Schizophrenia as a Disorder of Communication

The first characterizations of schizophrenia invoked the concept of disordered thought and broken mind as central to its clinical presentation [1, 2]. Interestingly, Bleuler's characterization of schizophrenia was couched in terms of four A's association, with its focus on disordered language, affectivity, ambivalence, and autism, all of which implicate different aspects of social function [3]. Bleuler captured much that is still relevant to the study of cognitive dysfunction in schizophrenia and, in fact, covers quite well the topic of social communication dysfunction highlighted in this issue. The research that followed these early characterizations firmly established the link between abnormal brain structure and function, mediated by genetics, and many clinical and cognitive manifestations of this devastating disease [4–6]. Over the last several years, great progress has been achieved in the understanding of mechanisms of schizophrenia [7– 10]. And while a comprehensive theory of schizophrenia is still elusive, many compelling accounts of schizophrenia pathology have been put forward and generated valuable insights [8, 9, 11–15]. Within the field of study of the cognitive dysfunction in schizophrenia, research has focused on different aspects of what was described recently as " cold cognition " and included attention, memory systems that vary in duration, capacity, and operations, as well as language and perceptual mechanisms [9]. The last few years brought a welcome broadening of this field of study as it has been noted that abnormalities in " hot cognition " including abnormalities in emotion and affect processing from both face and voice are an important component of schizophrenia pathology [16, 17]. Social cognition, whose functions draw on both processes of " cold " and " hot " cognition, has become a focus of intense interest with studies addressing the ability to convey one's attitudes and intentions and adaptively predict and interpret the attitudes and intentions of others. Finally and importantly, it has been increasingly recognized that impairments in social cognition contribute to both clinical and functional outcomes in schizophrenia [18, 19]. The aim of the current issue is to broaden the discourse on the nature of cognitive dysfunction in schizophrenia. We propose that the cognitive dysfunction in schizophrenia should be conceptualized as a disorder of communication rather that of language itself and that communication disorder is the core clinical deficit of schizophrenia. We believe that an array of sensory and cognitive processes and their interactions enable human beings to enter into meaningful social communication. Thus, …