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This article focuses on the schizophrenic disorganization syndrome, which was initially described by Bleuler (who used the term "dissociation") as lying at the heart of schizophrenia. While adopting a neo-Bleulerian approach, we describe schizophrenic disorganization using a pathogenetic hypothesis and a three-part structure. First, we discuss previous approaches to characterizing and defining schizophrenic disorganization, providing arguments in favor of a complementary approach to describing schizophrenic disorganization that relies on a pathogenetic analysis of the disorganization syndrome, and especially thought and language disorders. Second, we present two possible cognitive pathophysiological mechanisms that may explain schizophrenic disorganization: (1) a deficit in the integration of contextual information, based on the results of semantic priming studies; and (2) a theory of mind deficit, based on the results of studies of the attribution of mental states to others. We propose a cognitive model of schizophrenic dysfunctioning on the basis of these two anomalies. Third, we summarize our published findings to examine the implications of these two cognitive pathophysiological mechanisms for schizophrenic disorganization. On the basis of the same two anomalies, we then propose and illustrate a neo-Bleulerian approach to the assessment of communication disorders that is critical to the improvement of schizophrenic disorganization's clinical description.

The ability of schizophrenia patients to access metaphorical meaning was studied on the basis of psycholinguistic models of metaphor processing. ERPs were recorded from 20 schizophrenic and 20 control participants who were asked to read metaphorical, literal, and incongruous sentences and to judge their meaningfulness. In all participants, incongruous endings to sentences evoked the most negative N400 amplitude, whereas literal endings evoked more negative N400 amplitude than metaphorical ones, consistent with the direct model of metaphor processing. Although the patients had ERPs patterns that were similar to controls, they exhibited a more negative N400 amplitude for all sentences, LPC amplitude reduction, and latency delay in both components. The results suggest that schizophrenics have no specific anomalies in accessing the meaning of metaphors but are less efficient in integrating the semantic context of all sentences--both figurative and literal.

The disorganization pattern in schizophrenia may be associated with a specific deficit of the cognitive ability referred to as theory of mind, and this deficit could be a state rather than a trait variable. Patients with thought and speech disorders may be more likely to understanding other people's mental states in unambiguous and common situations.

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