Psychological Psychological Explanation of Explanation of SchizophreniaSchizophrenia

Lesson ObjectivesLesson Objectives

By the end of the lesson you will be By the end of the lesson you will be able to:able to:

Describe and evaluate psychological Describe and evaluate psychological explanations of schizophrenia explanations of schizophrenia

Starter – CrosswordStarter – Crossword

Look through the pages on psychological Look through the pages on psychological explanations of schizophrenia to find the answers explanations of schizophrenia to find the answers to the clues. to the clues.

P198-199.P198-199.

Sociocultural / considers the role of social and family relationships Sociocultural / considers the role of social and family relationships Psychological / psychodynamic, behavioural and cognitive Psychological / psychodynamic, behavioural and cognitive schizophrenia / profound disruption of cognition and emotionschizophrenia / profound disruption of cognition and emotion Positive / excess or distortion of normal functionPositive / excess or distortion of normal function Negative / loss of normal functionNegative / loss of normal function Freud / psychodynamic approachFreud / psychodynamic approach Liberman / behavioural approachLiberman / behavioural approach Falloon / life events and schizophreniaFalloon / life events and schizophrenia Bateson / double bind theoryBateson / double bind theory Scheff / social labelling theoryScheff / social labelling theory

Psychological Psychological ExplanationsExplanations

Includes Psychological explanations, Includes Psychological explanations, e.g. Psychodynamic approach and e.g. Psychodynamic approach and Sociocultural factors.Sociocultural factors.

Sociocultural factors = considers the Sociocultural factors = considers the role of social and family role of social and family relationships relationships

SchizophreniaSchizophrenia

Characterised by a profound disruption Characterised by a profound disruption of cognition and emotion.of cognition and emotion.

This effects a persons language, This effects a persons language, thought and perception, mood and thought and perception, mood and sense of self.sense of self.

Positive symptoms = reflect an excess Positive symptoms = reflect an excess or distortion of normal functionor distortion of normal function

Negative symptoms = reflect a loss in Negative symptoms = reflect a loss in normal functionnormal function

Diagnostic criteria of Diagnostic criteria of schizophreniaschizophrenia

Positive SymptomsPositive Symptoms Delusions – paranoia, Delusions – paranoia,

grandiositygrandiosity

Experiences of control – Experiences of control – believe under control of believe under control of alien force.alien force.

Auditory hallucinations – Auditory hallucinations – bizarre, unreal bizarre, unreal perceptions, usually perceptions, usually auditory.auditory.

Disordered thinking – Disordered thinking – thoughts have been thoughts have been inserted or withdrawn from inserted or withdrawn from the mind.the mind.

Negative symptomsNegative symptoms Affective flattening – Affective flattening –

reduction in range and reduction in range and intensity of emotional intensity of emotional expression, including facial expression, including facial expression, tone of voice etcexpression, tone of voice etc

Alogia – lessening speech Alogia – lessening speech fluencyfluency

Avolition – reduction or Avolition – reduction or inability to take part in goal inability to take part in goal directed behaviour. directed behaviour.

Diagnosis requires 1 month Diagnosis requires 1 month of two or more positive of two or more positive symptoms. symptoms.

Psychodynamic approachPsychodynamic approach

Freud (1924)Freud (1924) Schizophrenia is the result of:Schizophrenia is the result of:

Regression to a pre-ego stage.Regression to a pre-ego stage. Attempts to re-establish ego control.Attempts to re-establish ego control.

Ego = driven by the reality principle Ego = driven by the reality principle which works to satisfy the ID in realistic which works to satisfy the ID in realistic ways. Makes the child accommodate to ways. Makes the child accommodate to the demands of the environment.the demands of the environment.

Regression to a pre-ego Regression to a pre-ego stage.stage.

If a schizophrenics world is harsh, e.g. cold If a schizophrenics world is harsh, e.g. cold and uncaring parents, a child may regress and uncaring parents, a child may regress back to a developmental stage before the back to a developmental stage before the ego was properly formed, ego was properly formed, before the child before the child had developed realistic awareness of the had developed realistic awareness of the external worldexternal world..

Schizophrenia is seen as an Schizophrenia is seen as an infantile state,infantile state, positive symptoms of positive symptoms of delusions of delusions of grandeurgrandeur reflect this condition. reflect this condition.

Whereas Whereas auditory hallucinationsauditory hallucinations reflect a reflect a persons attempt to persons attempt to re-establish ego re-establish ego controlcontrol – control of reality. – control of reality.

Behavioural ExplanationsBehavioural Explanations Explain schizophrenia as a consequence of Explain schizophrenia as a consequence of

faulty learning.faulty learning. If a child receives If a child receives little or no social little or no social

reinforcementreinforcement early on in life (parental early on in life (parental disinterest), the child will attend to disinterest), the child will attend to inappropriate and irrelevant environmental inappropriate and irrelevant environmental cues e.g. sound of a word instead of meaning. cues e.g. sound of a word instead of meaning.

Result – Result – child’s verbal or other child’s verbal or other behavioural responses will become behavioural responses will become bizarrebizarre and those who observe the child's and those who observe the child's behaviour will either avoid it or respond behaviour will either avoid it or respond erratically therefore reinforcing the bizarre erratically therefore reinforcing the bizarre behaviour.behaviour.

This cycle will eventually deteriorate into a This cycle will eventually deteriorate into a psychotic state.psychotic state.

Cognitive ExplanationsCognitive Explanations Acknowledges biological factors as a cause of Acknowledges biological factors as a cause of

initial sensory experiences e.g. hearing voices.initial sensory experiences e.g. hearing voices. BUTBUT claims further features of the disorder claims further features of the disorder

appear as appear as individuals attempt to individuals attempt to understand them. understand them.

When an individual experiences first sensory When an individual experiences first sensory symptoms, turn to friends, relatives to help symptoms, turn to friends, relatives to help understand them and validate them.understand them and validate them.

These people fail to do this, so the These people fail to do this, so the schizophrenic begins to believe they are hiding schizophrenic begins to believe they are hiding things from them, paranoia – this then causes things from them, paranoia – this then causes the individual to reject the feedback and the individual to reject the feedback and develop delusional beliefs that they are being develop delusional beliefs that they are being manipulated. manipulated.

Task TimeTask Time

Fill in to your boxes the criticisms Fill in to your boxes the criticisms for each psychological theoryfor each psychological theory

PsychodynamicPsychodynamic BehaviouralBehavioural CognitiveCognitive

Sociocultural factorsSociocultural factors Life events and SchizophreniaLife events and Schizophrenia::

Occurrence of stressful LE’s have been Occurrence of stressful LE’s have been linked to schizophrenia.linked to schizophrenia.

LE’s = death of a close friend, break up of a LE’s = death of a close friend, break up of a relationship, job lossrelationship, job loss

Falloon et al 1996 argues high levels of Falloon et al 1996 argues high levels of physiological arousal associated with physiological arousal associated with neurotransmitters in the stress response neurotransmitters in the stress response are thought to be the cause. are thought to be the cause.

Life event and Life event and Schizophrenia – Supportive Schizophrenia – Supportive

researchresearch Retrospective studies (study past events)Retrospective studies (study past events)

Brown and Birley (1968) LE’s play a Brown and Birley (1968) LE’s play a significant role in predicting episodes of significant role in predicting episodes of schizophrenia.schizophrenia.

Found: 50% people experienced major LE in 3 Found: 50% people experienced major LE in 3 weeks prior to episode. Only 12% reported on weeks prior to episode. Only 12% reported on 9 weeks prior. Control sample reported a low 9 weeks prior. Control sample reported a low and unchanging level of LE’s over the same and unchanging level of LE’s over the same period, suggesting LE’s trigger a relapse. period, suggesting LE’s trigger a relapse.

Life event and Life event and Schizophrenia – Supportive Schizophrenia – Supportive

researchresearch Prospective Studies (study future):Prospective Studies (study future):

Hirsch et al (1996) followed 71 Hirsch et al (1996) followed 71 schizophrenic patients over 48 weeks.schizophrenic patients over 48 weeks.

Found: LE’s made a significant, Found: LE’s made a significant, successive (continuous build up) successive (continuous build up) contribution in 12 months prior to contribution in 12 months prior to relapse than a concentrated effect just relapse than a concentrated effect just prior to an episode. prior to an episode.

Sociocultural factorsSociocultural factors Family relationships Family relationships Double Bind theory – Bateson et al 1956Double Bind theory – Bateson et al 1956

Children who receive contradictory messages Children who receive contradictory messages from their parents are more likely to develop from their parents are more likely to develop schizophrenia.schizophrenia.

Conflicting message = mother says I love you, Conflicting message = mother says I love you, but turns her head away in disgust. Child but turns her head away in disgust. Child received conflicting message about their received conflicting message about their relationship on different levels.relationship on different levels.

Verbal affection, non-verbal animosity (strong Verbal affection, non-verbal animosity (strong dislike)dislike)

Family relationshipsFamily relationships Bateson et al argued Child’s ability to Bateson et al argued Child’s ability to

respond is incapacitated by the respond is incapacitated by the contradictions.contradictions.

Prolonged exposure to these interactions Prolonged exposure to these interactions prevents the development of a coherent prevents the development of a coherent construction of reality.construction of reality.

Which in the long run manifests itself as Which in the long run manifests itself as schizophrenic symptoms, e.g. flattened effect, schizophrenic symptoms, e.g. flattened effect, delusions, hallucinations, incoherent thinking delusions, hallucinations, incoherent thinking and speaking and some cases paranoia. and speaking and some cases paranoia.

Family relationshipsFamily relationships Expressed emotion:Expressed emotion: Negative emotion or a high degree of expressed Negative emotion or a high degree of expressed

emotion (EE) is associated with schizophrenia.emotion (EE) is associated with schizophrenia.

EE = a family communication style that involves EE = a family communication style that involves criticism, hostility, and emotional over-criticism, hostility, and emotional over-involvement.involvement.

Linzen et al 1997 found a patient returning to a Linzen et al 1997 found a patient returning to a family with high EE is 4 times more likely to family with high EE is 4 times more likely to relapse.relapse.

Expressed emotion research Expressed emotion research supportsupport

Kalafi and Torabi 1996 studied the rate of Kalafi and Torabi 1996 studied the rate of relapse in schizophrenics in Iran.relapse in schizophrenics in Iran.

Found: High prevalence of EE in Iranian Found: High prevalence of EE in Iranian culture (overprotective mothers and rejecting culture (overprotective mothers and rejecting fathers) was one of the main causes of fathers) was one of the main causes of relapse. relapse.

Conclusion: Negative emotional climate Conclusion: Negative emotional climate (environment) in families seems to arouse (environment) in families seems to arouse patients and leads to stress beyond his or her patients and leads to stress beyond his or her coping methods.coping methods.

Sociocultural FactorsSociocultural Factors Social LabellingSocial Labelling

Scheff (1999) promoted the labelling theory of Scheff (1999) promoted the labelling theory of schizophrenia. schizophrenia.

Theory states social groups create the concept of Theory states social groups create the concept of psychiatric deviance by constructing rules for group psychiatric deviance by constructing rules for group members to follow.members to follow.

Thus the symptoms of schizophrenia are seen as Thus the symptoms of schizophrenia are seen as deviating (going against) from the rules that we attribute deviating (going against) from the rules that we attribute to ‘normal’ experience or behaviour.to ‘normal’ experience or behaviour.

Therefore those who display unusual behaviour are Therefore those who display unusual behaviour are considered deviant and the label schizophrenic may be considered deviant and the label schizophrenic may be applied which becomes a self fulfilling prophecy that applied which becomes a self fulfilling prophecy that promotes the development of other symptoms of promotes the development of other symptoms of schizophrenia (Comer 2003).schizophrenia (Comer 2003).

Fill in to your boxes the criticisms Fill in to your boxes the criticisms for each psychological theory – for each psychological theory – Sociocultural factors Sociocultural factors

Life events and SchizophreniaLife events and Schizophrenia Family relationshipsFamily relationships Social Labelling Social Labelling

PlenaryPlenary Psychological explanations include:Psychological explanations include: Includes Psychological explanations, Includes Psychological explanations,

Psychodynamic, Behavioural, Cognitive and Psychodynamic, Behavioural, Cognitive and Sociocultural factors.Sociocultural factors.

Sociocultural explanations include:Sociocultural explanations include: Life events and SchizophreniaLife events and Schizophrenia Family relationshipsFamily relationships Social Labelling Social Labelling considers the role of social and family considers the role of social and family

relationships relationships