Psychological Explanations for Schizophrenia

Schizophrenia: Psychology Definition

Schizophrenia affects around 24 million people worldwide (WHO, 2022) and is a mental health disorder characterised by psychosis and positive and negative symptoms. Symptoms include paranoia, hallucinations, and affective flattening, to name a few.

Schizophrenia Examples

Examples of the symptoms schizophrenic patients experience fall within the positive or negative symptom bracket, typically. For instance, positive symptoms include:

• Hallucinations (a person may hear other voices or see people that do not exist, perhaps traumatic images).
• Delusion (a person may believe they are the next coming of Jesus or believe they are someone extremely important politically).
• Paranoia (a person may believe someone is following them or listening in on their conversations, such as the police, or may believe family members are listening in on them).

Negative symptom examples include:

• Slow movements (a person may become sluggish, moving more dispassionately)
• Speech poverty (also known as alogia, speech poverty manifests as a decline in speaking; conversations slow down or stop altogether)
• Avolition (lack of motivation, patients may struggle to motivate themselves to engage with the world, including family and friends.

Psychological Explanations for Schizophrenia

According to psychological explanations of schizophrenia, family dysfunction, cognitive dysfunction (dysfunctional thought processing), and socio-cultural factors can trigger schizophrenia. Family dysfunction focuses on the unfavourable behaviours experienced between family members and the patient. Cognitive explanations focus on the impairment of cognitive functions, and socio-cultural explanations focus on social status.

Schizophrenia: Family Dysfunction

Psychological explanations of schizophrenia highlight how family dysfunction affects the development of schizophrenia. So, what are family dysfunctions?

These communication and behaviour methods create confusing situations based on harmful 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.

• Other family members feel stressed, creating tension, guilt, of general unease in the patient, their siblings, and their parents.

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 prominent theories seek to expand on family dysfunction and the psychological explanations for schizophrenia.

The Schizophrenogenic Mother

As proposed by Fromm-Reichmann (1948), the schizophrenogenic mother describes a particular type of parent. Typically, they are:

• Uncaring.
• Highly critical.
• Controlling.
• Cold.

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.

The Double Bind Theory

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.

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 due to these confusing interactions, affecting a child's perception of reality, according to Bateson et al. (1956).

These develop into full schizophrenic symptoms if left unattended.

Expressed Emotions (EE)

Expressed emotions are where within a family, there are high levels of:

• Criticism and critique.

• Hostility and animosity.

• Emotional over-involvement from parents (including 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.

Households with high levels of expressed emotions significantly increase relapse rates in the hospitalisation of schizophrenic patients (Vaughn & Leff, 1976).

Schizophrenia: Cognitive Explanations

Cognitive explanations for schizophrenia are the notion that the impairment of cognitive functions (dysfunctional thought processing) can explain the development of schizophrenia. Dysfunctional thoughts can eventually lead to delusions, memory issues, and other concerning symptoms.

Dysfunctional Thought Processing

Frith (1979) suggested that schizophrenia was due to a faulty attention system, known as the attention-deficit theory.

Usually, this is unimportant information such as:

• Random smells you sense throughout the day, such as coffee on your morning walk or cutting grass.

• Brief attention distractions that flag in your peripheral vision.

• Random thoughts that are tangents from your main focus.

These pieces of information are filtered and dismissed as they are not necessary.

In a patient with schizophrenia, it is suggested there is 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.

Matussek (1952; as cited in Hemsley, 2005) highlighted how, in a patient with schizophrenia, there was a:

When the building blocks schemas provide are longer there, context is lost, and attention is diverted to inappropriate or otherwise meaningless sources that would usually be ignored (Hemsley, 2005). Frith (1979) believed schizophrenic patients sought to explain the usually ignored information they perceived, which, according to Hemsley (2005), could allude to why they experienced delusions.

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. 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 expressing emotion, social situations and speech comprehension.

Frith (1992) separated dysfunctional thought processing into two categories:

1. Meta-representation

2. Central control

Meta-representation

Meta-representation highlights how ideas develop and naturally flow from one thought to the next. It is a patient's ability to reflect on personal thoughts and experiences and how they all combine to affect behaviour.

Typically, in healthy patients, a flow exists between thoughts that they can trace back relatively easily. External influences, such as speech, shouldn't affect a healthy person's perspective of reality.

Speech heard from the external world affects how schizophrenic patient can understand their internal thoughts, however. Speech can interrupt thought processes, and it's hard to truly distinguish between external speech and internal thoughts for schizophrenic patients, according to Frith (1992).

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 to distinguish their thoughts from external speech.

Central Control

Central control issues manifest in the person struggling to ignore and override automatic thoughts and responses when trying to carry out a deliberate action.

Schizophrenia: Socio-cultural Explanations

Those with a low social status may be more likely to experience issues with schizophrenia compared to others, according to the socio-cultural explanation. Increased chances could be due to:

• Higher stress levels.
• Poor living conditions.
• Poverty.
• Social class status.

Each of the above can raise stress levels in its own right, and research finds that some schizophrenic patients cited stressful life events before the onset of their schizophrenia.

Psychological Treatment for Schizophrenia

Psychological treatment can be used for schizophrenia. Typically, psychological treatment involves cognitive behavioural therapy (CBT), family therapy, and token economy systems.

• CBT addresses dysfunctional thought processes using Ellis' ABC model, encouraging those with schizophrenia to perform reality tests.
• Family therapy involves the family and the patients, addressing household issues to treat schizophrenia.
• Token economy systems rely on operant conditioning, encouraging patients to perform approved behaviours for tokens to trade in for rewards.

Each treatment has its strengths and weaknesses and is not guaranteed to work.