Theory of mind is a psychological term that was coined by psychologists David Premack and Guy Woodruff in the late 1970s. This is how Premack and Woodruff described this concept in their seminal 1978 paper, “Does the chimpanzee have a theory of mind?”:
An individual has a theory of mind if he imputes mental states to himself and others.
Brevity can be an admirable trait in speakers and writers. But in certain circumstances (for example, when you’re trying to fully grasp a fundamental element of social cognition), it may be possible to be a bit too brief. With that thought in mind, let’s expand on this definition a bit.
In non-clinical terms, theory of mind may be summed up as follows:
- The ability to understand that you have a unique mental state that consists of thoughts, feelings, beliefs, desires, and similar elements.
- The ability to understand that other people also have their own thoughts, feelings, beliefs, and desires.
- The awareness that other peoples’ states of mind may not align with your own.
As noted earlier, theory of mind is one component of what mental health professionals refer to as social cognition. This term describes the range of mental processes that allow people to perceive others, interpret and understand them both verbally and nonverbally, and successfully interact with them.
What Does Healthy Theory of Mind Look Like?
Most people acquire theory of mind and other social cognition skills as a natural part of their development. For example, researchers have detected elements of theory of mind in children as young as age two. Experts also believe that theory of mind development may continue throughout adolescence and into adulthood.
Among its many benefits, healthy theory of mind is responsible for capabilities such as the following:
- Interpreting the behaviors of other people
- Predicting how others may act based on their previous behaviors
- Identifying the possible motivations that may prompt a person to act in a particular way
- Realizing that others may have contradictory points of view and/or demonstrably incorrect beliefs
Clearly, theory of mind plays an important role in a person’s ability to fully engage in a functioning society. If a person doesn’t acquire the skills that are associated with healthy theory of mind, they may have considerable difficulty making academic progress, finding and keeping a job, forming and maintaining meaningful relationships, and otherwise enjoying a full and satisfying life.
Several factors can have a negative impact on an individual’s theory of mind. These factors may include mental health concerns such as depression, bipolar disorder, and schizophrenia.
The Impact of Mental Illnesses on Theory of Mind
In January 2021, the journal Neuroscience and Biobehavioral Reviews published a systematic review of studies that focused on the relationship between theory of mind and depression, bipolar disorder, and schizophrenia. This review was conducted by a team of experts from University Medical Centre Utrecht and Erasmus Medical Center, both of which are in The Netherlands.
The review team noted that depression, bipolar disorder, and schizophrenia have all been associated with deficiencies in theory of mind. The purpose of their review, they wrote, was to determine if certain patterns of impairment could be linked to specific symptoms or disorders.
The team reviewed 44 studies that had been published between 2009 and 2020. Excerpts of their findings are included below.
Theory of Mind & Depression
Among patients with major depressive disorder, the review team discovered that severe symptoms were linked with significant deficits in theory of mind. However, an easing of symptoms was not always accompanied by improvements in theory of mind. This suggests that major depressive disorder may lead to persistent theory of mind deficits.
To further assess their findings, the team called for increased research into theory of mind among people who are in remission from major depressive disorder, or who are at risk for developing this form of depression.
Theory of Mind & Bipolar Disorder
When reviewing studies that involved people with bipolar disorder, the team found that the disorder’s impact on theory of mind varied depending on which type of episode the individuals were experiencing. People who were in the midst of manic episodes showed greater impairment than did people who were having a depressive episode.
The research team postulated that this may be due to certain similarities between bipolar disorder and schizophrenia. They noted that people with bipolar disorder who primarily have manic episodes have an increased risk for psychosis. Psychotic symptoms can also be characteristic of schizophrenia.
Theory of Mind & Schizophrenia
The research group stated that deficits in theory of mind seem to be “a marker of the schizophrenia spectrum disorders.” They also reported that patients who have schizophrenia are likely to experience “large-sized impairments” in this area.
Among the study subjects who had schizophrenia, research indicated that the degree of impairment mirrored the severity of psychotic symptoms. Perhaps surprisingly, some studies that were reviewed for this report also detected moderate theory of mind impairments in subjects whose parents or siblings had schizophrenia, even if the subjects themselves did not have this disorder.
Potential Effects of Impaired Theory of Mind
In addition to exploring the impact that bipolar disorder, depression, and schizophrenia can have on theory of mind, researchers have also studied the effects that impaired theory of mind can have on both the substance and qualify of a person’s life.
In a February 2020 letter to the editor of the journal Frontiers in Psychology, a team led by Manuel Sprung, PhD, noted that healthy theory of mind is associated with the following positive outcomes:
- Social development
- Prosocial behaviors
- Popularity among peers
- Reciprocated friendships
- Being rated as “socially skilled” by teachers
Dr. Sprung’s team, which cited multiple studies to support their assertions, also reported that superior theory of mind reduces a person’s risk for loneliness and social rejection.
In addition to experiencing isolation, rejection, and lack of peer support, people who struggle with theory of mind may also face a host of additional obstacles. For example, a 2017 study in the journal BMC Psychiatry found that theory of mind deficits can undermine a person’s ability to make good decisions.
The 2017 study was led by Liu-Quin Yang, PhD. Dr. Yang’s team studied 73 adults, 35 of whom had schizophrenia. The team used multiple assessment techniques, including a decision-making game, picture story analyses, and cognitive testing.
The researchers discovered that subjects whose test scores indicated they had theory of mind deficits were more likely to:
- Accept offers that were unfair to them
- Reject offers that were fair or advantageous to them
- Fail to grasp changes in fairness
- Misinterpret the intentions of others
These finding suggest that the combination of mental illness and impaired theory of mind can increase a person’s risk for being manipulated, swindled, or victimized in other ways.
For people who may already feel that they don’t fit in, these experiences can threaten to exacerbate their growing sense of exclusion and isolation.
Benefits of Treatment
For people who have been impacted by acute mental health concerns, effective comprehensive treatment may need to include a vibrant social component. In addition to helping people manage their symptoms, their treatment plan should also empower them to function more effectively within their families, workplaces, and communities.
At Crownview Psychiatric Institute, we work closely with each client to improve their social capabilities. Our programming includes dynamic therapies, life skills instruction, job skills sessions, and true wraparound support services. We understand the social challenges that so many of our clients have previously experienced, and we are committed to helping them make sustained progress toward a healthier and much more satisfying future.
To learn more about our comprehensive programming for adults who have depression, bipolar disorder, schizophrenia, and other complex mental illnesses, contact us today.
Gianna Melendez
Jodie Dahl, CpHT