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Psychological Explanations and Therapies for Schizophrenia

Psychological Explanations and Therapies for Schizophrenia

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Published by George Noorland

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Published by: George Noorland on Jun 14, 2012
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Psychological explanations of schizophrenia
Psychological theories
Freud (1924)
believed that schizophrenia was the result of two related processes,
regression to a pre-ego state and attempts to re-establish ego control.
If the world of the schizophrenic has been particularly harsh, for example if his or her parents were coldand uncaring, an individual may
regress to this early stage in their development before the egoproperly formed and before he or she had developed a realistic awareness of the external world.
Schizophrenia was thus seen by Freud as an infantile state, with some symptoms (e.g. delusions andgrandeur) reflecting this primitive condition, and other symptoms (e.g. auditory hallucinations) reflecting
the person’s attempts to
re-establish ego control.
This explanation of schizophrenia
acknowledges the role of biological factors
in causing the initialsensory experiences of schizophrenia, but claims that further features of the disorder appear asindividuals attempt to understand those experiences.
When schizophrenics’ first experience voices and other worrying sensory experience
s, they turn toothers to
confirm the validity of what they are experiencing
. Other people fail to confirm the reality ofthese experiences, so the schizophrenic comes to believe
that others must be hiding the truth
. Theybegin to
reject feedback from those around them and develop delusional beliefs that they arebeing manipulated and persecuted by others.
Socio-cultural factors
Life events and schizophrenia
A major stress factor that has been associated with a higher risk of schizophrenic episodes is theoccurrence of stressful life events. These are discrete stresses, such as the death of a close relative tothe break-up of a relationship.
A study by
Brown and Birley (1968)
found that, prior to a schizophrenic episode; patients who hadpreviously experienced schizophrenia reported
twice as many stressful life events
compared to ahealth control group.
Family Relationships
Double-bind theory
Bateson et al. (1956)
suggest that children who frequently receive
contradictory messages
from theirparents are more likely to develop schizophrenia. For example, if a mother tells her son that she loveshim while turning her head away in disgust; the child receives two conflicting messages about theirrelationship on different communicative levels, one of affection on the vernal level, and one of animosityon the non-verbal level.
The child’s ability to respond to the mothers incapacitated by such contradictions because one message
invalidates the other. These interactions
prevent the development of an internally coherentconstruction of reality
, and in the long run, this manifests itself as schizophrenic symptoms (e.g.flattened affect and withdrawal). These ideas were echoed in the work of
psychiatrist R.D. Laing
, whoargues that what we call schizophrenia is actually a reasonable response to an insane world.
Expressed emotion
Another family variable associated with schizophrenia is a negative emotional climate, or morespecifically, a high degree of expressed emotions.
Expressed emotion (EE) is a familycommunication style that involves criticism, hostility and emotional over-involvement
. Highlevels of EE are most likely to influence a relapse rates. A patient returning to a family with high EE is
about four times more likely to relapse than a patient returning to a family with low EE (
Linszen et al.,1997).
In a study of the relapse rates among schizophrenics In Iran,
Kalafi and Torabi (1996)
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 thesefamilies arouses the patient and leads to stress beyond his or her already impaired coping mechanisms,thus triggering a schizophrenic episode.
Labelling theory
The labelling theory of schizophrenia, popularised by
Scheff (1999),
states that social groups constructrules for members of their group to follow. The symptoms of schizophrenia (e.g. hallucinations and
delusions, and bizarre behaviour) are seen as deviant from the rules we ascribe to ‘normal’
If a person displays these unusual forms of behaviour, they are considered
deviant, and the label ofschizophrenic may be applied. Once this diagnostic label is applied it becomes a self-fulfillingprophecy that promotes the development of other symptoms of schizophrenia (Comer, 2003)
Retrospective studies
Brown and Birley (1968)
reported that life events play an important role inprecipitating episodes of schizophrenia. They found that about
50% of people experience stressful life eventsin the 3 weeks prior to a schizophrenic episode, while only 12% reported one in the weeks prior to that.
Acontrol sample reported a low and unchanging level of stressful life events over the same period, suggesting thatit was the life events that triggered the relapse.
Prospective studies-
unlike retrospective studies, which study events in the past, prospective studies monitorthe
presence or absence of stressful life events prospectively (i.e. in the future). Hirsch et al. (1996)
71 schizophrenic patients over a 48 week period
. it was clear that life events made a significantcumulative contribution in the
12 months preceding relapse
rather than having a more concentrated effect inthe period just prior to the schizophrenic episode (as suggested by the retrospective studies).
Psychotherapeutic explanations
There is
no research evidence
to support Freud’s specific ideas concerning schizophrenia, except that
subsequent psychoanalysis have claimed, like him, that disordered family patterns are the cause of thisdisorder. For example,
Fromm-Reichmann (1948)
described ‘
schizophrenegenic moth
or familieswho are rejecting, overprotective, dominant and moralistic, as important contributory influences in thedevelopment of schizophrenia.
Studies have shown that
parents of schizophrenic patients do behave differently
from parents ofother kinds of patients, particularly in the presence of disturbed offspring (
Oltmanns et al., 1999
) but
this is as likely to be a consequence of their children’s problems as a cause.
Cognitive explanations
There is much evidence of a physical basis for the cognitive deficits associated with schizophrenia, forexample, research by
Meyer-Lindenberg et al. (2002),
which found a link between excess dopamine in
the prefrontal cortex, and working memory. The suggestion that ‘madness’ is a consequence of 
disbelieving others receives curious support from a recent suggestion for treatment.
Yollowlees et al. (2002)
have developed a machine that produces virtual hallucinations, such ashearing
the TV tell you to kill yourself, or one person’s face morphing into another. The intention is to
show schizophrenics that their hallucinations are not real. As yet there is no evidence that this willprovide a successful treatment.
Life events and schizophrenia
Not all evidence supports the role of life events. For example,
van Os et al. (1994)
no link
 between life events and the onset of schizophrenia. Patients were not more likely to have had a majorstressful life event in the
3 months preceding the onset of their illness
. In a prospective part of the
study, those patients who had experienced a major life event went on to have a lower likelihood ofrelapse.
Evidence that does suggest a link between life events and the onset of schizophrenia is only
It could be that the beginnings of the disorder (e.g. erratic behaviour) were the cause ofthe major life events. Furthermore, life events
after the onset of the disorder (e.g. losing one’s job,
divorce) may be a consequence rather than a cause of mental illness.
Family relationships
The importance of family relationships in the development of schizophrenia can be seen in an adoptionstudy by
Tienari et al. (1994).
In this study those adopted children who had schizophrenic biologicalparents were more likely to become ill themselves than those children with non-schizophrenic biologicalparents.
However, this difference only emerged in situations where the
adopted family was rated as disturbed
.In other words the illness only manifested itself under appropriate environmental conditions
. Geneticvulnerability alone was not sufficient.
Double-bind theory
There is some evidence to support this particular account of how family relationships may lead toschizophrenia.
Berger (1965)
found that schizophrenics reported a
higher recall of double-bindstatements by their mothers than non-schizophrenics. However, this evidence may not bereliable
, as patients’ recall may be affected by their 
Liem (1974)
measured patterns of parental communication in families with a schizophrenic child andfound
no difference
compared to normal families.
Hall and Levin (1980)
analysed data from various previous studies and found
no difference
betweenfamilies with and without a schizophrenic member in the degree to which verbal and non-verbalcommunication were in agreement.
Expressed emotion
The effects of expressed emotion have received much more universal empirical support than double-bind theory. However, there is the issue of whether
EE is a cause or an effect of schizophrenia
.Either way it has led to an effective form of therapy where high EE relatives are shown how to reducelevels of expressed emotion.
Hogarty et al. (1991)
found that such therapy can significantly reduce relapse rates. However, with alltherapies, it is not clear whether the
EE intervention was the key element of the therapy or whetherother aspects of family intervention may have helped.
Expressed emotion and culture
Although findings on expressed emotion have been replicated cross-culturally, expressed emotion is much less common in families of people with schizophrenia outside the west(
Jenkins and Karno, 1992
). One possible explanation for this is that non-western cultures are less individualistand less committed to concepts of personal responsibility than western societies such as the US and UK. Thus,they are less likely to blame someone with schizophrenia for their actions.
Labelling theory
In a review of the evidence,
Scheff (1974)
18 studies
explicitly related to labelling theory. He judged
13 to be consistent with the theory and 5 to be inconsistent
, thus concluding that the theorywas supported by the evidence.
A study which he assessed as supporting labelling theory was the
Rosenhan study
. Rosenhan found
that once the ‘
label’ of schizophrenia had been applied, the ‘diagnosis’ continued to influence the
behaviour of staff toward the patient, even when it was no longer warranted.

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