Page 255 Question 4 (a) and (b)
DESCRIBE ANY ONE MENTAL DISORDER.
DISCUSS SOCIAL/PSYCHOLOGICAL EXPLANATIONS GIVEN FOR
Schizophrenia is a serious psychotic disorder that is characterised by a loss of contact with reality. Kraepelin in 1902 originally called schizophrenia Dementia Praecox which is a senility of youth. He believed that the typical symptoms were due to a form of mental deterioration which began in adolescence. Symptoms are mainly disturbances of thought processes but also extend to disturbances of behaviour and emotion.
There are two traditional symptom categories of schizophrenia. Acute schizophrenia is classified as type one, as a functional disorder which has positive symptoms such as hallucinations and delusions. Chronic schizophrenia is classified as type two, as an organic disorder which has negative symptoms such as apathy and withdrawal. These two main symptom categories have been abandoned by DSM-IV, which is the latest version of the American manual for all mental disorders, symptoms and possible treatments.
Schizophrenia is now classified into three main subtypes, paranoid in which the person is less disturbed, disorganised or hebephrenic which is what most people associate schizophrenia as, and catatonic which is the most serious of the three.
In paranoid schizophrenia the person may have delusions of grandeur which is when they believe they are someone famous or grand for example The Messiah or Elvis, or when they believe they posses magical powers. Delusions of persecution is another symptom. This is when they believe that others are plotting against them, they are being spied upon, talked about or being deliberately victimised. Paranoid schizophrenia sufferers may also have auditory hallucinations which are voices heard in the absence of external stimuli which are often critical, warning them of danger or giving them commands. Slater and Roth in 1969 regarded hallucinations as the least important of all the symptoms because they are not exclusive to schizophrenia. In paranoid schizophrenia the personality is better preserved than in the other two kinds. It is a type one, functional, acute and positive type of schizophrenia.
Disorganised schizophrenia typically makes a gradual appearance between the ages of twenty and twenty-five. The hebephrenic will display the symptoms of paranoid schizophrenia as well as disorganised behaviour and speech. The person may have severe disruption in the ability to perform everyday living activities such as showering, dressing themselves and preparing and cooking meals. They may speak inappropriately and say things that do not make any sense and are in a confusing order. Inappropriate behaviour may also be shown for example they might laugh when they are being told terrible news. They may have flat emotions, where no emotional response is shown. Their eyes are lifeless ,their speech is toneless and emotionless and they look like they are staring at nothing particular, into space. Their behaviour is out of context. The disorganised type is in-between the traditional classifications of positive and negative symptoms.
Catatonic schizophrenia includes the symptoms of paranoid and disorganised schizophrenia along with some more serious symptoms, and is a type two, negative and chronic. The schizophrenic may show apathy which is the lack of interest in normal goals, the loss of drive when they feel drained of energy, tired and are unable to continue with things they have begun.
Cataleptic stupor is also a symptom where the person stands motionless or in bizarre postures, like a statue. Excessive motor activity is common when they move in odd and disturbing ways, sudden movement which appears purposeless and is not implicated by external stimuli. The person may also repeatedly echo words spoken by others, or the accentuated imitation of the mannerisms of other people. This is called echolalia.
Although schizophrenia was originally called the senility of youth by Kraepelin, Bleuler in 1911 observed that many patients displaying these symptoms did not go on deteriorating and theta illness often begins much later than adolescence. He then called the illness schizophrenia, meaning split mind or divided self in which the personality loses its unity.
Genetic theorists study three areas in schizophrenia, family history, twins and adoption. The studies I have looked at show that people who have schizophrenic relatives are more likely to get the illness than the general public. Kendler et al’s 1985 study shows that first degree relatives of those with schizophrenia are eighteen times more at risk than the general population. Zimbardo et al in 1995 compiled data from family and twin studies conducted in European populations between 1920 and 1987. He found that the degree of risk correlates highly with the degree of genetic relatedness. Gottesman and Shields in 1982 studied identical twins reared apart and found 58% concordance for schizophrenia suggesting genetics are important not the environment. Tienari in 1969 studied 112 individuals born to schizophrenic mothers then adopted, compared this group with a matched control. 7% of the experimental group developed schizophrenia and only 1.5% of the control group developed it.
However I am looking at the social and psychological explanations given for this disorder, although I think the genetic theories are valid and also apply.
Behaviourists studies show that schizophrenia is due to conditioning and observational learning and that people show schizophrenic behaviour when they are more likely to be reinforced. Ullman and Krasmer in 1969 said that staff in hospitals reinforced schizophrenic behaviour in their patients by paying more attention to those who display characteristics of the disorder. The patients see that if they disobey the staff and play up, the staff will make a fuss over them. Psychologists say that schizophrenic behaviour can be modified through conditioning, as it is the brain that is affected, but the thought disorder cannot be changed. It is difficult to explain schizophrenic behaviour when people do not have the opportunity to observe such patterns and it is generally accepted that the behavioural model of a social explanation of schizophrenia has little contribution to our understanding of the cause of schizophrenia.
The psychodynamic model is due to a regression to an infantile stage of function. Freud calls this the oral stage. Freud believes that there are three stages of the oral stage, the id, the ego and the superego. The id wants immediate gratification, the ego tries to control the id and apply a reality principle, and the superego which is the conscience which controls guilt and morality uses defence mechanisms when the ego has too much pressure. Freud believes schizophrenia occurs when the ego becomes overwhelmed by demands of id or besieged by unbearable guilt from the
superego. The ego cannot cope so it uses defence mechanisms to protect itself which is regression. The schizophrenics fantasies become confused with reality which gives rise to hallucinations and delusions. Freud suggested that delusions and bizarre speech patterns may make sense when preceded by the phrase I dreamed….. Freud is suggesting that the schizophrenic is dreaming and the hallucinations are not really happening, but they cannot tell the difference between dreams and reality.
In the 1950’s and 1960’s it was thought that schizophrenia was caused by a dysfunction of communication in the family. Fromm Reichman in 1948 used the term schizophrenogenic families to describe families with high expressed emotion. This means families with emotional tension, many secrets, close alliances and conspiracies. Bateson et al in 1956 suggested the double bind situation where children are given conflicting messages from parents who express care but are also critical. He thought that this led to self doubt, confusion and eventually withdrawal. This theory went into decline in the 1970’s as there was more convincing evidence for a genetic predisposition in schizophrenia
Vaughn and Leff who worked at the medical research council in London, published a paper in 1976. They were more interested in the part the family might play in the course rather than the cause of schizophrenia. They suggested that in families with high expressed emotion there is a higher relapse rate in discharged patients. Their research was stimulated by an earlier study by Brown in 1972. Vaughn and Leff found similar results to Brown. 51% of schizophrenics who returned to homes with high expressed emotions relapsed and only 13% relapse rate in those returning to homes with low expressed emotions.
There are now treatment programmes for the family of the schizophrenic including training in controlling expressed emotion. This approach has been criticised as many schizophrenics are not in contact with their family, or have minimal contact and yet there is no evidence that such people are less prone to relapse. This study was done by Goldstein in 1988. It could be argued that any social environment could be regarded as having high or low expressed emotion. High expressed emotion may well develop as a response to living with the burdens of schizophrenia.
Bebbington and Kuipers in 1992 showed the results of prospective studies of expressed emotion. In all of the patients that returned to a home with high expressed emotion situation, the relapse rate is always higher than if the schizophrenic was returning to a home with low expressed emotion.
The social/psychological explanations for schizophrenia are not conclusive but neither are all the other explanations as there is no cure for schizophrenia, the most serious of all mental disorders. I think that schizophrenia is inherited but not totally. There are other factors which can cause or worsen it when the schizophrenic is vulnerable and interact with environmental factors such as stressful life events.
References: Psychology for ‘A’ Level. Cardwell, Clark and Meldrum. p246-255. 1987. Collins Educational.