Psychological explanations

• Fromm-Reichmann proposed a psychodynamic explanation for schizophrenia based on the accounts she heard from her patients about their childhoods. Fromm-Reichmann noted that many of her patients spoke of a particular type of parent, which she called the schizophrenogenic mother.
• According to Fromm-Reichmann the schizophrenogenic mother is cold, rejecting and controlling, and tends to create a family climate characterised by tension and secrecy. This leads to distrust that later develops into paranoid delusions and ultimately schizophrenia.
• Bateson et al. agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within a family.
• Double-bind theory = the developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what this is, and feel unable to comment on the unfairness of this situation or seek clarification. When they get it 'wrong' the child is punished by withdrawal of love.
• Double-bind theory:

  The child is left with an understanding of the world as confusing and dangerous, and this is reflected in symptoms like disorganised thinking and paranoid delusions. Bateson was clear that this was neither the main type of communication in the family of someone with schizophrenia nor the only factor in developing schizophrenia, just a risk factor.
• Expressed emotion= the level of emotion, in particular negative emotion, expressed towards a person with schizophrenia by their carers who are often family members.
• Expressed emotion contains several elements:

  • verbal criticism of the person (occasionally accompanied by violence)
  • hostility towards the person (including anger and rejection)
  • emotional overinvolvement in the life of the person, including needless self-sacrifice
• These high levels of expressed emotion directed towards the individual are a serious source of stress for them. this is primarily an explanation for relapse in people with schizophrenia. However, it has also been suggested that it may be a source of stress that can trigger the onset of schizophrenia in a person who is already vulnerable.
• Family dysfunction = refers to processes within a family such as poor family communication, cold parenting and high levels of expressed emotion. These may be risk factors in both the development and maintenance of schizophrenia.
• Family dysfunction:

  • the schizophrenogenic mother
  • double-bind theory
  • expressed emotion
• Cognitive explanations = explanations that focus on mental processes such as thinking, language and attention
• Cognitive explanations:

  • dysfunctional thinking
  • metarepresentation of dysfunction
  • central control dysfunction
• Dysfunctional thought processing = information processing that does not represent reality accurately and produces undesirable consequences
• Schizophrenia is associated with several types of dysfunctional thought processing and these can provide possible explanations for schizophrenia as a whole. Schizophrenia is characterised by disruption to normal thought processing.
• Reduced thought processing in the ventral striatum is associated with negative symptoms, whilst reduced processing of information in the temporal and cingulate gyri is associated with hallucinations (Simon et al.). This lower-than-usual level of information processing suggests that cognition is likely to be impaired.
• Frith et al. identified two kinds of dysfunctional thought processes. The first is metarepresentation, the cognitive ability to reflect on thoughts and behaviour. This allows us to interpret the actions of others.
• Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. This would explain hallucinations of hearing voices and delusions like thought insertion.
• Frith et al. also identified issues with the cognitive ability to suppress automatic responses while we perform deliberate actions. Speech poverty and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts. For example, people with schizophrenia tend to experience derailment of thoughts because each word triggers associations and the person cannot suppress automatic responses to these.
• There is evidence linking family dysfunction to schizophrenia. Indicators of family dysfunction include insecure attachment and exposure to childhood trauma. Read et al. found that adults with schizophrenia are disproportionately likely to have insecure attachment. Read et al. also reported that 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse. In the Mørkved study, adults with schizophrenia reported at least one childhood trauma. This strongly suggests family dysfunction makes people more vulnerable to schizophrenia.
• However, there is a poor evidence base for any of the family explanations. Although there is plenty of evidence supporting the idea that childhood family-based stress is associated with adult schizophrenia, there is almost none to support the importance of family-based theories such as the schizophrenogenic mother and double bind. Both these theories are based on clinical observation of people with schizophrenia and also informal assessment of their mothers' personalities, not systematic evidence. Family explanations cannot account for the link between childhood trauma and schizophrenia.
• There is evidence for dysfunctional thought processing. Stirling et al. compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 30 people without schizophrenia. Tasks included the Stroop task in which participants have to name the font-colours of colour-words, so have to suppress the tendency to read the words aloud. As predicted by Frith et al.'s central control theory, people with schizophrenia took longer (over twice as long on average) to name the font-colours. This means cognitive processes of people with schizophrenia are impaired.
• However, cognitive explanations only explain proximal origins of symptoms. Cognitive explanations for schizophrenia are proximal explanations because they explain what is happening now to produce symptoms. Distal explanations focus on what initially caused the condition. Possible distal explanations are genetic and family dysfunction explanations. What is currently unclear is how genetic variation or childhood trauma might lead to problems with metarepresentation or central control. This means cognitive theories on their own only provide partial explanations for schizophrenia.