Socio-cultural Explanations for Schizophrenia

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Evaluation

  • Onset- none of the explanations offer a credible, single explanation for the onset of schizophrenia. Although the diathesis stress model does put forward the idea that an environmental stressor could trigger the onset of the illness of which family dysfunction could be one
  • Labelling theory- demonstrates how a diagnostic label can influence attitudes and expectations therefore it could be a possible explanation for maintenance of symptoms. Support is scarce however
  • Relapse- family dysfunction has been shown to be a crucial factor in relapse (Brown and Vaughan & Leff)
  • Family therapy- where patients and their families talk about their relationships with each other, worries and resentments, has been found to be very effective in preventing relapse
  • Cause and effect- hard to identify whether it is family dysfunction thta causes schizophrenia or vice vera (more likely)
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Relapse

Brown- studied family communication patterns in schizophrenics returning home

  • Patients returning home to a high level of expressed emotion were more likely to relapse than those returning to a low level of expressed emotion
  • Expressed emotion refers to the attitudes expressed by family memebrers when taling about their schizophrenic family member, along 5 seperate scales

Vaughan and Leff

  • Followed up 128 patients who had returned home after being discharged from hospital and rated their family members form expressed emotion
  • Patients whose families were high in negative expressed emotion were more likely to relapse than families that were rated low in negative expressed emotion
  • Relatives rated high in negative expressed emotion were likely to be hostile and critical in their communications about the patient
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2. Triggers

Marital Schism- Lidz

  • The mother and father are in open conflict with each other
  • Each spouse is trying to undercut the other and compete for loyalty of the child

Marital Skew- Lidz

  • Hostility is less open
  • The mother dominates family life and the father appears to be passive
  • The mother is trying to get loyalty by being more dominant
  • The father is trying to get loyalty through sympathy

According to Lidz, the child becomes caught in the middle of either of these family structures as any attempt to please one parent will be viewed as rejection by the other. As a defence mechanism (e.g. denial), the child may become extremely confused, allowing them to avoid acknowledging or resolving the conflict. Consequently they retreat to schizophrenia.

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1. Triggers

Double Bind Communication

  • Refers to parents who communicate pairs of messages to their children which are contradictory to each other
  • The contradiction is between the verbal message (tone as well as what you are saying) and the non-verbal message (body language)
  • Children become confused and develop a strategy where they ignore the verbal message and  focus on the non-verbal message due to a limited moral understanding
  • This leads to suspicion of what people say and fixation to the meaning of gestures or tones
  • This can lead to paranoia or delusions of referance
  • Little evidence to support this theory although it has been argued that it may be important in the maintenance of schizophrenic symptoms and the likelihood of relapse
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2. Labelling

Evaluation of Labelling Theory

  • Diagnosis- without diagnosis mental health professionals would be unable to research and treat the problem without distinguishing which individuals actually had the disease
  • Spitzer (1985)- Criticised the conclusions that were drawn from the Rosenhan study by arguing that behaviour is only meaningful when it's understood in context e.g. singing in a library would not be considered normal
  • Choosing to show schizophrenic symptoms- it is hard to justify someone choosing to live up to a label that effects your whole life and carrie such a heavy stigma to it
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The Diathesis Stress Model

  • Refers to an approach that mental illness is caused by a combination of a genetically inherited predisposition and environmental stress
  • These environmental triggers can come from: double-bind communication, marital schism/skew, trauma/stress and smoking cannabis
  • Genes and the environment rarely, if ever, work in isolation with a combination or nature and nurture being the most likely explanation- the diathesis stress model therefore supports this theory
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1. Labelling

  • The idea that when a person is labelled as schizophrenic, it influences their behaviour in the future--> self fulfilling prophecy
  • The theory states that diagnosis is simply a way of labelling individuals who society considers to be devient
  • Labelling is dangerous as it stigmatises and stereotypes patients whose subsequent actions will be interpreted as part of their schizophrenic behaviour and may face discrimination based on this diagnosis
  • The effects of labelling have also been shown to influence attitudes towards a patient- once an individual has been given the label of schizophrenia, there are expectations about how they will behave. The patient will then want to live up to those expectations and continue to behave in a 'bizarre' way
  • Reinforcement through receiving attention for their 'bizarre' behaviour means that they are likely to continue to act that way
  • Rosenhan- 8 pseudo patients complaining of auditory hallucinations were admitted, 7 with the diagnosis of schizophrenia and 1 with the diagnosis of manic depression after which they then stopped complaining of auditory halluciantions, it took an average of 19 days for the ppts to convince the hospital staff they were well enough to go home. Rosenhan concluded that once a patient is diagnosed they are labelled, after this point their behaviour is interpreted in line with the diagnostic label--> self fulfilling prophecy
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