Psychological explanations

• Family dysfunction


  Sees maladaptive relationships and communication within families as a source of stress that can cause or influence the development of schizophrenia
• Characteristics of parents of schizophrenics

  - High levels of interpersonal conflict

  - difficulty communicating with each other

  - being excessively controlling and critical of their children
• Bateson et al


  Coined the term 'double bind' to explain the contradictory situations children may be placed in by their parents.

  - where verbal message given but opposite behaviour is exhibited

  - parent tells child to be 'more spontaneous' but if child is more spontaneous it becomes confused and uncertain as by doing it they are clearly not being spontaneous.

  ---> leads to a negative reaction of social withdrawal and flat effect in order to escape double bind situations.
• Bateson (1956)


  Case study of recovering schizophrenic who was visited by his mother.

  - embraced her warmly but she stiffened and when he withdrew she said 'don't you love me anymore'

  - he blushed and she commented 'he shouldn't be so easily embarrassed and afraid of feeling'

  she left and he assaulted an aide and was restrained

  - example of a double bind
• Reduction of support


  -theory was initially popular but Bateson was later accused of selective bias in focusing only on aspects of interviews with schizophrenics that supported his claims

  - this and recent evidence supporting a genetic link has lessened support
• Schizophrenogenic mother


  Frieda Fromm-Reichmann (1948) noted that many of her patients spoke of a specific parent (schizophrenogenic mother)

  - schizophrenogenic meaning schizophrenia causing

  Characteristics: cold, rejecting, controlling and tended to create a family dynamic categorised by tension and secrecy

  - leads to distrust that develops into paranoid delusions and schizophrenia.
• Expressed emotion


  Where families who persistently exhibit criticism and hostility exert a negative response especially on recovering schizophrenics who when returning to their families react to expressed emotions by relapsing to an active phase of the disorder and experience severe positive symptoms of hallucinations and delusions of persecution.
• Tiernari et al (2004)

  Levels of schizophrenia in adopted individuals who were the biological children of schizophrenic mothers was 5/8% in those adopted by healthy families compared with 36.8% for children raised in dysfunctional families.

  -supports the idea that family dysfunction can play a role in the development of schizophrenia and that individuals with high genetic vulnerability are more likely to be affected by an environmental stressor (diathesis stress model)
• Patino et al (2005)

  Established 7 problems which characterise family dysfunction

  - poor adult relationships

  - lack of warmth between adults

  - visible disturbance of mother - child relationship (f-c and sibling-c)

  - parental overprotection and child abuse

  Migrants who experienced at least 3 had 4 times the normal level of vulnerability compared to the double level risk of migrants not experiencing family dysfunction

  - family dysfunction increases likelihood of stressors triggering schizophrenia
• Kavanagh (1992)


  Reviewed 26 studies of expressed emotion, finding that the mean relapse of schizophrenia patients who returned to high expressed emotion families was 48% compared to 21% living with low expressed emotion families

  - supports the idea that high expressed emotion increases the likelihood of relapse
• Cause or effect - AO3

  However, having a schizophrenic within a family can be problematic and stressful on relationships

  - therefore it could be that the dysfunction may be due to someone suffering with schizophrenia not the cause
• Therapies - AO3


  Theory supported by successful therapies focusing on reducing expressed emotions within families and achieving lower relapse rates than other therapies.

  theory can be said to have predictive validity as the theory must have some accuracy for the therapy to work
• Incomplete explanation

  Fails to explain how children who come from such families don't develop schizophrenia. leaving it an incomplete explanation.
• Maintenance


  Whilst the causal role of family dysfunction in schizophrenia appears weak, it does appear to play a major role in the maintenance of the disorder.
• Cognitive theories


  Focus on maladaptive thought processes as central feature of schizophrenia

  - Beck and Rector (2005) proposed a cognitive model that combines a complex interaction of neurobiological, environmental, behavioural and cognitive factors to explain schizophrenia.

  - a more holistic approach to schizophrenia
• Brain functioning abnormalities


  Abnormalities within brain functioning are seen as increasing vulnerability to stressful life experiences, which in turn lead to dysfunctional beliefs and behaviours
• Cognitive deficits


  Occur where sufferers experience problems with attention, communication and information overload.

  - sufferers are also seen as unable to deal with inappropriate ideas, such as misperceiving voices in their heads as people actually trying to speak to them, rather than perceiving them more sensibily as 'inner speech', which most people perceive
• Positive symptoms


  Delusions are seen as occurring because of active cognitive biases (thinking in irrational ways) such as external attributions like individuals believing they are being persecuted

  - hallucinations are understood in terms of biased information processing, while cognitive deficits experienced by schizophrenics are referred to as alien control symptoms, where sufferers believe their thoughts and behaviours being influenced by external people and forces
• Negative symptoms


  Seen as occurring due to the use of cognitive strategies to control high levels of mental stimulation

  - schizophrenics may actually experience a greater level of emotion than they physically display, as not displaying emotion is one strategy to control levels of emotion being experienced internally.
• O'Carroll (2000)


  Reviewed available evidence to report that cognitive impairment is found in 75% of schizophrenics, particularly in memory, attention, motor skills, executive function and intelligence, supporting Beck and Rector's cognitive model. Cognitive impairments often pre-dated illness onset, did not occur as a result of substance abuse and were related to social and functional impairments.
• Elvevag and Goldberg (2000)

  Reported that schizophrenia is better characterised by cognitive deficits than symptoms and that these cognitive deficits are an enduring feature of schizophrenia which are not specific to subtypes of the disorder, with memory and attention being the main cognitive deficits forming the core dysfunction of the disorder

  - supports the cognitive explanation of schizophrenia

  - if true then it should be possible to construct a specific cognitive deficit profile from which to diagnose the disorder, this is yet to happen
• Bowie and Harvey (2006)

  Supported the work of Elvevag and Goldberg, finding that cognitive impairments are the core feature of schizophrenia

  - they found that these impairments pre-date the onset of the disorder and are found throughout the course of it

  - further support for beck and rector's cognitive model

  - with additional support coming from the fact that they found that effective therapies seem to reduce cognitive deficits and thus improve functioning in schizophrenic patients
• Lack explanation

  However, cognitive theories in themselves do not explain what led to the cognitive dysfunctions seen in schizophrenics and therefore can't be seen as explaining the causes of schizophrenia .

  - therefore an incomplete explanation
• Combination explanations


  However, they do provide an explanation for both positive and negative symptoms of the disorder

  - and can 'work alongside' other theories such as the biological theory to provide fuller understanding of the causes and maintenance of the disorder