psychological explanations

• psychological explanation

  SZ

  A) family dysfunction

  B) cognitive explanations

  
• family dysfunction


  caused by abnormal patters of communication within the family, can cause onset and relapse of SZ

  includes SZ mother, double-bind hypothesis and expressed emotion
• Schizophrenogenic mother

  Sz comes from being reared by a cold and dominant mother who is both overprotective but rejecting, whilst she seems self-sacrificing she actually uses the child to satisfy her own emotional needs, the split from reality may cause the onset of Sz symptoms

  outdated: based on old concepts that a mothers behaviour is responsible for the outcome of the child, low temporal validity

  gender biased: over exaggerated the importance of maternal style

  social insensitive: role of women, blames the women for Sz in her child
• double bind hypothesis

  Bateson et al (1956) suggest that children who receive contradictory messages from their parents are more likely to develop Sz, they are receiving a message of affection but with animosity simultaneously

  these interactions prevent the development of an internally coherent construction of reality and manifests as Sz symptoms

  little evidence to support this theory and is hard to collect

  Bateson et al case study: recovering Sz questioned his mother love when she hugged him but withdrew, but this is weak and lacks population validity and therefore generalisability
• expressed emotion

  where families persistently exhibit criticism, hostility and a general negative influence upon recovering Sz who then relapse and show positive symptoms, its a family communication style

  including verbal criticism, talking about the patient in a hostile way ad emotional over-involvement in their lives

  4x more likely to relapse due to having a lower tolerance for intense emotional situations, the negative emotional climate leads to stress beyond the patients coping mechanisms
• evaluation of EE

  studies: Hooley et al and Kavanagh did meta-analysis studies

  Hooley: patients with EE families have twice the average rate of relapse

  Kavanagh: 48% chance of relapse in EE families compared to 21% in low EE families

  Lebell et al (1993) suggested that how patients appraise the behaviour of their relatives is important
• family dysfunction evaluation

  issue with cause and effect: no way of knowing if it causes Sz in a family member or if the stress of living with a Sz patient causes hostility, no scientific explanation as C+E can't be established

  not all children raised in dysfunction families develop Sz so its not the only cause

  no way to disentangle nature / nurture so it could be a biological cause
• family therapy: a form of psychotherapy 


  based on the idea that as family dysfunction plays a role in the development and rehabilitation of Sz, bettering communication within families should help people with Sz to recover

  aims: improve positive and decrease negative forms of communication

  increase tolerance levels, decrease feelings of guilt for having an illness in the family, enhance relatives ability to solve problems

  commonly use drugs alongside therapy

  importance: NICE (2014) recommends it should be offered to all Sz patients who are in contact with family members and are high risk
• procedure of family therapy

  therapist has regular meetings with the whole family, build rapport

  family is taught to be supportive of each other and each given a role

  emphasis on openness with no confidentiality but with boundaries

  usually between 3 months to a year with at least 10 sessions

  aims to reduce the level of EE within the family as EE causes relapse

  provides family with info about Sz, support the individual and resolve any issues likes ensuring the sufferer keeps medical appointments
• evaluation of family therapy

  good: useful for patients who lack awareness of their illness and families can assist in therapy, they have valuable insight into their behaviour

  bad: nature of therapy causes issues like being reluctant to share information, cause tension, lowers the effectiveness if they don't engage properly

  good: cost effective and economical, lower needs for hospitalisation as there is a decrease of relapse patients so its cheaper and educates family members

  bad: combination of drugs and therapy can be costly, isnt always possible