Psychological Explanations: Family Dysfunction
These explanations suggest that abnormal functioning within families can act as a RISK FACTOR. This is really important to emphasise in exams. None of these explanations claim to solely explain schizophrenia.
You have the option to watch this video, or you can read and makes notes 🙂
Double-Bind Theory: RISK FACTOR EXPLANATION
Bateson (1956) DBT could be a risk factor in the development of schizophrenia . This is when you receive two conflicting messages: Verbally affectionate but non-verbally hostile.
As a result, the child feels constantly worried about doing the wrong thing, but is unsure what is right or wrong due to receiving mixed messages. When they ‘get it wrong’ (which is often) the child is punished by the withdrawal of love. This leaves the child to understand the world as dangerous, confusing and unpredictable.
This dysfunctional family environment could lead to magnifying certain schizophrenic symptoms. For example, Paranoid delusions could occur, this is because the child finds it very difficult to predict the world around them, this makes them feel paranoid and unsure of when the next negative conflict or situation will happen. This makes the child feel on edge and cautious. Avolition could occur because the child is constantly faced with failure. The child appears to be wrong in every thing that they do. This could leave the child feeling helpless and unmotivated to try anything, thus leading to a lack of goal-directed behaviour. They develop an attitude of ‘what is the point?’ Disorganised behaviour may happen as the child could act out as they are not sure what is right and what is wrong. They may also imitate the mixed messages that they receive which would be perceived as abnormal to others. Emotional flattening may occur as the child could be afraid to show emotion because when they have it has possibly been followed by a negative confrontation.
Schizophrenic Mother – CAUSAL EXPLANATION
A common misconception of this theory, is that the mother has schizophrenia, and passes it on to the child. This is not the case. The context of the theory was the belief that early mother-child interactions exerted a primary and determining effect on later psychopathology. The theory is called schizophrenic mother, but actually, it would be more appropriate to call it the ‘schizophrenia causing mother’.
This theory is based on accounts that Fromm-Reichman had heard from patients. She describes the mother is described as cold, rejecting and controlling. The environment is tense and full of secrecy.
This relationship leads the child to feel distrust that could later develop into paranoid delusions. The child may constantly feel that they are being victimized and this could magnify into the child believing that people are out to get them. In addition, by the mother rejecting the child and expressing little positive emotion, they may experience emotional flattening because their role model has provided little opportunity to observe normal emotional functioning.
Expressed Emotion (EE) – RISK TO TRIGGERING RELAPSE
This is a family communication style of: criticism, hostility and over-involvement. They tend to talk more and listen less. It is important to recognise that this theory only claims to explain how someone with a genetic vulnerability can be triggered to develop schizophrenia OR it can cause a RELAPSE in someone who already has schizophrenia.
It appears that the negative emotional climate in these families, leads to high levels of stress. This stress mounts on top of their already impaired coping mechanisms, thus triggering a schizophrenic episode.
Remember:
- Criticism = negative comments
- Hostility = aggressive comments like threats
- Emotional over-involvement = interfering in other family members’ affairs
Evaluation: Family dysfunction
- Research to support: The theory that family dysfunction can act as a risk factor to schizophrenia. Bateson (1956) outlines many examples of dysfunctional family relationships through clinical observations and interviews with patients. One example included observing a mother who was visiting her son in hospital after a schizophrenic episode. He put his arm around her and the mother stiffened and moved away. When he withdrew his arm and the mother asked him “Don’t you love me any more?” Following her departure he assaulted a nurse. This evidences the confusing mixed messages that may be experienced and evidences a link between family dysfunction and schizophrenia.
- Useful Applications: The explanations of family dysfunction had led to the development of family therapies. Pharoah et al. developed a type of family therapy and reviewed 53 studies in order to understand the effectiveness of it for families of schizophrenia sufferers. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year and improves quality of life for patients and their families.
- Issues with Research: There is no empirical evidence to support double bind or schizophrenic mother. Research by Bateson (1956) is anecdotal and based on clinical observations and interviews. This evidence may not be valid. Firstly, Bateson maybe biased in the observations as he may have looked for instances that fit in line with his double bind theory. Secondly, the research that is gathered about childhood experiences, has been collected after the schizophrenic symptoms have developed. This may lead to inaccurate information being gathered. The patients may have distorted views of their childhood as they may have experienced auditory or visual hallucinations that they were unable to separate from reality.
- Ethics/Socially sensitive – Research by Fromm-Reichman and Bateson create a sense of parent blaming. Parents have already suffered enough by living with a child who has schizophrenia. Parents of schizophrenics are typically life long carers. There are serious ethical concerns in blaming the family, particularly as there is little evidence upon which to base this. Gender bias is also an issue as the mother tends to be blamed the most, which means such research is highly socially sensitive. This suggests that the research therefore does not protect individuals from harm.
- Alternate explanations: Gottesman (2010) found that the risk of mental illness was much greater for children who had two parents with a diagnosis of bipolar or schizophrenia: 67.5% of offspring who had both parents diagnosed with schizophrenia, had developed a mental health issue by the age of 52. The family dysfunction explanation and the cognitive explanation ignores the impact of the biological causes. This suggests that the psychological explanations are too simplistic. It is also difficult to assume that cognitive faults or family dysfunction leads to hallucinations, especially when there is a lot more biological support for the positive symptoms. Therefore, an interactionist approach is needed in order to provide the most credible explanation for schizophrenia.
Psychological Treatment: Family Therapy
Families can play an important role in helping a person with schizophrenia recover and stay well. Family intervention in the treatment of schizophrenia has developed as a result of studies of the family environment and its possible role in affecting the course of schizophrenia. Research has consistently shown that the long-term outcome for an individual with schizophrenia has much to do with the relationship between the individual and those who care for them. Poor relationships tend to result in poor outcomes, i.e. a greater chance of relapse. The main aim of family therapy is to provide support for carers in an attempt to make family life less stressful and so reduce re-hospitalisation.
How does it work?
By reducing levels of expressed emotion and stress, and by increasing the capacity of relatives to solve related problems, family therapy attempts to reduce the incidence of relapse for the person with schizophrenia. Families are taught to have weekly family meetings solving problems on family and individual goals, resolve conflict between members, and pinpoint stressors. The main steps for family therapy are:
Identify: Through interviews and observation the therapist identifies strengths and weaknesses of family members and identifies problem behaviours.
Educate: teaching the patient and the family the actual facts about the illness, it’s causes, the influence of drug abuse, and the effect of stress and guilt.
Communicate: training the family in skills that help them to communicate more effectively with each other.
Pharoah et al (2010) recommends a number of strategies. I have developed the memory strategy UNITES to help you remember the key strategies of family therapy. Pharoah didn’t come up with this, so please feel free to use this as part of revision. But don’t say in your exams that Pharoah uses a UNITES therapy.
UNITES
Unity in caring for the individual with schizophrenia
Negative emotion and stress reduction
Irritation and guilt reduction
Teaching boundaries
Educating relatives about schizophrenia
Solve and anticipate problems
Evaluation of Family Therapy:
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- Research to support the effectiveness of Family Therapy: Pharoah et al. developed a type of family therapy and then reviewed 53 studies in order to understand the effectiveness of it for families of schizophrenia sufferers. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year, improves medication compliance and improves quality of life for patients and their families.
- Research to oppose/question the effectiveness of Family therapy: Pharoah et al. research shows mixed results. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year, improves medication compliance and improves quality of life for patients and their families. Firstly, the evidence is described as ‘moderate’, which implies that there is mixed findings in terms of how effective it is. Secondly, it could be suggested that the main reason for its effectiveness is more to do with the fact that it increases medication compliance. Patients are more likely to reap the benefits of medication because they’re more likely to comply with their medication. This casts doubt on the effectiveness of family therapy alone. Therefore, we must be cautious in drawing the conclusion that family therapy is effective in treating schizophrenia as it is difficult to establish a cause and effect when considering the research by Pharoah.
- Freewill is encouraged in Family therapy – Family therapy teaches the family strategies and this encourages freewill as it helps them to understand that they can make active and conscious choices to change their family dynamic. This could be why Pharoah found success rates in terms of long-term effectiveness. This is because family therapy allows the family to solve and anticipate issues themselves and therefore they do not need to rely on medical and health resources on a regular basis. This could make family therapy more useful because it helps to reduce the cost of care by training the family to be effective carers.
- Free will issues in Family therapy – The fact that family therapy encourage a sense a freewill and works on the basis that the patient has to make a conscious choice to be committed to the treatment causes some issues. Family therapy in particular requires the commitment of not just one member, but several. This may not be possible, as some members of the family may not be want to participate as they find it too painful. In addition, the negative symptoms such as avolition and emotional flattening can lead to a reluctance to participate and an inability to engage and therefore act as a deterministic factor.
- Usefulness Family therapy – FT could be deemed more useful in the sense that it doesn’t cause any physical side effects in comparison to anti-psychotic drugs. Use evidence from studies in biological treatments for schizophrenia.
- Practical Issues – Usefulness of Family Therapy- However, could be deemed less useful because therapies are expensive and can be very time consuming. This means that it can be difficult to offer therapy on a mass scale (especially when it is the most common psychotic disorder), and it could lead to drop out rates, especially when a patient in going through a severe episode. The individual and the family must be committed and attend regular sessions in order for it to be successful.
- Idiographic approach/Individual differences –Family therapy targets and improves the unique deficits of each individual. Unlike drug therapies that provide a one fits all approach.
CGS Psychology Blog: Mrs Harris 