Preserved intention understanding during moral judgments in schizophrenia

Abstract

Introduction Although there is convincing evidence for socio-cognitive impairments in schizophrenia spectrum disorder (SSD), little evidence is found for deficient moral cognition. We investigated whether patients with SSD showed altered moral judgments in a story task where the protagonist either had a neutral or malicious intention towards another person. This paradigm examined whether SSD relates to altered moral cognition in general or specifically to impaired integration of prior information (such as beliefs) in moral judgments. Methods 23 patients and 32 healthy controls read vignettes created in a 2 x 2 design. The protagonist in each story either had a neutral or negative intention towards another person which, as a result, either died (negative outcome) or did not die (neutral outcome). Participants rated the moral permissibility of the protagonist’s action. Standard null hypothesis significance testing and equivalent Bayes analyses are reported. Results Schizophrenia patients did not differ significantly in permissibility ratings from healthy controls. This finding was supported by the Bayes analyses which favoured the null hypothesis. Task performance was not related to symptom severity or medication. Conclusions The current findings do not support the notion that moral judgments are deficient in schizophrenia. Furthermore, the current study shows that patients do not have observable difficulties in integrating the protagonist’s belief in the rating of the moral permissibility of the action-outcome.

Blindness of intentions and metacognitive deficits during moral judgements in schizophrenia

“…Each observation is the average of 16 measurements on a 4-point scale (1)(2)(3)(4) of the studies presented earlier. 19,20 The present results indicate a reduction in the level of moral cognition and its impact on the evaluation of the intentions and moral conduct of others. Another mediator of the postulated relationships is social cognition, including mentalization skills, the dysfunctions of which will be reflected in moral judgments and thus in attitudes and behaviors, including aggressive ones.…”

“…Some studies indicate that there are no deficits in moral judgments, i.e., patients with schizophrenia have no observable difficulties in understanding the intentions of others in social situations and in evaluating the moral acceptability of the resulting behavior. 19 There are also studies conducted among adolescents indicating deficits in moral judgments. 15 In contrast, research by McGuire et al 20 indicates a link between negative symptoms in schizophrenia and severe judgments regarding behavior that is commonly accepted as a minor offense.…”

Effects of Integrated Moral Reasoning Development Intervention for Management of Violence in Schizophrenia: A Randomized Controlled Trial

“…Moral cognition is a multidimensional process, driven by moral reasoning, moral judgement, and decision-making, that influence a person’s behavior [ 15 ]. Moral cognition, which focuses on thinking processes, is actionable in schizophrenia, and it can be widely upheld under conditions of reasonable moral pluralism across different cultures, traditions and rules [ 16 , 17 , 18 ]. Moral reasoning determines whether a behavior is morally acceptable (right or wrong) [ 19 ] and plays a paradoxical role in schizophrenia [ 16 , 17 , 18 , 20 ].…”

“…Moral cognition, which focuses on thinking processes, is actionable in schizophrenia, and it can be widely upheld under conditions of reasonable moral pluralism across different cultures, traditions and rules [ 16 , 17 , 18 ]. Moral reasoning determines whether a behavior is morally acceptable (right or wrong) [ 19 ] and plays a paradoxical role in schizophrenia [ 16 , 17 , 18 , 20 ]. However, the form and content of the moral reasoning associated with schizophrenia have not been intensively studied.…”

“…Moral reasoning is not simply associated with violence, but also to its level of maturity. Studies often make assumptions about violence that often include an assumption of egoism and deficits in moral reasoning when individuals deviate from moral components and norms [ 2 , 16 , 23 ]. The patients who exhibit lower levels of moral reasoning are more prone to be violent.…”