Pscyhological explanations

• 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 for both the development and maintenance of schizophrenia
• Psychologists have attempted to link schizophrenia to childhood and adult experiences of living in a dysfunctional family
• Schizophrenogenic mother

  Fromm-Reichmann (1848) proposed a psychodynamic explanation for schizophrenia based on accounts she had heard from her patients about their childhoods. She noted many patients spoke of a particular type of parent - the schizophrenogenic mother, who is cold, rejecting, & controlling and tends to create a family climate characterised by tension & secrecy. This leads to distrust that later develops into paranoid delusions and ultimately schizophrenia.
• Double-bind theory


  Bateson et al 1972 agreed that family climate is important in the development of schizophrenia but emphasised the role of communication style within a family. The developing child regularly finds themselves trapped in situations where they fear doing the wrong thing, but receive mixed messages about what it is and feel unable to comment on the unfairness of this situation or seek clarification. When they get it wrong (often happens) child is punished by withdrawal of love. This leaves them with an understanding of the world as confusing and dangerous - reflected in symptoms - disorganised thinking & paranoid delusions.
• Expressed emotion (EE)


  The level of emotion (particularly negative emotion), expressed towards a person with schizophrenia by their carers who are often family members. EE contains several elements: Verbal criticism of the person, occasionally accompanied by violence, Hostility towards the person, including anger & rejection, Emotional overinvolvement in the life of the person, including needless self-sacrifice. High levels of EE directed at the individual = serious source of stress for them.
• High levels of expressed emotion directed at the individual with schizophrenia

  Serious source of stress for them
• High levels of expressed emotion directed at the individual with schizophrenia is primarily an explanation for relapse in people with schizophrenia. However, it has also been suggested that EE may be a source of stress than can trigger the onset of schizophrenia in someone who is already vulnerable e.g. due to their genetic make up (diathesis-stress model)
• Cognitive explanations


  Explanations that focus on mental processes such as thinking, language and attention
• Dysfunctional thought processing


  Information processing that does not represent reality accurately and produces undesirable consequences. Lower levels of information processing in some areas of the brain suggest cognition is impaired. E.g reduced processing in the ventral striatum is associated with negative symptoms
• Schizophrenia is characterised by disruption to normal thought processing - seen in many of its symptoms
• Reduced thought processing in the ventral striatum is associated with negative symptoms. Reduced processing of info in temporal and cingulate gyri is associated with hallucinations (Simon et al 2015). This lower than usual level of info processing suggests cognition is likely to be impaired.
• Metarepresentation dysfunction(Frith et al 1992)


  The cognitive ability to reflect on thoughts and behaviour. It allows us insight into our own intentions and goals. It also allows us to interpret the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts are being carried out by ourselves rather than someone else. This would explain hallucinations of hearing voices and delusions like thought insertion (the experience of having thoughts projected into the mind by others)
• Central control dysfunction


  Issues with cognitive ability to suppress automatic responses while we perform deliberate actions. Speech poverty & thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts. E.g. people with schizophrenia tend to experience derailment of thoughts because each word triggers associations and the person cannot suppress automatic responses to these.
• Stirling et al 2006 compared performance on a range of cognitive tasks in 30 people with schizophrenia and a control group of 18 people without schizophrenia. As predicted by Frith et al's central control theory, people with schizophrenia took longer - over 2x as long on average to name the font colours on the Stroop task. This means that the cognitive processes of people with schizophrenia are impaired.
• Cognitive explanations for schizophrenia are proximal explanations because they explain what is happening now to produce symptoms - as distinct from distal explanations which focus on what initially caused the condition. Possible distal explanations are genetic and family dysfunction explanation. What is currently unclear and not well-addressed it how genetic variation or childhood trauma might lead to problems with metarepresentation or central control. This means that cognitive theories on their own only provide partial explanations for schizophrenia.
• It appears that the abnormal cognition associated with schizophrenia is partly genetic in origin and the result of abnormal brain development (Toulopoulou et al 2019). This would suggest that schizophrenia is a biological condition.
• Limitation - evidence for family relationships is often retrospective

  • Read et al. (2005) reviewed 46 studies and concluded that 69% of all adult female inpatients with SZ and 59% of men had a history of physical and/or sexual abuse in childhood.
  • But most of this evidence is based on info about childhood experience gathered after the diagnosis. The symptoms may distort patients recall of their childhood experiences
  • This creates a problem with validity of evidence
• Limitation - Evidence for family based explanations is week

  • Poor childhood experiences may be associated with SZ but there is little evidence to support the importance of schizophrenogenic mothers, EE or double-bind.
  • Theses theories are mainly based on clinical observation of patients which are open to interpretation. They also have historically led to the blaming of parents already suffering over childs symptoms
  • These issues undermine the appropriatness and credibility of the family-based explanation
• Strength - Support for different information processing

  • Stirling et al (2006) compared 30 patients with SZ with 18 non-patients on cognitive tasks e.g. the Stroop task
  • Patients took over 2x as long as control group to supress the impulse to read the word and to name the ink colour. This supports Friths theroy of central control dysfunction. Other evidence also shows that processing differs in SZ patients
  • However, it is not clear whether these faulty cognitions are merely the proximal cause (cause of symptoms) or the underlying distal cause (origins of disorder)
• Limitation - Biological factors overlooked

  • Psychological explanations can be hard to reconcile with biological ones. 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 questions of whether both outcomes are really SZ
  • Alternatively we can view this in terms of the diathesis-stress model where the diathesis may be biological or psychological