Lesson 3 Flashcards
Psychological Explanations for Schizophrenia
The two main psychological explanations for SZ are Family dysfunction and Cognitive Explanations
Family Dysfunction
Psychologists have attempted to link SZ to childhood and adult experiences of living in a dysfunctional family (i.e. a family that is not functioning properly e.g. where there may be abuse, messy divorces, criminal activities, high poverty etc)
Three ways family dysfunction is explained
- The Schizophrenic mother
- Double-bind Theory
- Expressed Emotion
The schizophrenic mother
Fromm-Reichmann (1948) proposed a psychodynamic explanation for SZ based on the accounts she heard from her patients about their
childhoods. She noted that many of her patients spoke about a particular type of parent which she called the schizophrenogenic mother. The term ‘schizophrenogenic’ means ‘schizophrenia’ causing. Characteristics of this type of mother are: cold, rejecting and controlling as well as creating a family climate full of secrecy and tension. This leads the
child to having a lack of trust in relationships that later develop into paranoid delusions (the belief that one is being persecuted by another person) thus ultimately developing SZ. A point to be noted about the schizophrenogenic mother is that in those type of families, the father is often passive and doesn’t really get involved in child upbringing.
Double bind Theory
Bateson et al. (1972) agreed that family climate is important in the development of SZ but focused more on the actual family communication style. He
suggested that children who frequently receive contradictory messages from their parents. In this case, the child finds themselves trapped in situations which they fear doing the wrong thing but receive mixed messages about what this is. (An example of a
mixed message could be when a mother tells her child she loves him but is actually showing disgust when she tells him.) As a result the child is unable to comment about the unfairness of the situation or seek clarification. Thus when the child may get it wrong (which they often do), the child is punished by withdrawal of love. The child then feels confused about the world and sees it thus as a dangerous place – this may be reflected in SZ symptoms such as paranoid delusions. However, Bateson did clarify that this family communication style was a risk factor in the development of SZ but not the only cause!
Expressed Emotion
Expressed Emotion (EE) is the level of emotion, in particular negative emotion, expressed towards a patient by their carers who are often family members.
EE has several parts:
• Verbal criticism of the patient, occasionally shown with violence
• Hostility towards the patient, including anger and rejection
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• Emotional over-involvement in the life of the patient, including needless self-sacrifice
High levels of EE by the carers of the patients creates a serious source of stress – this may be a reason for the SZ patient to relapse – although EE can also be a trigger for the onset of SZ as well especially if the person has a genetic vulnerability to the disorder (diathesis-stress model)
Advantages of family dysfunction as a risk factor
There is research support for family dysfunction as a risk factor. For example in an adoption study by Tienari et al (1994). In this study, those adopted children who had schizophrenic biological parents were more likely to have SZ themselves than those
children with non-schizophrenic biological parents. However, this difference only emerged in situations where the adopted family was rated as disturbed or
‘dysfunctional’. In other words, the illness only manifested itself under appropriate environmental conditions. Genetic vulnerability alone was not sufficient. This shows that family dysfunction is a contributing factor to SZ.
There is also evidence to support the Double-Bind theory as an explanation of SZ. For example, Bateson (1956) reported on a case study when a recovering schizophrenic was visited in hospital by his mother. He embraced her warmly, but she stiffened, and when he withdrew his arms she said, ‘Don’t you love me any more?’ To which he blushed and she commented, ‘Dear, you must not be so easily embarrassed and afraid of your feelings.’ She then left and he assaulted an aide and had to be restrained. This gives support to the idea of double bind as the mother had obviously given mixed messages to her son in childhood hence his behaviour towards the aide.
There is also evidence for expressed emotion as a contributing factor to the relapse of SZ, Kavanagh (1992) reviewed 26 studies of expressed emotion, finding that the mean relapse rate for schizophrenics who returned to live with high expressed emotion
families was 48% compared to 21% to those who went to live with low expressed emotion families. This supports the idea that expressed emotion increases the risk of relapse for recovering schizophrenics.
Disadvantages of family dysfunction as a risk factor
The evidence for family dysfunction as a contributing factor to developing SZ is not very strong. For example, with regards to Double-bind theory, Liem (1974) measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families. This shows that this theory may not be
specifically related to SZ.
Also not all patients who live in high EE families relapse, and not all patients who live in low EE homes avoid relapse. Altorfer et al (1998) found that one-quarter of patients that they studied showed no physiological responses to stressful comments from their relatives. This shows that the evidence for EE as a contributing factor towards relapse and SZ is very mixed.
One problem with dysfunctional family explanations for SZ is that they have led historically to parent blaming – parents who have already suffered seeing their son/daughter developing SZ and having to bear life-long responsibility for their care will also suffer further trauma by being blamed for their son/daughter’s condition. This means that family dysfunction explanations may not be entirely ethical and may cause more harm than help to both the sufferer and their parents.
Cognitive Explanations for SZ
Cognitive explanations for schizophrenia focus on the role of mental processes. SZ is associated with several types of dysfunctional thought processing and thus provide explanations for SZ as a whole.
Two kinds of dysfunctional thought processing
Frith et al (1992) identified two kinds of dysfunctional thought processing that could underlie some symptoms:
- Meta representation
- Central control
Meta representation
this is the cognitive ability to reflect on thoughts and
behaviour which enables us an insight into our own intentions and goals as well as allowing us to interpret the actions of others. Thus a dysfunction in metarepresentation would disrupt this ability to
recognise our own actions and thoughts as being our own rather than someone else. This could explain auditory hallucinations and delusions (like thought insertions – where you believe that someone is putting thoughts into your head)
Central control
this is the cognitive ability to suppress automatic responses while we perform other actions instead (e.g. a voice in you might say: ‘don’t do this’ – then you choose whether you do it or not). Speech poverty and thought disorder could result from the inability to ignore your own automatic thoughts as well as what other could be saying to you (in your head) (e.g. so and so would tell me not to do this)
Sufferers with SZ tend to experience derailment (a confusion and breakdown) of their thoughts and what they say because there is too much going on in their thought processes thus they lose control of their own thoughts.
Advantages of Cognitive Explanations of SZ
There is strong evidence for dysfunctional thought processing in SZ. In one study Stirling et al (2006) compared 30 patients with a diagnosis of SZ with 18 non-patient controls on a range of cognitive tasks such as the stroop effect (this is when the colour
word is written in a different colour and you have to actually say the colour of the word rather than just reading the word). In his study Stirling found that patients with SZ took twice as long to say the colour of the word than controls – this study shows
dysfunctional thought processing in schizophrenics since they were struggling with separating the colour word from the actual colour that it was (e.g. saying the colour blue but the actual colour word written is red) because the Schizophrenics were not able to
separate the actual colour from the written word.
Another strength of cognitive explanations of schizophrenia is the success of cognitive behaviour therapy (CBT) used alongside drugs to treat schizophrenia. As schizophrenia is a thought disorder, clearly drugs cannot completely treat the disorder thus cognitive behavioural therapy will aim to question and challenge the hallucinations and delusions – as well as using behavioural techniques (such as positive reinforcement). CBT has been
proven to be effective thus further supporting the cognitive explanations of SZ.
Disadvantages of Cognitive Explanations of SZ
Although there is a wealth of evidence to support the idea that schizophrenics have dysfunctional thought processing, it is difficult to establish whether this is a cause or consequence of SZ for example did the dysfunctional thought processing begin and then
then person had symptoms of SZ or is the dysfunctional thought processing a consequence of SZ?
The cognitive explanation in explaining SZ is problematic in that it fails to take into account biological factors and does not acknowledge the fact that dysfunctional thought processing could also be due to abnormal dopamine levels in the brain. This explanation is therefore reductionist because it is simplifying SZ to very basic elements e.g. dysfunctional thoughts rather than considering other factors such as genes, neurotransmitters and stress which have all been shown to contribute to schizophrenia.
