psychological explanations of sz Flashcards
what psychological explanations are there?
Family Dysfunction:
- Schizophrenogenic Mother
- Double-bind Hypothesis
- High Expressed Emotion
Cognitive Explanation:
- Dysfunction in the Central Monitoring System
- Dysfunction in the Supervisory Attention System
- Dysfunction within Insight / Egocentric Bias
what does family dysfunction stress??
- These explanations emphasise family-orientated theories of the disorder that emphasise the importance of childhood upbringing and in particular trauma in the development of schizophrenia in adulthood.
Essentially these explanations stress the importance of how maladaptive family relationships and poor communication within the household contribute to the development of schizophrenia in adulthood.
what is family schism to do with the explanation of family dysfunction?
This relates to severe and chronic disequilibrium (imbalance) in the household and persistent family discord (constant tension and arguing within the family).
These experiences may well be pushed to the back of a child’s mind - but may resurface in adulthood as symptoms of Schizophrenia
what is a family skew to do with the explanation of family dysfunction?
- This is when one parent is dysfunctional and the other maintains a peacemaking stance. Sometimes this comes across as one domineering parent and one submissive parent, that refuses to criticise or recognise negative qualities in the other parent.
- The child internalises this type of relationship as the norm, and may develop disorganised thoughts / speech as an adult - contributing to schizophrenia.
explain the theory of the schizophrenic mother in the explanation of family dysfunction?
Fromm-Reichmann (1948) used this term to describe a mother who is domineering, insensitive, controlling, overprotective as well as rejecting.
This type of mother may micromanage her kids and refuse to acknowledge their independence which sets up lines of faulty communication between her and the child - contributing to symptoms of schizophrenia in adulthood.
In the 1970’s this theory was broadened to include how the father and entire family could have schizophrenogenic tendencies.
This can create excessive stress that could trigger psychotic thinking and develop into schizophrenia in adulthood.
explain the theory of the double bind hypothesis in the explanation of family dysfunction?
Bateson et al. (1956) focused on contradictory communication coined ‘double-bind’.
Families that communicate in this way make kids more susceptible to schizophrenia in adulthood. E.g., the mother tells her child she loves them, yet at the same time turns her head away in disgust.
Hence, the child receives conflicting messages and placed in a no-win situation.
As a result the child becomes confused and suspicious and cannot develop an internally coherent construction of reality.
This may contribute to the development of schizophrenia in early adulthood, through paranoia and disorganised thinking.
explain the high expressed emotion theory in the explanation of family dysfunction?
This revolves around how family interactions affect the development of schizophrenia rather than its onset.
High EE families express considerable emotion – higher levels of concern for, and / or hostility towards the patient.
Kuipers et al. (1983) found that high EE relatives talk more and listen less.
Linszen et al. (1997) found that patients returning to a high EE household are four times more likely to relapse than those whose family has low EE. This finding has been replicated several times.
what are the positive evaluations of family dysfunction?
- There is evidence to support the theoretical foundations of dysfunctional family relationships as an explanation for schizophrenia.
Lidz et al (1965) looked at the cases of 50 schizophrenic patients and investigated their family backgrounds. Forty-five (90%) were found to have seriously disturbed families. 60% of the patients had one or both parents with a serious personality disorder. Also, parental marriages were often skewed (characterised by one dominant and one submissive parent).
This implies… dysfunctional family backgrounds may well contribute to the development of schizophrenia, suggesting preventative measures could be put in place if awareness is raised. - This is more compelling evidence to show how returning to a household with high EE effects relapse of schizophrenic symptoms.
Butzlaff and Hooley (1998) completed a meta-analysis of 26 studies and found that when patients suffering from schizophrenia returned to families with high EE they experienced more than twice the rate of relapse of schizophrenia symptoms.
This provides further concurrent validity to Linszens et al. (1997) findings that high EE clearly relates to schizophrenia.
Therefore, this shows how high levels of EE clearly impacts on the relapse of schizophrenia. Therefore, when looking at treatment options, we can try and prevent relapse through family therapy. - This explanation has been practically applied to help those suffering from schizophrenia.
Family therapy is a very effective treatment to come out of this explanation that aims to help the patient and the family come to terms with the schizophrenia diagnosis, how to readily spot early signs of relapse and how to cope without resorting to high levels of EE.
This implies… the dysfunctional family explanation of schizophrenia has been beneficial to the 1% of the population that struggle with this psychotic condition, and may help to restore family dynamics.
what are the negative evaluations of family dysfunction?
- There is a cause and effect argument with dysfunctional families as an explanation for schizophrenia.
Perhaps if you have a child that is particularly susceptible to mental health concerns, a normal parental response would show excessive concern, involvement and guidelines for their child.
This may suggest that high expressed emotion may well be a response to kids with emotional distress, as opposed to a contributing factor to the development of schizophrenia.
This suggests unusual family behavioural patterns may be a response to schizophrenia not a cause. - Alternative explanations of schizophrenia are more scientific and hence, more credible. The approach explains the origins of schizophrenia as a consequence of a dysfunctional family, which is based on factors that are difficult to study objectively (e.g. childhood and the unconscious mind). These concepts are subjective and require a degree of interpretation which restricts the validity of the account.
Better, more scientific alternatives include: biological explanations of schizophrenia such as the dopamine hypothesis.
Because: dopamine levels can be objectively measured through PET scans or analysis of cerebrospinal fluid.
This suggests… the family dysfunctional explanation of schizophrenia is redundant as more trustworthy explanation are available. - This explanation can be criticised for causing further problems for the individual with schizophrenia and their families.
The explanation tends to blame the way parents have raised and interacted with their children as the sole cause of schizophrenia. This is hardly protecting patients and their families from harm, and in some instances can be seen to make family dynamics even worse. For instance, patients may become resentful of their parents thinking their schizophrenia diagnosis is their fault.
This suggests… that in such a socially sensitive topic clinicians need to be mindful of how causal factors for schizophrenia are discussed with patients and their families.
what does the cognitive explanation of schizophrenia stress?
To explain schizophrenia, this approach emphasises the role of faulty information processing and claims many patients suffering from schizophrenia have dysfunctional thought processes.
In particular it claims the symptoms of schizophrenia are due to specific “cognitive deficits’’ (impaired thought processes).
- Cognitive psychology claims schizophrenia sufferers have problems with a high-level cognitive process called meta-representation. This is the ability to reflect upon thoughts, behaviours and feelings that gives us the sense of self-awareness.
- There are several dysfunctional aspects of thought processing that patients may experience and each helps explain different types of symptoms.
- Several cognitive processes are recognised to contribute to this, and each explain different symptoms.
explain the theory of dysfunction in the central monitoring system in the cognitive explanation?
Typically, this ‘process’ labels & recognises actions and thoughts as ‘being done by me’ or ‘mine’.
A malfunction within the CMS could explain positive (category A) symptoms of schizophrenia such as hallucinations and delusions.
This is because of misattribution errors - our inner speech / articulatory control process (Phonological Loop from the Working Memory Model) are linked to external sources such as other people’s voices rather than our own inner voice.
explain the theory of dysfunction within the supervisory attention system in the cognitive explanation?
Typically this ‘process’ responsible for generating self-initiated actions.
Problems with a person’s SAS are therefore associated with the negative symptoms of schizophrenia such as flat affect, speech poverty and avolition.
E.g., not responding to environmental stimuli with appropriate (or even any) emotions because of a faulty SAS (flat affect and speech poverty), limiting interactions.
explain the theory of dysfunction within insight/ egocentric bias?
Typically we can all see we are not central component to all events in the world - we usually grow out of this way of thinking early on.
With schizophrenia, there is an egocentric bias – they tend to believe everything relates to them specifically, so they jump to false conclusions
E.g. muffled voices = people’s criticisms
E.g. flashes of light = signals from God
An egocentric bias can lead to delusions of grandeur because they believe they are central to all events going on around them and are therefore the most important person on the planet.
what are the positive evaluations of the cognitive explanation?
- There is evidence to support the theoretical foundations of dysfunctional thinking and schizophrenia.
Bentall (1991) asked participants to either generate category items themselves (e.g. animals beginning with the letter B) or read out category items. One week later, participants were asked whether they had generated the words for themselves, read them, or whether they were new.
Results showed schizophrenic participants with hallucinations performed worse (i.e., were unable to identify the source of the words); than schizophrenic patients without hallucinations and both groups performed worse that non-schizophrenic controls.
This highlights the idea that schizophrenics have a deficit when it comes to monitoring ‘own’ behaviour and therefore supports the idea that the positive symptoms of schizophrenia are linked to a faulty CMS. - This explanation has been practically applied to help those suffering from schizophrenia.
For example, Cognitive Behavioural Therapy aims to challenge and change the cognitive deficits of patients with schizophrenia and alter their behaviour simultaneously through developing more rational constructive ways of thinking and functioning.
This has been shown to be very effective with many schizophrenic patients.
This implies… the cognitive dysfunctional explanation of schiz has been very useful to the 1% of the population that are suffering from schizophrenia. - The cognitive explanation is praised for being able to link both physiological and psychological aspects together to explain cases of schizophrenia.
Cognitive neuroscience links areas of the brain and information processing together to explain behaviour and with schizophrenia this can be readily appreciated.
For instance, by looking at damage to the hippocampus and regions linked to working memory we can see how they contribute to cognitive and memory deficits.
This means the explanation should be praised for taking a more comprehensive account of schizophrenia.
what is the negative evaluation of the cognitive explanation?
- Like other explanations the cognitive account of schizophrenia suffers from a cause and effect issue.
Although cognitive deficits are rife with schizophrenia - these may well be the effect of schizophrenia as opposed to a causal factor.
In fact both cognitive deficits and schizophrenia could be caused by another factor completely, e.g., high levels of dopamine activity in the mesocortical pathway.
This implies… dysfunctional thought processes may simply be a manifestation of schizophrenia as opposed to an instigating factor, reducing the usefulness of this theory when considering treatment options.
