Psychological explanations of SC

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  • Psychological explanations for schizophrenia
    • the psycodynamic view states that SC arises from and inability to plan reality- e.g. cannot draw logical conclusions and distinguish between the internal or external world
      • does not totally ignore genetic vulnerability but can trace the root of the difficulties back to childhood
        • the primary caregiver is responsible for helping the child overcome its anxieties and distinguish between the internal and external world
          • if this care is inadequate the child will not develop a proper sense of self- during adolescence when threats to their poor sense of self occur- schizophrenia symptoms arise
            • however there is little evidence to support this view
    • the Behavioural approach also failed to provide an explanation for the complexity of schizophrenia
      • according to behaviourists children learn to behave in odd bizarre ways and repeat these behaviours because they are rewarded with attention and sympathy
        • this is a highly unlikely mechanism for acquisition of the extraordinary range of behaviours characteristic of SC
    • more convincing explanations are family and cognitive models
    • Family models
      • Bateson- double blind theory- a child has repeated experiences with one or more family members in which they receive contradictory messages-
        • "you look tired, go to bed now" this demonstrates concern for the childs welfare but the tone and body language may present hostility and a desire to get rid of the child
        • repeated exposure to these contradictory messages result in the child resorting to delf-deception and develop a false sense of reality and an inability to communicate effectively
          • research pre-1970 generally supported this view that SC occurred in dysfunctional families however research was only carried out on family interactions after the schizophrenia was diagnosed and they rarely involved proper control groups
      • more recent research focused on the concept of expressed emotion (EE) origionally based on Brown (1972) which showed patients with SC were more likely to relapse if they returned to homes with high levels of EE (e.g. hostility, criticism) compared to those who returned to homes with low EE
        • EE is assesed by taping an interview with a relative of someone with SC and rating the frequency of critical comments made by the relative; the amount of statements of resentment made towards the patients; and the rating of statements displaying over-concern/involvement in the patient
          • research has shown that there is a relationship between relapse and living with a high EE relative  (e.g. that done by Tarrier et al)- EE seems to be a strong predictor of the course of the disorder
            • however EE studies are correlational and may reflect  the consequences of living with a severly disturbed individual instead of having any casual significance
            • research has also found high levels of EE in families of patients with other disorders such as depression and eating disorders (Kavanagh) so it is not a defining characteristic of families with a schizophrenic member
              • there has also been concerns about how the EE is measured- it requires only one observation which may not be sufficiant to give an accurate picture of the family dynamics
      • despite all of this it is clear that family enviroment has a clear role in the onset of SC and the course of the disorder
        • several prospective studies conducted found that high-risk children who go on to develop SC are more likely to come from families characterised by negative relationships, in comparison to those who do not develop the disorder despite being high risk
          • e.g. the israeli high risk study found that among the high risk none of those who had received 'good parenting' from a parent with SC went on to develop SC or a related disorder
            • it is thought that bad parenting and dysfunctional patterns of communication alone do not cause the disorder, but it is believed that an underlying vulnerability in certain individuals interacts with environmental stressors to encourage the onset of SC
    • cognitive models
      • focus on impaired thought processes that catagorise SC
        • cognitive deficit theories attempt to explain schizophrenia in terms of attention impairment- we can normally use selective attention mechanisms to filter incoming stimuli and process them to extract meaning
          • its thought that these filtering systems are impaired in those with SC and that they become overwhelmed with sensory information that they are unable to interpret
            • this is supported by the finding that people with schizophrenia perform poorly on various information processing tasks such as reaction time and categorization
              • cognitive theories simply describe symptoms of SC in cognitive terms instead of explaining how the symptoms origionate
                • they also assume underlying psychological abnormalities
      • models that integrate neurological and cognitive explanations are called neuropsychological models
        • Frith's model
          • people with SC can not distinguish between between actions driven by internal intention and external forces-
            • conscious processing is where the highest level of cognitive functioning takes place in full subjective awareness- we have limited capacity to carry out high order processes and so we can only carry out one at a time
              • in contrast preconscious processes occur without awareness- they are automatic and occur simultaneously
              • if the filter between the two processes breaks down information from the precocious could be passed into the conscious awareness
                • this information is misinterpreted as important and the individual feels the need to act upon it- Frith believes that this is how delusions origionate
                  • he explains auditory hallucinations in a similar way- we are constantly bombarded with sounds and noises and it is likely that the preconscious mechanisms test various interpretations of these sounds before the final interpretation is passed into the conscious awareness
                    • if the filter is defective it is possible that incorrect interpretations of the non-verbal sounds that seep into the precociousness are misinterpreted as verbal voices
                      • this filter may be defective as a result of an irregularity with the neuronal pathways connecting the hippocampus to the pre-frontal cortex which is linked to faulty regulation of dopamine in this part of the brain
                        • Frith has demonstrated some evidence for this hypothesis with changes in cerebral blood flow in the brains of people with SC whilst engaged in specific cognitive tasks
                          • although there is not universal support for this theory and it is criticized for failing to take sufficient account of environmental factors
        • Helmsley's model
          • some of the symptoms of SC arise from the disconnection between stored knowledge and current sensory input
            • cognitive psychologists refer to stored knowledge as schemas for various events and activities- a way to know what to expect when we revisit these activities and can rapidly decide which aspects to pay attention to
              • in people with schizophrenia they do not differentiate between schemas and new situations so they do not know what stimuli to pay attention to and which to dismiss-internal events are misinterpreted as sensations caused by external stimuli and result in experiencing hallucinations
                • Helmsley believes this is caused by abnormalities in the hippocampus- however there is no unequivocal evidence to support the theroy
      • Diathesis stress model
        • SC is a complex disorder and it is unlikely there is only one cause- most researchers accept an integrative approach that acknowledges a number of factors
          • Zubin and Spring- first to propose that stressful life events can trigger psychotic symptoms in individuals with an underlying biological predisposition to schizophrenia
            • genetic factors or adverse conditions in the womb can lead to a genetic vulnerability which can take the form of biochemical or neuroanatomical abnormalities-
              • this can lead to psychological vulnerability such as the inability to process information correctly- this then leads to cognitive distortions, misattributions, and hyperarousal
                • if the individual is exposed to stressful life events such as high EE or over-stimulating environment these cognitive difficulties then go on to produce the psychotic symptoms of SC- the individual will probably not experience these these psychotic episodes if they have good coping strategies or a warm supporting envrioment
                  • the diathesis stress model is useful in combining biological and psychologcal factors and has implicatins for therapy suggesting biological and psychological interventions should be combined


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