Emotion in Schizophrenia : Old Mystery , New Understanding

It has appeared both from crude observation and from detailed study of the facial expression that the alleged indifference , apathy, and emotional dishar-mony of the schizophrenic is more a matter of impression than correct evaluation of the inner experience of such a patient. It has followed that the study of such inner affective experiences by positive objective means seems urgently indicated if the nature of the schizophrenic processes is to be elucidated. Early psychological theorists such as Sullivan, Kraeplin, and Bleuler wrote extensively about the emotional lives of schizophrenia patients. In particular, they noted a peculiar mystery: Some patients with schizophrenia reported feeling strong emotions, yet their faces belied these internal experiences. These early writers provided vivid descriptions of emotional disturbances that often accompanied schizophrenia; yet their pleas for research on emotion in schizophrenia were largely ignored until recently. Recent methodological advancements , including the development of reliable, clinical rating scales, have made the study of emotional features in schizophrenia more feasible. For example, the Scale for the Assessment of Negative Symptoms (SANS; Andreasen, 1983) includes a subscale for the symptom of flat affect, which refers to a lack of outward emotional expression. One unfortunate shortcoming of these ratings scales is that they typically assess only one component of emotion. However, emotion is most clearly defined by a consideration of multiple components, including expression, experience, cognition, and psychophysiology. Perhaps one of the most important advancements in the study of emotion and schizophrenia has been the adoption of methods developed in other areas of psychology and social science. In particular, paradigms from basic emotion research have enabled investigators interested in schizophrenia to examine the concordance among components of emotion. For example , in recent laboratory studies of emotion in schizophrenia, partici-pants' facial expressions have been videotaped during the presentation of emotionally evocative stimuli , such as film clips or slides. Participants have filled out questionnaires describing their subjective emotional reactions to the stimuli, and some studies have also used psychophysiological methods, such as measures of heart rate and skin conductance (i.e., palm sweating), to assess emotion. This new, multidisciplinary approach has yielded a number of important findings on which components of emotion are disrupted in schizophrenia. One of the most robust findings to emerge from empirical research on emotion in schizophrenia is that compared with nonpatients, schiz-ophrenia patients display fewer observable positive and negative facial expressions of emotion in response …