1. Psychological explanation

2. Starter
Create a plan for the essay title: Discuss biological explanations for schizophrenia. (Total 16 marks)

3. Exam questions
Psychological explanations for schizophrenia: family dysfunction and cognitive explanations, including dysfunctional thought processing.
Briefly outline family dysfunction as an explanation for schizophrenia [2 marks]
Outline and evaluate one or more psychological explanations for schizophrenia [16 marks]

4. Teach it
Working in groups of 3 – each person has an explanation of family dysfunction causing sz.
Double blind theory
Expressed emotion
Cognitive explanation
10 minutes to learn
You will need to teach each other and the others need to take notes on the other explanations you are being taught.
5 mins for each explanation.

5. Family Relationships
biological processes are clearly important in both the origins and symptoms of schizophrenia
psychological processes are also important
impact of family relationships has been put forward as a possible explanation for schizophrenia.  
Psychologists have attempted to link schizophrenia to childhood and adulthood experiences of living in a dysfunctional family

6. Breakdown in communication
3 key characteristics research has suggested is evident in Sz in relation to their family
Conflict
Breakdown in communication
Criticism

7. Double Bind Theory (Bateson, 1956)
The double bind hypothesis is a psychological explanation which can be classed as a socio-cultural explanation.
Bateson suggested that schizophrenia is best understood as a wider problem occurring within the family.
It is not an inborn mental disorder but instead is a learned confusion in thinking.
Schiz. can be attributed to the exposure to, and participation in dysfunctional communication patterns in the family.
An example of this dysfunctional communication pattern is double bind communication.
Double bind communication is where a pair of messages are mutually contradictory. (Message and meta-message do not mean the same thing)

8. Double Bind Theory (Bateson, 1956)
For example…
“A mother tells her son/daughter that they are not affectionate enough but when the child shows affection, the mother pushes them away with the comment “grow up, you big baby”.
Small children in particular have difficulty with these contradictory messages
Parents who send out mutually contradictory signals such as in the example above place their children in impossible situations where they cannot act in one way without in some way going against their parent’s apparent wishes.
and can neither ignore the message nor leave the relationship because they are so dependent upon their parent(s).

9. Double Bind Theory (Bateson, 1956)
How does this lead to the development of schizophrenia?
The child doesn't know how to respond to the conflict between the words and the body language.
The result is that children lose their grip on reality and if double bind messages are presented continually and habitually within the family context from infancy on by the time the child is old enough to have identified the double bind situation, it has already been internalised and the child is unable to confront it.
Negative symptoms of social withdrawal and flat affect may be an appropriate and logical response to such situations
The solution then is to create an escape from the conflicting logical demands of the double bind into the world of the delusions.

10. Complete the activity on double bind theory

11. Expressed Emotion
Expressed Emotion (EE) is a qualitative measure of the amount of emotion displayed within the family setting, usually by family members or care takers.
The theory proposes that a high level of EE within the home of the schizophrenic can:
Worsen the prognosis in patients with schizophrenia
Increase the likelihood of relapse and readmission into hospital for the patient.
A high EE household is made up of three dimensions:

12. Three dimensions of Expressed Emotion
1. Hostility:
Hostility is a negative attitude directed at the patient because the family feels that the disorder is controllable and that the patient is choosing not to get better. Problems in the family are often blamed on the patient. The family believes that the cause of many of the family’s problems is the patient’s mental illness.
2. Emotional over-involvement:
It is termed emotional over-involvement when the family members blame themselves for the mental illness. The family member shows a lot of concern for the patient and the disorder. The pity from the relative causes too much stress and the patient relapses to cope with the pity.
3. Critical Comments:
Critical attitudes are combinations of hostile and emotional over-involvement. It shows an openness that the disorder is not entirely in the patients control but there is still negative criticism. Critical parents often influence the patient’s siblings to be the same way.
Family communication style that involves:
Critical comments through both tone and content, occasionally accompanied by violence
Hostility towards the patient, including anger and rejection
Emotional over-involvement in the life of the patient, including needless self-sacrifice

13. How does this result in relapse?
This high level of EE becomes too much for the patient to handle as they have to deal with criticism from those they would need support from in their time of recovery.
This stress may cause the patient to relapse and make them fall into a cycle of rehabilitation and relapse.
The only way to escape this cycle is for the family to go through Family Intervention Therapy together.
This will greatly lower family conflicts and reduce the amount of EE within the household.

14. Complete the questions on expressed emotion
Activity 3
Complete the questions on expressed emotion

15. Support for family dysfunction as a risk factor
There is evidence to suggest that difficult family relationships in childhood are associated with increased risk of schizophrenia in adulthood
For example, Read (2005) reviewed 46 studies of child abuse and schizophrenia in adulthood and concluded that 69% of adult in-patients with a diagnosis of schizophrenia had a history of child abuse - for men the figure was 59%
Adults with insecure attachments to their primary carer are also more likely to develop schizophrenia

16. Weak evidence for family based explanations
Year 2: Schizophrenia
Weak evidence for family based explanations
Information about childhood experiences is gathered after the symptoms have developed, therefore the schizophrenia may have distorted the patients’ recall of these childhood experiences – this creates a serious problem of validity
Dysfunctional family explanations for schizophrenia have historically led to parent-blaming. Parents, who have already suffered at seeing their child’s descent into schizophrenia underwent further trauma by receiving blame for the condition
PSYB3

17. Summary of explanation
Psychological explanations look to the person’s environment to explain schizophrenia
Families can influence both the onset (through socialisation) and the maintenance (through high EE) of schizophrenia
The diathesis-stress model of schizophrenia is where biological factors cause a predisposition to develop schizophrenia the stress factors in the environment may well be to do with family dysfunction

18. Cognitive Explanations for Schizophrenia

19. So…lets recap the cog approach
What does the Cognitive approach assume?
assumes that the key to understanding people is understanding how the mind works
primarily concerned with investigating internal mental processes like thinking, problem solving and memory.
It explains behaviour in terms of how the mind processes information
The underlying idea is that the mind works like a computer – information is inputted, stored and retrieved.
As information processors our minds we actively organise and manipulate the information we receive – we do not merely passively respond to our environment
So in terms of schizophrenia we are interested in the processes and the way information is organised / processed

20. Cognitive Approach Assumptions
The cognitive explanation of schizophrenia is based around the idea of faulty information processing and faulty thinking.
In non-schizophrenic brains, we are able to filter incoming stimuli and process them to extract meaning.
It is thought that these filtering mechanisms and processing systems are defective in the brains of schizophrenics.

21. Cognitive models
According to Frith (1979), schizophrenia is the result of a faulty attention system.
Preconscious thought (i.e. thought that occurs without awareness) contains huge quantities of information from our senses that would normally be filtered. Schizophrenia may be the result of a breakdown of this filtering process, resulting in overload.
For Frith this accounts for the positive symptoms of schizophrenia, such as hallucinations, delusions and disorganised speech.
According to Frith (1992) cognitive deficits are caused by abnormalities in those areas of the brain that uses use dopamine, especially the prefrontal cortex.
He showed that schizophrenics have reduced blood flow to these areas (indicating reduced brain activity) during certain cognitive tasks.

22. What’s going on inside the ‘black box’?
People are laughing on the bus
There’s something wrong with me

23. What’s going on inside the ‘black box’?
My papers are not where I left them
People are trying to sabotage my career

24. What’s going on inside the ‘black box’?
I can’t hear what people are saying
My family is plotting against me

25. Faulty processing filter
In a person without Sz, they are able to distinguish between information that is important and information that isn’t.
However in the mind of a person with Sz, they have a faulty processing system and it said they have an inability to distinguish between information that is already stored and new incoming information.
As a result, the person with Sz is subjected to sensory overload and does not know which aspects of a situation to attend to and which to ignore. This may result in them:
Being confused.
Not being able to grasp what actually reality.

26. Frith’s model
Frith suggested that people with Sz fail to monitor their own thoughts correctly and so misattribute them to the outside world.
When a person with Sz hears voices, it is actually their own inner speech being misinterpreted however they may believe that someone or something in the external world is communicating with them.

28. Frith et al (1992) has conducted lots of research into the cog explanation
2 key terms that you need to refer to:
Metarepresentation: ability to reflect on our own thoughts… do you think a Sz has this ability? Why?
Central control: ability to supress automatic reponses. Does a Sz have this? Why?

29. Frith et al – two kinds of dysfunctional thought processing
Metarepresentation is the cognitive ability to reflect on thoughts and behaviours. This is the insight into own our intentions and goals. It allows us to interpret the actions of others. Dysfunction in metarepresentation would disrupt our ability to recognise our own actions and thoughts as being carried out by ourselves rather than someone else. This would explain hallucinations of voices and delusions like thought insertion (others put ideas into your head).
Central control is the cognitive ability to suppress automatic responses while we perform deliberate actions instead. Disorganised speech and thought disorder could result from the inability to suppress automatic thoughts and speech triggered by other thoughts. E.g. Schizophrenics often suffer from thought derailment because words trigger associations and the patient cannot suppress automatic responses to them.

30. Cognitive models
Bentall (1994) argued that schizophrenics have attentional bias towards stimuli of a threatening and emotional nature, so stimuli associated with violence, pain etc.
Helmsley’s (1993) model states that schizophrenia arise from a disconnect between our schemas (expectations of certain situations) and actual sensory input.
In people with schizophrenia, this differentiation between schemas and new situations does not occur.
There is a confusion between internal events and external stimuli and can result in the experience of hallucinations.

31. Positive symptoms: Hallucinations
Thinking irrationally would lead to…. Such as…. If the information is not correct (dysfunctional) this could also lead to deficits in their ability to process the real world…. This could lead to symptoms such as ….
The individual not thinking clearly and potentially ‘exaggerating’
Delusions … specifically of persecution (everyone is out to get me)
Hallucinations

32. Evaluation of Cognitive Approach
Focuses on the current cognitions
Plenty of research into the idea
Influential and popular model
Includes biological and the psychological
Empowers the individual to change
Ignores the environmental influences
Unscientific - lacks experimental support.
Blaming the individual can make the disorder worse
Is thinking irrational?
Which is the cause? Which is the effect?
Describes rather than explains.
A key principle of science is that a theory should account for all the data, but adopt the simplest explanation possible (law of parsimony). Does the cognitive explanation achieve this?

33. Evaluate psychological explanations of schizophrenia.
Exam Question
Evaluate psychological explanations of schizophrenia.
(Total 16 marks)

34. Mark Scheme
AO2 / AO3 = 16
Candidates are required to provide an evaluation of psychological explanations of schizophrenia.
The question refers to explanations in the plural since it could be difficult for candidates to provide sufficient evaluative material on a single psychological explanation for full marks.
However, given that evaluative points are often relevant to more than one explanation, no partial performance criteria apply for this question.
Candidates can legitimately refer to biological explanations but answers will only gain credit where the material is clearly used to offer commentary on the worth of psychological explanations. Detailed descriptions of biological explanations cannot gain credit. Similarly, detailed descriptions of psychological explanations cannot gain credit – the focus in this part of the question is on evaluation.

35. Mark Scheme The evaluation can be both positive and negative:
the cognitive explanation can be criticised for being descriptive rather than explanatory.
More general evaluations that apply to most psychological explanations include the following: none of them can adequately account for the indisputable fact that schizophrenia runs in families and that the increased risk is directly associated with the degree of relatedness.
There is a lack of strong empirical evidence to support the psychological explanations and there is also a problem of disentangling cause and effect (eg does faulty thinking cause schizophrenia or vice versa?).
It is also legitimate to refer to therapies ie that treatments arising from psychodynamic and behavioural explanations appear to have little therapeutic effect in schizophrenia.

36. Mark Scheme
Another general point concerns the diversity of symptoms found in people diagnosed either with schizophrenia or a sub-type of schizophrenia – it may be the case, for example, that some explanations can account for certain symptoms better than others. Candidates might also use the diathesis-stress model as a way of reconciling biological and psychological explanations.