MODULE 5 - INDIVIDUAL DIFFERENCES TREATING MENTAL DISORDERS



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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).

Schneider’s (1959) first rank symptoms:

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 (-)

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:

MISCONCEPTIONS:

There are many misunderstandings about schizophrenia.

Is schizophrenia ‘split personality’ or like a ‘Jekyll and Hyde’ character?

Are people with schizophrenia violent?

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Evaluation of the genetic basis of Schizophrenia

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Evaluation of the biochemical basis of Schizophrenia

|Strengths |Weaknesses |

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|* Evidence supporting |*There is contradictory evidence. Some studies show that schizophrenics have lower|

|������ L-DOPA (used in the treatment of PARKINSON’S |levels of dopamine in certain areas of their brain. |

|DISEASE) which |*To be effective, antipsychotics have to reduce dopamine activity to below their |

|INCREASES the amount of dopamine, can produce symptoms |normal levels. If the theory is true then reducing dopamine levels to normal |

|of schizophrenia. |should be sufficient. |

|������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)| |

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Where do these abnormalities originate? Consider the next hypothesis:

Viral infection and Complications during pregnancy

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|DESCRIPTION (A01) |DESCRIPTION (A01) |

|O____________ C________________ has been used to explain |1) The schizophrenic will have some b_______________ abnormality which will |

|schizophrenia (e.g. Liberman, 1982- FAULTY LEARNING). The idea is |lead to strange sensory experiences. |

|that most people learn from their environment to respond to | |

|s_________ c__________. When the response is socially acceptable |2)Then, according to Comer (1995) the schizophrenia when first confronted by |

|then it will be reinforced. Some people, however, do not receive |voices or visions will turn to r__________, f______________ etc. to help them|

|these r______________ and they will stop attending to these social |understand what is happening. |

|cues and focus instead on other, often irrelevant cues. As they do | |

|this more and more their behaviour will become more and more bizarre |3) When these people d___________ the existence of these visions or voices |

|which means that their behaviour will eventually receive a lot of |that the schizophrenic knows they are experiencing then they will come to |

|attention: this attention will act as a r_____________ for the |believe that their friends and relatives are trying to h_______ the truth |

|behaviour. There has been some support for this because it has been |from them and |

|shown that schizophrenics can learn appropriate responses if they are| |

|rewarded with cigarettes, food, attention etc. (e.g. Belcher, 1988). |4) they will eventually r__________ all feedback from others. |

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| |5) They will eventually believe that they are being m_______________ or |

| |persecuted (Garety, 1991)-FAULTY THINKING. |

|COMMENTARY- evidence and evaluation |COMMENTARY- evidence and evaluation |

|A02 |A02 |

|*NATURE OR NURTURE? |* 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. |

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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).

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|re-disposing |recipitating |erpetuating |

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Schizophrenia

Characteristics of Schizophrenia

Positive symptoms

Negative symptoms

Misconceptions

Biological explanations Psychological

Genetic Behavioural

Viral Infection Psychodynamic

Brain dysfunction Cognitive

Biochemical

Sociocultural

Life events

Family relationships

Social Labelling

Social Drift theory

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.

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 1-month period, (or less if successfully treated) for diagnosing schizophrenia

4. Which areas of functioning must the symptoms have disturbed?

_______________________

thoughts are controlled by external forces i.e. Martians, government etc.

______________________________

voices are heard discussing thoughts and behaviour, may be obscene and order patient to do things

________________

False beliefs (incompatible with reality, persecution of grandeur)

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 (-)

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.

Ï% 1893: Ï● 1893: ● 1911: ● 1959: ● 1970 to the present:

Emil Kraepelin separated affective psychoses (e.g. mania) from non-affective psychoses; he gave the term ‘dementia praecox’ to clinical conditions resembling the main forms of schizophrenia.

Kurt Schneider defined first-rank symptoms, which now comprise criteria

(a)–(d) of the ICD-10 classification.

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.

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:

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.

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?

These explanations can be split

into 4 cateogries:

GENETIC

BIOCHEMICAL

NEUROLOGICAL (Brain DYSFUNCTION)

VIRAL

A01

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.

Mainly look at family, twin and adoption studies.

A02

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…………………………………….

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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 uniform from 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

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

A01

The DOPAMINE HYPOTHESIS

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What is a NEUROTRANSMITTER (NT)?

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.

A02

EVIDENCE FOR:

Anti-psychotic drugs:

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 anti-psychotic 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)

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

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 ____________________.

Basal Ganglia: involved in movement and emotions and integrating sensory information. Abnormality can contribute to hallucinations and paranoia.

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.

Hippocampus: Mediates learning and memory formation, these functions are impaired in Schizophrenia

Limbic System (Amygdala): involved in emotion: Disturbances are thought to contribute to the agitation frequently seen in schizophrenia

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?

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.

A02

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.

A01

EVIDENCE

FOR ptcc 196

A01/2

The

Viral Theory

WINTER BIRTH-

Torrey (2000):

VIRAL INFECTION during pregnancy

De Messias et al (1998):

IMPORTANCE OF THE 2ND TRIMESTER

in PREGNANCY-

Van Os et al (1997) Comer (2003)

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

Strengths

• Explains

why Sz

appears in

individuals

with no family

history of the

disorder

• Karlsson (2001)

3rd 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

conditions.

Weaknesses

• Methodological problems-studies such as those of Torrey were based on correlational data and so caution should be observed when attempting to infer causation.

•

EVALUATION

EXAM TIP: although we have 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 QUALITY (describe explanations in depth) than QUANTITY (list many explanations but not in detail

Overall evaluation of bio explanation of Sz

Biological explanations are deterministic, i.e. assume that some individuals will inevitably develop Sz. Patient is seen as passive and bio cause = bio treatment

IGNORES SOCIAL FACTORS

TRY THIS ESSAY AND APPLY YOUR KNOWLEDGE: Describe & evaluate 1 or more biological explanation of schizophrenia

These explanations can be

split into 2 cateogries:

1) Psychological-

Psychodynamic, Behavioural and Cognitive

2) Socio-cultural

Life Events, Family relationships and Social Labelling

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

A01

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

Explanation-

SCHIZOPHRENOGENIC MOTHER: Fromm-Reichmann

(1948) ptcc page 199

A02

EVALUATION:

LACK OF RESEARCH EVIDENCE: (except the alternatives)

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:

A02

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)

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).

DESCRIPTION:

EXAMPLES OF DISCRETE STRESSES:

• Death of a close relative,

•

•

EVIDENCE FOR:

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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

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 SELF-FULFILLING 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.

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.

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

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:

ARGUMENTS AGAINST:

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.

EVIDENCE FOR:

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?

Task: READ THE ARTICLE ‘Living with Schizophrenia’ (David Putwain) and answer the questions below.

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

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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