Metaphor Processing in Schizophrenia Patients: A Study of Comprehension and Explanation of Metaphors

Open access


The study assessed the quantity and quality of errors made by schizophrenia patients in understanding and interpretation of the same metaphors, to evaluate metaphor understanding and explanation depending on the type of presentation material, and to analyze the correlation of illness symptoms with metaphor comprehension and explanation. Two groups of participants were examined: a schizophrenia sample (40 participants) and a control group (39 participants). Metaphor processing was assessed by the subtests of the Polish version of the Right Hemisphere Language Battery (RHLB-PL). The patients were also evaluated with the Positive and Negative Syndrome Scale (PANSS). Schizophrenia patients scored significantly lower in explanation of metaphors, making more incorrect literal and abstract mistakes or providing no answer more frequently. No differences were observed in understanding metaphors; no correlation between symptoms and metaphor processing was obtained. In both groups, picture metaphors were easier to comprehend and written metaphors were easier to comprehend than to explain.


  • Anand, A., Wales, R. J., Jackson, H. J., & Copolov, D. L. (1994). Linguistic impairment in early psychosis. Journal of Nervous and Mental Disease, 182(9), 488-493.

  • Andreasen, N. C. (1979a). Scale for the Assessment of Positive Symptoms. Iowa City, IA: University of Iowa.

  • Andreasen, N. C. (1979b). Scale for the Assessment of the Negative Symptoms. Iowa City, IA: University of Iowa. Andreasen, N. C. (1979c). Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability. Archives of General Psychiatry, 36(12), 1315-1321.

  • Andreasen, N. C., Arndt, S., Alliger, R., Miller, D., & Flaum, M. (1995). Symptoms of schizophrenia. Methods, meanings, and mechanisms. Archives of General Psychiatry, 52(5), 341-351.

  • Bang, M., Kim, K. R., Song, Y. Y., Baek, S., Lee, E., & An, S. K. (2015). Neurocognitive impairments in individuals at ultra-high risk for psychosis: Who will really convert? Ausralian & New Zealand Journal of Psychiatry, 49(5), 462-470. doi: 10.1177/0004867414561527

  • Benedict, H. (1979). Early lexical development: comprehension and production. Journal of Child Language, 6(2), 183-200.

  • Blaney, P. H. (1974). Two studies on the language behavior of schizophrenics. Journal of Abnormal Psychology, 83(1), 23-31.

  • Bokat, C. E., & Goldberg, T. E. (2003). Letter and category fluency in schizophrenic patients: A meta-analysis. Schizophrenia Research, 64(1), 73-78.

  • Brune, M., & Bodenstein, L. (2005). Proverb comprehension reconsidered - 'theory of mind' and the pragmatic use of language in schizophrenia. Schizophrenia Research, 75(2-3), 233-239. doi: 10.1016/j.schres.2004.11.006

  • Bryan, K. (2014). Psychiatric disorders and Communication. In L. Cummings (Ed.), Handbook of Communication Disorders (pp. 300-318). Cambridge: Cambridge University Press.

  • Chapman, L. J. (1960). Confusion of figurative and literal usages of words by schizophrenics and brain damaged patients. Journal of Abnormal and Social Psychoogyl, 60, 412-416.

  • Condray, R., Steinhauer, S. R., Cohen, J. D., van Kammen, D. P., & Kasparek, A. (1999). Modulation of language processing in schizophrenia: Effects of context and haloperidol on the event-related potential. Biological Psychiatry, 45(10), 1336-1355.

  • Condray, R., Steinhauer, S. R., van Kammen, D. P., & Kasparek, A. (2002). The language system in schizophrenia: Effects of capacity and linguistic structure. Schizophrenia Bulletin, 28(3), 475-490.

  • Corcoran, R. (1999). Autonoetic awareness, executive social skills, and the appreciation of intention: Figurative reasoning in amnesia, confabulation, and schizophrenia. Cogn Neuropsychiatry, 4(1), 55-80. doi: 10.1080/135468099396061

  • de Bonis, M., Epelbaum, C., Deffez, V., & Feline, A. (1997). The comprehension of metaphors in schizophrenia. Psychopathology, 30(3), 149-154.

  • Defeyter, M. A., Russo, R., & Partlin, P. L. (2009). The picture superiority effect in recognition memory: A developmental study using the response signal procedure. Cognitive Development, 24(3), 265-273.

  • Drury, V. M., Robinson, E. J., & Birchwood, M. (1998). 'Theory of mind' skills during an acute episode of psychosis and following recovery. Psychological Medicine, 28(5), 1101-1112.

  • Elvevag, B., Helsen, K., De Hert, M., Sweers, K., & Storms, G. (2011). Metaphor interpretation and use: A window into semantics in schizophrenia. Schizophrenia Research, 133(1-3), 205-211. doi: 10.1016/j. schres.2011.07.009

  • Elvevag, B., Weickert, T., Wechsler, M., Coppola, R., Weinberger, D. R., & Goldberg, T. E. (2002). An investigation of the integrity of semantic boundaries in schizophrenia. Schizophrenia Research, 53(3), 187-198.

  • Gardner, D. M., Murphy, A. L., O'Donnell, H., Centorrino, F., & Baldessarini, R. J. (2010). International consensus study of antipsychotic dosing. American Journal of Psychiatry, 167(6), 686-693. doi: 10.1176/appi.ajp.2009.09060802

  • Gentner, D. (1988). Metaphor as structure mapping: The relational shift. Child Development, 59, 47-59.

  • Gibbs, R. (2006). Metaphor: Psychological Aspects. Santa Cruz, CA: Elsevier Ltd.

  • Guy, W. (1976). The clinical global impression scale. ECDEU Assessment Manual for Psychopharmacology-revised (pp. 218 - 222).

  • Iakimova, G., Passerieux, C., Denhiere, G., Laurent, J. P., Vistoli, D., Vilain, J., & Hardy-Bayle, M. C. (2010). The influence of idiomatic salience during the comprehension of ambiguous idioms by patients with schizophrenia. Psychiatry Research, 177(1-2), 46-54. doi: 10.1016/j.psychres.2010.02.005

  • Iakimova, G., Passerieux, C., & Hardy-Bayle, M. C. (2006). La compréhension des métaphores dans la schizophrénie et la dépression. Une approche expérimentale [The understanding of metaphors in schizophrenia and depression. An experimental approach]. Encephale, 32(6 Pt 1), 995-1002.

  • Iakimova, G., Passerieux, C., Laurent, J. P., & Hardy-Bayle, M. C. (2005). ERPs of metaphoric, literal, and incongruous semantic processing in schizophrenia. Psychophysiology, 42(4), 380-390. doi: 10.1111/j.1469-8986.2005.00303.x

  • Jarema, M. (2015). Standardy leczenia farmakologicznego niektórych zaburzeń psychicznych. [Standard pharmacological treatment of certain mental disorders]. Gdańsk: ViaMedica.

  • Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.

  • Kiang, M., Light, G. A., Prugh, J., Coulson, S., Braff, D. L., & Kutas, M. (2007). Cognitive, neurophysiological, and functional correlates of proverb interpretation abnormalities in schizophrenia. Journal of the International Neuropsychological Society, 13(4), 653-663. doi: 10.1017/ S1355617707070816

  • Kramer, I., Rauber-Luthy, C., Kupferschmidt, H., Krahenbuhl, S., & Ceschi, A. (2010). Minimal dose for severe poisoning and influencing factors in acute human clozapine intoxication: A 13-year retrospective study. Clinical Neuropharmacology, 33(5), 230-234. doi: 10.1097/WNF.0b013e3181f0ec55

  • Kremen, W. S., Seidman, L. J., Faraone, S. V., & Tsuang, M. T. (2003). Is there disproportionate impairment in semantic or phonemic fluency in schizophrenia? Journal of the International Neuropsychological Society, 9(1), 79-88.

  • Kuperberg, G., Ditman, T., Kreher, D. A., & Goldberg, T. E. (2009). Behavioural and electrophysiological approaches to understanding language dysfunction in neuropsychiatric disorders: insights from the study of schizophrenia In S. Wood, N. B. Allen, & C. Pantelis (Eds.), The neuropsychology of Mental Illness (pp. 67-95). Cambridge, England: Cambridge University Press.

  • Kuperberg, G. R. (2010a). Language in schizophrenia Part 1: An Introduction. Language and Linguistics Compass, 4(8), 576-589. doi: 10.1111/j.1749- 818X.2010.00216.x

  • Kuperberg, G. R. (2010b). Language in schizophrenia Part 2: What can psycholinguistics bring to the study of schizophrenia...and vice versa? Language and Linguistics Compass, 4(8), 590-604. doi: 10.1111/j.1749- 818X.2010.00217.x

  • Kuperberg, G. R., Kreher, D. A., Goff, D., McGuire, P. K., & David, A. S. (2006). Building up linguistic context in schizophrenia: Evidence from self-paced reading. Neuropsychology, 20(4), 442-452. doi: 10.1037/0894- 4105.20.4.442

  • Kurtz, M. M., & Marcopulos, B. A. (2012). Cognition in schizophrenia. In M. M. Kurtz & B. A. Marcopulos (Eds.), Clinical neuropsychological foundations of schizophrenia (pp. 1-25). New York, NY: Psychology Press.

  • Lakoff, G., & Johnson, M. (2003). Metaphors We Live By. Chicago, MA: The University of Chicago Press.

  • Langdnon, R., Davies, M., & Coltheart, M. (2002). Understanding minds and understanding communicated meanings in schizophrenia. Mind and Language, 17(1-2), 68-104.

  • Lidzba, K., Schwilling, E., Grodd, W., Krageloh-Mann, I., & Wilke, M. (2011). Language comprehension vs. language production: Age effects on fMRI activation. Brain and Language, 119(1), 6-15. doi: 10.1016/j. bandl.2011.02.003

  • Łojek, E. (2007). The Right Hemisphere Language Battery - Polish Version. Manual. Warsaw, Poland: Pracownia Testów Psychologicznych.

  • Mashal, N., & Kasirer, A. (2012). Principal component analysis study of visual and verbal metaphoric comprehension in children with autism and learning disabilities. Research in Developmental Disabilities, 33(1), 274-282. doi: 10.1016/j.ridd.2011.09.010

  • Mashal, N., Vishne, T., Laor, N., & Titone, D. (2013). Enhanced left frontal involvement during novel metaphor comprehension in schizophrenia: Evidence from functional neuroimaging. Brain and Language, 124(1), 66-74. doi: 10.1016/j.bandl.2012.11.012

  • McKenna, P. K., Mortimer, A. M., & Hodges, J. R. (1994). Semantic memory and schizophrenia. In A. S. Davis & J. Cutting (Eds.), The neuropsychology of schizophrenia (pp. 163-178). Hove: Psychology Press.

  • McKenna, P. K., & Oh, T. M. (2005). Schizophrenic speech. Cambridge: Cambridge University Press.

  • Mitchell, R. L., & Crow, T. J. (2005). Right hemisphere language functions and schizophrenia: The forgotten hemisphere? Brain, 128(Pt 5), 963-978. doi: 10.1093/brain/awh466

  • Mo, S., Su, Y., Chan, R. C., & Liu, J. (2008). Comprehension of metaphor and irony in schizophrenia during remission: The role of theory of mind and IQ. Psychiatry Research, 157(1-3), 21-29. doi: 10.1016/j.psychres.2006.04.002

  • Mossaheb, N., Aschauer, H. N., Stoettner, S., Schmoeger, M., Pils, N., Raab, M., & Willinger, U. (2014). Comprehension of metaphors in patients with schizophrenia-spectrum disorders. Comprehensive Psychiatry, 55(4), 928-937. doi: 10.1016/j.comppsych.2013.12.021

  • Nestor, P. G., Han, S. D., Niznikiewicz, M., Salisbury, D., Spencer, K., Shenton, M. E., & McCarley, R. W. (2001). Semantic disturbance in schizophrenia and its relationship to the cognitive neuroscience of attention. Biological Psychology, 57(1-3), 23-46.

  • Owen, M. J., Sawa, A., & Mortensen, P. B. (2016). Schizophrenia. Lancet, 388(10039), 86-97. doi: 10.1016/S0140-6736(15)01121-6

  • Paivio, A. (1991). Dual coding theory: Retrospect and current status. Journal of Canadian Psychology, 45, 255-287.

  • Parnas, J. (2011). A disappearing heritage: The clinical core of schizophrenia. Schizophrenia Bulletin, 37(6), 1121-1130. doi: 10.1093/schbul/sbr081

  • Paulsen, J. S., Romero, R., Chan, A., Davis, A. V., Heaton, R. K., & Jeste, D. V. (1996). Impairment of the semantic network in schizophrenia. Psychiatry Research, 63(2-3), 109-121.

  • Pawełczyk, A., Kotlicka-Antczak, M., łojek, E., Ruszpel, A., & Pawełczyk, T. (2017). Schizophrenia patients have higher-order language and extralinguistic impairments. Schizophrenia Research. Advance online publication. doi: 10.1016/j.schres.2017.04.030

  • Pawełczyk, A., Kotlicka-Antczak, M., Łojek, E., Pawełczyk, T. (2017). Preliminary study of higher-order language and exralinguistic impairments in individuals with high clinical risk of psychosis and first episode of schizophrenia. Early Intervention in Psychiatry. Advanced online publication. doi: 10.1111/ eip.12482

  • Pickering, M. J., & Garrod, S. (2013). An integrated theory of language production and comprehension. Behavioral Brain Science, 36(4), 329-347. doi: 10.1017/ S0140525X12001495

  • Rapp, A. M., Langohr, K., Mutschler, D. E., & Wild, B. (2014). Irony and proverb comprehension in schizophrenia: Do female patients "dislike" ironic remarks? Schizophrenia Research and Treatment, 2014, 8410-86. doi: 10.1155/2014/841086

  • Rzewuska, M. (2002). Validity and reliability of the Polish version of the Positive and Negative Syndrome Scale (PANSS). International Journal of Methods in Psychiatric Research, 11(1), 27-32.

  • Salisbury, D. F., O'Donnell, B. F., McCarley, R. W., Nestor, P. G., & Shenton, M. E. (2000). Event-related potentials elicited during a context-free homograph task in normal versus schizophrenic subjects. Psychophysiology, 37(4), 456-463.

  • Salisbury, D. F., Shenton, M. E., Nestor, P. G., & McCarley, R. W. (2002). Semantic bias, homograph comprehension, and event-related potentials in schizophrenia. Clinical Neurophysiology, 113(3), 383-395.

  • Scherzer, P., Leveille, E., Achim, A., Boisseau, E., & Stip, E. (2012). A study of theory of mind in paranoid schizophrenia: A theory or many theories? Frontiers in Psychology, 3, 432. doi: 10.3389/fpsyg.2012.00432

  • Searle, J. R. (1993). Metaphor. In A. Ortony (Ed.), Metaphor and thought (2nd ed., pp. 83 - 111). Cambridge, England: Cambridge University Press.

  • Sperber, D., Wilson, D. (2002). Pragmatics, modularity and mindreading. Mind and Language, 17, 3-23.

  • Sestito, N., & Goldberg, T. E. (2012). Medication and Cognition in Schizophrenia. In B. A. Marcopulos & M. M. Kurtz (Eds.), Clinical Neuropsychological Foundations of Schizophrenia (pp. 255-274). New York, NY: Taylor and Francis.

  • Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., . . . Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, Suppl 20, 22-33;quiz 34-57.

  • Sitnikova, T., Salisbury, D. F., Kuperberg, G., & Holcomb, P. I. (2002). Electrophysiological insights into language processing in schizophrenia. Psychophysiology, 39(6), 851-860.

  • Thomas, P., King, K., Fraser, W. I., & Kendell, R. E. (1990). Linguistic performance in schizophrenia: A comparison of acute and chronic patients. British Journal of Psychiatry, 156, 204-210, 214-205.

  • Titone, D., Levy, D. L., & Holzman, P. S. (2000). Contextual insensitivity in schizophrenic language processing: Evidence from lexical ambiguity. Journal of Abnormal Psychology, 109(4), 761-767.

  • Townsend, L. A., Malla, A. K., & Norman, R. M. (2001). Cognitive functioning in stabilized first-episode psychosis patients. Psychiatry Research, 104(2), 119-131.

  • van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet, 374(9690), 635-645. doi: 10.1016/S0140-6736(09)60995-8

  • Winner, E., Rosenstiel, A., & Gardner, H. (1976). The development of metaphoric understanding. Developmental Psychology, 12, 289-297.

Journal Information

CiteScore 2016: 0.24

SCImago Journal Rank (SJR) 2016: 0.200
Source Normalized Impact per Paper (SNIP) 2016: 0.380


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 35 35 35
PDF Downloads 8 8 8