AO1 - Family Dysfunction Schizophrenia

• Many studies have attempted to link schizophrenia to childhood and adult experiences of living in a dysfunctional family.
• Froom-Reichmann (1948) proposed a psychodynamic explanation for schizophrenia based on accounts she heard from her patients. Many reported a particular type of parent which she called a ‘schizophrenogenic mother’.
• Froom-Reichmann (1948) suggested a schizophrenogenic mother is cold, rejecting and controlling. These mothers create a family climate characterised by tension and secrecy which leads to distrust and can develop into paranoid delusions and ultimately schizophrenia.
• Bateson et al (1972) agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within the family.
• The family dysfunction explanation is concerned with sources of stress, which can bring on problems with people who have a genetic predisposition to schizophrenia. This is known as the diathesis-stress model.
• Sometimes the source of stress is within the family but it is difficult to identify the exact underlying cause of this stress.
• Some psychologists suggest that family relationships with abnormal communication styles may play a part in schizophrenia by creating highly stressful environments.
• Expressed emotion (EE) is the level of emotion, in particular negative emotion which is expressed towards a person with schizophrenia by their carers who are often family members.
• Linszen et al (1997) suggested that expressed emotion (EE) is a communication style the involves criticism, hostility and emotional over involvement. They suggest a patient returning to a family with high-EE is about four times more likely to relapse than a patient whose family is low in EE.
• McGlashan (1994) proposed that expressed emotion (EE) which is overly critical or highly emotive may be involved in the cause of schizophrenia.
• Research into expressed emotion (EE) reveals that family dynamics are an important predictor of relapse of positive symptoms with schizophrenia.
• Brown et al (1972) and Vaughn et al (1976) both established the detrimental effects of ineffective medication and high face-to-face contact on relapse rates of patients living in high-EE families.
• Kavanagh (1992) conducted a meta-analysis and reported a 48% relapse rate in high-EE environments, versus 21% in low-EE environments.
• It is not known as whether or not high EE exists as a true cause of relapse in schizophrenia or whether it reflects the stress within the family who are living with a patient with a chronic mental illness.
• Smith et al (1993) found that high-EE relatives report higher levels of stress and have more difficulty coping then low-EE relatives.
• Eva et al (1995) found that relatives who score highly on EE assessments tend to listen effectively and talk more in family interviews.
• Read et al (2005) reported that 69% of women and 59% of men with schizophrenia had a history of physical and/or sexual abuse.
• Morkved et al (2017) found that adults with schizophrenia reported at least one childhood trauma, mostly abuse. This strongly suggests but family dysfunction makes people more vulnerable to schizophrenia.
• Patino et al (2005) conducted a cross-sectional study with 3426 children and adolescents looking at family dysfunction and migration history. They found that both factors were associated with a four times risk of developing psychotic symptoms.
• Stress releases cortisol, which is a hormone that causes multiple effects within the body including its role in the fight or flight response. In the long term these effects are harmful physically and mentally.
• Tienari et al (2004) found that 37% of high-genetic risk adoptees living in a dysfunctional family environment developed schizophrenia compared to only 5% of those in healthy family environments.
• Bateson (1972) devised the double-bind hypothesis, which claims but if there is a contradictory position there will be negative consequences. Bateson hypothesised that growing up in a high negative-emotion environment could lead to psychosis.
• Kavanagh (1992) supports Bateson’s double-bind hypothesis, as it was found that schizophrenic patients returning home to high-emotion families had higher relapse rates than those returning to low-emotion families.