1. Psychopathology: Schizophrenia UNIT 4: PSYA4 lcb@beauchamp.org.uk

2. Topic Content In relation to their chosen disorder: 1.Schizophrenia 2.Depression 3.Phobic disorders 4.OCD Candidates should be familiar with the following:  Clinical characteristics of the chosen disorder.  Issues surrounding the classification and diagnosis of their chosen disorder, including reliability and validity.  Biological explanations of their chosen disorder, for example, genetics, biochemistry.  Psychological explanations of their chosen disorder, for example, behavioural, cognitive, psychodynamic and socio-cultural.  Biological therapies for their chosen disorder, including their evaluation in terms of appropriateness and effectiveness.  Psychological therapies for their chosen disorder, for example, behavioural, psychodynamic and cognitive- behavioural, including their evaluation in terms of appropriateness and effectiveness.

3. Psychological explanations of schizophrenia 1. Psychodynamic – Freud (1924). 2. Socio-cultural – double-bind theory (Bateson et al, 1956) and expressed emotion. 3. Cognitive – metarepresentation and central control (Frith, 1992).

4. Psychodynamic Explanation – Freud (1924) He believed that the origins of mental disorder, i.e. schizophrenia, lie in the unresolved conflicts of childhood which are unconscious. Freud’s theory of personality states that we have three components in our personality – the id, ego and superego – which we develop during different stages of our life.

5. Id, Ego and Superego At birth, personality ruled by id (driven by the pleasure principle – an innate drive to seek immediate satisfaction – it gets what it wants). By age one the ego develops as a consequence of experience with reality (it cannot always get what it wants). Around age 5 the superego emerges (embodies our conscience and our sense of right or wrong). These develop during different stages of our life.

6. Stages of psychosexual development Oral phase –infant obtains satisfaction from eating and sucking (up to 18 months). Anal phase– child derives satisfaction from the anal region (18-36 months). Phallic phase– genitals become a source of satisfaction (3-6 years). Latency phase – boys and girls spend little time together (age 6 to puberty). Genital phase– genitals main source of sexual pleasure (onset of puberty onwards).

7. Stages of psychosexual development If a child experiences severe problems or excessive pleasure at any stage this leads to fixation (basic energy or libido becomes attached to that stage for many years). Later in life, adults who experience very stressful conditions show regression (behaviour becomes less mature and like that displayed during a psychosexual stage at which they fixated as children).

8. More Freud… Throughout life the id, ego and superego are in conflict because each represents different motives – pleasure, reality and ideal behaviour. This conflict causes anxiety. In order to reduce this anxiety the ego uses unconscious ‘defence mechanisms.’ These include repression (putting unpleasant thoughts in the unconscious), projection (blaming someone else), denial, displacement (venting anger elsewhere), and regression (behaving like a child).

9. Pair task Complete the gap-fill in your booklets of Freud’s psychodynamic explanation of schizophrenia.

10. Answers Freud (1924) believed that schizophrenia was the result of two related processes; regression to a pre-ego state (i.e. the id) and attempts to re-establish ego control. He believed that most adults with schizophrenia experienced very harsh childhood environments, often because they were raised by cold, uncaring and unsupportive parents. This means that they often fixated at the early stages of psychosexual development (e.g. oral stage). Schizophrenia develops when the adult regresses to the earliest stage of development, before his or her ego had developed (i.e. to the id, where the focus of all a person’s attention was on themselves and satisfying their own basic needs.) As a result the person ceases to operate on the basis of the reality principle and so loses touch with reality. The regression to very early childhood leads to symptoms such as delusions of grandeur and the creation of neologisms (new words). When individuals with schizophrenia find themselves reduced to an infantile stage they try hard to regain contact with reality and attempt to re-establish ego control. For example, the auditory and visual hallucinations were believed to be the result of the sufferer’s attempts to regain some contact with the real world.

11. Evaluation (A02) A great deal of research has found that the parents of the vast majority of schizophrenic sufferers are not cold and uncaring, as Freud described them, but are sensitive and caring individuals, scared and devastated by their child’s illness. This contradicting research therefore criticises the basis of the psychodynamic explanation of schizophrenia according to Freud (1924).

12. Evaluation (A02) The psychodynamic explanation of schizophrenia is very complex as it involves assumptions about defence mechanisms and stages of psychosexual development. There is very little support for these assumptions as they are abstract concepts. These are difficult to measure (as not actual physical things and are unconscious). Therefore the theory is difficult to prove wrong (unfalsifiable - not able to be proven false but also not necessarily true). This limits the validity of the theory as an explanation for schizophrenia.

13. Socio-cultural explanations of schizophrenia Read the information on the Double Bind Theory by Bateson et al (1956) in your booklets. Answer the 7 questions in your booklets to check your understanding of the theory.

14. Mischler and Waxler (1968) Found that mothers talking to their schizophrenic daughters were aloof and unresponsive, but behaved in a much more normal and responsive way with their non-schizophrenic children. What does ‘aloof’ mean? Reserved, indifferent, detached. However it could be argued that this communication problem might be the result of the disorder rather than the cause. This therefore highlights a major flaw in this theory. Since the schizophrenia must have been identified before the family could be studied, the communication could be an effect of the disorder.

15. Liem (1974) Measured patterns of parental communication in families with a schizophrenic child and families with a non-schizophrenic child. Found no difference in parental communication between the two groups. Therefore there is little evidence to provide strong support for the double bind theory of schizophrenia, which means the theory lacks validity.

16. Supporting research for EE Linszen et al (1997) - A patient returning to a family with high EE is 4 times more likely to relapse than a patient who returns to a family low in EE. Supported by similar findings from Brown (1972). This suggests that a negative emotional climate (high in EE) in these families arouses the sufferer and leads to stress beyond their already impaired coping mechanisms, thus triggering a schizophrenic episode (i.e. relapse).

17. Exam focus In the exam they could ask you the following question, although it has never come up before. “Outline and evaluate one psychological explanation of schizophrenia. (8+16 marks) IF this question did come up, you would want to use the umbrella term of ‘family relationships’ as your psychological (i.e. socio-cultural) explanation. This allows you to write about the double bind theory AND expressed emotion.

18. Attention Deficit Theory: ANSWERS Frith (1979) suggested that schizophrenia is the result of a faulty attentional system. Preconscious thought (i.e. thought that occurs without awareness) contains huge amounts of information from our senses that would normally be filtered, leaving only a small amount to enter into conscious thought. Schizophrenia is the result of a breakdown of this filtering process, resulting in an overload (i.e. thoughts that would normally be filtered out as irrelevant or unimportant are now interpreted in conscious awareness as more significant than they really are). This means that the individual is overloaded with external stimuli which they are unable to interpret appropriately and so they experience the world very differently to the rest of us. Because there is a problem with attention, schizophrenics have difficulty focusing on anything for a period of time, giving the impression of disordered thought. For Frith, this accounts for the positive symptoms of schizophrenia such as delusions, auditory hallucinations and disorganised speech.

19. Attention Deficit Theory McKenna (1994) – schizophrenics do not seem to be any easier to distract than non-schizophrenics when engaged on cognitive tasks. This goes against the suggestion that have faulty attentional system. Therefore, this lack of experimental support questions the validity of the theory in explaining the development of schizophrenia. Led Frith to propose a second cognitive explanation of schizophrenia (1992).

20. Metarepresentation (Freud, 1994) Is the ability to reflect on our thoughts, behaviour and experience. It is the mental ability that allows us self-awareness of our own intentions and goals. It also allows us to interpret the actions of others. Problems in our metarepresentation would seriously disrupt our ability to recognise one’s own actions and thoughts as being carried out by ‘me’ rather than someone else.

21. Brown and Birley (1968) Studied patients with schizophrenia who had just recently experienced a schizophrenic episode, and compared them with a healthy control group. 50% of these schizophrenic patients had experienced at least one major life event in the 3 weeks beforehand. This suggests life events can trigger a schizophrenic episode, providing support for valid theory.

22. Evaluation (A02) A criticism of this research is that it uses retrospective data. This is because…it relies on patients reports of the nature and timing of life events. It could be argued that the timing of life events may have been distorted by the sufferer to ‘explain’ or ‘justify’ their schizophrenic episode. Also, memory is not always 100% accurate so their memory for life events may have been altered, therefore reducing the validity of the findings. If the research findings are not valid this weakens the support for the theory.

23. Evaluation (A02) Another criticism is that this is correlational research; there is a link between life events and schizophrenia. This means…that it is difficult to establish cause and effect. It could be that life events triggered the onset of a schizophrenic episode (e.g. death of a loved one) OR that the onset of a schizophrenic episode was the cause of the life events (e.g. divorce).

24. Diathesis-stress model According to this model the occurrence of psychological disorders like schizophrenia depends on two factors: - 1. Diathesis: a genetic vulnerability or predisposition to disease or disorder, i.e. schizophrenia. 2. Stress: some severe or disturbing environmental event.

25. Diathesis-stress model There is clear evidence of a diathesis – i.e. genetic vulnerability – for schizophrenia. However not everyone who inherits the genetic component becomes schizophrenic (e.g. 48% concordance rate for MZ twins, 46% for 2 schizophrenic parents). Therefore we could explain this in terms of the psychological factors that trigger the disorder, such as stressful life events. In conclusion, it is clear that several factors play a part in causing schizophrenia so a multi-dimensional approach is needed in order to fully understand the disorder.