Schizophrenia: Psychological Explanations For Schizophrenia: Family Dysfunction

Question 1

What is family dysfunction?

Answer 1

Explanations explain schizophrenia in terms of problematic patterns of behaviour within the patients family.

Question 2

What is a type of dysfunctional family process?

Answer 2

• High levels of expressed emotion (EE). This refers to an intensity of negative emotion expressed towards a patient by their family members/carers.
• High levels of expressed emotion manifest in three ways:
  1) Hostility — a negative attitude toward the patient, stemming from the mistaken belief that the disorder is controllable.
  2) Critical comments — complaints and accusations. Often labelling the patient as lazy or selfish.
  3) Emotional Over involvement — an overprotective, intrusive, and controlling approach, often marker by needless self-sacrifice.
• EE is primarily an explanation for relapse in schizophrenia, with patients in high EE family environments facing a greater risk of mental health decline and potential hospitalisation.
• However, using the diathesis stress model, it has also been suggested that the stress caused by EE may trigger the onset of schizophrenia in a person who already has a vulnerability to developing the illness.

Question 3

What supporting evidence for the role of EE as an explanation for schizophrenia?

Answer 3

For example, Tiernari’s (2004) adoption study of 19,000 Finnish adoptees found that high levels
of criticism and conflict and low levels of empathy in the family increased the risk that the child
would later develop schizophrenia —but only for children with a biological mother with
schizophrenia. This finding provides support for the role of family dysfunction/expressed emotion as causing
schizophrenia as the high levels of criticism that Tiernari found were a risk factor for the onset of
schizophrenia are characteristic of the critical comments that characterize high levels of expressed
emotion/family dysfunction. However, this finding suggests that EE alone is a limited explanation for
schizophrenia, as family dysfunction in Tiernari’s study was only a risk factor for those with a genetic
predisposition, meaning EE by itself cannot explain schizophrenia. Furthermore, a strength of this
study is its longitudinal design, which allowed the researchers to measure family dysfunction before
the onset of schizophrenia. This effectively controls for an issue affecting much of the research into
family dysfunction: a reliance on retrospective evidence, which could be invalid due to issues with
the participants’ recall of their childhood.

Question 4

What is a problem with family dysfunction explanations of schizophrenia?

Answer 4

They are socially sensitive. Socially sensitive research is research which has a potentially harmful social consequences, either
for participants or for people connected to the research. Family dysfunction explanations for schizophrenia are socially sensitive, as they risk stigmatizing
families for their role in their child’s schizophrenia e.g., blaming the family of a relapsing patient for
a relapse due to the high levels of expressed emotion within the family. However, as Sieber and
Stanley have argued, social sensitivity researchers should not necessarily avoid researching socially
sensitive topics. If family dysfunction, like expressed emotion (EE), contributes to relapse, it should
be studied to aid families. However, researchers must avoid reinforcing blame.

Question 5

Explain the schizophrenogenic mother.

Answer 5

• An older family dysfunction explanation for schizophrenia is the psychodynamic theory of schizophrenogenic mother. According to this, people develop schizophrenia as they are raised by a parent who is cold, rejecting and controlling and who creates a family’s climate environment by tension and secrecy.
• This dysfunctional family climate weakens the child’s ego (the rational part of our
  personality that works on the reality principle), making them vulnerable to the distorted
  thinking that characterizes the positive symptoms.

Question 6

The schizophrenogenic mother explanation for schizophrenia is now regarded as invalid due to a lack of empirical evidence.

Answer 6

In 1983, the psychiatrist Thomas McGlashan, who had been a leading psychodynamic therapist
for people with schizophrenia, analyzed 446 patient records at Chestnut Lodge and concluded that
psychodynamic therapy was ineffective for schizophrenia. This evidence shows that the psychodynamic schizophrenogenic mother theory lacks predictive
validity. If psychodynamic explanations, such as the schizophrenogenic mother, were valid, then
psychodynamic treatments should be effective. McGlashan’s finding that they are ineffective
therefore suggests psychodynamic explanations are invalid. This finding is particularly compelling
because it came from a researcher who had dedicated decades to developing psychodynamic
treatments for schizophrenia. His willingness to challenge their effectiveness underscores the weak
evidence base for both these treatments and the theories that support them, such as the
schizophrenogenic mother explanation.