- Freud (1924) believed schizophrenia was the result of two related processes: regression to a pre-ego stage and attempts to re-establish ego control.
- If the world of the schizophrenic has been particularly harsh, an individual may regress to this early stage in their development before the ego was properly formed and before he/she had developed a realistic awareness of the external world.
- Schizophrenia was seen by Freud as an infantile state, with some symptoms( e.g. delusions of grandeur) reflecting this primitive condition, and other symptoms (e.g. auditory hallucinations) reflecting the persons attempt to re-establish ego control.
- There is no research evidence to support Freuds specific ideas. Except psychoanalysts have claimed that disordered family patterns are the cause of this disorder.
- Fromm-Reichmann(1984)- Described "schizophrenic mothers" or families who are rejecting, overprotective, dominant and moralistic, as important contributory influences in the development of schizophrenia.
- Studies have shown that parents of schizophrenic children behave differently from parents of other kinds of patient, particularly in the presence of their disturbed offspring (Oltmanns et al 1999)- But this is likely to be a consequence of their children's problems as a cause.
- Acknowledges the role of the biological factors in causing the initial sensory experiences of schizophrenia, but claims the further features of the disorder appear as the individuals attempt to understand those experiences.
- When schizophrenics first experience hearing voices and other worrying sensory experiences, they turn to others to confirm the validity of the experiences. Other people fail to confirm the reality of these experiences; the schizophrenic comes to believe that others are withholding/hiding the truth.
- They begin to reject feedback from those around them and develop delusional beliefs that they are being manipulated and persecuted by others.
COGNATIVE - COMMENTARY
Evidence for the physical basis of the cognitive deficits associated with schizophrenia-
- Meyer-Lindenberg et al (2002)
-Found a link between excess dopamine and the prefrontal cortex, and the working memory.
The suggestion that "madness" is a consequence of disbelieving others is supported by a recent suggestion for treatment:
- Yellowlees et al (2002)
-Developed a machine that produces virtual hallucinations, such as hearing voices or the TV telling you to kill yourself, or of one persons face morphing into another.
-The intention is to show schizophrenics that their hallucinations are not real.
-As yet there is no evidence that this will provide successful treatment.
LIFE EVENTS AND SCHIZOPHRENIA
The occurrence of stressful life events has been associated with a higher risk of schizophrenic episodes - such as the death of a close relative or the break up of a relationship (discrete stresses).
- Brown and Birley (1968) -retrospective study
-Reported that life events play an important role in precipitating episodes of schizophrenia.
-They found 50% of people experience a stressful life event in the 3 weeks prior to a schizophrenic episode (12% 9 weeks prior)
-Control sample reported low unchanging level of stressful life events over the same period,-suggesting that it was the life events that triggered the relapse.
LIFE EVENTS AND SCHIZOPHRENIA - CONTINUED
- Hirsch et al (1996) -prospective study
-Followed 71 schizophrenic patients over a 48 week period.
-It was clear that life events made a significance cumulative contribution in the 12 months proceeding relapse rather than having a more concentrated effect in the period just prior to the schizophrenic episode.
High levels of psychological arousal associated with neurotransmitter changes are thought to be involved (Falloon et al, 1996).
LIFE EVENTS AND SCHIZOPHRENIA - COMMENTARY
- van Os et al (1994)
-Reported no link between life events and the onset of schizophrenia.
-Patients were not more likely to have had a stressful life event in the 3 months preceding the onset of the illness.
-In a prospective part of the study, those patients who had experienced a major life event went on to have a lower likelihood of a relapse.
- Evidence that suggests a link between life events and the onset of schizophrenia is only correlational.
- It could be the beginnings of the disorder( e.g. erratic behavior) were the cause of the major life events.
- Life events after the onset of the disorder (e.g. losing one's job) could be consequence rather than cause of the mental illness.
- Popularised by Scheff (1999)
- Theory states that social groups construct rules for members of their group the follow.
-The symptoms of schizophrenia (e.g. hallucinations and delusions, and bizarre behavior) are seen as deviant from the rules we ascribe to "normal" experience.
- If a person displays these unusual forms of behavior, they are considered deviant; the label of "schizophrenic" may be applied.
-Once this diagnostic label is applied it becomes a self-fulfilling prophecy that promotes the development of other symptoms of schizophrenia (Comer, 2003).
LABELING THEORY- COMMENTARY
- Scheff (1974)
-Evaluated 18 studies explicitly related to labeling theory.
-He judged 13 to be consistent with the theory, thus concluding that the theory was supported by the evidence.
- Rosenhan (1973) (pseudo-patients)
-Found that once the "label" of schizophrenia had been applied the diagnosis continued to influence the behavior of staff toward the patient, even when it was no longer warranted.
- Bateson et al (1956)
-Suggested that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia.
- E.g. a mother saying "I love you" but turns away in disgust.
-The child has received to conflicting messages about their relationship on different communicative levels.
-The child's ability to respond to the mother is incapacitated by such contradictions because one message invalidates the other.
- These interactions prevent the development of an internally coherent construction of reality, this eventually manifests itself as schizophrenic symptoms (e.g. flattened affect and withdrawal).
- These ideas were echoed in the work of psychiatrist R.D. Laing, who argued that schizophrenia is actually a reasonable response to an insane world.
DOUBLE-BIND THEORY - COMMENTARY
- Berger (1965)
-Found that schizophrenics reported a higher recall of double-bind statements by their mothers than non-schizophrenics.
- Liem (1974)
-Measured patterns of parental communication in families with a schizophrenic child.
-Found no difference when compared to families without a schizophrenic member.
- Hall and Levin (1980)
-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.
EXPRESSED EMOTION (EE)
- Expressed emotion (EE) is a family communication style that involves criticism, hostility and emotional over-involvement.
-It appears that the negative emotional climate in these families arouses the patient and leads to stress beyond his or her impaired coping mechanisms, thus triggering a schizophrenic episode.
- High levels of EE are more likely to influence relapse rates.
A patient returning to a family with high EE is 4 times more likely to relapse than a patient returning to a family with low EE (Linszen et al 1997).
- Kalafi and Torabi (1996) (Iran)
-Found that the higher prevalence of EE in Iranian culture (overprotective mothers and rejective fathers) was one of the main causes of schizophrenic relapses.
EXPRESSED EMOTION (EE) - COMMENTARY
- The effects of EE have received much more universal empirical support than the double-bind theory.
- There is the issue whether EE is a cause or an effect of schizophrenia.
- EE has led to an effective form of therapy where high EE relatives are shown how to reduce levels of EE.
- Hogarty et al (1991)
-Found that such therapy can significantly reduce relapse rates.
-However, it is not clear whether the EE intervention was the key element of therapy or whether other aspects of family intervention may have helped.