An article published in the July-August issue of Comprehensive Psychiatry applies a stage theoretic model to schizophrenia, concluding that only 6% of afflicted subjects reach formal operations. Although the authors’ understanding of Piaget is clearly not constructivist (and therefore IMHO misses the point), it is nonetheless an interesting use of his framework.  That said, however, their failure to “do the history” has resulted in a contribution that leaves much to be desired.

Abstract
Objective: The objective of the study was to evaluate from the perspective of the Piaget developmental model the cognitive functioning of a sample of patients diagnosed with schizophrenia.

Method: Fifty patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 40 healthy matched controls were evaluated by means of the Longeot Logical Thought Evaluation Scale.

Results: Only 6% of the subjects with schizophrenia reached the “formal period,” and 70% remained at the “concrete operations” stage. The corresponding figures for the control sample were 25% and 15%, respectively. These differences were statistically significant. The samples were specifically differentiable on the permutation, probabilities, and pendulum tests of the scale.

Conclusions: The Longeot Logical Thought Evaluation Scale can discriminate between subjects with schizophrenia and healthy controls. 

The paper fills only 4 journal-length pages, of which one is entirely devoted to references and another dominated by front matter. An image and several charts make the remaining text easier to understand, but — because none of the relevant history is examined and none of the theory they use explained — their study’s implications go unaddressed.

There also seems to be a conflation between Piagetian and neo-Piagetian theory, with a focus on brain maturation over the nature or quality of the interactions that lead to the construction of functional structures. Had the authors examined the practical differences in the predictions made by these two perspectives, I can’t but wonder if their conclusions might have been more useful in both theory and practice….

Given that formal operations is marked primarily by a drive for coherence between reality and constructed knowledge structures, what is it about the aetiology of schizophrenia that makes for such an impact on those afflicted?

Could the incorporation of a neurological approach in clinical research — to examine the differences in underlying structures — inform our general understanding of the construction of mental functioning? (Or, since there were no pharmacological controls in the study, would it just constitute an indictment of the drugs prescribed for this group?) What about the socio-ecological contexts in development?

And where is the literature review on the application of Piaget-inspired theory to schizophrenia research? Although PsycInfo returns nothing, a preliminary search in Google Scholar shows 2570 results!  (A more complex search yields 4290 results, many of which are obviously relevant to the question under consideration.)

In short, although potentially very useful, this article — following the mandate of the journal in which it was published — is just a report: it announces that many schizophrenic subjects suffer from abnormal cognitive declines, which can be characterized according to a stage theoretic model.

There is, on this account, a lot of work still to be done; are there any interested clinical students out there?

-JTB.

Reference
Torres, A., Olivares, J. M., Rodriguez, A., Vaamonde, A., & Berrios, G. E. (2007). An analysis of the cognitive deficit of schizophrenia based on the Piaget developmental theory. Comprehensive Psychiatry, 48(4), 376-379.