Tuesday 7 September 2021

Disturbances of Shared Intentionality in Schizophrenia and Autism

Today's post is by Alessandro Salice (University College Cork) and Mads Gram Henriksen (University of Copenhagen) on their new paper “Disturbances of Shared Intentionality in Schizophrenia and Autism” (published in 2021 in Frontiers in Psychiatry).

Alessandro Salice

In the past decades, shared intentionality (i.e., the capacity to share mental states like beliefs, intentions or emotions) has attracted intense attention in several disciplines. These include various theoretical disciplines (e.g., philosophy and game theory), empirical sciences of the mind (e.g., developmental psychology, social psychology, and cognitive sciences), and social sciences (e.g., anthropology, economics, and sociology). By now, the idea that shared intentionality pervasively characterizes human psychology and, therefore, human forms of social life has become fairly uncontroversial in the literature.

However, the large body of insights secured by this burgeoning line of research has, so far, remained largely neglected in psychiatry. In particular, the relevance of shared intentionality and its potential to enrich our understanding of mental disorders such as schizophrenia and infantile autism have not yet been fully appreciated.

While relevant literature does recognize that problems of sociality are part and parcel of the two syndromes, these problems are usually considered sequela of social cognitive deficits, and no references to shared intentionality are made. Moreover, with the extension of the diagnostic boundaries of the autism spectrum and the contemporary autism research that typically focuses on persons without intellectual disability, knowledge of the qualitatively different problems of sociality in autism and schizophrenia are gradually disappearing.

Against this background, our recent paper ‘Disturbances of Shared Intentionality in Schizophrenia and Autism’ (Frontiers in Psychiatry, 2021) pursues two main goals (by amplifying and enhancing some theses already presented in Salice & Henriksen 2015).

On the one hand, it aims at filling the aforementioned gap in psychiatric literature by specifically focusing on how shared intentionality breaks down in schizophrenia and infantile autism. Specifying the nature of these social difficulties–and especially how they differ from each other in the two syndromes–may potentially help resolve the growing differential-diagnostic confusion between schizophrenia and autism spectrum disorder in clinical psychiatry. On the other, by illuminating how shared intentionality is disrupted in the two syndromes, the article also intends to shed light on the pre-conditions of shared intentionality when it is functioning normally or unproblematically.

To achieve these goals, we develop an empirically informed, conceptual account of two main forms of shared intentionality: joint intentionality and we-intentionality. Joint intentionality crucially relies on the agents’ mentalizing abilities such as mindreading and the ability to factor in (or “to be moved” by) their partner’s intentions in deliberation and action planning.

By contrast, we-intentionality relies on the agents’ capacity to understand themselves as group members and to adopt the group’s perspective (on the nature of these two processes, see this other entry). Armed with this account, we then move our attention to the social difficulties in schizophrenia and in the severe end of the autism spectrum disorder (infantile autism), respectively.

Mads Gram Henriksen

When approaching the topic of sociality in schizophrenia, one is likely to encounter a staggering puzzle. On the one hand, patients with schizophrenia often report continuous difficulties in establishing and maintaining social relations with others, and frequently these difficulties are a source of loneliness and isolation. On the other hand, patients may simultaneously report that they enjoy and often participate in various forms of social interactions.

We explain this apparent incongruity in social behavior by arguing that, in schizophrenia, we-intentionality appears to be disrupted, while joint intentionality remains unaffected. The main – although perhaps not exclusive – sources of problems of we-intentionality in schizophrenia are identified in trait-like, non-psychotic, anomalous self-experiences (also called ‘self-disorders’), which empirical studies consistently have found to hyper-aggregate in schizophrenia spectrum disorders but not in other mental disorders or healthy controls.

In short, our claim is that the enduring presence of anomalous self-experiences may affect these patients’ capacity to understand themselves as group members (in the specific sense at stake in group identification) and, by extension, their ability to engage in we-intentionality.

When it comes to infantile autism, aberrant social behaviour has been considered as a hallmark of the syndrome since it was first described by Kanner and Asperger in the 1940s. We hypothesize that this pervasive aberrance in social behaviour can be cashed out in terms of difficulties that impact both joint and we-intentionality.

In relation to joint intentionality, we argue that characteristic impairments in the intuitive understanding of other persons make it difficult to track and consider their intentions and to factor them in in action planning and conduct. Put another way, persons with severe autism are often not ‘moved’ by others’ intentions, which directly impacts their capacity to form participatory intentions and, thus, to engage in joint intentionality.

The root of these difficulties is, in our view, best described by Hobson, who argues that persons with autism have a decreased propensity to identify-with others: they rarely are emotionally drawn or ‘moved’ to assume the others’ bodily expressed psychological attitude and, eventually, to acquire it as a potential attitude for themselves.

We claim that this decreased ability to understand others’ attitudes plays a crucial role in inhibiting we-intentionality, too. More specifically, we suggest that the very same difficulties that persons with infantile autism encounter in adopting another individual’s perspective may affect the adoption of a group’s perspective.

In conclusion, the picture emerging from our article is that joint intentionality and we-intentionality are complex abilities that rests on various psychological pre-conditions. Consequently, alterations in these pre-conditions may have important consequences for the subject’s sociality and reverberate in the ways in which the subject interacts with others.

While, evidently, there is currently no available experimental design to test our account or empirical evidence to validate or falsify it, we hope that our paper illustrates that research on shared intentionality can shed a new, refreshing light on some complex issues of relevance in psychiatry and clinical psychology.

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