10. Schizophrenia
Family dysfunction – psychological explanation:
Schizophrenogenic mother: Fromm-Reichmann (1948), psychodynamic
Schizophrenogenic = 'schizophrenia-causing’.
Many schizophrenic patients spoke of a ‘type’ of parent – cold, rejecting, controlling.
Leads to tension and secrecy within the family, causing distrust and, ultimately, paranoid
delusions (of being persecuted by another person) i.e., schizophrenia.
Double-bind theory: Bateson et al (1972), family communication style can be a risk-factor for SZ
Double-bind communication = contradictory signals about right/wrong thing to do in a situation.
SZ feels they cannot act without contradicting their parents’ wishes; they are punished with
withdrawal of love when they get it wrong.
Leads to stress, feeling the world is a confusing and dangerous place. Leads to paranoid delusions
and disorganised thinking when trying to resolve the impossible.
Expressed emotion (EE): level of negative emotion expressed towards SZ from family members/carers
Criticism = negative comments; may be picked up by the rest of the family. Can be accompanied
by violence.
Hostility = negative attitudes towards SZ; may act as if they have chosen not to get better or
blame them for their condition. Can include anger and rejection.
Emotional over-involvement = family blame themselves for condition and needlessly self-
sacrifice, making the patient feel guilty.
All three act as major sources of stress for SZ; can cause relapse or induce SZ in those with a
predisposition (e.g., genes).
EVALUATION:
+ Supporting evidence
o Read et al (2005): adults with SZ are disproportionately likely to have been exposed to childhood
trauma and/or have insecure attachment. 69% women and 59% men have a history of
physical/sexual abuse.
o Therefore, evidence that family dysfunction increases vulnerability to SZ; +ve correlation.
- Socially sensitive (parent-blaming)
o Blame placed largely on family (especially mother), which could create more EE towards SZ.
o Therefore, explaining SZ only in terms of family dysfunction may be detrimental to care. Limited
usefulness.
- Lack of support for SZ mother and double-bind theory
o Only based on clinical observation and informal assessment of SZ patients’ mothers’
personalities; no systematic evidence.
o Therefore, lacks validity and scientific credibility; cannot account for link between family
dysfunction and SZ.
, Cognitive explanation:
Schizophrenia is characterised by dysfunctional thought processing; reduced processing in ventral
striatum is associated with negative symptoms and reduced processing in temporal and cingulate gyri is
associated with hallucinations.
Metarepresentation dysfunction: ability to reflect on thoughts and behaviours
Metarepresentation gives insight into one’s intentions and goals and allows interpretation of
other people’s actions.
MD impairs the ability to recognise actions as one’s own, explaining delusions and hallucinations.
Central control dysfunction: cognitive inability to suppress automatic responses (thoughts and speech)
Explains speech poverty and thought disorder, which could result from the inability to suppress
automatic thoughts/speech triggered by other thoughts.
Words/thoughts trigger associations and automatic responses cannot be prevented.
EVALUATION:
+ Supporting evidence
o Stirling et al (2006): compared performance of schizophrenics to control group on Stroop task
(naming font colours of colour-words). SZs took over twice as long to name colours.
o Therefore, evidence for impaired cognitive processing in SZs. Increases validity of explanation.
- Proximal explanation
o Can only explain present symptoms of disorder, not the origin of it (e.g., genetics, family
dysfunction etc).
o Therefore, limited explanation. Need to know how genetics/family dysfunction lead to impaired
cognitive function.
- Not solely psychological
o Central control dysfunction explained as being a result of neural dysfunction (E.g., excess
dopamine).
o Therefore, lack of clarity in explanation; is SZ then a biological condition?
Drug therapy:
Antipsychotic drugs are used to treat schizophrenia. Psychosis is a loss of contact with reality (e.g.,
hallucinations, delusions).
Typical antipsychotics: chlorpromazine (1950s)
Maximum of 1000mg administered daily; taken orally. Usually a gradual increase from 400-
800mg.
Act as antagonists to dopamine system by blocking DA receptors in synapses of the brain.
DA initially builds up before reducing and normalising neurotransmission, reducing SZ symptoms
(e.g., hallucinations).
Also, an effective sedative as it affects histamine receptors; used to calm individuals if they are
anxious. More effective administered as syrup.
Family dysfunction – psychological explanation:
Schizophrenogenic mother: Fromm-Reichmann (1948), psychodynamic
Schizophrenogenic = 'schizophrenia-causing’.
Many schizophrenic patients spoke of a ‘type’ of parent – cold, rejecting, controlling.
Leads to tension and secrecy within the family, causing distrust and, ultimately, paranoid
delusions (of being persecuted by another person) i.e., schizophrenia.
Double-bind theory: Bateson et al (1972), family communication style can be a risk-factor for SZ
Double-bind communication = contradictory signals about right/wrong thing to do in a situation.
SZ feels they cannot act without contradicting their parents’ wishes; they are punished with
withdrawal of love when they get it wrong.
Leads to stress, feeling the world is a confusing and dangerous place. Leads to paranoid delusions
and disorganised thinking when trying to resolve the impossible.
Expressed emotion (EE): level of negative emotion expressed towards SZ from family members/carers
Criticism = negative comments; may be picked up by the rest of the family. Can be accompanied
by violence.
Hostility = negative attitudes towards SZ; may act as if they have chosen not to get better or
blame them for their condition. Can include anger and rejection.
Emotional over-involvement = family blame themselves for condition and needlessly self-
sacrifice, making the patient feel guilty.
All three act as major sources of stress for SZ; can cause relapse or induce SZ in those with a
predisposition (e.g., genes).
EVALUATION:
+ Supporting evidence
o Read et al (2005): adults with SZ are disproportionately likely to have been exposed to childhood
trauma and/or have insecure attachment. 69% women and 59% men have a history of
physical/sexual abuse.
o Therefore, evidence that family dysfunction increases vulnerability to SZ; +ve correlation.
- Socially sensitive (parent-blaming)
o Blame placed largely on family (especially mother), which could create more EE towards SZ.
o Therefore, explaining SZ only in terms of family dysfunction may be detrimental to care. Limited
usefulness.
- Lack of support for SZ mother and double-bind theory
o Only based on clinical observation and informal assessment of SZ patients’ mothers’
personalities; no systematic evidence.
o Therefore, lacks validity and scientific credibility; cannot account for link between family
dysfunction and SZ.
, Cognitive explanation:
Schizophrenia is characterised by dysfunctional thought processing; reduced processing in ventral
striatum is associated with negative symptoms and reduced processing in temporal and cingulate gyri is
associated with hallucinations.
Metarepresentation dysfunction: ability to reflect on thoughts and behaviours
Metarepresentation gives insight into one’s intentions and goals and allows interpretation of
other people’s actions.
MD impairs the ability to recognise actions as one’s own, explaining delusions and hallucinations.
Central control dysfunction: cognitive inability to suppress automatic responses (thoughts and speech)
Explains speech poverty and thought disorder, which could result from the inability to suppress
automatic thoughts/speech triggered by other thoughts.
Words/thoughts trigger associations and automatic responses cannot be prevented.
EVALUATION:
+ Supporting evidence
o Stirling et al (2006): compared performance of schizophrenics to control group on Stroop task
(naming font colours of colour-words). SZs took over twice as long to name colours.
o Therefore, evidence for impaired cognitive processing in SZs. Increases validity of explanation.
- Proximal explanation
o Can only explain present symptoms of disorder, not the origin of it (e.g., genetics, family
dysfunction etc).
o Therefore, limited explanation. Need to know how genetics/family dysfunction lead to impaired
cognitive function.
- Not solely psychological
o Central control dysfunction explained as being a result of neural dysfunction (E.g., excess
dopamine).
o Therefore, lack of clarity in explanation; is SZ then a biological condition?
Drug therapy:
Antipsychotic drugs are used to treat schizophrenia. Psychosis is a loss of contact with reality (e.g.,
hallucinations, delusions).
Typical antipsychotics: chlorpromazine (1950s)
Maximum of 1000mg administered daily; taken orally. Usually a gradual increase from 400-
800mg.
Act as antagonists to dopamine system by blocking DA receptors in synapses of the brain.
DA initially builds up before reducing and normalising neurotransmission, reducing SZ symptoms
(e.g., hallucinations).
Also, an effective sedative as it affects histamine receptors; used to calm individuals if they are
anxious. More effective administered as syrup.
