Flat and blunted affect. Clinicians use this term to describe a person whose face expresses little emotion. Their voice may be atonal, with minimal cadence, unlike the natural sing-song like expression we make in the simple act of talking with each other. But does this mean such a person does not have a range of emotions as broad as you or I? What if the problem is not the type of emotion or lack of emotion, but the inability to connect the emotion with an appropriate facial expression?
Some people with schizophrenia have such impairment, and indeed, this feature is often central to the condition. Investigators from The Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine explored how the inability of people with schizophrenia to communicate their emotions with their faces may contribute to the apparent social difficulty of people with this condition. When we cannot read another person’s face how are we meant to react or respond empathically? Does this difficulty in expressing emotions lead others to respond to the person with schizophrenia in a certain, and possibly inappropriate, way.
420 subjects were shown photographs of 6 people with stable schizophrenia and asked to compare them to photos of six people who did not have the condition. The faces expressed five universal emotions: happy, sad, anger, fear, and disgust, and a neutral face. Except for some photos where the faces were posed, the observes had more difficulty accurately identifying the expressions of people with schizophrenia. Their faces were not an accurate reflection of their mood.
This has enormous ramifications for possible treatment modalities. What if people with schizophrenia could match a posed face with a true emotion? How would that enhance their socialization? And would enhanced socialization, and being understood, have an impact to decrease paranoia and derogatory hallucinations? We use similar techniques to help kids with Asperger’s learn to identify faces, and to make a face commensurate with their own internal emotion. Can we do the same with people who have these most prevalent thought disorders?
Can we get them from flat and blunted to animated and astute? Can we change the face of schizophrenia?
Do we recognize facial expressions of emotions from persons with schizophrenia?
Healey KM, Pinkham AE, Richard JA, Kohler CG. Schizophr Res. 2010 Sep;122(1-3):144-50. Epub 2010 May 21.