Hello and welcome to psychboost, In this video we will be explaining
schizophrenia using psychological theories. This includes how maybe relationships and communication
styles within the family have a role to play in the development of the disorder,
but also cognitive explanations that suggest schizophrenia results from a dysfunction
in how people process their thoughts. So let's begin!
The first term we are going to use is family dysfunction, this term is suggesting that the
families of people with schizophrenia have some problem in the way that they interact and over
time that has resulted in the expression of schizophrenia. I'm going to use three
examples of family dysfunction, the schizophrenic mother, double-bind theory and expressed emotion.
So starting with the schizophrenogenic mother, this confusing word is
a combination of schizophrenia and genic meaning generating or creating.
So a schizophrenogenic mother means a mother who creates schizophrenia within their child.
This theory has psychodynamic origins, and suggests while growing up the
child experienced a cold, rejecting and controlling relationship with their mother,
while the father was mainly passive. This stressful experience of living in a tense
household results in psychotic thinking, resulting in the positive symptom of paranoid delusions.
A second concept is that of double bind theory. This suggests in the family the
child is constantly receiving mixed messages about what is expected from them. For example
they may get told that they need to be more independent, being told, I don't like it when you
sit around the house so much, why don’t you go and do something", but when they try to be independent
the parent could be over protective and say "I don’t like it when you go outside, I worry so much
about you, I really don’t think you can handle being outside on your own." This mixed message
approach to parenting according to Bateson (1972) can result in disorganised thinking and paranoia.
And a final family dysfunction explanation is expressed emotion. This is the attitude
the caregivers have about the person with schizophrenia, measured by what the caregiver
says about themExamples of problematic social interactions are exaggerated involvement, this is
when the caregiver emphasises the level of burden they have, and how much they have to sacrifice,
saying things like "I do so much for you, it's so hard my life revolves around looking after you",
another aspect is criticism and control, so we would expect to see the caregiver say things such
as "you don’t know how to do anying, you need to listen to me more and do what you are told"
and finally hostility, this is when the sufferer would receive abuse, verbal or even physical,
but generally experiencing rejection, hearing things like "you’re a total waste of space"
We do have an evaluation supporting the theory that expressed emotion affects people with
schizophrenia. Butzlaff and hooley conducted a meta analysis including 27 studies, the
results indicated that a relapse in symptoms is significantly more likely for sufferers who have
a family with high levels of expressed emotion. On the wider point that family dysfunction is
a factor in the development of schizophrenia we can turn again to the research of Tienari,
this research looked at the adopted children of biologically schizophrenic mothers.
And the results showed 36.8% of those children who were adopted into psychologically unhealthy
families developed schizophrenia compared to only 5.8% of those that were adopted into
psychologically healthy families, suggesting that interpersonal family dynamics has a role
to play in the development of schizophrenia. We could add to this that this study also
suggests psychological factors may not tell the whole story as these were people who were
genetically vulnerable and 5.8% of those raised in psychologically healthy families
developed schizophrenia, far higher than the 1% expected in the general population.
Another psychological perspective that we can take is the cognitive suggestion that schizophrenia is
actually due to the individuals thoughts processes not working correctly, so being dysfunctional.
We can give four examples of how those thought processes can be dysfunctional,
a faulty attention system, a lack of central control, issues of metarepresentation and
issues with schemas. Let's take these issues one at a time.
Firstly, Firth suggests an attention deficit theory, claiming the attention
system of someone with schizophrenia is unable to filter preconscious thought,
their conscious mind is overloaded, and focused on thoughts that would normally be filtered out
before coming to consciousness. This theory provides an explanation
for both of the positive symptoms of hallucinations and delusions.
Firth also suggests there is an issue with central control. This is the process we use to make
deliberate actions, suppressing automatic actions and speech. For example seeing a door handle there
may be an automatic urge to open it. That would normally be suppressed, however with problems
with central control a schizophrenic patient may have difficulty resisting the urge, and struggle
to explain why they opened the door, resulting in delusions. Problems with central control can also
give an explanation for speech derailment, when during conversation the topic will frequently
change, this is due a lack of central control in resisting saying automatic thoughts out loud.
Meta-representation is how we identify that we are responsible for our own thoughts and actions.
If I make a decision I have a sense that it was me that made it. I do that by paying attention to
my own thought processes. However if there is a fault with this process it can result
in a feeling that my thoughts, and actions are being controlled by an outside force.
And finally there is an alternate cognitive explanation by Hemsley,
this takes the idea of the schema, which is a mental shortcut or template we use to quickly
understand and interact with objects in the word. Hemsley suggests that there is
a breakdown in new information coming into the senses and the activation of schemas.
This produces an overload of information and the sufferer becomes confused. This can also
result in old memories being misinterpreted as new information and producing auditory hallucinations.
When coming to evaluate we can consider brain imaging evidence provided by Firth.
30 patients had PET scans, these scans revealed a reduction in blood flow to the frontal cortex
in patients with negative symptoms like avolition and an inability to suppress automatic thoughts.
The same scans also showed increased activity in areas of the temporal lobe that are
associated with the retrieval of memories in those patients with reality distortion.
All of this suggests that there are differences in the way that people process thoughts.
A second cognitive evaluation considers central control, Stirling conducted the stroop test on
30 patients with schizophrenia and 18 controls. This is a simple to conduct task in which you
present the names of colors written in a different colour of ink, you ask the participant to name the
ink colour, this is difficult to do quickly and requires central control to avoid shouting out the
colour that is written. Stirling found that the patients with schizophrenia took twice as long to
name the ink colours as the control patients, this suggests that people with schizophrenia really do
have issues with thought processing, in this case having a dysfunction in their central control.
We have covered a lot in this video, but before I finish I want to consider some other evaluations.
Firstly to look at the success of family therapy as a treatment, it is an effective intervention
and its effectiveness supports the argument for family dysfunction in some way causing
schizophrenia. We can make the same argument for the success of CBTp and cognitive causes.
But secondly the family dysfunction theory may have an ethical problem,
by suggesting that the family is responsible for the disorder is effectively placing the blame on
them. So we could say research in this area is socially sensitive, we may be causing additional
anxiety to people who are already dealing with the symptoms of their family member.
Also when considering family dysfunction we have to consider it may not be the family dysfunction
that caused the schizophrenia, it could be the other way around,
it may be the behaviour of the sufferer has led to a breakdown in communication within the family.
We also cannot ignore the significant amount of evidence such as that provided by Gottesman
that schizophrenia is a genetic disorder, so biologically caused,
potentially due to an imbalance of neurotransmitters.
We could argue there is an interaction between biological and psychological causes,
but it's likely schizophrenia isn't entirely a psychological illness.