Psychological explanations for schizophrenia

• Two main explanations:

  Family dysfunction and cognitive explanations
• Fromm-Reichmann's psychodynamic explanation based on patients' early experiences of 'schizophrenogenic mothers' (mothers who cause schizophrenia)
• Schizophrenogenic mothers:

  Cold, rejecting and controlling, and create a family climate of tension and secrecy. This leads to distrust and paranoid delusions and schizophrenia
• Three theories under family dysfunction:

  Schizophrenogenic mothers, double-bind theory and expressed emotion
• Double-bind theory:

  Bateson et al. described how a child may be regularly trapped in situations where they fear doing the wrong thing, but receive conflicting messages about what counts as wrong. They cannot express their feelings about the unfairness of the situation.

  When they 'get it wrong' (often) the child is punished with withdrawal of love- they learn the world is confusing and dangerous, leading to disorganised thinking and delusions
• Expressed emotion:

  The level of emotion (mainly negative) expressed towards the schizophrenic patient and includes:

  • Verbal criticism of the patient
  • Hostility towards them
  • Emotional over-involvement in their life

  High levels of EE cause stress in the patient, a primary explanation for relapse in patients with schizophrenia
• Three cognitive explanations:

  Dysfunctional thought processing, metarepresentation and dysfunction of central control
• Dysfunctional thought processing:

  Lower levels of information processing in some areas of the brain suggest cognition is impaired. For example, reduced processing in the ventral striatum is associated with negative symptoms
• Metarepresentation:

  This is the cognitive ability to reflect on thoughts and behaviour

  This dysfunction disrupts our ability to recognise out thoughts as our own- could lead to the sensation of hearing voices (hallucination) and having thoughts placed in the mind by others (delusions)
• Dysfunction of central control:

  Frith et al. identified dysfunction of central control as a way to explain speech poverty- central control being the cognitive ability to suppress automatic responses while performing deliberate actions.

  People with schizophrenia experience derailment of thoughts and spoken sentences because each word triggers automatic associations that they cannot suppress
• Limitation: evidence for family relationships is often retrospective

  Read et al. reviewed 46 studies and concluded that 69% of all adult female inpatients with schizophrenia (59% of men) had a history of physical and/or sexual abuse in childhood. But most of this evidence is based on information about childhood experiences gathered after the diagnosis. The symptoms may have distorted the patients' recall of their childhood experiences. This created a problem with the validity of the evidence
• Limitation: evidence for family-based explanations is weak:

  Poor childhood experiences may be associated with schizophrenia, but there is little evidence to support the importance of schizoprenogenic mothers, expressed emotion of double-bind. These theories are mainly based on clinical observation of patients (open to interpretation). They have also historically led to blaming of parents already suffering over their child's symptoms. These issues undermine the appropriateness and credibility of the family-based explanation
• Limitation of cognitive explanation: biological factors overlooked

  Psychological explanations can be hard to reconcile with biological ones (e.g. genetics). If the biological explanations are valid, how do they fit with psychological ones? Perhaps both biological and psychological factors can separately produce the same symptoms- this raises the question of whether both outcomes are really schizophrenia. Alternatively, we can view this in terms of the diathesis-stress model where the diathesis may be biological or psychological.
• Limitation of cognitive explanation: direction of causality

  It remains unclear whether cognitive factors are a cause or result of the neural correlates and abnormal neurotransmitter levels in schizophrenia. For example, does dysfunctional metarepresentation reduce levels of dopamine in the superior temporal gyrus? Or is the direction of causality the reverse? This questions the validity of the cognitive approach in explaining the underlying origins of the conditions