Schizophrenia: Psychological Theories

1. Schizophrenia: Psychological Theories • Family systems theory • Psychosocial & environmental stress

2. Starter: • In your group see if you can remember as much as you can about the picture just shown and describe to your group what you saw so they can re-create the image. • The group who has the most accurate image wins.

3. Psychodynamic explanation • Psychoanalysists believe that psychological conflicts usually arise in childhood and are a result problems and conflicts between the developing personality (the ID, Ego and Superego). • These problems are unconscious to the individual and usually manifest as ‘Ego defense mechanism’ e.g.: repression, projection, denial, regression, sublimation, displacement, humour, rationality and intellectualization.

4. Make a storyboard! – design in groups how an unresolved development of the ego could cause schizophrenia – 15 minutes to create and present Internal conflict damages development Confusion on what is right and wrong A person has all 3 components Peron’s inability to resolve conflict This leads to a person establishing control through being selfish Under developed ego causes schizophrenia

5. Ego defense mechanisms protect the person from distress but can cause problems in their own way. • Thus causing an unresolved conflict and damage to the developed and balance of the ego, superego and the Id.

6. Cognitive Behavioural: Family Systems Theory • Origins in: • The psychoanalytical tradition (the influence of the family on abnormal behaviour) • Systems thinking (idea that things are best understood by looking at the relationships between a set of entities)

7. Diathesis Stress Model: • Design a graph showing the level of stress in their environmental situation and how this may cause someone to be mentally ill:

8. F M C1 C3 C2 Family System A family can be seen as a set of entities, each interacting with all the others. The behaviour of each entity can only be understood by looking at its relationships with the others

9. F M C1 C3 C2 Family System If one person starts to behave abnormally the problem might not lie within that person Their behaviour may be a manifestation of a problem occurring within the wider family system C2

10. Double Bind Theory (Bateson, 1956) • Schizophrenia is a consequence of abnormal patterns in family communication • The patient is a ‘symptom’ of a family-wide problem • They become ‘ill’ to protect the stability of the family system

11. Double Bind Theory • In a double bind situation a person is given mutually contradictory signals by another person • This places them in an impossible situation, causing internal conflict • Schizophrenic symptoms represent an attempt to escape from the double bind

12. Double Bind Theory • Bateson (1956) reports clinical evidence (interviews, observations) illustrating use of double bind communication by parents of schizophrenia patients • Issues of researcher (confirmatory) bias • Problems with direction of causality

13. Double Bind Theory • Liem et al (1974) compared communication patterns in families with & without a schizophrenic member • Abnormality in parental communication was a response to the schizophrenic symptoms, not vice versa • Some issues with ecological validity

14. Double Bind Theory –Social Cultural • Some evidence that family processes play a role in relapse of schizophrenia patients following stabilisation • Relapse more likely (58% vs. 10%) where family is high in ‘expressed emotion’ (Brown et al, 1966) • Families high in criticism, hostility & over-involvement lead to more relapse (Vaughn & Leff, 1976)

15. Social learning theory • The behavioural explanation suggests that schizophrenia is a consequence of faulty learning. Children who do not receive reinforcement early in their lives will put larger attention into irrelevant environmental cues. • Bizarre behaviour by parents is copied by children. Parents then reinforce this behaviour and the behaviour becomes progressively more unusual, until eventually the child acquires the label of being ‘schizophrenic’.

16. Supporting research: • Scheff’s (1966) labelling theory suggests that individuals labelled in this way may continue to act in ways that conform to this label. Bizarre behaviour is rewarded with attention, and becomes more and more exaggerated in a continuous cycle before being labelled as ‘schizophrenic’:

17. Punishment Withdrawal Labelled as odd Reinforced by attention Conforming to label

18. Cognitive-behavioural studies: • Breakdown of relationship between information that has already been stored in memory and new, incoming information e.g. schemas • People are subjected to sensory overload and do not know which aspects of a situation to deal with & can be delusional • Internal thoughts are attributed to external sources and are therefore experienced as auditory hallucinations

19. Frith (1992) • Attempts to explain positive symptoms • Unable to distinguish between actions generated externally and those generated internally • Can be explained by faulty operation of meta-representation mechanism: 1 inability to generate willed action 2 inability to monitor willed action 3 inability to monitor beliefs and intentions of others • Specifically a disconnection between frontal and posterior areas of the brain

20. Genetic Links • Is malfunctioning cognitive processing linked genetically? • Park (1995) identified working memory deficits in schizophrenics and their 1st degree non-schizophrenic relatives • Faraone (1999) similarly found deficits in auditory attention • These are a manifestation of genetic predisposition to schizophrenia and may even cause schizophrenia…but cannot explain why some relatives do not develop it even though they have the predisposing gene

21. Evaluation Limited scope of cognitive theories • They simply describe some of the symptoms in cognitive terms • Hemsley’s model has little evidence for a neurological, hippocampus deficit – but animal studies • Frith’s theory – little support, reductionist • No evidence to evaluate at this time

22. Psychodynamic ‘talking therapies’ • Based on assumption that individuals are unaware of the unconscious influence on current psychological state. • Maintains that it is the patient’s ego trying to re-assert authority and control. • Some symptoms reflect infantile state

23. Evaluation: • Very little evidence to support this view of schizophrenia • Behaviour of the parents seen to be a key influence, but could be consequence rather than cause. • Does not take into account biological factors.

24. Synoptic link!!! • Both psychological theories and social-cultural factors do not take into account that some less-individualist cultures may express less emotion (seen as a negative symptom) Therefore it is culturally biased. • Remember that US clinicians are more likely to diagnose compared to other western societies.