Schizophrenia: Schizophrenia: Psychological TheoriesPsychological Theories

• Family systems theoryFamily systems theory• Psychosocial & environmental Psychosocial & environmental

stressstress

Starter:Starter:• In your group see if you can In your group see if you can

remember as much as you can remember as much as you can about the picture just shown and about the picture just shown and describe to your group what you describe to your group what you saw so they can re-create the saw so they can re-create the image. image.

• The group who has the most The group who has the most accurate image wins.accurate image wins.

Psychodynamic explanationPsychodynamic explanation• Psychoanalysists believe that psychological Psychoanalysists believe that psychological

conflicts usually arise in childhood and are a conflicts usually arise in childhood and are a result problems and conflicts between the result problems and conflicts between the developing personality (the ID, Ego and developing personality (the ID, Ego and Superego). Superego).

• These problems are unconscious to the individual These problems are unconscious to the individual and usually manifest as ‘Ego defense mechanism’ and usually manifest as ‘Ego defense mechanism’ e.g.: e.g.: repression, projection, denial, repression, projection, denial, regression, sublimation, displacement, regression, sublimation, displacement, humour, rationality and intellectualization. humour, rationality and intellectualization.

Make a storyboard! – design in groups how Make a storyboard! – design in groups how an unresolved development of the ego could an unresolved development of the ego could

cause schizophrenia – 15 minutes to create cause schizophrenia – 15 minutes to create and presentand present

A person has all 3 components Internal conflict damages development

Confusion on what is right and wrong

Peron’s inability to resolve conflict

This leads to a person establishing control through being selfish

Under developed ego causes schizophrenia

• Ego Ego defense mechanisms protect the person defense mechanisms protect the person from distress but can cause problems in their from distress but can cause problems in their own way.own way.

• Thus causing an unresolved conflict and Thus causing an unresolved conflict and damage to the developed and balance of the damage to the developed and balance of the ego, superego and the Id.ego, superego and the Id.

Cognitive Behavioural: Cognitive Behavioural: Family Systems TheoryFamily Systems Theory

• Origins in: Origins in: • The psychoanalytical tradition (the The psychoanalytical tradition (the

influence of the family on abnormal influence of the family on abnormal behaviour)behaviour)

• Systems thinking (idea that things are Systems thinking (idea that things are best understood by looking at the best understood by looking at the relationships between a set of relationships between a set of entities)entities)

Diathesis Stress Model:Diathesis Stress Model:• Design a graph showing the level of Design a graph showing the level of

stress in their environmental situation stress in their environmental situation and how this may cause someone to be and how this may cause someone to be mentally ill:mentally ill:

Family SystemFamily System

M F

C1

C2

C3

A family can be seen as a set of entities, each interacting with all the others.

The behaviour of each entity can only be understood by looking at its relationships with the others

Family SystemFamily SystemIf one person starts to behave abnormally the problem might not lie within that person

M F

C1

C2

C3

Their behaviour may be a manifestation of a problem occurring within the wider family systemC2

Double Bind Theory (Bateson, Double Bind Theory (Bateson, 1956)1956)

• Schizophrenia is a consequence of Schizophrenia is a consequence of abnormal patterns in family abnormal patterns in family communicationcommunication

• The patient is a ‘symptom’ of a The patient is a ‘symptom’ of a family-wide problemfamily-wide problem

• They become ‘ill’ to protect the They become ‘ill’ to protect the stability of the family systemstability of the family system

Double Bind TheoryDouble Bind Theory

• In a double bind situation a person is In a double bind situation a person is given mutually contradictory signals given mutually contradictory signals by another personby another person• This places them in an impossible This places them in an impossible

situation, causing internal conflictsituation, causing internal conflict• Schizophrenic symptoms represent an Schizophrenic symptoms represent an

attempt to escape from the double bindattempt to escape from the double bind

Double Bind TheoryDouble Bind Theory• Bateson (1956) reports clinical Bateson (1956) reports clinical

evidence (interviews, evidence (interviews, observations) illustrating use of observations) illustrating use of double bind communication by double bind communication by parents of schizophrenia patientsparents of schizophrenia patients• Issues of researcher (confirmatory) Issues of researcher (confirmatory)

biasbias• Problems with direction of causalityProblems with direction of causality

Double Bind TheoryDouble Bind Theory• Liem et al (1974) compared Liem et al (1974) compared

communication patterns in families communication patterns in families with & without a schizophrenic with & without a schizophrenic membermember• Abnormality in parental communication Abnormality in parental communication

was a response to the schizophrenic was a response to the schizophrenic symptoms, not vice versasymptoms, not vice versa

• Some issues with ecological validitySome issues with ecological validity

Double Bind Theory –Social Double Bind Theory –Social CulturalCultural

• Some evidence that family processes Some evidence that family processes play a role in relapse of play a role in relapse of schizophrenia patients following schizophrenia patients following stabilisationstabilisation• Relapse more likely (58% vs. 10%) Relapse more likely (58% vs. 10%)

where family is high in ‘expressed where family is high in ‘expressed emotion’ (Brown et al, 1966)emotion’ (Brown et al, 1966)

• Families high in criticism, hostility & Families high in criticism, hostility & over-involvement lead to more relapse over-involvement lead to more relapse (Vaughn & Leff, 1976)(Vaughn & Leff, 1976)

Social learning theorySocial learning theory• The behavioural explanation suggests that The behavioural explanation suggests that

schizophrenia is a consequence of faulty schizophrenia is a consequence of faulty learning. Children who do not receive learning. Children who do not receive reinforcement early in their lives will put larger reinforcement early in their lives will put larger attention into irrelevant environmental cues.attention into irrelevant environmental cues.

• Bizarre behaviour by parents is copied by Bizarre behaviour by parents is copied by children. Parents then reinforce this behaviour children. Parents then reinforce this behaviour and the behaviour becomes progressively more and the behaviour becomes progressively more unusual, until eventually the child acquires the unusual, until eventually the child acquires the label of being ‘schizophrenic’.label of being ‘schizophrenic’.

Supporting research:Supporting research:• Scheff’s (1966)Scheff’s (1966) labelling theory labelling theory

suggests that individuals labelled in this suggests that individuals labelled in this way may continue to act in ways that way may continue to act in ways that conform to this label. Bizarre behaviour conform to this label. Bizarre behaviour is rewarded with attention, and is rewarded with attention, and becomes more and more exaggerated becomes more and more exaggerated in a continuous cycle before being in a continuous cycle before being labelled as ‘schizophrenic’:labelled as ‘schizophrenic’:

Punishment

Withdrawal

Labelled as odd

Conforming to labelReinforced by attention

Cognitive-behavioural studies:Cognitive-behavioural studies:• BBreakdown of relationship between reakdown of relationship between

information that has already been stored in information that has already been stored in memory and new, incoming information e.g. memory and new, incoming information e.g. schemasschemas

• People are subjected to sensory overload and People are subjected to sensory overload and do not know which aspects of a situation to do not know which aspects of a situation to deal with & can be delusionaldeal with & can be delusional

• Internal thoughts are attributed to external Internal thoughts are attributed to external sources and are therefore experienced as sources and are therefore experienced as auditory hallucinationsauditory hallucinations

Frith (1992)Frith (1992)• Attempts to explain positive symptomsAttempts to explain positive symptoms• Unable to distinguish between actions Unable to distinguish between actions

generated externally and those generated generated externally and those generated internallyinternally

• Can be explained by faulty operation of Can be explained by faulty operation of meta-representation mechanism: 1 inability meta-representation mechanism: 1 inability to generate willed action 2 inability to to generate willed action 2 inability to monitor willed action 3 inability to monitor monitor willed action 3 inability to monitor beliefs and intentions of othersbeliefs and intentions of others

• Specifically a disconnection between frontal Specifically a disconnection between frontal and posterior areas of the brainand posterior areas of the brain

Genetic LinksGenetic Links• Is malfunctioning cognitive processing Is malfunctioning cognitive processing

linked genetically?linked genetically?• Park (1995) identified working memory Park (1995) identified working memory

deficits in schizophrenics and their 1deficits in schizophrenics and their 1stst degree non-schizophrenic relativesdegree non-schizophrenic relatives

• Faraone (1999) similarly found deficits in Faraone (1999) similarly found deficits in auditory attentionauditory attention

• These are a manifestation of genetic These are a manifestation of genetic predisposition to schizophrenia and may predisposition to schizophrenia and may even cause schizophrenia…but cannot even cause schizophrenia…but cannot explain why some relatives do not develop explain why some relatives do not develop it even though they have the predisposing it even though they have the predisposing genegene

EvaluationEvaluationLimited scope of cognitive theoriesLimited scope of cognitive theories• They simply describe some of the They simply describe some of the

symptoms in cognitive termssymptoms in cognitive terms• Hemsley’s model has little evidence Hemsley’s model has little evidence

for a neurological, hippocampus for a neurological, hippocampus deficit – but animal studiesdeficit – but animal studies

• Frith’s theory – little support, Frith’s theory – little support, reductionistreductionist

• No evidence to evaluate at this timeNo evidence to evaluate at this time

Psychodynamic ‘talking Psychodynamic ‘talking therapies’therapies’

• Based on assumption that individuals Based on assumption that individuals are unaware of the unconscious are unaware of the unconscious influence on current psychological influence on current psychological state.state.

• Maintains that it is the patient’s ego Maintains that it is the patient’s ego trying to re-assert authority and trying to re-assert authority and control.control.

• Some symptoms reflect infantile stateSome symptoms reflect infantile state

Evaluation:Evaluation:• Very little evidence to support this Very little evidence to support this

view of schizophreniaview of schizophrenia• Behaviour of the parents seen to Behaviour of the parents seen to

be a key influence, but could be be a key influence, but could be consequence rather than cause.consequence rather than cause.

• Does not take into account Does not take into account biological factors.biological factors.

Synoptic link!!!Synoptic link!!!• Both psychological theories and Both psychological theories and

social-cultural factors do not take into social-cultural factors do not take into account that some less-individualist account that some less-individualist cultures may express less emotion cultures may express less emotion (seen as a negative symptom) (seen as a negative symptom) Therefore it is culturally biased.Therefore it is culturally biased.

• Remember that US clinicians are Remember that US clinicians are more likely to diagnose compared to more likely to diagnose compared to other western societies.other western societies.