Influence Clinical, Sociodemographic Factors On Mentalization In Schizophrenic Patients
Modern society is characterized by a high level of social uncertainty, instability, transitivity, which cannot but affect the qualitative aspects of existing social groups. These social conditions appear to be associated with the abilities in mentalization: understanding of mental states, which is especially difficult for patients with mental illnesses. The present study attempted to differentiate the connection between such clinical features of mentalization impairments as pseudo-mentalization and “psychic equivalence”, revealed through the lack of cognitive processing of social experience (the “complexity of representations” and the “understanding of social causality”) and the deficiency of emotional investment to relationships. Thus, difficulties in interpersonal relationships, “social anxiety,” reinforcing the negative “affective tone of relationships,” are associated with low empathy (p <0.05), while “limited affect,” increasing with the escalation of such deficiencies as “strange behavior and speech,” “general disorganization” and is also associated with reduced “understanding of social causality” (p <0.05). In the course of studies, it appeared that individuals with a higher education, as well as qualified in social sciences and humanities, have stronger skills in cognitive analysis of mental states: in “complexity of representation” (p <0.01) and “understanding social causality” (p <0.01). Patients not included in different social contexts are losing interest in other people and communication with them, limited in education and work possibilities, are deprived of an important resource necessary for establishing mutual understanding and productive interpersonal interaction.
Keywords: Mentalization impairmentsempathyschizophrenic spectrum disorderssocio-demographic factorsSCORS model
The connection between mentalization derangement and various mental disorders is investigated. The data on the influence of transitivity, precarity, uncertainty of the sociocultural situation on the development of self-identity are given (Dodell-Feder, Ressler, & Germine, 2019). The main consideration of this article is the contribution of specific clinical and socio-demographic factors to the ability of mentalization. Individuals with mental disorders are a special social group: social isolation, stigmatization, hospitalization, incapacitation, that make these patients especially vulnerable to mentalization impairment, leading to even greater social exclusion.
The present study tests the hypothesis about the role of clinical and socio-demographic factors as mediators of mentalization impairment.
Purpose of the Study
Purpose of the study is to identify the connection between clinical as well as socio-demographic characteristics, and cognitive and emotional-personal characteristics reflecting the specificity of mentalization in groups of patients with schizotypal disorders and paranoid schizophrenia in comparison with the control group.
Relationship between clinical traits and mentalization features in the studied individuals
Difficulties experienced by patients in the interpersonal sphere are confirmed by the data shown on the scale "interpersonal relationships factor" of the clinical questionnaire, which includes a subscale "ideas of reference". For the group of patients with paranoid schizophrenia, these features appeared to be combined with low empathy (r = -0.365, p <0.05): patients with pronounced ideas about a direct connection between external social events and their own personality, cannot put themselves in the place of the interlocutor and feel his psychological state, being too absorbed in their own thoughts and captured by affects, which often provokes the impairmnent in understanding of the Other in the form of pseudo-mentalization. Low ability for emotional empathy in the patients of this group is also associated with “lack of close friends” (r = -0.326, p <0.05). In addition, the higher the rates for “social anxiety”, the more hostile the expectations of interpersonal communication are in these patients (r = -0.347, p <0.01), at the same time, the high rates of “social anxiety” correspond to low empathy (r = -0.444, p <0.01).
Such traits as “strange behavior”, “strange speech” and “general disorganization”, inherent more in patients with paranoid schizophrenia, reflect their isolation from social norms and contexts, show correlation with low abilities in empathy and “understanding social causality” (p <0.05, see table
In the group of patients with paranoid schizophrenia the connection between “limited affect” (flattening of emotional life, poor emotional repertoire) and low empathy (-0.400, p <0.05) was also found, as well as the link with “understanding social causality” (r = -0.438, p <0.01), which emphasizes the importance of emotional reflection not only for compassion, but also for the search of a truly psychological component in the causality of interpersonal behavior. Patients of both clinical groups miss the psychological component in describing the determination of social behavior, or their view of the influence the mind exerts on behavior is excessively one-sided. In patients with paranoid schizophrenia logical errors and inconsistencies occurred more often.
The clinical traits also appeared to be associated with the cognitive parameters of mentalization in the group of patients with schizotypal disorders: “cognitive-perceptual deficiency”, “disorganization” and “limited affect” inherent in these patients correspond to reduced possibilities of “understanding social causality” and low “complexity of ideas” (p<0.05, see Table
The descriptions of the person’s inner world by the participants of the control group included not only situational factors, but also more or less constant personality characteristics. They were less subject to stereotyped patterns, more open to understanding the psychological determination of behavior (p <0.01).
The cognitive aspect of Self-Other relationship representation in the control group can be associated with such clinical trait as “magical thinking”: the part of the surveyed group that demonstrates irrational thinking, is also, as a rule, characterized by low “complexity of ideas” (r = -0.446, p <0.01, see Table
The connection between socio-demographic characteristics and the features of mentalization in the studied groups
Mentalization is the ability to understand the inner world, your own and the Other’s, inside close interpersonal relationships. Therefore, it can be expected that the presence and quality of such relationships in a person’s life will in a certain way affect the abilities for mentalization. Not many of the studied patients are in a relationship (14 patients out of 40 with schizotypal disorder and 12 out of 40 with paranoid schizophrenia), in comparison with participants in the control group (21 out of 40). The “affective tone of relationships” is more negative in patients compared to the control group (p = 0.073), which indicates their tendency to see the relationship as more hostile and emptier.
In patients with schizotypal disorder, the social circle is often broader than in patients with paranoid schizophrenia, but their interpersonal contacts are characterized by affective instability and social promiscuity, they are full of painful dependence, manipulation, and other destructive forms of behaviour, that are often stated as a model of family communication. Such relationships often involve blurred boundaries between themselves and the Other, causing difficulties in differentiating their own mental states from those of people around them.
The lack of close friends often correlates with a lack of motivation, interest in communication. Meanwhile, the prevalence of destructive forms of communication correlates with a distortion in motivation, with a shift in focus from the Other to oneself and one’s own needs. So, the emotional attitude towards the Other from the patients of both clinical groups was characterized by reduced investment: a low “emotional investment to the relationship”, in comparison with the participants in the control group (p <0.05). The reduction of the emotional component of mentalization in some cases can lead to an oversimplified understanding of the inner world of the Other, to emasculation of interpretations, to the phenomena of “psychic equivalence” as an impairment of mentalization, to the omission of the psychological component in the explanation of interpersonal behavior, etc.
More often than not, the respondents who have a technical educational background did not have a partner: they have never been involved in a romantic relationship, and in most cases never had a close friendship (r = -0.245, p <0.01), experiencing difficulties in social communication, which was indirectly confirmed by statistical results and was revealed, for example, in excessive suspicion (r = 0.189, p <0.05), limited ability to express one’s own emotional state and interact nonverbally with the interlocutor (r = 0.221, p <0.05). It can be assumed that the choice of a qualification that is not related with human communication was largely made with regards to the low possibilities in this area.
Mental representations of those who have a higher education were more often characterized by depth and cognitive complexity (r = 0.216, p <0.05); respondents with secondary special education, on the contrary, talked about thoughts and feelings in one-dimensional categories, or completely omitted psychological aspects from the description of social situations. The cognitive analysis of mental states: “complexity of ideas” (r = 0.259, p <0.01) and “understanding social causality”, were more accessible to individuals with a qualification in the social field and the humanities, unlike those who had a technical qualification (r = 0.252, p <0.01). Apparently, the identified correlations can be interpreted bilaterally: both resourcefulness and abilities in understanding of the mind can contribute to making decisions about the direction of future professional activity, and the need for constant involvement in solving problems related to communication, obviously contributes to the further development of skills in this area.
The links between mentalization features and such socio-demographic indicators as “gender” and “age” were not identified in this study, which underlines the fundamental importance of the “level of education”, “qualification” and “marital status” in the context of understanding of the mind.
Clinical traits and mentalization
In the patient groups a connection was discovered between the “limited affect”, which grows with higher rates in “strange behavior and speech”, “general disorganization” and “cognitive-perceptual deficiency”, and low abilities in “understanding social causality”, and also low “complexity of perceptions” (p <0.05). These findings demonstrate the importance of the emotional component, intact thinking and the ability to grasp social contexts for a complete cognitive analysis of the internal states. Difficulties in the sphere of interpersonal relations, “social anxiety”, reinforcing the negative “affective tone of relationships”, are associated with low empathy, which deprives the mentalization of an important resource.
“Magical thinking” is associated with a decrease in “cognitive complexity” (p <0.01) and “understanding of social causality” (p <0.05) in the control group, which depletes mental representations.
Socio-demographic characteristics and mentalization
A limited social circle of patients with paranoid schizophrenia and the predominance of destructive models in interpersonal relationships of patients with schizotypal disorders are associated with a change in motivation, a decrease in the “emotional investment to the relationship” and a negative “affective tone” of communication, which gives rise to mentalization impairment in the form of pseudo-mentalization. Mental representations of those who have a higher education were more often characterized by depth and cognitive complexity (p <0.05) in comparison with those who have a secondary special education. Those with a qualification in the social field or the humanities, unlike those who have a technical qualification, had better abilities in the cognitive analysis of mental states, showing higher “complexity of perceptions” (p <0.01) and “understanding social causality” (p <0.01).
Defining the group of patients with schizophrenic spectrum disorders as a special “subculture”
Thus, patients with schizotypal disorders and (especially) with paranoid schizophrenia exist in specific social conditions. They are exposed to frequent hospitalizations, stigmatization, disintegration in families, difficulties in raising children, loss of social connections and public interests, restrictions in getting higher education and a permanent job, which leads to desocialization, impedes the acquisition of skills in social interaction, which provokes escalation of clinical symptoms (“ideas of reference”, irrational thinking entailed by primary affects, “social anxiety”, “strangeness of behavior and speech”, “cognitive-perceptual deficiency”, “general disorganization”, “limited affect”) and leads to mentalization impairments in the form of pseudo-mentalization and “psychic equivalence”, reflected in the parameters of cognitive processing (reduced "complexity of perceptions" and "understanding of social causality"), in the absence of emotional involvement and empathy.
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