Discuss PSYCHOLOGICAL EXPLANATIONS OF SCHIZOPHRENIA

(8+16)

AO1

Many psychologists propose psychological explanations for schizophrenia. One of these explanations is that the disorder may be caused by a cognitive deficit. This theory explains schizophrenia as attention impairment, suggesting that it is caused by a defect in the patient’s ability to filter incoming information. This means that they are inundated by external stimuli, which they interpret

incorrectly and this therefore leads to schizophrenic behavior. Frith suggests that in particular, people with schizophrenia are unable to distinguish between actions that are brought about by external forces and those that are generated internally. This occurs because schizophrenics have problems with self-monitoring and so fail to keep track of their own intentions. As a result they may mistakenly regard their own thoughts as alien and as having come from someone else leading to auditory hallucination. Frith suggests that a failure in self-monitoring could also explain why schizophrenics may think that their movements are being controlled externally. Frith also proposes that schizophrenics may not have a ‘Theory of Mind’, the ability to understand what other people’s thoughts or intentions may be. This could help explain delusions and paranoid symptoms.

AO2

There is some research evidence to support Frith’s theory that schizophrenia is caused by faulty cognitive processes. McGuigan (1966) found that the larynx of patients with schizophrenia was often active during the time they claimed to be experiencing auditory hallucinations. This suggests that they mistook their own inner speech for that of someone else and therefore explains why a schizophrenic may claim to hear voices. However, there is evidence to suggest that explaining schizophrenia in terms of cognitive functioning may be incorrect. Research has shown that the cognitive deficit may have a genetic origin and this therefore suggests that the underlying cause of schizophrenia may be genetic rather than cognitive. (Faraone et al 1999)

IDA 

A major criticism of the theory however is the fact that it is difficult to establish cause and effect. For example in terms of the cognitive deficit, it is unclear as to whether having cognitive impairments will lead to schizophrenic symptoms such as delusions and hallucinations or whether having such symptoms may cause an interference with cognitive functioning. A better way to establish cause and effect may be to establish what genes are responsible for the disorder.

IDA

A further criticism of the theory is that it cannot account for all the symptoms of schizophrenia as it only explains positive symptoms, suggesting that hallucinations and delusions are brought about by problems in the cognitive processes, however it cannot explains to negative symptoms such as loss of emotion, and social withdrawal. These however may be better explained by family  explanations such as the role of expressed emotion.

AO1 

Schizophrenia may be explained by looking at family relationships and the family variables involved such as expressed emotion (EE). One for example is the “double-bind theory” in which Bateson et al suggest that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. For example if a mother tells her son that she love him yet at the same time turns her head away in disgust, the child receives two conflicting messages about their relationship on different communicative levels, one of affection of the verbal level, but one of animosity on the non verbal level. Bateson et al explains that these interactions prevent the development of an internally coherent construction of reality, and in the long run manifests it self as schizophrenic symptoms. These ideas were echoed in the work of psychiatrist R.D Laing.

AO1 

Another family variable associated with Sz is expressed emotion. Expressed emotion is a family communication style that involves, criticism, hostility and emotional over involvement. High levels of EE are most likely to influence relapse rates. Linszen et al said that schizophrenic patients are 4 times more likely to relapse returning home to a high EE family, than a patient returning home to a low EE family. In a study of the relapse rates among schizophrenics in Iran, found that the high prevalence of EE in  Iranian culture (overprotective mothers and rejective fathers) was one of the main causes of schizophrenic relapses. It appears  that the negative emotional climate in these families arouses the patient and leads to stress beyond his or her already impaired coping mechanisms thus triggering schizophrenic episode

AO2 

There is some research evidence to support the double bind theory, from Beger who found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics. However this evidence may not be reliable as patients recall may be affected by their schizophrenia.

AO2

However there are some less supportive studies from Liem who measured patterns of parental communication in families with a schizophrenic child and found no difference when compared to normal families. Further more Hall and Levin analysed data from various previous studies and found no difference between families with and without a schizophrenic member in the degree to which verbal and non-verbal communication were in agreement.

IDA 

A major criticism of the family relationships theory is that the theory is based on methodologically flawed studies, for example they did not include control groups and used a poor operationalized definition of schizophrenia. Along with this a major problem was that families were studied retrospectively long after the person’s mental disorder may have affected the family system.

IDA

There are some ethical issues with the theory also, as the double bind theory explains that because of mixed messaged parenting per se, it is the cause of schizophrenia within their child. This is highly unhelpful and destructive, as it places too much responsibility or blame on family members, who already have a hard time coping with the situation.

IDA

Expressed emotion as an explanation is considered both a strength and a weakness. Firstly a weakness because expressed emotion is clearly not an explanation for the cause of schizophrenia however a strength is that it’s a well accepted maintenance model for schizophrenia  and many prospective studies have been conducted which support EE hypothesis across many countries and culture (Miklowitz). So well accepted has the model become that treatment programs for schizophrenia usually include education and training for family member in controlling level of EE. Interestingly relapse rates are lower in countries like Nigeria and India, where there is less of a stigma for schizophrenia and so strong support is shown consequently exhibiting lower levels of negative expressed emotion.