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Psychological explanations for schizophrenia attribute the origin and development of schizophrenia to psychological causes rather than focusing on a purely biological explanation. It considers thoughts, emotions, and external experiences and how these have affected the patient and relationships with others (social interactions, family members, and work/education friends). It asks how these experiences have influenced the development of schizophrenia.
There are two primary considerations that the exam will focus on:
Family dysfunctions.
Cognitive explanations.
Family dysfunctions describe the unfavourable behaviours experienced between family members and the patient, such as cold, emotionless interactions, a lack of empathy, high levels of expressed emotions, and controlling behaviours.
These communication and behaviour methods create confusing situations based on unhealthy interactions between the parents and their child (the patient), resulting in abnormal behaviours. Conflict and uncertainty in a household commonly affect everyone, not just the patient in question.
Family dysfunctions cycles, Tyler Smith - StudySmarter Originals (Made in Canva)
Suppose this is a consistent issue within the family household. In that case, negative behaviours in the child (such as lashing out, behaving badly or erratically) can become more severe and can develop into symptoms of schizophrenia.
Three major theories seek to expand on family dysfunction and the psychological explanations for schizophrenia.
Proposed by Fromm-Reichmann (1948), the schizophrenogenic mother describes a particular type of parent. Typically, they are:
These behaviours often manifest in a way that explicitly excludes or affects the child (such as a lack of affirmation or love), inducing paranoid thoughts and delusions. These then develop further, sometimes into positive symptoms.
It is important to note the theory of the schizophrenogenic mother is no longer held today.
Developed by Bateson et al. (1956), the double bind theory is where a child (the patient) receives contradictory messages/signals from their parents throughout childhood.
For instance, a parent tells the child they love them whilst sneering at them with disgust. This disconnect between the statement and the emotion shown on the face creates a great deal of confusion, mistrust and paranoia in the child when it consistently happens.
If it is prominent throughout childhood, it is said to influence the development of schizophrenia. Paranoia and delusions, much like in the theory of the schizophrenogenic mother, are present as a result of these confusing interactions. These develop into full schizophrenic symptoms if left unattended.
The double bind theory diagram, Tyler Smith - StudySmarter Originals (Made in Canva)
Expressed emotions are where within a family, there are high levels of:
Criticism.
Hostility.
Emotional over-involvement (excessive self-sacrificing behaviours from the parent).
When a child is first diagnosed with schizophrenia, the child’s parent may feel a sense of immense guilt, affecting the parent’s behaviour towards the child.
They can become intrusive and overprotective, such as not allowing the child to go about their daily activities, discouraging their self-reliance. Parents, especially mothers, most commonly show emotional over-involvement. After some time of this overbearing behaviour, the patient may feel they can no longer cope and reverts to their illness as a coping device.
Households with high levels of expressed emotions significantly increase relapse rates in the hospitalisation of schizophrenic patients.
Cognitive explanations for schizophrenia is the notion that the impairment of cognitive functions can explain the development of schizophrenia.
Cognitive explanations explore how a patient thinks and how those thought processes affect cognitive function.
Frith (1979) suggested that schizophrenia was due to a faulty attention system, known as the attention-deficit theory.
This is where, in a healthy person, preconscious thoughts act as a filter for the bombardment of information we sense automatically.
Usually, this is unimportant information such as:
Random smells
Brief attention distractions
Random thoughts
These pieces of information are filtered and dismissed as they are not necessary.
In a patient with schizophrenia, it is suggested there’s a fault in this filtering system, resulting in sensory overload. This fault accounts for the positive symptoms such as hearing voices and tangents with thoughts and speech.
It has also been suggested there is a breakdown between memory and perception; they are not working together as they should. Additionally, there may be a lack of schemas (building blocks of the mind) - patients become overloaded, as they cannot rely on past experiences to adapt to new ones.
There are also issues with attention biases in those with schizophrenia:
Abnormal attention is given to threatening stimuli in patients due to a lack of self-monitoring. These are cognitive biases.
They blame delusions and hallucinations on external sources, not internal sources. So, their thoughts are ‘alien’ to them; they do not see these thoughts as their own.
They have a cognitive deficit because they cannot fully process different types of information (usually auditory and visual). This causes issues with the expression of emotion, social situations and speech comprehension.
Dysfunctional thought processing can be further separated into two categories:
Meta-representation
Central control
Meta-representation thought process, Tyler Smith - StudySmarter Originals (Made in Canva)
The image shows how healthy people understand they are responsible for their own thoughts. It’s how the mind gets from thought A to thought B to thought C and so on. A healthy person can follow this process, understand where each step came from and how they got from A to B to C.
In a patient with schizophrenia, this process is faulty. They are missing steps or cannot explain when asked how they got from A to C, as they are missing B.
Faults in this process cause a delusion of control. It creates issues with self-awareness. When a patient has positive symptoms, such as hearing voices, it is hard for them to distinguish this from their thoughts. Patients can’t justify their decisions, as they cannot tell a person where thought B came from or if thought B even exists at all.
Central control can ignore and override automatic thoughts and responses to carry out a deliberate action.
This affects speech, as they cannot control associations from one thought to another, leading to disorganised thoughts. Sentences will be jumbled, and topics will change frequently.
Psychological explanations attribute the origin and the development of schizophrenia to psychological causes (such as thoughts, behaviours, emotions, and relationships with family members and the environment), rather than focusing on a purely biological explanation.
Examples include symptoms such as hallucinations, paranoia, and delusions. These affect the person’s perception of the world around them.
In terms of psychological explanations, a schizophrenogenic mother, double-bind statements and expressed emotions can ‘trigger’ schizophrenia, or exacerbate existing issues that can develop into schizophrenia.
The biological model considers genetics, the dopamine hypothesis, and neural correlates as an explanation for schizophrenia.
This varies quite heavily depending on the patient. Commonly, in schizophrenia, delusions of persecution are seen often, alongside delusions of reference (belief that unrelated occurrences in the world have special personal significance).
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