Schizophrenia
Characteristics of Schizophrenia
Positive symptoms
Negative symptoms
Misconceptions
Biological explanations
Genetic
Viral Infection
Brain dysfunction
Biochemical
Psychological
Behavioural
Psychodynamic
Cognitive
Sociocultural
Life events
Family relationships
Social Labelling
Social Drift theory
1
Schizophrenia is one of the most serious psychiatric disorders. It is classified as a psychotic disorder
characterised by severe symptoms (that many would refer to as “abnormalities”) in the areas of
judgement, emotions, perceptions and behaviour. The name itself implies some kind of split: not, as
popular opinion would suggest, a split personality, but a split between the mind and reality. It was the
psychiatrist Bleuler who first labelled the disorder schizophrenia, deriving it from two Greek words
meaning split (schizo-) and mind (-phrenia). The schizophrenic appears to retreat from reality into his or
her own private world. Schizophrenia is most commonly characterised by both 'positive symptoms'
(those additional to normal experience and behaviour) and negative symptoms (the lack or decline in
normal experience or behaviour).
The onset is typically in late adolescence
and early adulthood,onset- Men: 18–25
years; women: 25–35 years
Prevalence The lifetime prevalence of
schizophrenia is commonly given at 1%.
The incidence of schizophrenia was given as a
range of between 7.5 and 16.3 cases per 100,000
of the population.
(See figure 14.1)
Men are more likely to suffer than females
DSM IV diagnostic criteria are:
A.
Characteristic Schizophrenia symptoms:
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if
successfully treated):
Delusions - false beliefs strongly held in spite of invalidating evidence, especially as a symptom of mental illness: for
example,
Paranoid delusions, or delusions of persecution, for example believing that people are "out to get" you, or the thought
that people are doing things when there is no external evidence that such things are taking place.
Delusions of reference - when things in the environment seem to be directly related to you even though they are not. For
example it may seem as if people are talking about you or special personal messages are being communicated to you
through the TV, radio, or other media.
Somatic Delusions are false beliefs about your body - for example that a terrible physical illness exists or that something
foreign is inside or passing through your body.
Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities. An
example of a grandiose delusion is thinking you are a famous rock star.
Hallucinations - Hallucinations can take a number of different forms - they can be: Visual (seeing things that are not
there or that other people cannot see),
Auditory (hearing voices that other people can't hear,
Tactile (feeling things that other people don't feel or something touching your skin that isn't there.)
Olfactory (smelling things that other people cannot smell, or not smelling the same thing that other people do smell)
Disorganized speech (e.g., frequent derailment or incoherence) - these are also called "word salads". Ongoing
disjointed or rambling monologues - in which a person seems to talking to himself/herself or imagined people or voices.
Grossly disorganized or catatonic behavior (An abnormal condition variously characterized by stupor/innactivity,
mania, and either rigidity or extreme flexibility of the limbs).
"Negative" symptoms of Schizophrenia , these symptoms are the lack of important abilities. productivity, thought to
reflect slowing or blocked thoughts, and often manifested as short, empty replies to questions.
B.
Disturbance must last for 6 months (including 1 month of the above symptoms)
C.
The symptoms must have produced a mark deterioration in functioning at work, in social
relations, and in self care.
2
TASK:
1. What is the word ‘schizophrenia’ derived from?
2. What is the prevalence rate of schizophrenia?
3. Give two examples of the symptoms, that need to be present for a significant portion of time during a 1month period, (or less if successfully treated) for diagnosing schizophrenia
4. Which areas of functioning must the symptoms have disturbed?
Schneider’s (1959) first rank symptoms:
________________
False beliefs (incompatible
with reality, persecution of
grandeur)
______________________________
voices are heard discussing thoughts
and behaviour, may be obscene and
order patient to do things
_______________________
thoughts are controlled by
external forces i.e. Martians,
government etc.
Task: Complete SCHIZOPHRENIA SYMPTOMS-SORTING ACTIVITY
Schneider (1959)
ACUTE: Type 1- Positive symptoms = addition to normal behaviour (+)
Slater & Roth (1969)
CHRONIC: Type 2-Negative symptoms = absence of normal behaviour (-)
Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning and/or
misinterpretations of perceptions or experiences. Delusions of being followed or watched are common,
as are beliefs that comments, radio or TV programs, etc., are directing special messages directly to
him/her.
Hallucinations are distortions or exaggerations of perception in any of the senses, although auditory
hallucinations (hearing voices within, distinct from one’s own thoughts) are the most common, followed
by visual hallucinations.
Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect
slowing or blocked thoughts, and often manifested as short, empty replies to questions.
Disorganized speech/thinking, also described as thought disorder or loosening of associations, is a
key aspect of schizophrenia. Disorganized thinking is usually assessed primarily based on the person’s
speech. Therefore, tangential, loosely associated, or incoherent speech severe enough to substantially
impair effective communication is used as an indicator of thought disorder by the DSM-IV.
Affective flattening is the reduction in the range and intensity of emotional expression, including facial
expression, voice tone, eye contact, and body language.
Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in
activities in daily living), unpredictable agitation or silliness, social disinhibition, or behaviors that are
bizarre to onlookers. Their purposelessness distinguishes them from unusual behavior prompted by
delusional beliefs.
Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding
environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre
postures, or aimless excess motor activity.
Other symptoms sometimes present in schizophrenia but not often enough to be definitional alone
include affect inappropriate to the situation or stimuli, unusual motor behavior (pacing, rocking),
depersonalization, derealization, and somatic preoccupations.
Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often
mistaken for apparent disinterest. (examples of avolition include: no longer interested in going out and
meeting with friends, no longer interested in activities that the person used to show enthusiasm for, no
longer interested in much of anything, sitting in the house for many hours a day doing nothing.)
Schizophrenia is usually an episodic illness as it consists of periods of acute disturbance (+)
interpersed with periods of better functioning (-)
3
Ideas about the disorder we now term schizophrenia crystallized towards the end of the last
century. The concept of this disorder has evolved during this century. Important landmarks in
the definition of this disorder are:
Eugen Bleuler coined the term ‘schizophrenia’ (‘splitting of the mind’); his
description placed more emphasis on thought disorder and negative
symptoms than on positive symptoms.
the main international classification systems, ICD-10 and DSM-IV, have
further clarified the diagnostic criteria.
The main distinction between ICD-10 and DSM-IV is that the latter specifies
a 6-month duration of symptoms and places a large emphasis on social or
occupational dysfunction.
Kurt Schneider defined first-rank symptoms, which now comprise criteria
(a)–(d) of the ICD-10 classification.
Emil Kraepelin separated affective psychoses (e.g. mania) from nonaffective psychoses; he gave the term ‘dementia praecox’ to clinical
conditions resembling the main forms of schizophrenia.
● 1893:
● 1911:
● 1959:
● 1970 to the present:
4
CASE STUDY: Schizophrenia
John was referred to a psychiatrist at the age of 22, after leaving home to go to college. Prior to that,
he had lived at home with his mother and sister and had always had problems making friends. Living
in a shared house with other students proved to be difficult, and he spent increasing amounts of time
in his room. He began to think that the other people in the house were plotting against him, and
imagined that they were standing outside his door and shouting abuse. As his work began to suffer,
he began to have paranoid thoughts about his college lecturers. This eventually extended to the belief
that MI5 had bugged the house with microphones hidden in the walls. After he left college and
returned to the family home, he had little energy and no interests. He remained unemployed and
continued to avoid contact with anyone outside the home. (Based on Lavender, 2000)
Reference: Lavender, T. (2000). Schizophrenia. In L. Champion & M. Power (Eds.), Adult Psychological Problems.
Hove, UK: Psychology Press.
Task:
Schizophrenia screening quiz: http://psychcentral.com/quizzes/schizophrenia.htm
MISCONCEPTIONS:
There are many misunderstandings about schizophrenia.
Is schizophrenia ‘split personality’ or like a ‘Jekyll and Hyde’ character?
No! Schizophrenia is a complex illness affecting a person’s whole being, their moods,
feelings, perceptions, thoughts, behaviour and ability to communicate. It is a severe and
disabling condition which is characterised by a profound disruption of cognition and emotion,
which affects a persons language, thought, perception, affect and even sense of self.
Are people with schizophrenia violent?
No! Sufferers are usually withdrawn and prefer to be left alone. People with schizophrenia are
not especially prone to violence, particularly if they had no record of violent behaviour before
being diagnosed with mental illness. Unfortunately, rare cases attract media attention and
dominate people’s perceptions of schizophrenia. The main danger for people suffering from
schizophrenia is violence to themselves and an increased risk of suicide.
Task:
.
Answer the following questions after reading the article “Schizophrenia-Destiny in your genes”-Neil Ingram
1. Why is schizophrenia very hard to diagnose?
2. Highlight the difference between positive and negative schizophrenic symptoms
3. State the concordance rate for identical twins developing schizophrenia
4. Highlight why genetic factors are not the only possible cause for schizophrenia
5. According to the article what was the first life stress event that Corven experienced that Michael
did not?
6. At which stage in pregnancy did Maureen develop the flu and what effect did this have on the
unborn twins?
5
A01
Mainly look at
family, twin and
adoption studies.
A02
These explanations can be split
into 4 cateogries:
GENETIC
BIOCHEMICAL
NEUROLOGICAL (Brain DYSFUNCTION)
VIRAL
The fact the schizophrenia tends to run in families (20%
chance if one parent is schizophrenic and 50% chance if both
parents schizophrenic), led to the inference that it has a
g____________ basis. According to the genetic hypothesis,
the more closely related the f____________ member is to
the schizophrenic, the greater their chance of developing the
disorder.
EVIDENCE FOR:
TWIN STUDIES: Gottesman (1991)
found that closer the degree of genetic
relatedness the higher the incidence of
schizophrenia than the general populace.
(See graph) 48% concordance for MZ
FAMILY STUDIES: Gottesman (1991)
reviewed concordance rate between
family members. Both parents (46%),
one parent (16%) and sibling (9%)
whereas general population have 1%
chance of schizophrenia onset.
Some argue MZ twins may have same
environmental treatment than DZ so..
ADOPTION STUDIES: allow the
clearest separation between genetic and
environmental factors. They look at
adopted children who later develop
schizophrenia and compare to their
biological and adoptive parents.
Kety (1988) found…………………………………….
…………………………………………………………………………
…………………………………………………………………………
…………………………………………………………………………
…………………………………………………………………………
GENE-MAPPING STUDIES:
Sherrington (1988) a gene located on
chromosome 5 has been linked to
schizophrenia
Miyakawa (2003) schizophrenics have a
defective version of a gene called
PPP3CC
KEY STUDY: Heston, L.L. (1966) “Psychiatric disorders in
foster home reared children of schizophrenic mothers”
British Journal of Psychiatry, vol 112, 819-825
AIM: To investigate the extent to which genetic factors play a part in the
development of schizophrenia
METHOD: A longitudinal study on 47 people who had been born between
1915 and 1945 to women with schizophrenia in a state mental hospital. The
infants were separated from their mothers at birth and raised by foster or
adoptive parents. A control group of 50 participants were selected from the
same children’s homes, both were assessed in 1964
RESULTS: The following main findings are significant:
 31 / 47 children of schizophrenic mothers had a mental health diagnosis
(66%) compared to 9 / 50 of the controls (18%)
 5 (16.6%) had a diagnosis of schizophrenia.
The ‘schizophrenia’ group had been more involved in criminal activity and
had more often been discharged from the armed services for psychiatric
problems.
CONCLUSIONS: Provides strong support for the importance of genetic
factors in the development of schizophrenia. Children reared without contact
with their schizophrenic mothers were still more likely to become
schizophrenic than the controls.
EVALUATION: The data was gathered from a time span of over 40 years.
Earlier interpretations of symptoms were different/less uniform6from today.
A02
EVIDENCE AGAINST:
-NOT 100%-Concordance rate between MZ twins is not 100% and therefore genetics
cannot offer a complete explanation.
-ELICITED TREATMENT-The higher concordance rate in MZ than DZ may be due to
the fact that they are treated the same so NURTURE may explain the concordance
rate not NATURE
-NOT 100%-Fewer than 50% of children where both parents have schizophrenia
develop the disorder, which is evidence against a genetic link.
-SHARE SIMILAR ENVIRONMENTS- High degree of genetic similarity between
family members often fund themselves spending more time together too so
environmental factors could also affect them
-HETEROGENEITY OF SCHIZOPHRENIA- Farmer (1987) have found that the
concordance depends on different symptoms. Concordance rate of MZ was 0% for
FRMs but 50% for the broader criteria
Evaluation of the genetic basis of Schizophrenia
strengths
Weaknesses
EXTENSION TASK:
Research: The
Genain quadruplets
who suffered
schizophrenia.
(Rosenthal, 1963)
DIATHESIS-STRESS MODEL
This states that an individual has a G____________
P_________________ to develop schizophrenia, but that
it is only triggered by STRESSFUL EVENTS IN THE
E_______________________
EVIDENCE: Tienari (1987) FINNISH ADOPTION STUDY.
High risk + healthy environment = low schizophrenia
Low risk + disturbed environment = low schizophrenia
7
The DOPAMINE HYPOTHESIS
A01
What is a NEUROTRANSMITTER (NT)?
A02
EVIDENCE FOR:
Anti-psychotic drugs:
Within a neuron, information is conveyed by electrical
impulses. But for transmission BETWEEN neurons,
NTs are needed.
When an electrical impulse arrives at the end of
neuron, a NT is released into a tiny gap (synaptic cleft)
between it & the beginning of the next neuron.
The sending neuron = PRE-SYNAPTIC NEURON &
receiving neuron = POST-SYNAPTIC NEURON
The released NT attaches to the receptor site on the
post-synaptic neuron and this triggers another
electrical impulse. Once its done its job, the NT is
recycled in one of two ways:
a) it may be taken back by the neuron that released it
(RE-UPTAKE)
b) it may be broken down chemically in the synapse
gap into smaller compounds by MONOAMINE
OXIDASE (MAO)
Serotonin (5-HT), noradrenaline and domapine (D2)
are major NTs - known as MAO transmitters.
Parkinson’s Disease: (have low dopamine levels) so
they are given drug L-DOPA to raise their dopamine levels (this
can produce symptoms very similar to schizophrenia, Grilly,
2002). Parkinsons type symptoms are also side effects of antipsychotic drugs which reduce dopamine levels. What does this
tell you?
Post Mortems and PET scans: post mortems on
schizophrenics show high levels of dopamine in the brain
especially the limbic system (Iversen, 1979) (see graph)
8
Evaluation of the biochemical basis of Schizophrenia
Strengths
+
* Evidence supporting
� L-DOPA (used in the treatment of
PARKINSON’S DISEASE) which
INCREASES the amount of
dopamine, can produce symptoms of
schizophrenia.
�Amphetamines, which
STMULATE dopamine release, also
produce schizoid type behaviour.
This can be seen in studies on rats,
such as research by (RANDRUP
& MUNKVAD, 1966).
� Specific studies (e.g. OWEN,
1978) have found increased
dopamine receptor density in the
brains of schizophrenics (both PET
scans & postmortems).
* Further refinements of the
hypothesis show that
schizophrenics have excess D2
receptors and D2 receptors
are oversensitive. (Davidson
and Neale, 2001)
Weaknesses
*There is contradictory evidence. Some
studies show that schizophrenics have lower
levels of dopamine in certain areas of their
brain.
*To be effective, antipsychotics have to reduce
dopamine activity to below their normal levels.
If the theory is true then reducing dopamine
levels to normal should be sufficient.
EXTENSION TASK
1: Identify another
piece of animal
research that is
used to investigate
Sz
EXTENSION TASK 2: You may want
to do additional research into the
‘dopamine hypothesis’ to get more
A02 evaluative points
9
A01
There is a growing body of evidence which suggests that schizophrenia may be caused by
abnormalities to b____________ structure.
In particular, the following brain areas have been implicated in the development of schizophrenia:
(i) BRAIN VOLUME- Enlarged ________________(appears to be associated with negative
symptoms). This is fluid filled cavities due to the loss of subcortical brain cells.
The ventricles of a person with schizophrenia are on average about 15% bigger than normal.
This implies that the brain areas around the
border of the ventricles have shrunk or
decreased in volume, the ventricular space
becoming larger as a result and also decrease in
brain weight.
Picture: MRI scans of 28 year old male identical
twins showing an enlarged brain ventricles in the
twin with schizophrenia (left) compared with his
well brother (right). Torrey (2002).
The enlarged ventricles may be the result of poor
brain development or tissue damage.
(ii) SPECIFIC BRAIN AREAS- Many brain regions and systems operate abnormally in schizophrenia.
Buchsbaum (1990) found abnormalities in the _________________ cortex (frontal lobe), the
___________________, the __________________ and the ____________________.
Frontal Lobe:
Critical to problem
solving, insight and
other high level
functioning. Low
frontal lobe
activation when
engaging in mentally
challenging tasks.
In schizophrenia this
leads to difficulty in
planning actions and
organising thoughts.
Limbic System (Amygdala): involved in
emotion: Disturbances are thought to
contribute to the agitation frequently seen in
schizophrenia
Basal Ganglia: involved in movement and
emotions and integrating sensory
information. Abnormality can contribute to
hallucinations and paranoia.
Hippocampus:
Mediates learning
and memory
formation, these
functions are
impaired in
Schizophrenia
10
A02
Evidence For:
Enlarged Ventricles: Brown et al (1986) found decreased brain weight and enlarged ventricles
MRI (Magnetic Resonance Imaging) showed that in MZ twins where one had schizophrenia and the
other didn’t, the schizophrenic twin had more enlarged ventricles (Suddath, Torrey et al, 1990)
Abnormalities in Specific Brain Regions: Cannon et al (1998) found that the pre-frontal area does
not kick into action when patients perform complex tasks (like Wisconsin Card sorting)
People with Sz show abnormality in cognitive, behavioural, social and emotional development before
the onset of the disorder, which is consistent with the neurodevelopment hypothesis. Walker (1994)
analysed clips of home movies of pre-schizophrenic children and found they showed more unusual
hand movements than their healthy siblings.
What did Lewin discover about the Brain structure of Sz men?
A02
Evidence Against:
Enlarged Ventricles:
The differences in the MZ twins brains show that genetics or neurodevelopmental factors are not solely
responsible, as only environmental factors can account for such differences
Research has shown that enlarged ventricles are found in non-schizophrenics, which contradicts this as
a physical cause.
Specific Brain regions: Whilst MRI studies appear to provide conclusive evidence of structural
abnormalities, it is worth noting that they do not always agree on the regions of the brain affected. For
example Flaum (1995) found no abnormalities in the temporal lobe regions whereas Woodruff (1997)
found quite significant reductions in the temporal lobe, compared with controls.
EVALUATION:
1) Causality -C______________ and E___________ This can be seen in two ways:(a) MEDICATION
(b) SCHIZOPHRENIA → BRAIN CHANGES
2) Reliability –lack of consistency in the nature of brain abnormalities across different research
3) Nature or Nurture- brain abnormalities could be genetic but differences in MZ twins suggest nurture.
4) Generalisability- Brain dysfunction is linked to negative symptoms only.
Where do these abnormalities originate? Consider the next hypothesis:
11
Viral infection and Complications during pregnancy
A01
The
Viral Theory
Brain abnormalities are caused
by exposure to viruses before birth.
VIRAL INFECTIONS such as measles,
pneumonia and Influenza A, DURING
PREGNANCY especially the 2nd trimester
(when the developing brain is forming crucial
interconnections).
SEASONALITY EFFECT: high proportion of
Sz are born in the winter months (when
flu’s are most prevalent). Viral infection
enters brain and is dormant until it is
activated by hormones at
puberty.
A02
EVALUATION
Weaknesses


Methodological problemsstudies such as those of
Torrey were based on
correlational data and so
caution should be observed
when attempting to infer
causation.
EVIDENCE
FOR ptcc 196
WINTER BIRTHTorrey (2000):
A01/2
VIRAL INFECTION during pregnancy
De Messias et al (1998):
IMPORTANCE OF THE 2ND TRIMESTER
in PREGNANCYVan Os et al (1997) Comer (2003)
Strengths
 Explains
why Sz
appears in
individuals
with no family
history of the
disorder
Karlsson (2001)
of those who
recently developed
Sz had high levels of
retrovirus (virus binds to
DNA and can be passed on to
the next generation) in their
cerebrospinal fluid c.f.
none in normal
EXAM TIP: although we have
conditions.
covered a lot of biological
explanations, you may not be able
to cover all of these in the time
given so make sure you provide
Overall evaluation of bio explanation of Sz
QUALITY (describe explanations in
Biological explanations are deterministic, i.e.
depth) than QUANTITY (list many
explanations but not in detail
assume that some individuals will inevitably

3rd
develop Sz. Patient is seen as passive and bio
cause = bio treatment
IGNORES SOCIAL FACTORS
12
These explanations can be
split into 2 cateogries:
1) PsychologicalPsychodynamic, Behavioural and Cognitive
2) Socio-cultural
Life Events, Family relationships and Social Labelling
TRY THIS ESSAY AND APPLY YOUR KNOWLEDGE:
Describe & evaluate 1 or more biological explanation of
schizophrenia
A01
Freud believed that schizophrenia involves a two-part psychological process:
1. Regression to pre-ego stage
2. Attempts to re-establish ego control
He believed that it stems from a basic conflict between a person’s self-gratifying impulses and the
demands of the real world. When the real world is difficult, stressful, anxiety-producing then the person
will regress to an early part of the oral stage called primary narcissism (where the ego has not
separated from the id AND great self-interest). The lack of ego functioning results in loss of contact with
reality.
When they reach this stage, the schizophrenic will then try to re-establish ego control and try to interact
with reality
Schizophrenic symptoms:
Regressive:- delusions of self-importance (grandiosity)
regress to the PRIMARY NARCISSISM (focus on self)
Restorative/Restitutional:- Hallucinations and delusions
(as fantasies get mixed with reality)
ALTERNATIVE Psychodynamic
ExplanationSCHIZOPHRENOGENIC MOTHER: Fromm-Reichmann
(1948) ptcc page 199
A02
EVALUATION:
LACK OF RESEARCH EVIDENCE: (except the alternatives)
A02
SPECULATIVE: impossible to test empirically concepts such as ego, regression etc.
DATED: conducted in the Victorian era and so may lack temporal validity.
SAMPLE BIAS: He used his own patients, upper-class Viennese women so population validity
low.
EMPHASIS ON THE PAST: focus on the past means present problems are negelected.
Freud’s Research may have little relevance to schizophrenics today as the research may be
era-dependent and context bound.
CAUSALITY:
13
TASK: Read through the A01 points on the behavioural and cognitive explanations of
Sz and then complete the A02 section for each explanation (see PTCC page 199)
DESCRIPTION (A01)
DESCRIPTION (A01)
O____________ C________________ has
been used to explain schizophrenia (e.g.
Liberman, 1982- FAULTY LEARNING). The
idea is that most people learn from their
environment to respond to s_________
c__________. When the response is socially
acceptable then it will be reinforced. Some
people, however, do not receive these
r______________ and they will stop
attending to these social cues and focus
instead on other, often irrelevant cues. As
they do this more and more their behaviour
will become more and more bizarre which
means that their behaviour will eventually
receive a lot of attention: this attention will act
as a r_____________ for the behaviour.
There has been some support for this
because
it
has
been
shown
that
schizophrenics
can
learn
appropriate
responses if they are rewarded with
cigarettes, food, attention etc. (e.g. Belcher,
1988).
1) The schizophrenic will have some
b_______________ abnormality which will lead to
strange sensory experiences.
COMMENTARY- evidence and evaluation
A02
COMMENTARY- evidence and evaluation
A02
*NATURE OR NURTURE?
2)Then, according to Comer (1995) the
schizophrenia when first confronted by voices or
visions will turn to r__________,
f______________ etc. to help them understand
what is happening.
3) When these people d___________ the
existence of these visions or voices that the
schizophrenic knows they are experiencing then
they will come to believe that their friends and
relatives are trying to h_______ the truth from
them and
4) they will eventually r__________ all feedback
from others.
5) They will eventually believe that they are being
m_______________ or persecuted (Garety, 1991)FAULTY THINKING.
* DESCRIPTIVE RATHER THAN EXPLANATORY:
Describe symptoms but do not explain, in order to
explain the origins of Sz, they need to be combined
with biological models.
* EXPLAINING SYMPTOMS: cannot offer a full
explanation of Sz but accounts for some symptoms
like hallucinations and delusions.
*
14
DESCRIPTION:
EXAMPLES OF DISCRETE STRESSES:
 Death of a close relative,


EVIDENCE FOR:
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SOCIAL ECONOMIC STATUS:
Some studies (e.g. Srole et al, 1962) have
suggested that schizophrenia is not evenly
distributed throughout the population and that
the lower socio-economic status (SES) you
investigate then the more likely you are to
find schizophrenics.
Clark (1948) showed that low status
occupations have much higher rates of
schizophrenia than high status.
Kohn (1973) suggests that this could be
something to do with personal strategies for
coping with stress. He argues that working
class people emphasise conformity more than
middle class people and that this might mean
that they have fewer personal resources when
faced with stresses. Of course, these ideas
have caused a great deal of controversy.
Evaluation:- There is a great deal of argument
about whether schizophrenia is the cause of
social disadvantage (the social drift
hypothesis) or whether schizophrenia is the
result of social disadvantage (the social
causation hypothesis).
EVIDENCE AGAINST:
Van Os et al (1994) reported no link between
life events & onset of Sz. Equal likelihood of
having or not having major life event in the 3
months prior to onset of Sz.
CORRELATIONAL: hard to determine causality
15
DESCRIPTION: In 1962 Szasz claimed that Sz as a disorder did not exist, and believed
it was society’s way of classifying individuals who did not follow society’s controls on
behaviour and instead demonstrated bizarre behaviour. According to Szasz ‘Mental
Illness’ is simply a lable used to exclude individuals from as they are not ‘classed’ as
‘normal’.
In 1966 Scheff developed a theory that argued that Sz may be largely a social role,
which on receiving a psychiatric diagnosis this creates a stigma or mark of social
disgrace. This label of ‘mental illness’ then creates expectations from the patient and
others, as a result sufferers then conform to this role and in turn create a SELFFULFILLING PROPHECY.
According to Scheff (84) some deviant behaviour gets labelled as mental illness, which
then leads to rejection by others and to self-identification as mentally ill. Individuals
then take on this identity and behave in a way that confirms the original diagnosis.
According to Scheff the Label influences:
a) how the person will continue to behave
b) how others will react to them.
EVIDENCE FOR:
In ‘On being sane in insane places’-Rosenhan (1973) claims that psychiatric (diagnostic)
labels tend to become self-fulfilling prophecies. Psychiatric labels stick in a way that other
medical labels don’t. More seriously, everything the patient says and does is interpreted in
accordance with the diagnostic label once its been applied. For example after admission
the pseudo-patients kept a written record of how the ward was run. This was documented
by the nursing staff as ‘patient engages in writing behaviour’. In other words, the writing
was seen as a symptom of their pathological behaviour. See SUMMARY SHEET.
ARGUMENTS AGAINST:
Kimble et al (1980) PTCC pg 199
CONSIDER Module 2- Abnormality.
Can you think of cultures which would
not consider hallucinations as being
abnormal?
(See case study below to help you)
Teachers at a Minneapolis school in were
convinced that one of their pupils had a
psychological disorder. The pupil, a
Chippewa boy, kept seeing thunderbirds –
mythical birds. Unfortunately for him, nobody
else at the school could see them. The boy’s
parents were called in and said they were
delighted with their son’s sightings. A
psychiatrist was asked to examine the boy.
He was concerned about the visions – they
are often seen as a symptom of
schizophrenia in Western psychiatry – but
admitted that the boy seemed normal in
every other respect. Luckily, a member of the
anthropology department at the university
who had studied the Chippewa was
contacted. He explained that there was
nothing wrong with the boy, in fact just the
opposite. In traditional Chippewa culture, the
thunderbird is a supernatural being and it is a
great honour to have such visions. Far from
seeing his behaviour as psychologically
abnormal, the boy and his parents saw it as
something to be proud of. In terms of:
American culture- the boy’s behaviour is
abnormal and may well indicate a
psychological disorder. Chippewa culture- it
indicates psychological wellbeing.
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DESCRIPTION-
DESCRIPTION:
Example: a mother induces her son to give her a hug but
when he does she tells him ‘not to be such a baby’.
EVIDENCE FOR:
EVIDENCE FOR:
ARGUMENTS AGAINST:
ARGUMENTS AGAINST:
Mischler & Waxler (1968) found significant differences in the way
mothers spoke to their schizophrenic daughters compared to their
normal daughters, which suggest that dysfunctional communication
may be a result of living with the schizophrenic rather than the
cause of the disorders.
ETHICAL IMPLICATIONS: blaming the family?
LACK OF EVIDENCE: there is research evidence that dysfunctional
communication characterises all family interactions to some
extent. Can you think of a time when you experienced double bind?
EXPLAINS MAINTENANCE NOT CAUSE: High EE has been well
supported as a factor in relapse (i.e. a factor in maintenance
rather than the cause) as individuals are 4x more likely to relapse
if EE high (Kavanagh, 1992).
MULTI-DIMENSIONAL APPROACH: not all siblings develop
schizophrenia, which challenges the family environment as the
cause. It is more likely to be explained by differences in genetic
vulnerability, cognition, and unconscious motivations.
CAUSE OR EFFECT: the family is seen as ‘schizophrenic’ and one
member becomes a scapegoat for the whole family’s pathology OR
patient is already ill and part of the family’s way of dealing with
this is to develop abnormal (schizophrenic) forms of
communication.
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Task: READ THE ARTICLE ‘Living with Schizophrenia’ (David
Putwain) and answer the questions below.
1. According to Bateson what are the three defining
characterisitics of a double bind?
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2. What important issue within the family did Laing &
the anti-psychiatry movement highlight?
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3. What is meant by a relapse into psychoses?
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4. Highlight the two goals of family therapy
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5. What is meant by the term expressed emotion (EE)?
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6. Highlight the effect high negative EE has on the
schizophrenic patient compared to high levels of
positive EE.
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7. Outline how Sarason and Sarason have suggested
that the findings about EE has been misinterpreted
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The factors in Schizophrenia can be organised into those that create a
vulnerability (Predisposing), those that trigger the disorder
(precipitating), and those that maintain it (perpetuating).
Task: Considering the theories we have looked at, organise the following in the table
below. If you are not sure, write it in pencil. Note certain factors could go in more than 1.
1. Life events
7. Neurodevelopment Hypothesis
2. Family conflict
8. Dysfuncitonal family dynamics
3. Genetics
9 .Biochemistry
4. Expressed emotion
5. Faulty cognition
6. Reinforcement
HINT: There are 3 in each
re-disposing
recipitating
erpetuating
USING THIS IN THE EXAM:
Write a list of possible exam questions you could get on this topic.
Share with a partner.
Choose 2 different essays to answer.
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