Freud (1924) believed that schizophrenia was the result of two related processes:
- Regression to a pre-ego stage
- Attempts to establish ego control
If the world of the schizophrenic is particularly harsh, a child may regress to a stage of development before the ego was properly formed and before the child had developed a realistic awareness of the external world.
Schizophrenia was thus seen by Freud as an infantile state, some symptoms (e.g. delusions of grandeur) reflecting this primitive condition, others (e.g. auditory hallucinations) reflecting the person's attempts to re-establish ego control.
Evaluation of the psychodynamic explanation
- There is no research evidence to support Freud's specific ideas concerning schizophrenia except that subsequent psychoanalysts have claimed, like Freud, that disordered family patterns are the cause of this disorder.
- For example, Fromm-Reichmann (19480 described 'schizophrenic mothers; or families who are rejecting, overprotective, dominant and moralistic as important contributors to the development of schizophrenia.
- The parents of schizophrenic patients do behave differently from the parents of other kinds of patient, particularly in the presence of their disturbed offspring, but this is likely to be a consequence of their children's problems
- It is possible to support these psychoanalytic explanations by linking them to the explanations of family relationships.
- Behaviourists have attempts to explain the symptoms of schizophrenia as the consequence of faulty learning
- If a child receives little or no social reinforcement early on in life, the child will, instead of focusing on social stimuli in the normal way, attend to inappropriate and irrelevant environmental cues (e.g. the sound of a word rather than its meaning or the brightness of light in a room).
- As a result, the child's verbal and other behavioural responses will eventually appear somewhat bizarre. Those who observe the child's behaviour will either avoid it or respond erratically. This will reinforce the bizarre behaviour, eventually deteriorating into a psychotic state.
Evaluation of behavioural explanations
- The validity of behavioural explanations is moderately supported by the success of behavioural therapies used with schizophrenic patients
- Social skills training techniques have been used to help schizophrenics acquire useful social skills (e.g. Roder et al., 2002)
- The success of such programmes in reintegrating schizophrenics into the community suggests that these are skills schizophrenics failed to learn in the first place.
- It acknowledges the role of biological factors in causing the initial sensory experience of schizophrenia but claims that further features of the disorder appear as individuals attempt to understand them
- When schizophrenics first experience voices and other worrying sensory experiences, they turn to their friends and family to confirm the validity of what they are experiencing
- Other people fail to confirm the reality of these experiences, so the schizophrenic comes to believe they are hiding the truth
- Individuals begin to reject feedback from those around them and develop delusional beliefs that they are being manipulated and persecuted.
Evaluation of cognitive explanations
- There is much evidence of a physical basis for the cognitive deficits associated with schizophrenia supporting cognitive explanations
- Meyer-Lindenberg et al. (2002) found a link between poor working memory and reduced activity in the pre-frontal cortex
- The suggestion that 'madness' is a consequence of disbelieving others received curious support from a recent suggestion of treatment. Yellowlees et al. (2002) have developed a machine that produces virtual hallucinations, such as hearing the TV tell you to kill yourself or one person's face morphing into another's
- The intention is to show schizophrenics that their hallucinations are not real, but there is not yet any evidence that this will prove successful.
Life events and schizophrenia
- A major stress factor that has been associated with a higher risk of schizophrenic episodes is the occurrence of stressful life events. e.g. loss of a loved one or job loss. The mechanisms through which stress triggers schizophrenia has not been identified, although high levels of physiological arousal associated with neurotransmitter changes are thought to be involved
- Retrospective studies - Brown and Birley (1968) found approx 50% of people experienced a major life event in the 3 weeks prior to a schizophrenic episode, whereas only 12% reported one in the 9 weeks prior to that. A control sample reported a low and unchanging level of life events during the same period, suggesting that life events triggered the relapse
- Prospective studies - These monitor the presence or absence of life events prospectively. Hirsh et al. (1996) followed 71 schizophrenic patients over a 48 week period. Life events made a significant cumulative contribution in the 12 months preceding relapse rather than having a more concentrated effect in the period just prior to the schizophrenic episode.
Evaluation of life events and schizophrenia
- Not all evidence supports the role of life events. Van Os et al. (1994) reported no link between life events and onset of schizophrenia
- Patients were equally likely to have had a major life event or not in the 3 months before the onset of 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 relapse
- In any case, evidence suggesting a link between life events and the onset of schizophrenia is only correlational. The beginnings of the disorder (e.g. erratic behaviour) could have been the cause of the major life events
- Furthermore, life events after the onset of the disorder (e.g. losing one's job, divorce) may be a consequence of mental illness.
Double bind theory - Bateson et al. 1956
This theory suggests that children who frequently receive contradictory messages from their parents are more likely to develop schizophrenia. Prolonged exposure to such interactions prevents the development of an internally coherent construction of reality; in the long run, this manifests itself as typically schizophrenic symptoms such as flattened effect, delusions and hallucinations, incoherent thinking and speaking and in some cases paranoia
Expressed emotion (EE)
A family communication style that involves criticism, hostility and emotional over-involvement. High levels of EE are most likely to influence relapse rate. A patient returning to a family with high EE is about 4x more likely to relapse than a patient whose family is low in EE. In Iranian culture (overprotective mothers and rejecting fathers) was one of the main causes of relapse. The negative emotional climate in these families seems to arouse the patient and leads to stress beyond his or her already imposed coping mechanisms
Evaluation of family relationships
Double bind theory
There is some evidence to support the account of how family relationships may lead to schizophrenia. Berger (1965) found that schizophrenics reported a higher recall of double bind statements by their mothers than non-schizophrenics. This evidence may not, however, be reliable as patients' recall may be affected by their schizophrenia
Other studies are less supportive. Liem (1974) measured patterns of parental communication in families with a schizophrenic child and found no difference compared to normal families. Hall and Levin (1980)'s study also agreed with Liem
The effects of EE have received much more universal empirical support than the double bind theory. One issue is whether EE is a cause or an effect of schizophrenia. Either way, it had led to an effective form of therapy in which high-EE relatives are shown how to reduce EE. Hogarty et al. (1991) found that such therapy could significantlyreduce the relapse rate.
- The labelling theory of schizophrenia, popularised by Scheff (1999), states that social groups create the concept of psychiatric deviance by constructing rules of group members to follow.
- The symptoms of schizophrenia (e.g. hallucinations and delusions, bizarre behaviour) are seen as deviating from the rules we ascribe to 'normal' experience.
- Those who display these unusual forms of behaviour are considered deviant, and the label 'schizophrenic' may be applied.
- Once this diagnosis has been applied, it becomes a self-fulfilling prophecy that promotes the development of other symptoms of schizophrenia (Comer, 2003).
Evaluation of social labelling
- Some feel that a focus on social labelling draws attention away from the very real and disabling symptoms of schizophrenia
- Determinist- we have to live up to the labels we are given