Dysfunctional Family

Family Dysfunction in Schizophrenia

As mentioned above, abnormal behaviours can manifest in a multitude of ways, most commonly as a lack of closeness between family members, where conflict, judgement, and uncertainty are common. Neglectful behaviours from parents toward their child (such as expecting unattainable perfection, lacking empathy, control, and acting coldly towards the child) impact the relationships of the entire household, and negative behaviours (acting out, emotional reactions) can develop into more severe behaviours seen in schizophrenia further down the line.

Dysfunctional Family Meaning

Family dysfunction is a psychological explanation of schizophrenia. We can define a dysfunctional family as:

Overall, a dysfunctional family aids in the development, maintenance, and relapse rates of schizophrenia. Over the years, a few notable theories have gained traction. These will be discussed in what follows.

Dysfunctional Family Facts

As we briefly touched upon above, dysfunctional families tend to display common traits. These include:

• Lack of empathy
• Promoting unhealthy interactions between parent and child
• Acting Coldly
• Engaging in controlling behaviours

According to the Office for National Statistics (2019), children from dysfunctional family households are more likely to develop mental health disorders. It is important that, in understanding a disorder, factors such as family life are acknowledged.

What are the Types of Dysfunctional Family?

Laing and Esterson (1964), in their work, Sanity, Madness and the Family, disputed the long-running idea that schizophrenia should be looked at from a purely biological point of view, a mindset held up to the present day. They rejected the medical model, suggesting schizophrenia was not a disease but a result of external problems. Issues such as social pressures (an expectation to act in an ‘acceptable’ way within the patient and psychiatrist's culture) and relationships within the family, especially between the parent and child, play a more important role.

A few prominent theories support the idea of a family-based psychological explanation for the development and maintenance of schizophrenia in psychology.

In what follows, we identify and discuss these theories further.

The Schizophrenogenic Mother

First proposed by Fromm-Reichmann (1948), the term schizophrenogenic refers to a particular type of parent, as described by many patients with schizophrenia.

Fig. 2 - The schizophrenogenic mother is an outdated psychological explanation for schizophrenia.

Traits of schizophrenogenic parents include:

• Coldness (particularly towards children, shown through indifference or lack of affirmation and love)

• Uncaring

• Highly critical

• Controlling

• Rejecting

• Suspicious

According to Fromm-Reichmann, these behaviours encourage a hostile environment, leading to paranoia and sometimes delusions, which can affect a patient’s mental health in the long term. It is important to note that this theory of the schizophrenogenic mother is no longer held today.

The Double Bind Theory

Bateson et al. (1956) theorised that schizophrenia arises when a child receives contradictory messages from their parents. They suggested that this phenomenon increases the likelihood that a child will develop schizophrenia. They called this the ‘double bind theory’.

These negative interactions lead to internal confusion about what is real, which can cause paranoid thoughts and issues with the patient’s mental health. It affects a child's perception of reality, which can lead to positive symptoms of schizophrenia.

Fig. 3 - The double bind theory looks at how contradicting messages are related to schizophrenia.

Expressed Emotion in Schizophrenia

In families with a negative emotional climate, the hostile environment created by this communication style is associated with developing schizophrenia and higher chances of relapsing after receiving treatment, as supported by Amaresha and Venkatasubramanian (2012).

Expressed Emotion (EE) is a style of communication between families that involves:

• High levels of criticism.

• Hostility.

• Emotional over-involvement. This involves excessive self-sacrifice and extreme overprotective behaviours towards the patient. This can lead to a lack of self-reliance in the patient and overdependence on their parents, which can hamper long-term recovery.

Emotional over-involvement occurs as a result of guilt felt by the parent when their child is diagnosed with schizophrenia.

Brown et al. (1972) supported the suggestion that EE is prevalent in cases of relapse in schizophrenic patients after they are released from care. Following treatment in a hospital setting for psychotic episodes, families were inclined to show their schizophrenic relatives EE despite the fact that the patient did not express EE back. EE can be argued to be more important in the continuing struggle with schizophrenia because of this.

Lidz (1958) supported the idea that having emotionally distant parents can lead to symptoms of schizophrenia. More specifically, he suggested that the biological approaches are speculative compared to his research, which studies the whole patient. He highlighted the idea of a distortion of reality in schizophrenic patients.

What are the Strengths and Weaknesses of Theories of a Dysfunctional Family?

It is important to identify the supporting and opposing theories and studies of a dysfunctional family to back up your arguments in an exam. Citing studies will strengthen answers. But acknowledging how and why they support or disprove the theory being discussed is what examiners are looking for.

Strengths:

The strengths of the theories of dysfunctional families explore research supporting the arguments.

• The Double Bind Theory:

  • Bateson’s theory focuses on consistent exposure to contradictory messages, leading to confusion in thinking and communication. Berger (1965) found that schizophrenic patients, when compared to controls, had a higher recall of double bind statements from their childhood. They remembered contradictory messages from their mothers more often than those without schizophrenia. However, this is not a concrete result. Memory and recall are related symptoms associated with schizophrenia, and this may affect the results.

• Expressed emotions:

  • Kavanagh (1992) found that in over 26 studies, the median relapse rate for patients living with caregivers or families with high levels of EE was 48%, compared to 21% for families with low EE.

  • Similarly, Butzlaff and Hooley (1998) found living in high EE spaces produced more than double the baseline recurrent rate of symptoms in schizophrenic patients. Thus, EE has practical applications, as professionals can help improve symptoms by gaining insights into family lives.

Weaknesses:

The weaknesses of the theories of dysfunctional families explore research opposing the arguments.

• Placing blame on family members tends to cause issues of guilt in the parents, which can result in feelings of stress and anxiety. It isn’t ethical to blame family members for a diagnosis of schizophrenia, and these views are considered outdated or at the very least, unfair, by most psychiatrists and psychologists.

• It is almost impossible to say if family dysfunction is the cause of schizophrenia, or arises as a result of it (cause and effect)

• Memory is not always a reliable and accurate account of what happened. Considering that many symptoms of schizophrenia affect a patient’s understanding of reality (for example, patients struggle with symptoms of hallucinations, delusions, and hearing voices) relying on the patient’s memory is not the most secure method. There is no way to verify if the patient's memories are an accurate record of reality.

• There is evidence to suggest biological causes, not just family-based explanations exist. Although family dysfunctions may trigger schizophrenia, they may not be the root cause.

• The Double Bind Theory: There are gaps in experimental evidence. There’s a correlation (an association between two variables) but no cause (one variable directly affecting another). Due to gaps in experimental evidence, it is only a correlation between the theory and schizophrenia, not a causal relationship. Mishler and Waxler (1968) found parents spoke with their schizophrenic children differently when compared to their non-schizophrenic siblings. Whether this is a result of adapting to the disorder, or it is the cause itself, is unknown.

• Expressed Emotion (EE): It ignores positive caregiver interactions which have been proven to aid treatment outcomes. Some tests are not as complex as others. Some studies are not as robust as others, and use only one question when asking schizophrenics about EE: ‘How critical do you consider your relative to be of you?’. They are given a scale, from ‘not at all,’ to ‘very critical’. Asking one question may produce insufficient results. It also fails to acknowledge positive interactions, which often aid recovery and treatment (Amaresha & Venkatasubramanian, 2012).As well as this, Nomura et al. (2005) found interesting cultural differences in EE when comparing England to Japan. They looked at the expression of EE in carers of schizophrenic patients rather than focusing on the patient's relatives. English carers were more critical and showed higher levels of EE to their patients than Japanese carers. Their cultures are said to be intrinsically different to a point where family relationships are held in different regards, which could explain the difference in the carer's approaches to their patients.Japanese relationships are more focused on community systems, placing importance on the group and the household overall. Each individual is restricted both in behaviour and their opinions, which differs from a typical English family relationship. English families tend to place more importance or emphasis on the individuals of the family, where personal opinions and behaviours are open to discussion and criticism. Japanese people tend to avoid criticising their family members. This, in turn, affects the prevalence of EE (a component that requires criticism and a hostile environment) and how it plays a role in the maintenance of schizophrenia.