family dysfunction

• The schizophrenogenic mother hypothesis suggests that a mother's actions can trigger schizophrenia in her offspring.

  Fromm-Reichmann proposed the hypothesis based on accounts she heard from her therapy clients.
• She said the schizophrenogenic mother is cold, rejecting, controlling and tends to create a family climate characterised by tension and secrecy that leads to distrust, later causing paranoid delusions and ultimately schizophrenia.
• Bateson proposed the double bind theory and that whilst family climate is important, the communication style is also important in the development of schizophrenia. It's based around a child feeling trapped in situations where they fear doing the wrong thing but don't know how to communicate this as they receive mixed messages about what is right or wrong. When the child does work it out they are punished with withdrawal of love and leaves them with a confused and disorganised view of the world which is reflected in SCZ symptoms such as disorganised thinking and paranoid delusions.
• Expressed emotion is the level of emotion expressed towards a person with schizophrenia by their carers. It contains several elements including:

  • verbal criticism of the person, occasionally accompanied by violence
  • hostility towards the person including anger and rejection
  • emotional over-involvement in the life of the person

  high levels of expressed emotion from the carer's causes a serious source of stress for the SCZ patient and is a key cause of relapses.
• 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, Real et al reviewed 46 studies of child abuse and schizophrenia and concluded that 69% of adult women in-patients with a diagnosis of schizophrenia had a history of physical/sexual abuse. For men the figure was 59%. Adults with insecure attachments to their primary carer are also more likely to have schizophrenia (Berry).
• However, information about childhood experiences was gathered after the development of symptoms, and the schizophrenia may have distorted patients’ recall of their experiences. This creates a serious problem of validity.

  On balance, there is evidence linking family disfunction to schizophrenia, but it lacks validity.
• ~Weak evidence for family-based explanations

  Although there is evidence supporting the broad principle that poor childhood experiences in the family are associated with adult schizophrenia, there is almost none to support the importance of the schizophrenogenic mother or double blind. These theories are based on clinical observation of patients, using ‘crazy-making characteristics’ assessments which are now frowned upon.

  Another problem with dysfunctional family explanations is that they have led historically to parent-blaming.
• Parents who have had to deal with their child’s descent into schizophrenia and caring for them, also then received the blame for the condition. The shift in the 1980s from hospital to community care, often involving parental care, may be one of the factors leading to the decline of the schizophrenogenic mother and double bind theories – parents no longer tolerating them.
• Ethics

  A weakness of the theory is that it may not be ethical to say that schizophrenia is caused by their experiences as a child especially blaming on the mother. It is very deterministic and not all ‘schizophrenogenic’ mothers actually cause their children to have schizophrenia.