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Psychodynamic explanations of schizophrenia
The psychodynamic approach rose to popularity in the mid-20th century as an environmental explanation, emphasising the causal role of the family in the development of schizophrenia. It explains schizophrenia as a regression to the Id-dominated oral stage, with little awareness of the outside world. "Primary narcissism" develops - delusions arise from the child feeling threatened and persecuted by the outside world, but also feeling omnipotent over their internal world.
The schizophrenogenic mother
Fromm-Reichman and Kasanin were key psychologists in pioneering the concept of a "schizophrenogenic" mother, who was not schizophrenic herself, but would cause the development of schizophrenia in her children due to her treatment of them. The two central traits of the schizophrenogenic mother are being domineering (maternal overprotection) yet cold and uninvested (maternal rejection.)
Kasanin (1934) studied the parents of 45 schizophrenics and found maternal rejection in 2 patients, and maternal overprotection in 33. These results suggest that overprotection is the most significant quality of the archetypal schizophrenogenic mother, supporting the hypothesis of certain maternal behaviours inducing the development of schizophrenia in their children.
Kasanin gathered data through interviews and case-report studies, prone to methodological problems such as researcher bias and subjectivity that reduce internal and external validity. The case reports were retrospective, so detail may have been recalled incorrectly, biased towards reporting maternal overprotection due to leading questions, or carrying the risk of false information due to social desirability bias. Also, the significant mental disturbances, possible substance abuse, and chronic use of antipsychotic medications all contribute towards a mental state where information from early life may not be recalled correctly.
Schofield and Balian also studied the early lives of schizophrenic patients. The only significant distance they found between schizophrenics and non-schizophrenics was the quality of the maternal relationships - schizophrenics were more likely to have had less affectionate mothers.
Schofield and Balian's study was a retrospective, in-depth interview on the profoundly mentally ill, many of whom had histories of substance abuse and chronic use of antipsychotic medications, meaning that information was likely to be unreliable.
Mischler (1968) carried out an observation of mothers with schizophrenic children and found the mothers to be aloof, unresponsive and emotionally distant - but only towards their schizophrenic children, behaving normally towards their non-schizophrenic children. This raises an important issue of cause and effect - the coldness and distance attributed to the schizophrenogenic mother may be her response to psychological disturbances in the child.
Parker criticised this theory by suggesting that there is no archetypal schizophrenogenic mother- there is a parental type distinguised by hostility, criticism and intrusiveness, but this type is not particularly overrepresented by the parents of schizophrenics.
Hinsie and Cambell criticised this hypothesis for ignoring the fact that many mothers fulfill Kasanin's criteria for schizophrenogenesis, but very few of them have children who develop schizophrenia, and not all schizophrenics have the archetypal schizophrenogenic mother, so the hypothesis is reductionist to suggest that the disorder is only a result of maternal relationships. The hypothesis is also reductionist in its failure to take evidence for a biological basis into account, such as the evidence for a significant genetic component.
Kasanin (1934) studied the parents of 45 schizophrenics and found maternal rejection in 2 patients, and maternal overprotection in 33. These results suggest that overprotection is the most significant quality of the archetypal schizophrenogenic mother, supporting the hypothesis of certain maternal behaviours inducing the development of schizophrenia in their children.
Kasanin gathered data through interviews and case-report studies, prone to methodological problems such as researcher bias and subjectivity that reduce internal and external validity. The case reports were retrospective, so detail may have been recalled incorrectly, biased towards reporting maternal overprotection due to leading questions, or carrying the risk of false information due to social desirability bias. Also, the significant mental disturbances, possible substance abuse, and chronic use of antipsychotic medications all contribute towards a mental state where information from early life may not be recalled correctly.
Schofield and Balian also studied the early lives of schizophrenic patients. The only significant distance they found between schizophrenics and non-schizophrenics was the quality of the maternal relationships - schizophrenics were more likely to have had less affectionate mothers.
Schofield and Balian's study was a retrospective, in-depth interview on the profoundly mentally ill, many of whom had histories of substance abuse and chronic use of antipsychotic medications, meaning that information was likely to be unreliable.
Mischler (1968) carried out an observation of mothers with schizophrenic children and found the mothers to be aloof, unresponsive and emotionally distant - but only towards their schizophrenic children, behaving normally towards their non-schizophrenic children. This raises an important issue of cause and effect - the coldness and distance attributed to the schizophrenogenic mother may be her response to psychological disturbances in the child.
Parker criticised this theory by suggesting that there is no archetypal schizophrenogenic mother- there is a parental type distinguised by hostility, criticism and intrusiveness, but this type is not particularly overrepresented by the parents of schizophrenics.
Hinsie and Cambell criticised this hypothesis for ignoring the fact that many mothers fulfill Kasanin's criteria for schizophrenogenesis, but very few of them have children who develop schizophrenia, and not all schizophrenics have the archetypal schizophrenogenic mother, so the hypothesis is reductionist to suggest that the disorder is only a result of maternal relationships. The hypothesis is also reductionist in its failure to take evidence for a biological basis into account, such as the evidence for a significant genetic component.
Marital schism, marital skew and double bind
Lidz proposed the concept of "marital skew" and "marital schism" being traits found in the relationship between the parents of a schizophrenic. Marital schism refers to the open hostility and criticism that occurs when the parents are unable to adopt role reciprocity (the ability to understand each other's goals, roles and motivations.) Marital skew refers to the tendency of one parent to dominate interaction - usually an intrusive and domineering mother and a distant, passive father.
A problem with this theory is the inability to isolate the direction of the cause and effect relationship between marital skew and schizophrenia. The early symptoms of schizophrenia in childhood and the resultant psychological vulnerability in the child could cause one parent to be more involved than the other.
However, Lidz did find supporting evidence for the role of the family in the development of schizophrenia - he found that 90% of schizophrenics have a family background that is disturbed in some way, while 60% have parents who either one or both suffer from a serious personality disorder.
Bateson proposed the idea of "double bind" scenarios being responsible for schizophrenia formation - receiving conflicting emotional messages from the parents in early childhood, for example, emotional warmth one day, withdrawal and hostility the next, leads to the child losing their grip on reality and seeing their own feelings as unreliable - contributing towards schizophrenia development.
Kennedy analysed letters sent between schizophrenics and their parents, and compared the results to a control group. The results showed evidence of double bind scenarios, but, like Parker's criticism of the schizophrenogenic mother hypothesis, double bind scenarios were not particularly over-represented by schizophrenic patients. Double bind scenarios were observed in the analysis of letters between non-schizophrenics and their parents too - he concluded that the majority of people get mixed messages, but most don't develop schizophrenia, so double bind theory cannot exclusively explain the illness.
Cause and effect is difficult to determine when carrying out research in this area - early schizophrenic symptoms in a child can put significant levels of stress upon a family, causing potential instability and disturbance.
A problem with this theory is the inability to isolate the direction of the cause and effect relationship between marital skew and schizophrenia. The early symptoms of schizophrenia in childhood and the resultant psychological vulnerability in the child could cause one parent to be more involved than the other.
However, Lidz did find supporting evidence for the role of the family in the development of schizophrenia - he found that 90% of schizophrenics have a family background that is disturbed in some way, while 60% have parents who either one or both suffer from a serious personality disorder.
Bateson proposed the idea of "double bind" scenarios being responsible for schizophrenia formation - receiving conflicting emotional messages from the parents in early childhood, for example, emotional warmth one day, withdrawal and hostility the next, leads to the child losing their grip on reality and seeing their own feelings as unreliable - contributing towards schizophrenia development.
Kennedy analysed letters sent between schizophrenics and their parents, and compared the results to a control group. The results showed evidence of double bind scenarios, but, like Parker's criticism of the schizophrenogenic mother hypothesis, double bind scenarios were not particularly over-represented by schizophrenic patients. Double bind scenarios were observed in the analysis of letters between non-schizophrenics and their parents too - he concluded that the majority of people get mixed messages, but most don't develop schizophrenia, so double bind theory cannot exclusively explain the illness.
Overall evaluation of psychodynamic explanations
The causal role of the family lacks reliable and objective empirical evidence, and established relationship so far is only correlational.
However, lots of research suggests an unstable family background may increase the risk of schizophrenia in children who already have a biological predisposition - Sorri et al's study of Swedish adoptive children of schizophrenics found that the quality of adoptive parenting was the most important factor in determining whether the children grew up to develop schizophrenia. Wahlberg (2000) examined earlier data and concluded that environmental factors such as family communication can strongly affect the chance of schizophrenia development in children with a genetic predisposition to the disorder.
Neil suggested that political and cultural conditions post-WWII influenced psychodynamic theories into schizophrenia, as psychologists such as Bowlby placed greater emphasis on the role of the mother in the early development of the child. It is possible that the sudden focus on maternal roles led to the scientific popularity of the schizophrenogenic mother hypothesis, rather than the theory having any specific credibility.
Cause and effect is difficult to determine when carrying out research in this area - early schizophrenic symptoms in a child can put significant levels of stress upon a family, causing potential instability and disturbance.
Cognitive explanations of schizophrenia
The cognitive approach seeks to explain schizophrenia as the result of faulty information processing. Frith explains it as a result of faulty "metarepresentation" the cognitive process that allows us to reflect on our thoughts and behaviour, generate thoughts, ideas and intentions, and to reflect on the thoughts and behaviour of others.
Metarepresentation takes place through the action of two systems - the "supervisory attention system" that is responsible for self-generated actions, and the "central monitoring system", that is responsible for recognising our thoughts as our own, and external voices as belonging to others. Problems with the supervisory attention system lead to the negative symptoms such as alogia, catatonia and apathy, while problems with the central monitoring system lead to the positive symptoms such as hallucinations, delusions and thought disturbances.
Frith (1980) carried out a card guessing game with groups of both schizophrenics and non-schizophrenics, guessing whether a drawn card would be black or red. Non-schizophrenics made logical choices, taking into account probabilities and cards already drawn. Schizophrenics made very rigid decisions, finding it difficult to take self-generated cognitive actions and ideas into account, as well as probabilities.
Frith and Done (1986) carried out a verbal fluency assessment of schizophrenics and non-schizophrenics, where they were given a category and asked to generate lists. Schizophrenics performed very poorly in this task compared to the control group. In a similar visual fluency task involving categorisation, they performed equally poorly.
Bentall (1991) had schizophrenics either generate words for a list, or read off the list. A week later, they were read the words used in the initial test, and asked if they'd generated them or read them a week ago. Compared to a control group, schizophrenics performed very poorly.
Lots of empirical evidence supports the cognitive explanation - the above studies support the concept of some very definite cognitive impairment in schizophrenics, such as an inability to recognise self-generated thoughts. However, the patients' history of strong antipsychotic medication could account for the cognitive impairment in these tests.
The cognitive explanation manages to explain the both positive and negative symptoms of schizophrenia, as opposed to the dopamine hypothesis which only manages to explain the positive symptoms. However, it only explains the symptoms of schizophrenia, not the causes - what causes the metarepresentative faults in the first place?
Hemsley (1993) explained schizophrenic symptoms as a result of an inability to activate schemas. Schemas develop in early childhood as a way to categorise and process information from the outside world - if these fail to activate correctly, self-generated sensory information could be interpreted as external, causing an auditory hallucination.
This theory manages to explain the origins of auditory hallucinations, but has little empirical evidence to support it.
Social explanations of schizophrenia
Social causation theory seeks to explain the overrepresentation of schizophrenics in poor and deprived urban populations as a result of factors such as poor education, diet, healthcare, access to drugs, unemployment, overcrowding and stress.
Social drift theory suggests that schizophrenia development is not a consequence of deprivation, but a cause of it - schizophrenia symptoms lead to economic and social hardship due to being unable to hold down jobs, mortgages, relationships, which leads to moving into poor urban areas.
Castle (1993) studied Camberwell, a deprived area of London, and found that the majority of schizophrenics were born locally, as opposed to having moved there after developing schizophrenia, supporting the causation theory and challenging drift.
However, potential effects of drift cannot be ruled out - it is possible that the schizophrenics born there also had schizophrenic parents who moved there due to socioeconomic hardship - and evidence suggests a definite genetic basis to schizophrenia.
Overcrowding is a common issue affecting wellbeing in deprived areas, leading to greater exposure to viruses - if the viral explanation is true, that could explain how socioeconomic hardship increases the risk of schizophrenia development. Malnutrition is also a problem - poverty leads to malnutrition, which leads to illness and possibly abnormalities in the development of brain anatomy, another theorised explanation of schizophrenia.
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