family dysfunction (psychological)

• schizophrenogenic mother

  Fromm-Reichman (1948)

  • based on childhood accounts
  • psychodynamic principles - recognised typically cold, controlling and rejecting mother leads to excessive stress triggering psychotic thinking
  • largely due to distrust
  • family climate characterised tension and secrecy
  • conflict, communication issues, criticism and control
  • father often passive
• Double blind communication

  Bateson (1972)

  • communication style within the family
  • mixed messages (verbal given but opposite behaviour exhibited)
  • can't of right thing
  • disorganised thinking, paranoia (positive symptoms)
  • punished by withdrawal of love
  • world confusing and dangerous = cause as loose touch with reality
• Expressed Emotion

  
  

  Kavanagh 1992

  • Where family shows exaggerated involvement, control criticism and hostility increasing likelihood of relapse
  • high levels of stress

  researchers found relapse rate doubled

  
  

  trigger for SZ when considering diathesis stress models

  
  

  EE correlational studies
• treatment - family therapy

  • informal sessions 6 months designed to help whole family
  • aims to improve quality of communication and interaction between family members
  • reduce stress promote empathy and improve relationships
  • stress found to increase risk of relapse and so aims to reduce experiences of expressed emotion through
  • psychoeducation (educate families about cause, symptoms and reduce anger/aggression/guilt so recognise early signs for intervention)
  • inclusion and sharing (bring everyone's experiences of disorder into group - cooperation and trust)
  • reducing family stress (everyone develops coping strategies so manage difficulties that may arise to avoid patterns of EE behaviours)
  • introducing effective communication (BFT involves introducing problem solving skills and communication skills to improve support in family unit)
  • recognised by NHS
• AO3 - research support

  • tienari et al
  • adopted individuals compared to individuals who's bio mothers SZ and those who were not. Found that when raised in a disturbed family environment both groups of adoptees showed greater psychopathology
  • strength of family disfunction as an explanation of SZ
  • use of adoptive studies is an effective control used to disentangle genetic causes from psychological ones
• AO3 - lack of reliability

  • subjective nature of definition and poor operationalisation as argued by Harrington
  • eg. schizophrenogenic mother outlined as having crazy making characteristics
  • psychodynamic theories lack scientic support so much be seduced with caution
  • hypothesis is untestable and so difficult to generalise
  • can't make general laws (nomothetic as a result)
• AO3 - alternate explanation

  • Diathesis stress model
  • acknowledges role of a range of factors taking a multidisciplinary approach
  • stressful life events (EE) could trigger psychotic symptoms in individuals with biological predisposition
  • genetic factors or adverse conditions in womb lead to vulnerability that is biochemical or neuroanatomical
  • lead to psychological vulnerability - inability to appropriately process information in the form of cognitive processing deficits
  • these deficits could lead to distortions if exposure to stressful life events like family environment being overstimulating go having high expressed emotion
  • cognitive difficulties may be exacerbated and lead to psychotic symptoms seen in SZ patients (delusions and hallucinations)
• AO3 - unnecessary socially sensitive

  • blames parenting style
  • suffered as child struggling with symptoms
  • lifelong responsibility for their care
  • ethically insulting to parents
  • destructive - promotes guilt rather than being productive - teaching coping methods
• AO3 - effectiveness of treatment methods

  • Family therapy
  • appropriate as considers impact on family unit as a whole
  • identifies external causes and aims to provide strategies to improve functioning as a family unit
  • acknowledges experience of wider family and pottential effects on them

  inline with suggestions from diathesis model - perhaps interactions treatment most appropriate

  • drugs
  • family therapy used to ensure compliance with drugs
• AO3 - treatments effectiveness

  • shown to reduce the rate of relapse significantly and improve compliance with mediation and to reduce ratings for EE within the family
  • important as relapse rates of 70% when drugs not taken
  • Montero 2001 found no difference between groups relapse and readmission to hospital BFT improved social functioning and reduced delusions and distorted thinking perhaps due to inclusion if patient and reduction in stress
  • does have treatment benefits
• AO3 - treatment appropriateness

  • accommodating to cultural differences
  • therapy can be delivered in accordance either cultural practices
  • collectivist cultures tend to have closer family ties and increased levels of compassion
  • Xiong 1994 found 61% patients in drug care condition relapsed compared to 33% of drug and BFT after one year
  • teaching communicative strategies reduces stress effectively and provides a long term treatment even when generalised
• AO3 - treatment appropriateness

  • doesn't consider individual differences and circumstances
  • may not be appropriate for all family situations
  • may be a reluctance to be open and share sensitive information resulting in an inability to generate an effective coping strategy
  • may struggle to be around family which may feel triggering particularly if members are in denial of responsibility/origin of SZ symptoms
  • may not be appropriate all round as relies on active participation