11:231–239.

    Article  PubMed  CAS  Google Scholar 

  91. Pinkham AE, Penn DL, Perkins DO, et al.: Implications for the neural basis of social cognition for the study of schizophrenia. Am J Psychiatry 2003, 160:815–824.

    Article  PubMed  Google Scholar 

  92. Brothers L: The social brain: a project for integrating primate behavior and neurophysiology in a new domain. Concepts Neurosci 1990, 1:27–51.

    Google Scholar 

  93. Trivers RL: Social Evolution. Menlo Park: Benjamin-Cummings; 1985.

    Google Scholar 

  94. Sullivan RJ, Allen JS: Social deficits associated with schizophrenia defined in terms of interpersonal Machiavellianism. Acta Psichiatr Scand 1999, 99:148–154. The social deficits of schizophrenia are interpreted in an evolutionary context of Machiavellian social dexterity, stressing deficits in evolved psychologic mechanisms that mediate the interpretation of affect and deceptive intention in others. Male patients with schizophrenia are relatively non-Machiavellian compared with control and schizophrenia females, and that social problems associated with the condition may reflect this relative social credulity.

    CAS  Google Scholar 

  95. Christie R, Geis FL: Studies in Machiavellianism. New York: Academic Press; 1970.

    Google Scholar 

  96. Hadwin J, Baron-Cohen S, Howlin P, et al.: Does teaching theory of mind have an effect on the ability to develop conversation in children with autism? J Autism Dev Disord 1997, 27:519–537.

    Article  PubMed  CAS  Google Scholar 

  97. Roncone R, Falloon IR, Mazza M, et al.: Is theory of mind in schizophrenia more strongly associated with clinical and social functioning than with neurocognitive deficits? Psychopathology 2002, 35:280–288.

    Article  PubMed  Google Scholar 

  98. Ozonoff S, Miller JN: Teaching theory of mind: a new approach to social skills training for individuals with autism. Autism Dev Disord 1995, 25:415–433.

    Article  CAS  Google Scholar 

  99. Sarfati Y, Passerieux C, Hardy-Bayle M: Can verbalization remedy the theory of mind deficit in schizophrenia? Psychopathology 2000, 33:246–251.

    Article  PubMed  CAS  Google Scholar 

  100. Roncone R, Mazza M, Frangou I, et al.: Theory of mind’s deficit rehabilitation in schizophrenia: a pilot study about metacognitive strategies in a group treatment. Neuropsychol Rehabil 2004, in press.

  101. Feuerstein R: Instrumental Enrichment. Baltimore: University park press; 1980.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of L’Aquila, Blocco 11, Via Vetoio, I-67100, Coppito, L’Aquila, Italy

    Massimo Casacchia MD

Authors
  1. Massimo Casacchia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica Mazza PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rita Roncone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Casacchia, M., Mazza, M. & Roncone, R. Theory of mind, social development, and psychosis. Curr Psychiatry Rep 6, 183–189 (2004). https://doi.org/10.1007/s11920-004-0063-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-004-0063-3

Keywords

Search

Navigation