Psychological explanations for schizophrenia attribute the origin and development of schizophrenia to psychological causes rather than focusing on a purely biological explanation. It considers thoughts, emotions, and external experiences and how these have affected the patient and their relationships with others (social interactions, family members, and work or education friends). It asks how these experiences have influenced the development of schizophrenia.
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Jetzt kostenlos anmeldenPsychological explanations for schizophrenia attribute the origin and development of schizophrenia to psychological causes rather than focusing on a purely biological explanation. It considers thoughts, emotions, and external experiences and how these have affected the patient and their relationships with others (social interactions, family members, and work or education friends). It asks how these experiences have influenced the development of schizophrenia.
So, what are the psychological explanations for schizophrenia?
Schizophrenia affects around 24 million people worldwide (WHO, 2022) and is a mental health disorder characterised by psychosis and positive and negative symptoms. Symptoms include paranoia, hallucinations, and affective flattening, to name a few.
Examples of the symptoms schizophrenic patients experience fall within the positive or negative symptom bracket, typically. For instance, positive symptoms include:
Negative symptom examples include:
According to psychological explanations of schizophrenia, family dysfunction, cognitive dysfunction (dysfunctional thought processing), and socio-cultural factors can trigger schizophrenia. Family dysfunction focuses on the unfavourable behaviours experienced between family members and the patient. Cognitive explanations focus on the impairment of cognitive functions, and socio-cultural explanations focus on social status.
Psychological explanations of schizophrenia highlight how family dysfunction affects the development of schizophrenia. So, what are family dysfunctions?
Family dysfunction describes the unfavourable behaviours experienced between family members and the patient, such as cold, emotionless interactions, a lack of empathy, high levels of expressed emotions, and controlling behaviours.
These communication and behaviour methods create confusing situations based on harmful interactions between the parents and their child (the patient), resulting in abnormal behaviours. Conflict and uncertainty in a household commonly affect everyone, not just the patient in question.
Suppose this is a consistent issue within the family household. In that case, negative behaviours in the child (such as lashing out, behaving badly or erratically) can become more severe and can develop into symptoms of schizophrenia.
Three prominent theories seek to expand on family dysfunction and the psychological explanations for schizophrenia.
As proposed by Fromm-Reichmann (1948), the schizophrenogenic mother describes a particular type of parent. Typically, they are:
These behaviours often manifest in a way that explicitly excludes or affects the child (such as a lack of affirmation or love), inducing paranoid thoughts and delusions. These then develop further, sometimes into positive symptoms.
It is important to note the theory of the schizophrenogenic mother is no longer held today.
Developed by Bateson et al. (1956), the double bind theory is where a child (the patient) receives contradictory messages/signals from their parents throughout childhood.
If it is prominent throughout childhood, it is said to influence the development of schizophrenia. Paranoia and delusions, much like in the theory of the schizophrenogenic mother, are present due to these confusing interactions, affecting a child's perception of reality, according to Bateson et al. (1956).
These develop into full schizophrenic symptoms if left unattended.
Expressed emotions are where within a family, there are high levels of:
Criticism and critique.
Hostility and animosity.
Emotional over-involvement from parents (including excessive self-sacrificing behaviours from the parent).
When a child is first diagnosed with schizophrenia, the child’s parent may feel a sense of immense guilt, affecting the parent’s behaviour towards the child.
Households with high levels of expressed emotions significantly increase relapse rates in the hospitalisation of schizophrenic patients (Vaughn & Leff, 1976).
Cognitive explanations for schizophrenia are the notion that the impairment of cognitive functions (dysfunctional thought processing) can explain the development of schizophrenia. Dysfunctional thoughts can eventually lead to delusions, memory issues, and other concerning symptoms.
Frith (1979) suggested that schizophrenia was due to a faulty attention system, known as the attention-deficit theory.
This is where, in a healthy person, preconscious thoughts act as a filter for the bombardment of information we sense automatically.
Usually, this is unimportant information such as:
Random smells you sense throughout the day, such as coffee on your morning walk or cutting grass.
Brief attention distractions that flag in your peripheral vision.
Random thoughts that are tangents from your main focus.
These pieces of information are filtered and dismissed as they are not necessary.
In a patient with schizophrenia, it is suggested there is a fault in this filtering system, resulting in sensory overload. This fault accounts for the positive symptoms, such as hearing voices and tangents with thoughts and speech.
It has also been suggested there is a breakdown between memory and perception; they are not working together as they should. Additionally, there may be a lack of schemas (building blocks of the mind) - patients become overloaded, as they cannot rely on past experiences to adapt to new ones.
Matussek (1952; as cited in Hemsley, 2005) highlighted how, in a patient with schizophrenia, there was a:
lack of continuity of his perceptions both in space and over time. He saw the environment only in fragments. There was no appreciation of the whole. He saw only details against a meaningless background. (p. 92)
When the building blocks schemas provide are longer there, context is lost, and attention is diverted to inappropriate or otherwise meaningless sources that would usually be ignored (Hemsley, 2005). Frith (1979) believed schizophrenic patients sought to explain the usually ignored information they perceived, which, according to Hemsley (2005), could allude to why they experienced delusions.
There are also issues with attention biases in those with schizophrenia:
Abnormal attention is given to threatening stimuli in patients due to a lack of self-monitoring. These are cognitive biases.
They blame delusions and hallucinations on external sources, not internal sources. They do not see these thoughts as their own.
They have a cognitive deficit because they cannot fully process different types of information (usually auditory and visual). This causes issues with expressing emotion, social situations and speech comprehension.
Frith (1992) separated dysfunctional thought processing into two categories:
Meta-representation
Central control
Meta-representation highlights how ideas develop and naturally flow from one thought to the next. It is a patient's ability to reflect on personal thoughts and experiences and how they all combine to affect behaviour.
Frith suggests issues with meta-representation lead to positive symptoms, such as hearing voices.
Typically, in healthy patients, a flow exists between thoughts that they can trace back relatively easily. External influences, such as speech, shouldn't affect a healthy person's perspective of reality.
Speech heard from the external world affects how schizophrenic patient can understand their internal thoughts, however. Speech can interrupt thought processes, and it's hard to truly distinguish between external speech and internal thoughts for schizophrenic patients, according to Frith (1992).
Faults in this process cause a delusion of control. It creates issues with self-awareness. When a patient has positive symptoms, such as hearing voices, it is hard to distinguish their thoughts from external speech.
Central control issues manifest in the person struggling to ignore and override automatic thoughts and responses when trying to carry out a deliberate action.
Central control can affect speech, for instance, as those with schizophrenia cannot control associations from one thought to another, leading to disorganised thoughts. Sentences will be jumbled, and topics will change frequently.
Those with a low social status may be more likely to experience issues with schizophrenia compared to others, according to the socio-cultural explanation. Increased chances could be due to:
Each of the above can raise stress levels in its own right, and research finds that some schizophrenic patients cited stressful life events before the onset of their schizophrenia.
Psychological treatment can be used for schizophrenia. Typically, psychological treatment involves cognitive behavioural therapy (CBT), family therapy, and token economy systems.
Each treatment has its strengths and weaknesses and is not guaranteed to work.
Psychological explanations attribute the origin and the development of schizophrenia to psychological causes (such as thoughts, behaviours, emotions, and relationships with family members and the environment), rather than focusing on a purely biological explanation.
According to psychological explanations of schizophrenia, family dysfunction, cognitive dysfunction (dysfunctional thought processing), and socio-cultural factors can trigger schizophrenia.
This varies quite heavily depending on the patient. Commonly, in schizophrenia, delusions of persecution are seen often, alongside delusions of reference (belief that unrelated occurrences in the world have special personal significance).
The cognitive approach to schizophrenia ascribes the origin of the disorder as a result of dysfunctional thought processes. Examples include a faulty attention system and a lack of schemas.
Cognitive impairments and symptoms in schizophrenia are related in that dysfunctional thought processing (cognitive impairments) can give rise to symptoms of schizophrenia. For example, dysfunctional thought processing can manifest into delusions, memory issues, and language impairment.
What is family dysfunction?
A dysfunctional family is one that lacks empathy and shows signs of unhealthy interactions between parents, and/or between parents and their children. This may create a confusing situation for the child, which may, in turn, produce erratic behaviours in the child.
What did Lidz (1958) suggest in his study?
Lidz suggested that having emotionally distant parents can lead to symptoms of schizophrenia. He also said that biological explanations are speculative compared to his research, which studies the whole patient.
Name one strength of the theory that family dysfunctions lead to schizophrenia.
In expressed emotion households, Kavanagh (1992) found that in over 26 studies, the mean relapse rate for patients living with caregivers or families with high levels of EE was 48%, compared to 21% for families with low EE. This suggests family dysfunction in households has an effect on the patient.
What did Laing and Esterson (1964) disagree with?
They disagreed with the idea that mental health should be looked at purely from a biological point of view. They rejected the current medical model.
What did Berger (1965) find?
He found that schizophrenic patients, when compared to controls, had a higher recall of double bind statements from their childhood.
What did Butzlaff and Hooley (1998) find in their study?
They found that schizophrenic patients living in high EE spaces produced more than double the baseline recurrent rate of symptoms.
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