psych explanations for schizophrenia Flashcards
What are 3 aspects of fam dysfunction explanation
Schizophrenogenic mother
Double-bind theory
Expressed emotion and schizophrenia
What is the schizophrenogenic mother
Fromm-Reichmann proposed a psychodynamic explanation for schizophrenia based on the accounts she heard from her patients about their childhoods. She noted that many of her patients spoke of a particular type of parent, which she called the schizophrenogenic mother. According to Fromm-Reichmann the schizophrenogenic mother is cold, rejecting and controlling, and tends to create a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions (i.e. beliefs of being persecuted by another person), and ultimately schizophrenia.
What is the double bind theory
- Bateson et al. stated the developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is, and feel unable to comment on the unfairness of this situation or seek clarification. When they get it ‘wrong’ (which is often) the child is punished by withdrawal of love.
- Parents may express care but at the same time appear critical. It can also relate to a contradiction between a person’s verbal behaviour and non-verbal behaviour.
- This leaves them with an understanding that the world is confusing and dangerous, and this is reflected in symptoms like disorganised thinking and paranoid delusions.
E.g. parents who say they care whilst appearing critical or who express love whilst appearing angry.
What is 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 contains several elements:
* Verbal criticism of the person, occasionally accompanied by violence
* Hostility towards the person, including anger and rejection
* Emotional overinvolvement in the life of the person, including needless self-sacrifice
High levels of EE cause stress for the patient and is used as an explanation for relapse in people with schizophrenia. However, it has also been suggested that it may be a source of stress that can trigger the onset of schizophrenia in a person who is already vulnerable, due to their genetic make-up (the diathesis-stress model)
Evaluation of family dysfunction
Research support
P - One strength of these explanations is evidence linking family dysfunction to schizophrenia
E - Indicators of family dysfunction include insecure attachment and exposure to childhood trauma, especially abuse. According to a review by Read et al. (2005) adults with schizophrenia are disproportionately likely to have insecure attachment, particularly Type C or D. Read et al. also reported that 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse. In the Mørkved et al. (2017) study, most adults with schizophrenia reported at least one childhood trauma, mostly abuse.
E - This strongly suggests that family dysfunction makes people more vulnerable to schizophrenia
Explanations lack support
P - One limitation of family explanations is the poor evidence base for any of the explanations.
E - Although there is plenty of evidence supporting the idea that childhood family-based stress is associated with adult schizophrenia, there is almost none to support the importance of traditional family-based theories such as the schizophrenogenic mother and double bind. Both these theories are based on clinical observation of people with schizophrenia and also informal assessment of their mothers’ personalities, but not systematic evidence.
E - This means that family explanations have not been able to account for the link between childhood trauma and schizophrenia.
Parent-Blaming
P - One limitation of the family dysfunction explanation is that it implies that parents are responsible for the problems of their children.
E - Linking family dysfunction to schizophrenia is highly socially sensitive because it can lead to parent-blaming. Mothers seem to be particularly blamed, an example of gender bias. For parents already having to watch their child experience the symptoms of schizophrenia and take responsibility for their care, to be blamed, adds insult to injury.
E - This suggests that the research therefore does not protect individuals from harm.
What do cognitive explanations suggest about schizophrenia
A cognitive explanation focuses on the role of mental processes, in this case several types of dysfunctional thought processing may cause schizophrenia. Schizophrenia is characterised by disruption to normal thought processing, as seen in many of its symptoms. Lower than usual levels of processing in various areas of the brain are associated with both positive and negative symptoms (see biological explanation).
What are the cognitive explanations
Frith et al. (1992) identified two kinds of dysfunctional thought processing that could underlie some symptoms:
Metarepresentation is the cognitive ability to reflect on your thoughts and behaviours. This allows us insight into our own intentions and goals and allows us to interpret the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. This would explain hallucinations of voices and delusions like thought insertion.
Central control is the cognitive ability to suppress automatic responses while we perform deliberate actions. Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts. Sufferers with schizophrenia tend to experience derailment of thoughts and spoken sentences because each word triggers associations, and the patient cannot suppress automatic responses to these.
Evaluation of cognitive processes
Research support
P - One strength of cognitive explanations is evidence for dysfunctional thought processing
E - Stirling et al. (2006) compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 30 people without schizophrenia. Tasks included the Stroop task, in which participants have to name the font-colours of colour-words, so have to suppress the tendency to read the words aloud. As predicted by Frith et al.’s central control theory, people with schizophrenia took longer - over twice as long on average - to name the font-colours
E - This means that the cognitive processes of people with schizophrenia are impaired
A proximal explanation
P - One limitation of cognitive explanations is that they only explain the proximal origins of symptoms
E - Cognitive explanations for schizophrenia are proximal explanations because they explain what is happening now to produce symptoms - as distinct from distal explanations which focus on what initially caused the condition. Possible distal explanations are genetic and family dysfunction explanations. What is currently unclear and not well-addressed is how genetic variation or childhood trauma might lead to problems with metarepresentational or central control
E - This means that cognitive theories on their own only provide partial explanations for schizophrenia
