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  • Print publication year: 1996
  • Online publication date: May 2010

Comments on Roger Brown's chapter

Summary

The brusk, blunt responses of schizophrenic patients to Field's “Discourse Completion Task” may at first suggest that these patients are showing the social consequences of the chronic form of their illness, which results in failures in personal and social functioning. Gruenberg called these effects “the Social Breakdown Syndrome” (Gruenberg, 1967), which is a secondary, and purely sociogenic, type of decompensation. It is a result both of the patient's illness and of the responses of those who come into contact with him or her once they detect the dysfunctions; but it is not a necessary expression of the disease itself.

Very quickly, however, one must discard this explanation, because the first-degree relative, who does not have schizophrenia, also shows the same insensitive, blunt, Gricean responses. And, strikingly, the relative demonstrates this callousness on all 24 items, just as the patients did. While we wait for the results of a larger study that can give us reliable distributions of this phenomenon, we can make a few additional observations.

The two patients and the relative engaged in face-threatening acts with no apparent self-consciousness or awareness of their social consequences. On the face of it, then, these people did not seem to understand the intentions or suppositions of the people they were addressing. It is as if their sense of empathy was significantly reduced, to be replaced by a mechanical, flat and devitalized social commerce. We have, of course, previously recognized this feature of chronic schizophrenia in the emotional blunting described by Kraepelin.