Difficulties in understanding irony and sarcasm are part of the social cognition deficits in patients with schizophrenia. A number of studies have reported higher error rates during comprehension in patients with schizophrenia. However, the relationships of these impairments to schizotypal personality traits and other language deficits, such as the comprehension of proverbs, are unclear. We investigated irony and proverb comprehension in an all-female sample of 20 schizophrenia patients and 27 matched controls. Subjects indicated if a statement was intended to be ironic, literal, or meaningless and furthermore rated the meanness and funniness of the stimuli and certainty of their decision. Patients made significantly more errors than controls did. Globally, there were no overall differences in the ratings. However, patients rated the subgroup of stimuli with answers given incorrectly as having significantly less meanness and in case of an error indicated a significantly higher certainty than controls. Across all of the study participants, performances in irony ( ) and proverb ( ) comprehension were significantly correlated with schizotypal personality traits, suggesting a continuum of nonliteral language understanding. Because irony is so frequent in everyday conversations, this makes irony an especially promising candidate for social cognition training in schizophrenia. 1. Background Defective appraisal of the intention of others and difficulties with language are hallmark features of psychopathology in schizophrenia. Social cognition deficits have been previously identified and are currently being extensively researched. The results show that deficits in social cognition are relevant to real-world functioning and outcome [1]. Training of social cognitive skills has gained increasing interest in schizophrenia therapy. In this context, the comprehension of ironic remarks by patients with schizophrenia has become a research focus both as an outcome measure and as a training goal [1–5]. This is obvious, considering that the decision on whether a remark made by others is intended to be ironic or not is slightly artificial, but is instead required routinely in everyday interaction. Everyone is familiar with irony. It is remarkably frequently used, as shown by linguistic research [6, 7]. For example, Gibbs [8] showed that 1 out of 8 conversational turns in an everyday communication among college students was ironic. In the case of linguistic irony (which alone is discussed here), an ironic expression is usually incorrect and often the opposite of what the
References
[1]
M. F. Green, C. E. Bearden, T. D. Cannon et al., “Social cognition in schizophrenia, part 1: performance across phase of illness,” Schizophrenia Bulletin, vol. 38, no. 4, pp. 854–864, 2012.
[2]
V. M. Drury, E. J. Robinson, and M. Birchwood, “‘Theory of mind” skills during an acute episode of psychosis and following recovery,” Psychological Medicine, vol. 28, no. 5, pp. 1101–1112, 1998.
[3]
M. F. Green, G. Hellemann, W. P. Horan, J. Lee, and J. K. Wynn, “From perception to functional outcome in schizophrenia: modeling the role of ability and motivation,” Archives of General Psychiatry, vol. 69, no. 12, pp. 1216–1224, 2012.
[4]
M. M. Kurtz and C. L. Richardson, “Social cognitive training for schizophrenia: a meta-analytic investigation of controlled research,” Schizophrenia Bulletin, vol. 38, no. 5, pp. 1092–1104, 2012.
[5]
R. Herold, T. Tenyi, K. Lenard, and M. Trixler, “Theory of mind deficit in people with schizophrenia during remission,” Psychological Medicine, vol. 32, no. 6, pp. 1125–1129, 2002.
[6]
J. M. Whalen, P. M. Pexman, and A. J. Gill, “‘Should be fun—not!”: incidence and marking of nonliteral language in e-mail,” Journal of Language and Social Psychology, vol. 28, no. 3, pp. 263–280, 2009.
[7]
J. M. Whalen, P. M. Pexman, A. J. Gill, and S. Nowson, “Verbal irony use in personal blogs,” Behaviour & Information Technology, vol. 32, no. 6, pp. 560–569, 2013.
[8]
R. W. J. Gibbs, “Irony in talk among friends,” Metaphor and Symbol, vol. 15, no. 1, pp. 5–27, 2000.
[9]
R. W. J. Gibbs and H. L. Colston, Interpreting Figurative Meaning, Cambridge University Press, Cambridge, UK, 2012.
[10]
H. L. Colston and A. N. Katz, Eds., Figurative Language Comprehension: Social and Cultural Influences, Lawrence Erlbaum Associates, Mahwah, NJ, USA, 2005.
[11]
P. M. Pexman, “Social factors in the interpretation of verbal irony: the roles of speaker and listener characteristics,” in Figurative Language Comprehension: Social and Cultural Influences, H. L. Colston and A. N. Katz, Eds., vol. 209–232, Lawrence Erlbaum Associates, Mahwah, NJ, USA, 2005.
[12]
M. A. Creusere, “Theories of adults' understanding and use of irony and sarcasm: applications to and evidence from research with children,” Developmental Review, vol. 19, no. 2, pp. 213–262, 1999.
[13]
S. Kumon-Nakamura, S. Glucksberg, and M. Brown, “How about another piece of pie: the allusional pretense theory of discourse irony,” Journal of Experimental Psychology: General, vol. 124, no. 1, pp. 3–21, 1995.
[14]
A. N. Katz, D. G. Blasko, and V. A. Kazmerski, “Saying what you don't mean: social influences on sarcastic language processing,” Current Directions in Psychological Science, vol. 13, no. 5, pp. 186–189, 2004.
[15]
M. Harris and P. M. Pexman, “Children’s perceptions of the social functions of verbal irony,” Discourse Processes, vol. 36, no. 3, pp. 147–165, 2003.
[16]
R. Kreuz, D. Long, and M. Church, “On being ironic: pragmatic and mnemonic implications,” Metaphor and Symbolic Activity, vol. 6, no. 1, pp. 149–162, 1991.
[17]
R. Giora, “On irony and negation,” Discourse Processes, vol. 19, no. 2, pp. 239–264, 1995.
[18]
S. Dews, J. Kaplan, and E. Winner, “Why not say it directly? The social functions of irony,” Discourse Processes, vol. 19, no. 3, pp. 347–367, 1995.
[19]
R. Giora, “Irony and its discontent,” in The Psychology & Sociology of Literature, E. Ibsch, G. Steen, and D. Schram, Eds., John Benjamins, Amsterdam, The Netherlands, 2001.
[20]
P. M. Pexman, “It's fascinating research: the cognition of verbal irony,” Current Directions in Psychological Science, vol. 17, no. 4, pp. 286–290, 2008.
[21]
A. M. Rapp, K. Langohr, D. E. Mutschler, S. Klingberg, B. Wild, and M. Erb, “Isn't it ironic? Neural correlates of irony comprehension in schizophrenia,” PLoS ONE, vol. 8, no. 9, article e74224, 2013.
[22]
D. Titone, D. L. Levy, and P. S. Holzman, “Contextual insensitivity in schizophrenic language processing: evidence from lexical ambiguity,” Journal of Abnormal Psychology, vol. 109, no. 4, pp. 761–767, 2000.
[23]
D. Salisbury, “N400 to lexical ambiguity and semantic incongruity in schizophrenia,” International Journal of Psychophysiology, vol. 75, no. 2, pp. 127–132, 2010.
[24]
D. Ketteler, A. Theodoridou, S. Ketteler, and M. J？ger, “High order linguistic features such as ambiguity processing as relevant diagnostic markers for schizophrenia,” Schizophrenia Research and Treatment, vol. 2012, Article ID 825050, 7 pages, 2012.
[25]
R. Langdon, M. Coltheart, P. B. Ward, and S. V. Catts, “Disturbed communication in schizophrenia: the role of poor pragmatics and poor mind-reading,” Psychological Medicine, vol. 32, no. 7, pp. 1273–1284, 2002.
[26]
S. Mo, Y. Su, R. C. Chan, and J. Liu, “Comprehension of metaphor and irony in schizophrenia during remission: the role of theory of mind and IQ,” Psychiatry Research, vol. 157, no. 1–3, pp. 21–29, 2008.
[27]
M. H. Kosmidis, E. Aretouli, V. P. Bozikas, M. Giannakou, and P. Ioannidis, “Studying social cognition in patients with schizophrenia and patients with frontotemporal dementia: theory of mind and the perception of sarcasm,” Behavioural Neurology, vol. 19, no. 1-2, pp. 65–69, 2008.
[28]
R. S. Kern, M. F. Green, A. P. Fiske et al., “Theory of mind deficits for processing counterfactual information in persons with chronic schizophrenia,” Psychological Medicine, vol. 39, no. 4, pp. 645–654, 2009.
[29]
A. Sparks, S. McDonald, B. Lino, M. O'Donnell, and M. J. Green, “Social cognition, empathy and functional outcome in schizophrenia,” Schizophrenia Research, vol. 122, no. 1–3, pp. 172–178, 2010.
[30]
M. Champagne-Lavau, A. Charest, K. Anselmo, J.-P. Rodriguez, and G. Blouin, “Theory of mind and context processing in schizophrenia: the role of cognitive flexibility,” Psychiatry Research, vol. 200, no. 2-3, pp. 184–192, 2012.
[31]
M. M. Hensler, Sind konkretistische Denkst？rungen eine homogene Entit？t? Untersuchungen zum Verst？ndnis nicht-wortlicher Sprache bei schizophrenen Patienten [Dissertation], University of Tuebingen, Department of Psychiatry and Psychotherapy, 2009.
[32]
R. Langdon, M. Davies, and M. Coltheart, “Understanding minds and understanding communicated meanings in schizophrenia,” Mind & Language, vol. 17, no. 1-2, pp. 68–104, 2002.
[33]
A. M. Rapp, “The brain behind nonliteral language: insights from brain imaging,” in The Handbook of the Neuropsychology of Language, M. Faust, Ed., vol. 1, pp. 406–424, Wiley-Blackwell, West Sussex, UK, 2012.
[34]
A. M. Rapp, D. E. Mutschler, and M. Erb, “Where in the brain is nonliteral language? A coordinate-based meta-analysis of functional magnetic resonance imaging studies,” NeuroImage, vol. 63, no. 1, pp. 600–610, 2012.
[35]
A. M. Rapp, D. E. Mutschler, B. Wild et al., “Neural correlates of irony comprehension: the role of schizotypal personality traits,” Brain and Language, vol. 113, no. 1, pp. 1–12, 2010.
[36]
R. Giora, On Our Mind: Salience, Context, and Figurative Language, Oxford University Press, 2003.
[37]
A. M. Rapp and B. Wild, “Nonliteral language in alzheimer dementia: a review,” Journal of the International Neuropsychological Society, vol. 17, no. 2, pp. 207–218, 2011.
[38]
H. J. Wegrocki, “Generalizing ability in schizophrenia: an inquiry into the disorders of problem thinking in schizophrenia,” Archives of Psychology, vol. 254, article 76, 1940.
[39]
L. J. Chapman, “Confusion of figurative and literal usages of words by schizophrenics and brain damaged patients,” Journal of Abnormal and Social Psychology, vol. 60, no. 3, pp. 412–416, 1960.
[40]
D. R. Gorham, “Verbal abstraction in psychiatric illness: assay of impairment utilizing proverbs,” The Journal of Mental Science, vol. 107, pp. 52–59, 1961.
[41]
R. H. Goldstein and L. F. Salzman, “Proverb word counts as a measure of overinclusiveness in delusional schizophrenics,” Journal of Abnormal Psychology, vol. 70, no. 4, pp. 244–245, 1965.
[42]
M. de Bonis, C. Epelbaum, V. Deffez, and A. Feline, “The comprehension of metaphors in schizophrenia,” Psychopathology, vol. 30, no. 3, pp. 149–154, 1997.
[43]
P. Thoma and I. Daum, “Neurocognitive mechanisms of figurative language processing—evidence from clinical dysfunctions,” Neuroscience & Biobehavioral Reviews, vol. 30, no. 8, pp. 1182–1205, 2006.
[44]
A. M. Rapp, “The role of the right hemisphere for language in schizophrenia,” in Language Lateralization and Psychosis, I. E. Sommer and R. S. Kahn, Eds., pp. 147–156, Cambridge University Press, Cambrigde, UK, 2009.
[45]
A. M. Rapp and P. Schmierer, “Proverbs and nonliteral language in schizophrenia: a systematic methodological review of all studies published 1931–2010,” Schizophrenia Research, vol. 117, no. 2-3, p. 422, 2010.
[46]
C.-E. Brattemo, “Interpretations of proverbs in schizophrenic patients. Further studies,” Acta Psychologica, vol. 20, no. 3, pp. 254–263, 1962.
[47]
D. R. Gorham, “Additional norms and scoring suggestions for the Proverbs Test,” Psychological Reports, vol. 13, no. 2, pp. 487–492, 1963.
[48]
D. Freeman, “Suspicious minds: the psychology of persecutory delusions,” Clinical Psychology Review, vol. 27, no. 4, pp. 425–457, 2007.
[49]
A. Wittorf, K. E. Giel, M. Hautzinger et al., “Specificity of jumping to conclusions and attributional biases: a comparison between patients with schizophrenia, depression, and anorexia nervosa,” Cognitive Neuropsychiatry, vol. 17, no. 3, pp. 262–286, 2012.
[50]
G. Salvatore, P. H. Lysaker, R. Popolo, M. Procacci, A. Carcione, and G. Dimaggio, “Vulnerable self, poor understanding of others' minds, threat anticipation and cognitive biases as triggers for delusional experience in schizophrenia: a theoretical model,” Clinical Psychology & Psychotherapy, vol. 19, no. 3, pp. 247–259, 2012.
[51]
I. Falkenberg, K. Klügel, M. Bartels, and B. Wild, “Sense of humor in patients with schizophrenia,” Schizophrenia Research, vol. 95, no. 1–3, pp. 259–261, 2007.
[52]
V. P. Bozikas, M. H. Kosmidis, M. Giannakou et al., “Humor appreciation deficit in schizophrenia: the relevance of basic neurocognitive functioning,” The Journal of Nervous and Mental Disease, vol. 195, no. 4, pp. 325–331, 2007.
[53]
B. Wild, Humor in Psychiatrie und Psychotherapie: Neurobiologie, Methoden, Praxis, Schattauer, Stuttgart, Germany, 2012.
[54]
J. O. Polimeni, D. W. Campbell, D. Gill, B. L. Sawatzky, and J. P. Reiss, “Diminished humour perception in schizophrenia: relationship to social and cognitive functioning,” Journal of Psychiatric Research, vol. 44, no. 7, pp. 434–440, 2010.
[55]
M. Gelkopf, “The use of humor in serious mental illness: a review,” Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 342837, 8 pages, 2011.
[56]
R. Langdon and M. Coltheart, “Recognition of metaphor and irony in young adults: the impact of schizotypal personality traits,” Psychiatry Research, vol. 125, no. 1, pp. 9–20, 2004.
[57]
C. S. Jahshan and M. J. Sergi, “Theory of mind, neurocognition, and functional status in schizotypy,” Schizophrenia Research, vol. 89, no. 1–3, pp. 278–286, 2007.
[58]
D. Mutschler, Funktionelle Neuroanatomie ironischer Sprache: zum einfluss des Pers？nlichkeitsmerkmals Schizotypie auf die Sprachperzeption [Inaugural-dissertation], Universit？t Tübingen, 2010.
[59]
M. Cochrane, I. Petch, and A. D. Pickering, “Aspects of cognitive functioning in schizotypy and schizophrenia: evidence for a continuum model,” Psychiatry Research, vol. 196, no. 2-3, pp. 230–234, 2012.
[60]
M. T. Nelson, M. L. Seal, C. Pantelis, and L. J. Phillips, “Evidence of a dimensional relationship between schizotypy and schizophrenia: a systematic review,” Neuroscience & Biobehavioral Reviews, vol. 37, no. 3, pp. 317–327, 2013.
[61]
M. Annett, “A classification of hand preference by association analysis,” British Journal of Psychology, vol. 61, no. 3, pp. 303–321, 1970.
[62]
U. Tewes, Hawie-R: Hamburg-Wechsler Intelligenztest für Erwachsene, Revision 1991, Hans Huber, G？ttingen, Germany, 1994.
[63]
S. Lehrl, G. Triebig, and B. Fischer, “Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence,” Acta Neurologica Scandinavica, vol. 91, no. 5, pp. 335–345, 1995.
[64]
C. Klein, B. Andresen, and T. Jahn, “Erfassung der schizotypen Pers？nlichkeit nach DSM-III-R: Psychometrische Eigenschaften einer autorisierten deutschsprachigen übersetzung des “Schizotypal Personality Questionnaire” (SPQ) von Raine,” Diagnostica, vol. 43, no. 4, pp. 347–369, 1997.
[65]
N. C. Andreasen, M. Pressler, P. Nopoulos, D. Miller, and B.-C. Ho, “Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs,” Biological Psychiatry, vol. 67, no. 3, pp. 255–262, 2010.
[66]
P. Thoma, M. Hennecke, T. Mandok et al., “Proverb comprehension impairments in schizophrenia are related to executive dysfunction,” Psychiatry Research, vol. 170, no. 2-3, pp. 132–139, 2009.
[67]
J. Uekermann, P. Thoma, and I. Daum, “Proverb interpretation changes in aging,” Brain and Cognition, vol. 67, no. 1, pp. 51–57, 2008.
[68]
Duden, Redewendungen und Sprichw？rtliche Redensarten: W？rterbuch der Deutschen Idiomatik, Duden, Mannheim, Germany, 2nd edition, 2002.
[69]
A. Raine, “The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria,” Schizophrenia Bulletin, vol. 17, no. 4, pp. 555–564, 2001.
[70]
N. C. Andreasen, Scale for the Assessment of Positive Symtpoms (SAPS), University of Iowa, Iowa city, Iowa, USA, 1984.
[71]
N. C. Andreasen, “Negative symptoms in schizophrenia. Definition and reliability,” Archives of General Psychiatry, vol. 39, no. 7, pp. 789–794, 1982.
[72]
S. R. Kay, A. Fiszbein, and L. A. Opler, “The positive and negative syndrome scale (PANSS) for schizophrenia,” Schizophrenia Bulletin, vol. 13, no. 2, pp. 261–276, 1987.
[73]
A. T. Beck, E. Baruch, J. M. Balter, R. A. Steer, and D. M. Warman, “A new instrument for measuring insight: the Beck Cognitive Insight Scale,” Schizophrenia Research, vol. 68, no. 2-3, pp. 319–329, 2004.
[74]
A. G. Guerrero and P. H. Lysaker, “Socially na？ve self-appraisal moderates the relationship between cognitive insight and positive symptoms in schizophrenia,” Schizophrenia Research, vol. 143, no. 1, pp. 97–101, 2013.
[75]
C. M. Elmore and D. R. Gorham, “Measuring the impairment of the abstracting function with the Proverbs Test,” Journal of Clinical Psychology, vol. 13, no. 3, pp. 263–266, 1957.
[76]
M. Lenzenweger, Schizotypy and Schizophrenia, Guilford Press, New York, NY, USA, 2011.
[77]
S. McDonald, S. Flanagan, J. Rollins, and J. Kinch, “TASIT: a new clinical tool for assessing social perception after traumatic brain injury,” The Journal of Head Trauma Rehabilitation, vol. 18, no. 3, pp. 219–238, 2003.
[78]
M. K. Humphrey, F. M. Bryson, and G. M. Grimshaw, “Metaphor processing in high and low schizotypal individuals,” Psychiatry Research, vol. 178, no. 2, pp. 290–294, 2010.
[79]
N. J. Mitchley, J. Barber, J. M. Gray, D. N. Brooks, and M. G. Livingston, “Comprehension of irony in schizophrenia,” Cognitive Neuropsychiatry, vol. 3, no. 2, pp. 127–138, 1998.
[80]
B. Casetta and V. Goghari, “Theory of Mind abilities in schizophrenia: a family study,” Schizophrenia Bulletin, vol. 39, supplement 1, p. S258, 2013.
[81]
D. Leitman, R. Ziwich, R. Pasternak, and D. Javitt, “Theory of Mind (ToM) and counterfactuality deficits in schizophrenia: misperception or misinterpretation?” Psychological Medicine, vol. 36, no. 8, pp. 1075–1083, 2006.
[82]
D. G. Blasko and V. A. Kazmerski, “ERP correlates of individual differences in the comprehension of nonliteral language,” Metaphor and Symbol, vol. 21, no. 4, pp. 267–284, 2006.
[83]
S. L. Ivanko, P. M. Pexman, and K. M. Olineck, “How sarcastic are you? Individual differences and verbal irony,” Journal of Language and Social Psychology, vol. 23, no. 3, pp. 244–271, 2004.
[84]
H. H？fner, “Gender differences in schizophrenia,” Psychoneuroendocrinology, vol. 28, supplement 2, pp. 17–54, 2003.
[85]
J. Miettunen and E. J？？skel？inen, “Sex differences in Wisconsin Schizotypy Scales—a meta-analysis,” Schizophrenia Bulletin, vol. 36, no. 2, pp. 347–358, 2010.
[86]
I. Ziv, D. Leiser, and J. Levine, “Social cognition in schizophrenia: cognitive and affective factors,” Cognitive Neuropsychiatry, vol. 16, no. 1, pp. 71–91, 2011.
[87]
A. M. Rapp and A. E. Steinh？user, “Functional MRI of sentence-level language comprehension in schizophrenia: a coordinate-based analysis,” Schizophrenia Research, vol. 150, no. 1, pp. 107–113, 2013.
