What is the cause of schizophrenia? If we know the cause, how do we treat schizophrenia? The origin and development of schizophrenia is a hot debate among psychologists and medical professionals. Whilst some suggest that the origin of schizophrenia is purely biological, others disagree, suggesting external factors, such as a person's social environment, play a large role in the development of the disorder.
Ultimately, each theory holds some form of truth. However, what’s not to say that all these theories have the potential to be somewhat correct? And what’s stopping us from combining these theories? The interactionist approach explores this avenue.
- We are going to delve into the interactionist approach to schizophrenia.
- First, we will provide an interactionist approach definition.
- Then, we will explore various Interactionist approach examples, focusing on the diathesis-stress model.
- Finally, we will discuss the advantages and disadvantages of the interactionist approach, including criticisms of the interactionist approach.
- We will also cover how interactionist approaches are used in the treatment of schizophrenia.
Interactionist Approach: Definition
The interactionist approach combines explanations to explain a behaviour or phenomenon, incorporating biological, psychological, and social perspectives. It combines all aspects of nature and nurture debates to determine potential causes of behaviours and, ultimately, the best way to treat mental health issues. Schizophrenia is a good example.
Fig. 1 - The interactionist approach to schizophrenia examines the combination of approaches to explaining schizophrenia. The interactionist approach to schizophrenia examines how the combination of biological, psychological, and social factors explains the development of schizophrenia.
In the interactionist approach to schizophrenia, biological, psychological, and social factors are linked to the cause of schizophrenia to understand how the symptoms develop. We can then use the interactionist approach to help treat the disorder. The best-known example of the interactionist approach in schizophrenia is the diathesis-stress model.
Interactionist Approach: Schizophrenia
The interactionist approach to schizophrenia combines multiple approaches to explain the disorder's origin and explore potential treatment plans. Schizophrenia, according to the interactionist approach, can be explained by biological, social, and psychological factors.
- Biological factors include genetic vulnerabilities, neural correlates, and biochemical factors (dopamine imbalances).
- Psychological factors include family dysfunction, expressed emotions, and traumatic childhood experiences.
- Social factors include low social status.
To treat schizophrenia from an interactionist perspective, we can examine these areas and address them appropriately. An example of an interactionist approach in schizophrenia is the diathesis-stress model.
Interactionist Approach Example: The Diathesis-Stress Model
The diathesis-stress model is an example of the interactionist approach. It explores how predispositions (vulnerabilities) to disorders can be triggered by environmental stressors, resulting in disorders such as depression and schizophrenia.
The diathesis-stress model, first introduced by Meehl (1962) in schizophrenia, is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor). This internal vulnerability or diathesis is predisposed, and Meehl initially held that this was due to a single ‘schizogene’.
If a person did not have this gene or genetic susceptibility, Meehl argued, no external stressors could cause schizophrenia. However, if they did have the gene, childhood trauma (such as experiencing expressed emotions or family dysfunction) or a negative life event could trigger schizophrenia.
Further research refutes the notion that schizophrenia results from a specific gene.
We now know schizophrenia is a polygenetic disorder in which dopamine imbalances, external factors, and environmental factors can cause a predisposition to the disorder. These events can cause or the result of developmental problems, such as complications at birth or abuse in childhood that affects brain development.
Fig. 2 - The development of schizophrenia, including its symptoms, can be affected by resources and support.
In addition, potential problems arise from negative psychological experiences such as academic pressure or relationship failure.
Psychology: Interactionist Approach
The interactionist approach in psychology uses a combination of approaches to explain behaviour and phenomena across various psychological discussions. It is often integrated into explanations and treatments to help treat those with certain disorders.
Examples include depression, anxiety, and schizophrenia, amongst other mental health disorders.
Evaluation of Internal Vulnerabilities and Triggers
Let's examine some of the research investigating the approaches.
Janssen et al. (2004) came to a similar conclusion in their study. They analysed 4045 samples of individuals aged 18 to 64, recording the first onset of psychotic symptoms with a two-year follow-up period. Childhood trauma was assessed at baseline (before exposure to any intervention, treatment, or study).
Read (2001) developed the idea that vulnerability might be related to nervous system development. They proposed that when traumatic experiences occur early enough in life or are particularly severe, these experiences are associated with biological abnormalities such as dopamine, norepinephrine, and serotonin abnormalities, acting as a diathesis by altering neurological development. Read (2001) presented the traumagenic neurodevelopmental model (TN) of schizophrenia.
Factors such as substance abuse, particularly cannabis, have also been linked to the development of schizophrenia.
The above studies have clarified that it is necessary to reconsider stress as a trigger, as many different aspects of life can influence a diathesis.
The interactionist approach is explored in two prominent studies associated with schizophrenia. Let's examine them further.
Gottesman (1991)
Gottesman (1991) studied cases of schizophrenia in identical and non-identical twins:
Identical twins share 100% of their DNA. These results suggest that schizophrenia is most likely genetic. However, if schizophrenia were exclusively genetic, the concordance rate for identical twins would have to be 100%. Since this is not the case, this suggests that both twins have a genetic susceptibility to schizophrenia, but only one had a psychological experience that triggered the disorder.
Tienari et al. (2004)
Tienari (2004) studied a Finnish national sample of biological children of schizophrenic mothers who had been adopted:
Tienari (2004) suggests a biological diathesis (internal vulnerability) to schizophrenia triggered by a psychological stressor. In this case, it is the dysfunctional family environment because children in this environment were more likely to develop schizophrenia than children who grew up in a healthy environment.
Advantages and Disadvantages of the Interactionist Approach
The interactionist approach is not without its advantages and disadvantages. First, let's examine some advantages.
- The interactionist approach is holistic, considering all factors rather than reducing a disorder to individual components. The biological approach to schizophrenia, for instance, has issues with reductionism. The interactionist approach avoids these issues by combining different factors.
- The interactionist approach is often supported by research, as demonstrated above, as well as Gottesman (1991) and Tienari (2004).
Criticism of the Interactionist Approach
Now, let's examine the criticisms of the interactionist approach.
- However, the interactionist approach has treatment issues, as we cannot conclusively say which treatment plan addressing each area works best. Is the medication treating the issue, or is the therapy proving more effective?
- When considering multiple approaches, how to address these areas becomes more complex and more expensive. Providing cognitive behavioural therapy, family therapy, antipsychotic medication, and social support is costly, time-consuming, and addresses many different areas. Treatment can become increasingly complex and convoluted as a result.
The Interactionist Approach to Treating Schizophrenia
As a large body of research suggests that schizophrenia is both a genetic and an environmental disorder, the interactionist approach indicates that combining biological and psychological therapy is the most effective way to treat schizophrenia.
The interactionist approach is considered a more holistic explanation of human behaviour (it looks at the patient as a whole person, not just their psychological needs). It considers all possible causal factors and does not reduce them to one (reductionism). It has more validity in its interpretation of what causes schizophrenia.
It considers the nature-nurture debate and the importance of heredity and environmental influences.
In patients with extreme or severe schizophrenic symptoms (hallucinations, extreme aggression, delusions, and paranoia), as described in the article on drug therapy, the patient can first be treated with biological drugs to combat these symptoms and then receive psychological treatment. Thus, the severe symptoms can be alleviated before the patient receives cognitive behavioural therapy (CBT), which provides him with the cognitive skills to change his maladaptive behaviours.
Tarrier et al. (2004) found evidence of the effectiveness of combined treatment plans – CBT was combined with antipsychotic medication treatment in patients with schizophrenia. They found significant benefits to combined therapy over 18 months compared to treatment with antipsychotic medication alone on symptom measures. Patients had fewer positive symptoms, were less severe, and spent fewer days in the hospital. Therefore, the interactionist approach is more effective than antipsychotic treatments alone.
Despite the support for combined treatments and the links between biological components and external stressors, there is still a problem with the interactionist approach as a complete explanation of schizophrenia.
There continue to be problems with patients affecting the efficacy of their treatments. Using a multidisciplinary approach seems to improve treatment efficacy. However, patients may still drop out of treatment (single treatment problems), and severe symptoms may affect their ability to participate in treatment, even with medication.
Interactionist Approach - Key takeaways
- The interactionist approach is concerned with how the interaction of biological, psychological, and social factors explains the development of schizophrenia.
- Initially, it was assumed that schizophrenia was due to a single ‘schizogene’ (Meehl, 1962), which was later revised and is now considered a polygenetic disorder.
- The diathesis-stress model, first introduced by Meehl (1962) in schizophrenia, is a psychological concept that holds that schizophrenia is due to a diathesis (an internal vulnerability) and an environmental trigger (stressor).
- Studies support the link between early childhood trauma, negative life experiences, and an internal vulnerability to schizophrenia that increases the likelihood of developing the disorder.
- A combination of treatment therapies is a vital feature of the interactionist approach and shows promising treatment results (fewer symptoms and hospitalisations).
- The interactionist approach is a holistic view and avoids issues of reductionism. It considers the nature-nurture debate and the importance of hereditary and environmental influences (substance abuse, childhood trauma, problems with parents).
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