Family Dysfunction

• Who came up with the family dysfunction theory?

  Bateson (1972)
• What is the double bind theory?

  • Family communication had an impact on the development of schizophrenia
  • Caused by contradictory messages from parents, if a parent says “I love you "in an aggressive way, their words are loving but their tone is opposite of that
  • The child is confused and does not know how to respond appropriately as any choice is wrong.
  • Child responding incorrectly, the parent may withhold love
  • This can lead to paranoia and delusions experienced by patients as they perceive the world as dangerous
  • This is a risk factor, not the sole factor
• Supporting study for double bind communication?

  • Supporting evidence for double bind communication comes from Berger (1965), he reported that schizophrenics reported more double-binding statements than non-schizophrenics.
  • However, a patient's recall may be affected by mental illness.
  • On the other hand, Bateson (1956) reported a case study in which a mother hugged a schizo, embracing him and stiffened but when schizo withdrew, she said “Don’t you love me anymore”.
  • This supports the idea of double bind statements but it is a case study so it lacks population validity and generalisability. 
• Criticism study of double bind theory?

  • Liem (1974) measured parental communication in families with  schizophrenia child and found no difference compared with normal families.
  • In another study, they also analysed previous research and found no difference in double bind communication between a normal/schizophrenic child.
  • Therefore, the double bind theory may lack validity.
• What is expressed emotion?

  • Relatives of the person express their emotions.
  • High levels of expressed emotions means more emotions negatively expressed by the caregiver.
  • These kinds of people talk more and then listen less. 

  There are 3 types of expressed emotion:

  • Critical - negative comments about the person
  • Hostile - Physical or verbal irritability or aggression - “you’re a waste of space”
  • Over concern/involvement - self-sacrificing behaviour/ controlling behaviour
• What does high EE do?

  • This can cause a high level of stress and is associated with a higher risk of relapse.
  • Linzen (1997) found patients going back to a highly EE family have a 4x relapse than those who have a low EE family.
  • The negative emotional climate arouses the patients, leads to overstressing of the person’s coping mechanisms and leads to an episode.
• Positive evaluation for EE?

  • Kavanagh (1992) conducted a meta-analysis of EE and found that patients who went to high EE families had a 48% chance of relapse rate compared to 21% for low EE families.
  • EE is responsible for relapse.
  • Therapies focusing on reducing EE are more effective in reducing relapse rates as a result suggesting that EE does increase higher relapse rates
• Negative evaluation for EE?

  • Not all patients in low EE avoid relapse and not all patients in high EE relapse.
  • There may be individual differences. Lebell et al (1993) showed that a patient's appraisal of family was also important.
  • Cases where high EE are not stressful/negative, they can do well regardless of an objective rating. Patient’s perception is important, not EE.
• Reductionism evaluation of family dysfunction?

  • Schizophrenia is solely down to the family environment.
  • It does not explain why some children in dysfunctional families fail to get schizophrenia.
  • Family members share the same environment and genes.
  • There could also be a biological explanation for the onset of schizophrenia.
  • Tsuang et al (1990) estimated that a first-degree relative of schizophrenia has 5-20x as much risk of developing schizo.
  • The diathesis stress model is a better explanation.
• Socially sensitive nature of family dysfunction?

  • Socially sensitive - It is emotionally difficult to watch children suffering with symptoms of schizophrenia, knowing they need to give lifelong care for their child.
  • Being blamed can be insulting, it can also be stressful. and may explain why these theories have not been emphasised as much in recent decades.