Psychological explanations for schizophrenia 1

1. Psychological explanations for schizophrenia 1 Pages 206-207 of Year 2 book Family Dysfunction PSYB3

2. Family Relationships • Although biological processes are clearly important in the both the origins and symptoms of schizophrenia, psychological processes are also important • The impact of family relationships has been put forward as a possible explanation for schizophrenia.   • Psychologists have attempted to link schizophrenia to childhood and adulthood experiences of living in a dysfunctional family PSYB3

3. Schizophrenogenic mother • Early theorists influenced by Freudian ideas, thought that a ‘schizophrenogenic mother’, who was cold, dominant and created conflict, caused schizophrenia to emerge in the child (1948) • These mothers were said to be rejecting, overprotective, self-sacrificing, moralistic about sex and fearful of intimacy • The distrust, resentfulness and instability caused by such a parent was thought to induce a schizophrenic reaction. PSYB3

4. Schizophrenogenic mother (AO3) • By the 1980s research had concluded that there was no such thing as a ‘schizophrenogenic mother’ • It had become apparent that only a small percentage of women who might arguably fit the criteria of schizophrenogenic mother had actually produced schizophrenic children. • Conversely, many schizophrenics were found to have mothers who did not fit the criteria • The theory has been criticised for hindering progress in psychiatry and understanding of this complex disorder PSYB3

5. ‘Double Bind’ • This contradictory information was termed ‘double bind’ - the children are ‘punished’ for doing what was asked (giving a hug, then being pushed away) and then punished again when the parent gives no reason for pushing them away. • This theory suggests that children will become confused and lose their grip on reality. Negative symptoms of social withdrawal and flat affect may be an appropriate and logical response to double bind situations • https://m.youtube.com/watch?v=RAlmBNVVQMw

6. Double-bind theory: AO3 • There is some support for the theory, i.e. Berger (1965) found that schizophrenics reported a higher recall of double-bind statements by their mothers than non-schizophrenics. • However, this evidence may not be reliable as patients’ recall may be affected by their schizophrenia • Other studies find little support for the theory: • Liem(1994) and Hall and Levin (1980) found no difference in the patterns of parental communication in families with a schizophrenic child in comparison to normal families PSYB3

7. Complete handout 8.8 PSYB3

8. Psychological explanations for schizophrenia 2 Pages 206-207 of Year 2 book Family Dysfunction PSYB3

9. Expressed Emotion (EE) High EE is a family communication style that involves: • Critical comments through both tone and content, occasionally accompanied by violence • Hostility towards the patient, including anger and rejection • Emotional over-involvement in the life of the patient, including needless self-sacrifice If these factors are high, then the risk of a relapse is high. https://www.youtube.com/watch?v=_g2qzcAjVzQ

10. Supporting evidence for family dysfunction theory Brown (1966) • Expressed emotion (EE): families where communications are commonly to do with criticism, hostility and disapproval are said to have high EE • People recovering from schizophrenia and discharged from hospital were followed up over a 9-month period. • Interviews with family members were conducted to determine the level of expressed emotion PSYB3

11. Families where expressed emotion (EE) levels were high resulted in 58% of people with schizophrenia returning to hospital for further treatment, compared to only 10% of those from low expressed emotion families • Family relationships can affect the degree of recovery rates of people with schizophrenia. • However, it is possible that it is difficult behaviour from the sufferer that influences the family behaviour patterns rather than the other way round. PSYB3

12. Evaluation of the EE explanation • It is unclear whether EE is a casual agent in the relapse rates or just a reaction to the patient's behaviour • High EE communication patterns are not specific to schizophrenia (depressive illness, eating disorders) • More evident in Western families • There is a problem with how EE is measured which is usually via one interview PSYB3

13. Complete handout 8.7 PSYB3

14. Support for family dysfunction as a risk factor • There is evidence to suggest that difficult family relationships in childhood are associated with increased risk of schizophrenia in adulthood • For example, Read (2005) reviewed 46 studies of child abuse and schizophrenia in adulthood and concluded that 69% of adult in-patients with a diagnosis of schizophrenia had a history of child abuse - for men the figure was 59% • Adults with insecure attachments to their primary carer are also more likely to develop schizophrenia PSYB3

15. Weak evidence for family based explanations • Information about childhood experiences is gathered after the symptoms have developed, therefore the schizophrenia may have distorted the patients’ recall of these childhood experiences – this creates a serious problem of validity • Dysfunctional family explanations for schizophrenia have historically led to parent-blaming. Parents, who have already suffered at seeing their child’s descent into schizophrenia underwent further trauma by receiving blame for the condition • In the 1980s there was a shift from hospital to community care (often involving parental care), and this possibly added to a decline of the schizophrenogenic mother and double-bind theories PSYB3

16. Summary of explanation • Psychological explanations look to the person’s environment to explain schizophrenia • Families can influence both the onset (through socialisation) and the maintenance (through high EE) of schizophrenia • The diathesis-stress model of schizophrenia is where biological factors cause a predisposition to develop schizophrenia the stress factors in the environment may well be to do with family dysfunction PSYB3

17. Essay question Discuss family dysfunction as an explanation for schizophrenia (16 marks) Could you answer this? PSYB3

18. Homework Ensure you have written up your class notes to include the following: • A definition of family dysfunction • An explanation of ‘the schizophrenogenic mother’ • An explanation of double-bind theory • An explanation of expressed emotion and schizophrenia • Evaluation of the role of family dysfunction in schizophrenia