DYSFUNCTIONAL FAMILIES AO1

• Fromm-Reichmann suspected that the relationships between family members could be the catalyst for the development of schizophrenia. The interactions between family members can be vital in an individual’s upbringing as family plays a very influential role in a person’s life, which can possibly also hold them accountable for being a trigger.
• The double bind theory suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia.
• Gregory Bateson et al (1956) proposed that the symptoms that are present in individuals with schizophrenia were the due to the communication difficulties within the family, especially between parents and their children.
• Conflicting messages

  This is seen through the idea of conflicting messages where schizophrenia may develop as a child is continuously exposed to social interactions where there are two conflicting messages and the child is incapable of understanding whether they should ignore or respond. These communication contradictions causes the child’s inability to respond the right way, as the verbal and nonverbal messages cancel

  each other out.
• Words need to match with actions otherwise it confuses children.

  Bateson et al claimed that long-term exposure to these sorts of communication contradictions means that the child learns to see the world in contradictory scenarios in their environment and that they are unable to discriminate between the contradictory messages, as they have internalised the double bind situation. Bateson et al also believed that this eventually led to the symptoms of schizophrenia, such as hallucinations and delusions, as a means of escaping the contradictory demands of the double bind situation.
• Expressed emotion describes the level and type of emotion shown towards the patient by their carer, and is often a significant source of stress for the patient. This means that they are less likely to take their medication or comply with cognitive therapies provided by their hospital or institution, hence being a leading cause for relapse.
• In 1959, Brown investigated 156 men with schizophrenia who relapsed after they had been discharged, and discovered that the relapse was strongly connected with the type of

  home the men were discharged to.Those men discharged to stay with their parents or wives were more likely to relapse than those men who lived in lodgings or with their siblings.
• He found a relationship between the amount of expressed emotion (EE) and the likelihood of relapse, after interviewing the wives and parents of individuals with schizophrenia. Families who engage in expressed emotion show high levels of criticism, hostility and emotional over involvement.
• Hostility was noted as generally being present in the interviews with high EE caregivers. This hostility was thought to be the result of unmanageable anger, irritation and lead to rejection towards the patient.
• Emotional over-involvement (EOI) could be seen in high levels of both happiness and sadness, excessive self-sacrifice and extreme overprotective behaviour of the caregiver towards the individual with schizophrenia.

  This was more evident in the parent caregivers, as they frequently reported feeling guilty for their child’s illness and this guilt led them to excessive reparative efforts and ultimately the emotional over-involvement.
• Warmth was measured by the vocal qualities, smiling and empathy expressed when the caregiver was talking about the individual with schizophrenia. Warmth was generally

  evident in low EE caregivers. Similarly low EE caregivers showed positive. Positive regard is the number of reinforcing statements in which the caregiver expresses support and appreciation of the individual with schizophrenia.
• One way of challenging these negative family dynamics is through family intervention, as a way of reducing relapse in individuals with schizophrenia.