Family dysfunction

• Family dysfunction

  Refers to processes in a family such as poor communication, cold parenting and high levels of expressed emotion, these may be risk factors for both the development and maintenance of schizophrenia.
• Schizophrenic mother - Frieda Fromm reichmann

  Psychodynamic basis, mothers who are cold, rejecting, controlling cause schizophrenia. They create tension and secrecy in the family, leads to distrust and paranoia.
• Double bind- Bateson (1972)

  Stated that children received mixed messages from parents, e.g. being asked for a hug and then being pushed away, communication may be contradictory and they learn they can’t trust the messages they receive from others and as a result they don’t trust their own feelings and perceptions.

  often leads to paranoid delusions and disorganised thinking.
• Expressed emotion 

  a family communication style that involves:

  critical comments through tone and content, sometimes accompanied by violence

  hostility towards patient including anger and rejection

  emotional over involvement in the life of the patient, including needless self sacrifice 

  if these factors are high, the risk of relapse is high and it is a source of stress.
• Schizophrenogenic mother leads to distrust and paranoia

  Associated with delusions and hallucinations
• expressed emotion need to low self-worth and guilt and stress

  Associated with psychotic thinking and paranoid delusions
• A limitation is its socially sensitive 

  family-based explanations have led to parent-blaming.

  Parents, who have already suffered at seeing their child's descent into SZ and who are likely to bear the lifelong responsibility for their care, feel responsible for their child's illness causing even greater stress and anxiety.

  This suggests that psychological explanations of schizophrenia are socially sensitive and highly unethical, therefore may have negative implications in society.
• A strength is research support

  Indicators of family dysfunction include insecure attachment and exposure to childhood trauma, especially abuse.

  69% of women and 59% of men with schizophrenia have a history of physical or sexual abuse.

  most adults with schizophrenia reported at least one childhood trauma, mostly abuse.

  This strongly suggests that family dysfunction makes people more vulnerable to schizophrenia.
• One limitation of family explanations is the poor evidence base for any of the 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 theories such as the schizophrenogenic mother and double bind.

  these theories are based on clinical observation of people with SZ and also informal assessment of their mothers' personalities

  This means that family explanations have not been able to account for the link between childhood trauma and schizophrenia.