PSYCHOLOGICAL EXPLANATIONS FOR SCHIZOPHRENIA
PSYCHODYNAMIC THEORIES:FAMILY DYSFUNCTION
Many psychological theories of schizophrenia propose that dysfunctional family interactions and relationships play a key causal role in the disorder's development. Essentially, a disturbed family environment is seen as a root cause, contributing to what Fromm-Reichmann described as schizophrenogenic families—families whose dynamics increase the risk of schizophrenia in children. Characteristics of these families may include poor communication, emotional tension, and secrecy. Such environments are seen as minefields of conflict and confusion, where children are exposed to high emotional stress, secret alliances, and mixed messages. These experiences can lead to mental distress, creating a foundation for the development of schizophrenia.
With the exception of Expressed Emotion, most of the theories related to family dysfunction in schizophrenia are based on psychodynamic principles. They emphasise the impact of unconscious processes, early childhood experiences, and family dynamics on mental health. By focusing on intrapsychic conflicts and unresolved tensions from early life, particularly within family relationships, these theories explore how emotional turmoil and dysfunctional interactions can shape psychological development and contribute to psychopathology. The primary focus is on how deep-seated emotional conflicts and dysfunctional relationships affect the ego, playing a potential role in the onset of schizophrenia
LAING’S THEORY OF SCHIZOPHRENIA
R.D. Laing proposed that schizophrenia is a response to an unhealthy family environment. He believed that families could be characterised by arguments, favouritism, and projection of frustrations onto their children. According to Laing, the behaviours and symptoms of schizophrenia are “sane” reactions to “insane” situations. He suggested that the seemingly bizarre language and incoherent speech patterns of people with schizophrenia are understandable attempts to make sense of a dysfunctional past and chaotic family environment. Essentially, Laing framed schizophrenia as a rational response to a deeply disturbing family context, rather than purely a biological illness.
MARITAL SCHISM (LIDZ)
Marital Schism, a theory developed by Lidz, focuses on the impact of parental conflict and division on a child’s mental health. Marital schism refers to situations where parents have conflicting goals, divided alliances, and open hostilitytowards each other, creating an unstable environment for the child. This dysfunctional family atmosphere can lead to disorientation and insecurity in children, contributing to the development of schizophrenia. The parents' inability to present a unified, stable relationship leads to confusion and insecurity in the child's developing sense of self and reality.
FREUDIAN PERSPECTIVE
SCHIZOPHRENIA AND THE EGO IN PSYCHOANALYTIC THEORY
In psychoanalytic theory, schizophrenia is seen as a breakdown or disintegration of the ego. The ego is a part of the mind that organises thoughts, applies reason, and maintains a sense of self. It is governed by what Freud called the reality principle.
REALITY PRINCIPLE EXPLAINED
The reality principle is the process by which the ego balances desires, impulses, and fantasies with the demands of the real world. It acts as a mediator between the id (which is driven by instinctual urges and desires for immediate gratification) and the superego (the moral conscience). The ego’s role is to navigate between these internal demands and external reality, helping to distinguish what is real from what is fantasy, and ensuring that thoughts and behaviours are rational and appropriate to the environment.
Freud saw the ego as a coherent structure that maintains our mental processes and self-identity. When the ego is no longer able to balance the demands of the id, the superego, and the real world, it leads to what Freud described as "ego death"—a complete collapse of self-identity, in which the person is unable to distinguish reality from fantasy.
In 1924, Freud wrote that in psychosis (including schizophrenia), the ego becomes disconnected from reality. This disconnection happens when the ego is overwhelmed by internal conflicts or external pressures, disrupting the individual's relationship with the outside world (Freud, 1924a). As a result, the individual may struggle to organise their thoughts coherently and maintain a realistic view of their surroundings, which can lead to symptoms like hallucinationsand delusions
Despite developing a theoretical framework for schizophrenia, Freud concluded that the disorder could not be treated through psychoanalysis. He believed that the inherent deficits in forming relationships, particularly the inability to develop transference (the process of projecting feelings onto the therapist), made psychoanalytic treatment ineffective for schizophrenia.
HARRY STACK-SULIVAN
However, between 1907 and 1908, some members of Freud’s inner circle—including Harry Stack Sullivan, Frieda Fromm-Reichmann, Federn, Jung, and Abraham—argued that psychoanalysis could be effectively applied to treat schizophrenia. They expanded on Freud’s ideas, each contributing different perspectives on the disorder’s origins and treatment potential.
Harry Stack Sullivan emphasised the role of the child’s earliest interactions with parents and saw these as major contributing factors to the development of schizophrenia. He theorised that mental illness was closely related to interpersonal relationships and pointed to specific characteristics within the families of schizophrenic patients, such as extreme inflexibility, poor communication, and mutual hostility. Sullivan suggested that individuals with schizophrenia lack a basic sense of trust, have poor ego boundaries, and display vulnerability to psychosis as a result.
FROMM-REICHMANN’S THEORY OF SCHIZOPHRENIA
Frieda Fromm-Reichmann was a psychoanalyst who made significant contributions to the understanding of schizophrenia from a psychoanalytic perspective. She developed the concept of the "Schizophrenogenic Mother," which became controversial in theories of schizophrenia's origins.
Fromm-Reichmann proposed that schizophrenia was rooted in disturbed family dynamics, with the mother playing a particularly influential role. According to her theory, the quality of the mother-child relationship significantly impacted the child's psychological development, with mothers of schizophrenic children often displaying paradoxical and damaging parenting styles. The Schizophrenogenic Mother was characterised by a blend of overprotection and emotional hostility, sending conflicting messages that the child struggled to reconcile.
CHARACTERISTICS OF THE SCHIZOPHRENOGENIC MOTHER
Overprotectiveness: The mother is excessively involved in the child's life, smothering the child with attention and control. This over-involvement inhibits the child’s ability to develop autonomy, fostering dependency.
Hostility and Rejection: At the same time, the mother displays hostile, rejecting, and cold behaviours. These conflicting messages—simultaneously encouraging dependence yet emotionally rejecting—cause confusion. Such double-bind communication (contradictory verbal and non-verbal messages) disrupts the child’s perception of reality, damaging their capacity to form stable relationships and contributing to the disintegration of the ego.
Controlling Behaviour: The mother is also seen as highly controlling, imposing high expectations and standards that are difficult for the child to achieve. This control, paired with hostility, places the child in a "no-win" situation, where they perceive that they can never behave correctly.
IMPACT ON THE CHILD’S DEVELOPMENT
Fromm-Reichmann believed this toxic combination of overprotection and hostility had profound effects on the child’s psychological development:
The child grows up feeling confused and anxious, unable to trust the mother’s intentions, resulting in attachment difficulties.
The inconsistency of emotional care impairs the development of a stable sense of self and reality, leading to ego weakness and poor self-boundaries.
To cope with the stress of the chaotic family environment, the child may regress to earlier developmental stages, displaying primitive thinking, hallucinations, and delusions typical of schizophrenia.
REGRESSION TO CHILDHOOD COMMUNICATION PATTERNS
Fromm-Reichmann argued that the symptoms of schizophrenia, such as hallucinations and delusional thinking, represented a regression to early childhood modes of communication and interaction. When faced with extreme emotional stress, the child retreats into a fantasy world as a means to escape the dysfunctional relationship with the mother. This regression leads to fragmented communication and disrupts the child’s ability to engage with the external world effectively.
EVALUATION OF THE PSYCHODYAMIC APPROACH
SULLIVAN AND FROMM-REICHMANN’S TREATMENT CLAIMS
Harry Stack Sullivan (1892–1949), a key figure in the development of the interpersonal theory of mental illness, claimed to have achieved a high recovery rate in treating schizophrenia in the 1920s (Wake, 2008). Both Sullivan and Fromm-Reichmann reported significant success rates in working with schizophrenic patients. However, critics point out that many of the patients they treated would not meet modern diagnostic criteria for schizophrenia as defined by the DSM or ICD and were possibly not as severely disturbed as patients seen today. This calls into question the validity of their reported success.
Furthermore, Roth and Fonagy have argued that psychodynamic therapy, even when combined with medication, is inadequate for effectively treating schizophrenia. More disturbingly, research suggests that this type of therapy can even harm patients, increasing the likelihood of hospitalisation. Roth and Fonagy conclude that during the acute phase of the disorder, patients are too emotionally fragile to handle a therapy that is intrusive and intense, making it potentially counterproductive.
ALPHA BIAS
LACK OF EMPIRICAL EVIDENCE SUPPORTING THE "SCHIZOPHRENOGENIC MOTHER" HYPOTHESIS
Psychodynamic explanations have been criticised for their gender bias and social sensitivity, particularly the focus on blaming mothers for causing schizophrenia. The theory of the "schizophrenogenic mother" is based on the assumption that, because mothers do most of the child-rearing, they have the greatest capacity to cause psychological harm. But Fromm-Reichmann's concept of the "schizophrenogenic mother" — suggesting that maternal behaviour is a significant cause of schizophrenia — has been largely discredited by modern research, e.g., Neill (1990) found no evidence that mothers cause schizophrenia, and Waring and Rick (1965) observed that mothers of schizophrenic individuals are more likely to be anxious, shy, and withdrawn. Such traits might reflect the stress of having a child with a severe disorder rather than a causal role in developing schizophrenia.
The misogynistic nature of these theories wrongly portrays mothers as harsh and withholding, whereas, in reality, many mothers face significant emotional challenges due to their child's condition. The emphasis on maternal blame perpetuates social stigma and fails to account for paternal roles or family dynamics as a whole.
PROBLEMS WITH RETROSPECTIVE DATA COLLECTION
Collecting retrospective data—gathering information about events from the past—presents significant challenges, as it often relies on self-reports or caregiver memories about events that may have occurred decades earlier. This raises concerns about the reliability of the data due to several factors:
Memory Inaccuracies: Over time, memories fade, distort, or are recalled inaccurately. Parents or caregivers may struggle to remember specific details, and the passing of years can result in incomplete or altered recollections of early childhood events, reducing the reliability of such data.
Subjectivity and Bias: Even when memories are somewhat accurate, they can still be influenced by current emotions, beliefs, or guilt. Caregivers may unintentionally reinterpret or reshape past events based on their current perspective, which can introduce bias and lead to inaccurate or misleading reports.
Repression of Memories: Painful or traumatic memories, especially those from distressing events, might be repressed or forgotten entirely. This selective forgetting further complicates the collection of accurate data, as critical information may be missing or unavailable.
CHALLENGES IN LINKING EARLY EXPERIENCES TO SCHIZOPHRENIA
Psychodynamic theory emphasises early childhood experiences, particularly those within the first two years of life, as the root cause of schizophrenia. However, this approach faces significant challenges. Schizophrenia typically manifests in late adolescence or early adulthood, creating a 20-year gap between the proposed cause and the development of symptoms. During this lengthy period, numerous factors such as genetics, social influences, and environmental stressors intervene, making it nearly impossible to isolate early childhood experiences as the sole cause of schizophrenia.
INADEQUATE COMPARISON TO CHILD DEVELOPMENT
Psychodynamic theories often claim that schizophrenia represents a regression to a child-like state. However, this analogy is flawed. Children are typically curious, emotionally expressive, and engaged with their environment, while individuals with schizophrenia often exhibit symptoms like emotional flatness, lack of motivation, and bizarre behaviour. These characteristics do not align with typical childhood development, weakening the argument that schizophrenia is a form of regression.
LIMITATIONS OF SUCCESS CLAIMS
Fromm-Reichmann’s reported success in treating schizophrenic patients has been questioned. Critics argue that many of her patients would not meet the modern DSM or ICD diagnostic criteria for schizophrenia. These patients may have been less severely disturbed than those treated today, which casts doubt on the validity of her reported success rates. This discrepancy calls into question the effectiveness of her psychodynamic approach when applied to modern standards of schizophrenia diagnosis and treatment.
ISSUES WITH DETERMINISM
While psychodynamic theories do not attribute schizophrenia to biology or free will, they are still deterministic. They argue that if someone grows up in a disturbed family environment, they are inevitably destined to develop schizophrenia. This kind of determinism has both positive and negative implications:
Negative Aspects: Blaming parents, particularly mothers, may lead to guilt and shame and cause them to be socially ostracised.
Positive Aspects: It could also inspire positive changes, such as encouraging Expressed Emotion training to improve family communication and support.
Psychodynamic theories are deterministic, suggesting that individuals raised in dysfunctional family environments are almost inevitably destined to develop schizophrenia. This approach risks creating guilt and stigma for parents, particularly mothers, by implying they are responsible for their child’s condition. However, this perspective could also promote positive interventions, such as expressed emotion (EE) training, which encourages families to communicate more effectively and reduce emotional intensity, potentially mitigating symptom severity.
REDUCTIONISM AND LACK OF A HOLISTIC VIEW
Psychodynamic explanations are reductionist, focusing narrowly on early childhood trauma and dysfunctional family dynamics while neglecting biological factors. Genetic studies, particularly involving monozygotic (MZ) and dizygotic (DZ) twins, provide strong evidence that genetics play a significant role in the development of schizophrenia. A more holistic approach, like the diathesis-stress model, recognises both biological predispositions and environmental influences, offering a more comprehensive understanding of the disorder.
HISTORICAL CONTEXT AND SOCIAL FACTORS
Fromm-Reichmann’s theory was developed within the psychoanalytic tradition, during a period when parental responsibility for psychological conditions was a dominant idea. At that time, understanding of schizophrenia and mental illnesses was limited, and her work reflected the psychoanalytic movement’s emphasis on early experiences and family dynamics. In contrast, modern approaches take into account broader socio-cultural factors such as poverty, stigma, and access to mental health care, which are now recognised as contributing to schizophrenia but were not fully addressed by Fromm-Reichmann’s model.
CHALLENGE OF FALSIFIABILITY
A major criticism of psychodynamic theory is its lack of falsifiability — a key requirement for scientific theories. If a therapist fails to uncover early childhood trauma or dysfunctional family dynamics in a patient, the theory often claims that these experiences are buried too deeply in the unconscious to be accessed. This circular reasoning makes the theory impossible to disprove, undermining its scientific credibility and making it difficult to validate through empirical research.
CONFLICTING APPROACHES: IDIOGRAPHIC VS. NOMOTHETIC
The psychodynamic approach encounters a methodological conflict between idiographic and nomothetic perspectives. Research and treatment often focus on individual case studies (idiographic), delving deeply into the unique experiences and personal histories of each patient. However, the overarching theories derived from these studies aim to establish broad, universal laws of behaviour (nomothetic), applying these findings to all individuals with schizophrenia. This inconsistency weakens the validity of psychodynamic explanations, as blending these two approaches without strong empirical evidence challenges the scientific integrity of the theory. An effective framework would require clear justification and data supporting the compatibility of both research methods.
CRITICISMS OF THE TREATMENT
PROBLEMS FORMING THERAPEUTIC RELATIONSHIPS WITH SCHIZOPHRENIC PATIENTS
One of the key issues in applying psychodynamic therapy to schizophrenia is the difficulty in forming close therapeutic relationships. Schizophrenic patients often experience disorganised thinking, hallucinations, and distorted perceptions of reality, making it challenging to establish the kind of interpersonal rapport required for psychodynamic therapy to be effective. Freud himself noted that the nature of psychotic disorders, such as schizophrenia, complicates the development of these therapeutic relationships, limiting the success of psychodynamic treatment compared to its application in disorders like depression.
RISK OF HARM FROM PSYCHODYNAMIC THERAPY
Psychodynamic therapy may be harmful to schizophrenic patients, particularly during acute episodes of the disorder. Critics argue that this form of therapy is too intense and intrusive for emotionally fragile individuals. Research suggests that such therapy can overwhelm patients and increase the likelihood of hospitalisation, making it counterproductive for those experiencing severe psychotic symptoms.
LIMITATIONS IN TESTING PSYCHODYNAMIC TREATMENTS
Evaluating the effectiveness of psychodynamic therapy for schizophrenia is difficult due to the nature of the treatment. Psychodynamic therapy focuses on unconscious processes and deep emotional conflicts, making it difficult to measure using standard empirical methods like randomised controlled trials (RCTs). This lack of empirical support reduces the credibility of psychodynamic therapy as an effective treatment for schizophrenia.
LIMITED ACCESSIBILITY AND FEASIBILITY
Psychodynamic therapy is often considered a treatment option for the wealthy due to its high cost and long-term nature. The therapy requires frequent sessions over an extended period, making it financially prohibitive for many patients. It is also rarely available within publicly funded health systems like the NHS, further limiting its accessibility. Additionally, the intense nature of psychodynamic therapy may not be suitable for individuals experiencing active psychotic symptoms, reducing its feasibility as a treatment option for schizophrenia.
LIMITATIONS IN TREATMENT APPROACH
Research indicates that multimodal treatments combining medication with psychological therapies such as Cognitive Behavioural Therapy (CBT) are more effective in treating schizophrenia than psychodynamic therapy alone. Psychodynamic approaches, which lack empirical support and do not address the biological aspects of schizophrenia, may be inadequate as standalone treatments. Modern interventions that integrate both biological and psychological components tend to yield better outcomes for patients.
ADVANCEMENTS IN UNDERSTANDING FAMILY DYNAMICS
Although Fromm-Reichmann’s theory focused heavily on dysfunctional family dynamics, modern approaches to schizophrenia treatment have shifted away from blaming family members. Family therapy and psychoeducation are now recognised as important components in treating schizophrenia, with a focus on improving communication and reducing stress within the family unit rather than pathologising family roles. These approaches reflect a more supportive, non-blaming framework, highlighting the limitations of Fromm-Reichmann’s emphasis on blaming family dynamics without offering practical solutions.
CONTRIBUTIONS TO UNDERSTANDING THE THERAPEUTIC RELATIONSHIP
Despite these criticisms, Fromm-Reichmann made valuable contributions to the understanding of therapeutic relationships in psychiatry. Her belief in treating schizophrenic patients as individuals, rather than as hopeless cases, challenged the pessimistic attitudes prevalent in her time. Her work laid the groundwork for more person-centred approaches in psychiatric care, although the specific psychodynamic methods she advocated may have been limited in their effectiveness
DOUBLE BIND THEORY
BERGER (1965)
DESCRIPTION OF THEORY
The Double Bind theory proposes that schizophrenia develops as a result of dysfunctional family communication rather than being caused by biological or genetic factors. Bateson and his colleagues coined the term "Double Bind" to describe situations in which children receive conflicting verbal and non-verbal messages from their parents. According to this theory, parents who communicate in contradictory ways predispose their children to schizophrenia by creating situations where the child is placed in a "no-win" scenario and is unable to respond appropriately.
HOW DOES A DOUBLE BIND CONTRIBUTE TO SCHIZOPHRENIA?
The theory suggests that when a child is repeatedly exposed to contradictory communications by influential family members during their formative years, it heightens their anxiety and causes emotional distress. As the child grows and becomes more aware of these double-bind situations, they are unable to understand or confront the inconsistencies. To escape this confusion and conflict, the child may develop delusional systems or experience hallucinations, which are characteristic symptoms of schizophrenia.
Exposure to double binds impairs the child’s ability to form an internally coherent view of reality. The conflicting messages lead to self-doubt and undermine the child’s sense of what is "real" versus "false." Furthermore, the lack of clear and consistent communication hinders the development of healthy relationships and self-awareness. Over time, these dysfunctional communication patterns can contribute to schizophrenia symptoms such as:
Delusions: The child may develop false beliefs as a coping strategy to reconcile the conflicting messages.
Hallucinations: The child may perceive things that are not there, as their grip on reality weakens.
Paranoia: Persistent feelings of being judged or punished can foster a sense of persecution and fear.
Ultimately, the Double Bind theory posits that the inability to resolve these conflicting messages and understand reality can lead to the development of schizophrenia, making it difficult for the individual to form stable interpersonal relationships.
WHAT CONSTITUTES A DOUBLE BIND?
A DOUBLE BIND occurs when a person is faced with two conflicting messages, creating a paradox that cannot be resolved. These contradictory messages can be:
BOTH VERBAL: e.g., spoken statements that contradict each other.
VERBAL AND NON-VERBAL: e.g., saying "I care about you" while displaying cold or hostile body language.
Unlike a simple "Catch-22," a double bind is more complex and involves the following conditions:
POWER DYNAMICS: The double bind must come from a powerful figure (e.g., a parent) imposing paradoxical demands on a less powerful person (e.g., a child), leading to helplessness.
CHILD’S PERCEPTION: The child experiences confusion, feeling disempowered and unable to understand or respond effectively to the situation.
HOW DEMANDS ARE IMPOSED: The conflicting demands are often subtle or implicit, making it hard for the child to address or understand them.
KEY FEATURES OF A DOUBLE BIND:
If the child takes a specific action, they are punished.
If they do not take the action, they are also punished.
If they attempt to point out the contradiction, they face further punishment.
The child cannot escape or leave the situation.
This leaves the child in a state of emotional and cognitive dissonance, unable to resolve or address the paradox, leading to self-doubt and confusion
DOUBLE BIND EXAMPLES
A classic example of a double bind is when a child is told by their mother, "I love you," but the mother's tone, facial expression, or body language conveys anger or disdain (e.g., a stern look or harsh voice). The child receives two opposing messages: one verbal ("I love you") and one non-verbal (anger). These conflicting signals leave the child unable to make sense of the communication, leading to confusion and self-doubt about their own understanding and perceptions of reality
Conflicting Affection: A mother complains that her son is not affectionate enough, but when he tries to hug her, she tells him that he is "too old" to show affection in this way. This conflicting demand—needing affection but rejecting its display—creates a no-win situation for the child.
Mixed Emotional Messages: A parent verbally expresses love, saying, "I care for you," but at the same time shakes their head in disgust or anger when the child makes a mistake. The verbal message is positive, but the non-verbal cues (tone, facial expression) convey disappointment or disapproval, leaving the child confused.
Punishment Framed as Love: A parent says, "I'm only smacking you because I love you." This statement frames physical punishment as an act of affection, causing the child to associate conflicting feelings of love and pain, creating emotional confusion.
Catch-22 Orders: A parent says, "I dare you to disobey me. You haven’t got the guts." This is a paradoxical order that simultaneously encourages and forbids disobedience. If the child disobeys, they face punishment; if they obey, they feel cowardly or weak.
No Escape Admissions: A mother tells her child, "If you admit you stole my money, I will beat you." If the child admits to stealing, they are hit; if they deny it or say nothing, they are also hit. This places the child in a situation where there is no way to avoid punishment, regardless of their response.
Conflicting Emotional Demands: A parent says, "Tell me how you really feel," but when the child opens up, the parent screams at them, accusing them of lying, being crazy, or being evil. The child is punished for expressing their feelings, making them reluctant to share in the future.
Contradictory Communication Promises: A parent demands that the child be "open" about their actions and then criticizes or verbally attacks them when they provide an explanation. Alternatively, if the child chooses not to explain (based on past criticism), the parent accuses them of being secretive or withdrawn.
No-Win Questions: These are questions designed to condemn the child no matter how they respond. For instance, "Have you stopped bullying your brother yet?" Whether the child answers "yes" or "no," they are condemned as either currently bullying or having done so previously. Other similar questions include, "Don't you love me?" or "Don't you want to be successful?" A "yes" answer leads to being criticized for failing to meet expectations, while a "no" answer leads to accusations of not caring or being inadequate.
Contradictory Expectations in Action: A child is given two conflicting instructions: if they follow one, they are chastised for not following the other. For example, a mother gives her son two shirts. To make her happy, he wears one to a family event. However, she becomes upset and asks, "Why didn't you wear the other one?" The child is left feeling that they cannot satisfy their parent’s expectations.
Inconsistent Statements Over Time: During a conversation, a parent makes two opposing statements. The child believes the parent has changed their mind and acts accordingly, only to be later criticized for not following the "original" instruction. This creates confusion and traps the child, making it difficult to know how to act or communicate effectively.
Religious Paradox: A common double bind within some religious teachings is, "God is love and unconditionally loving, but if you sin, you will go to hell." The message of unconditional love is contradicted by the threat of punishment for wrongdoing. If the child questions this inconsistency, they may be told they are sinful for doing so, furthering the conflict.
Being Genuine Paradox: A parent or authority figure instructs, "Be genuine." The more the child tries to "be genuine," the more they feel they are being inauthentic. Even the act of trying not to try is seen as another form of effort, creating a trap where the child can never truly "be themselves" without criticism or self-doubt.
Each of these examples highlights how double-bind communications place the child in a situation where they cannot respond correctly or resolve the conflict, which can lead to confusion, self-doubt, and emotional distress that the Double Bind theory suggests may contribute to the development of schizophrenia
RESEARCH STUDIES THAT SUPPORT DOUBLE BIND THEORY
For researchers to prove the Double Bind Theory, they must demonstrate that double-bind interactions occur more frequently in families with a schizophrenic member than in families without one. Proving that poor communication is a causal factor in schizophrenia is particularly challenging. Below is an outline of how researchers in this field conduct studies, followed by a detailed analysis of their methods and limitations.
HOW DO RESEARCHERS IN THIS FIELD CONDUCT RESEARCH?
Prospective Longitudinal Studies
Researchers follow a cohort of individuals or case studies over an extended period (often decades) to observe whether certain variables, such as family communication patterns, predict the onset of schizophrenia.Interviews and Observations of Families with a Diagnosed Schizophrenic Member
Interviews: Standard metrics such as the Communication Deviance Scale (CDS) or Bateson's own criteria for double-bind communication are used to assess family dynamics.
Observations: These are structured according to specific criteria, such as coding systems for verbal and non-verbal communication discrepancies, often focusing on parent-child interactions.
Retrospective Interviews with Schizophrenic Individuals and Their Relatives
Researchers conduct interviews with schizophrenics and their family members to recall and assess past communication patterns.
PROSPECTIVE LONGITUDINAL STUDIES
These studies track individuals over long periods to establish whether early-life communication patterns correlate with later development of schizophrenia. For instance:
GOLDSTEIN AND RODICK (1975):
Goldstein and Rodick studied adolescents with behavioural problems and their families over five years. Several adolescents developed schizophrenia or related disorders, and abnormal family communication predicted the onset of these conditions.
A03 EVALUATION: However, deviant communication was also found in families with manic disorders, suggesting that such patterns are not unique to schizophrenia, thereby limiting their application as a causal factor.
PROSPECTIVE STUDIES ANALYSIS
It is inherently difficult to prove that variables, particularly communication patterns, occurring 20 years earlier, could cause schizophrenia. Testing the Double Bind Theory using prospective studies faces significant challenges:
UNSCIENTIFIC RESEARCH METHODS Psychological theories like the Double Bind Theory face methodological limitations. To demonstrate that schizophrenia is purely caused by psychological factors, prospective longitudinal studies must be employed, but these are riddled with difficulties.
PARTICIPANT RECRUITMENT CHALLENGES Recruiting participants is one of the most significant obstacles. Families are often reluctant to partake in long-term, invasive studies. Transparency in research hypotheses can also lead to demand characteristics (where participants behave as they think is expected) and social desirability bias (where participants alter behaviour to appear more acceptable). For example, mothers may adjust their behaviour to avoid being blamed for their child’s condition.
CONTROL OVER FAMILY DYNAMICS Even when participants are willing, ensuring consistency across family variables—such as number of siblings, age gaps, income, religion, and the specific type of schizophrenia—adds another layer of complexity. Variations in these factors can skew results, making it difficult to attribute schizophrenia to communication patterns alone.
GENETIC PREDISPOSITION Ruling out genetics as a factor is crucial but difficult. Researchers need participants without a genetic predisposition to schizophrenia, which is rare. Schizophrenia occurs in only 1% of the general population, meaning studies would need to follow at least 3,000 participants to obtain 30 individuals who develop schizophrenia (1% of 3,000). Large-scale studies of this magnitude are time-consuming, costly, and resource-intensive, often requiring decades of observation.
RESEARCHER OBJECTIVITY AND VALIDITY OF BEHAVIOURS Another major issue is maintaining objectivity in interpreting observations. Accurately rating family interactions can be highly subjective, and practical constraints (e.g., limited budgets) often reduce the frequency and depth of observations, affecting data quality.
THE DOUBLE BIND ASSUMPTION The theory assumes that both schizophrenic individuals and their family members consistently communicate in double binds, even in the presence of researchers. However, Bateson (1969/1972) acknowledged that external observers may fail to understand the full context of interactions, leading to potential misinterpretations.
KLEBANOFF'S CRITICISM Klebanoff suggested that communication patterns linked to schizophrenia might be reasonable responses to unusual children, such as those with brain damage or intellectual impairments. In such cases, parental behaviour may be a reaction to the child’s needs, not the cause of schizophrenia.
OTHER INTERNAL VALIDITY ISSUES
Results from studies on family communication and schizophrenia can be confounded by various factors, including:
Hawthorne Effect: Participants may alter their behaviour simply because they know they are being observed.
Demand Characteristics: Families may act in ways they believe align with the researchers’ expectations.
Social Desirability Bias: Families might adjust their communication to seem more acceptable or less "blameworthy."
These factors reduce the internal validity of the studies and can lead to misleading conclusions about how families with schizophrenic members communicate.
INABILITY TO REPLICATE FINDINGS
A significant issue with the Double Bind Theory is the difficulty in replicating study results due to uncontrollable variables. Families have high individual differences, and the inability to standardise family dynamics leads to inconsistent findings, questioning the theory’s reliability.
SHIFT TO RETROSPECTIVE STUDIES
Given the difficulties of conducting prospective studies, researchers often turn to retrospective studies, which involve interviewing schizophrenic individuals and their families about their past communication patterns. Retrospective studies aim to uncover whether double-bind interactions occurred in these families, particularly focusing on the role of the primary caregiver, typically the mother, who is often seen as the source of such conflicting messages.
RETROSPECTIVE STUDIES
BLOTCHKY ET AL.
This study observed 15 families with a child enrolled in a short-term residential treatment programme. The findings revealed that mothers directed a significantly higher proportion of conflicting messages—where verbal content contradicted non-verbal cues—to the child with behavioural symptoms (71%) compared to other family members. Fathers did not exhibit this pattern, and mothers contributed more to the total conflicting messages within family interactions.
A03 EVALUATION: The study does not account for individual differences among the 15 family groups, limiting the understanding of how these varying dynamics might impact double-bind communication. Additionally, this study focuses more on behavioural symptoms rather than psychotic breakdowns, so its relevance to schizophrenia remains limited.
BERGER (1965)
Berger investigated family communication patterns retrospectively, using a questionnaire with 30 double-bind statements. Participants rated these statements on a four-point scale based on how frequently they recalled their mothers making such statements. The study included four groups: individuals diagnosed with schizophrenia and three comparison groups of non-schizophrenic individuals, including college students. The schizophrenic group reported a significantly higher incidence of double-bind statements compared to the college student group.
A03 EVALUATION: Although the schizophrenic group reported more double-bind statements, these differences were not significant when compared with other control groups who had medical or psychiatric conditions. The retrospective design raises concerns regarding recall bias, as schizophrenic patients may have distorted memories influenced by delusions or paranoia, limiting the reliability of the data.
BLUMENTHAL ET AL.
Blumenthal and colleagues examined communication discrepancies within families referred by schools for chronic emotional and behavioural disturbances. These communication patterns were compared to non-disturbed families during a five-minute discussion of family-related topics. It was found that mothers of disturbed families were more likely to exhibit conflicting messages between verbal and non-verbal cues, suggesting communication incongruence.
A03 EVALUATION: A potential confounding variable is that nearly half of the disturbed families were single-parent households, while all non-disturbed families were two-parent households. Single mothers may have had to play dual roles, contributing to inconsistencies in communication, which could unfairly bias the results toward blaming the mother for double-bind communication. Furthermore, this study focuses on emotional disturbance rather than psychosis, making its relevance to schizophrenia less clear.
BEAVERS, BLUMBERG, TIMKEN, AND WEINER (1965)
Beavers and colleagues studied the meta-communicative abilities of families with schizophrenic children. They found that mothers of schizophrenic children responded more evasively to interview questions and issued contradictory messages involving their children more frequently than mothers of non-schizophrenic children. This aligns with Bateson et al.'s concept that double-bind interactions impair the child's ability to interpret and discriminate messages.
A03 EVALUATION: These findings align with similar results from Wynn and Colleagues (1977), who found that parents of schizophrenic children tended to communicate in ambiguous or contradictory ways, reinforcing the idea that double-bind interactions play a role in the development of schizophrenia. However, the focus on mothers in these studies makes the theory particularly sensitive to gender bias, as the mother is often the primary caregiver and thus disproportionately blamed for the child’s schizophrenia.
CONTRADICTORY FINDINGS BY BEAKEL AND MEHRABIAN (1969)
In contrast to the studies mentioned above, Beakel and Mehrabian did not find significant differences between parents rated by clinical observers as having high levels of psychopathology and those rated as having lower levels of psychopathology when it came to double-bind statements. This challenges the universality of the Double Bind Theory as a predictor of schizophrenia and suggests that other factors, such as genetics, may play a more significant role in the development of psychotic disorders.
A03 EVALUATION: Some studies only included "problem families" or those already exhibiting dysfunction, which could bias the results and limit their generalisability. Excluding "non-problem" families means that the role of double-bind communication in the general population remains unclear. More diverse research is needed to fully understand the connection between family communication and schizophrenia.
ANALYSIS SPECIFIC TO RETROSPECTIVE STUDIES
RETROSPECTIVE RECALL ISSUES
Retrospective studies are often criticised due to the unreliability of the data they collect. Participants may struggle with memory recall, conceal uncomfortable details, or repress painful memories, especially from childhood. This creates a major issue, as researchers cannot verify the accuracy of these recollections, reducing the overall reliability of the findings.
Additionally, schizophrenic participants may not be reliable sources of information due to their condition. They may experience delusions or distorted memories, potentially recalling interactions as hostile or contradictory when this may not have been the case.
TIMING OF STUDIES AND FAMILY DYNAMICS
The nature of retrospective studies means that family dynamics are being observed long after the onset of schizophrenia. By this time, schizophrenia may have significantly altered family routines and behaviours, making it impossible to observe how the family functioned before the disorder emerged.
Impact on Family Dynamics: Living with someone who has schizophrenia can be distressing and disruptive for the entire family. This complicates the task of determining whether schizophrenia resulted from problematic family interactions or if the disorder itself caused changes in family behaviour. The "chicken and egg" problem remains unresolved, making it difficult to establish a direct causal relationship between family communication and schizophrenia.
OVERALL A03 EVALUATION
Many studies on family communication and schizophrenia place disproportionate blame on the mother, who is typically the primary caregiver. The idea that mother-child interactions cause schizophrenia lacks robust scientific support and does not account for why some children in the same family develop the disorder while others do not, or why some children exposed to similar environments remain unaffected.
SOCIAL SENSITIVITY AND GENDER BIAS
Theories like the Double Bind Theory are highly gender-biased and often unfairly place blame on mothers for their children's mental illnesses. Such theories contribute to a stigmatisation of mothers, perpetuating harmful stereotypes around caregiving and mental health without solid empirical backing.
BIOLOGICAL EXPLANATIONS AND MZ/DZ TWIN STUDIES
A critical limitation of the Double Bind Theory is its failure to account for the genetic basis of schizophrenia. Research consistently shows a strong genetic component, particularly through studies of monozygotic (MZ) and dizygotic (DZ) twins. MZ twins share 100% of their genes, and studies show a concordance rate of up to 50% for schizophrenia among MZ twins, while DZ twins, who share only 50% of their genes, show a concordance rate of around 15%. This stark difference strongly suggests that genetics play a substantial role in the disorder's development, undermining the idea that family communication alone can cause schizophrenia.
COUNTER-ARGUMENTS AND ALTERNATIVE EXPLANATIONS
The elevated risk for children of schizophrenic mothers may not stem from maternal behaviour alone. Genetic inheritance may play a significant role, with some genetic markers for schizophrenia being passed down more readily from the mother than the father.
Additionally, prenatal complications (e.g., birth trauma, infections, or stress) may contribute to a heightened risk of schizophrenia. These biological and environmental factors highlight the importance of considering multiple influences, rather than solely focusing on family communication patterns.
CRITIQUE OF OUTDATED THEORIES
The Double Bind Theory, like many psychological theories from earlier eras, is seen as speculative and outdated. More recent research focuses on well-supported factors such as genetics, trauma, and neglect as better explanations for schizophrenia. Studies on MZ and DZ twins strongly support the role of genetics, and more contemporary psychological models integrate both nature and nurture in understanding the disorder.
CURRENT CONSENSUS: NATURE AND NURTURE
The current consensus among researchers is that schizophrenia arises from a complex interaction between genetic vulnerability and environmental stressors, as outlined by the diathesis-stress model. While family dynamics, such as communication patterns, may play a role, they do not fully explain the disorder. A more comprehensive approach, which includes genetics and environmental triggers, provides a more complete understanding of schizophrenia.
In summary, while theories like the Double Bind Theory provide some insight into family dynamics, they are incomplete explanations that fail to consider the critical role of genetics in schizophrenia.
EXPRESSED EMOTION
A01 THEORY OF EXPRESSED EMOTION (EE)
Expressed Emotion theory (EE) was developed in the late 1970s.
Because proving psychological theories about the cause is problematic, researchers started looking at how families might contribute to the course of a schizophrenic’s illness rather than the cause of it. Therefore, this theory does not look at childhood or any past living conditions, rather it looks at how families affect the progression of the illness after treatment success. However, findings from EE can be extrapolated to theories about what causes schizophrenia as it shows that schizophrenia is affected by psychological factors such as hostile and critical communication. But be careful how you introduce this theory though and link to cause explicitly.
To understand the origins of the concept of “Expressed Emotion,” one has to go back to the 1950s for the influential research by George Brown. In 1956, George Brown joined the Social Psychiatry (MRCSP) Unit of London, which was established in 1948. When George Brown joined the MRCSP unit, the antipsychotic drug chlorpromazine was widely used to treat schizophrenia patients, which led to the discharge of long-stay patients after they became symptomatically stable and recovered functionally. However, many of these patients were to be readmitted soon after discharge due to symptom relapse. To understand the basis for the symptom relapse, a study was initiated by George Brown and his colleagues with 229 men discharged from psychiatric hospitals, 156 of them with a diagnosis of schizophrenia.
From the study, it was observed that the strongest link between relapse and readmission was the type of home to which patients were discharged. Surprisingly, the patients who were discharged from the hospital to stay with their parents or wives were more likely to relapse and need readmission than those who lived in lodgings or with their siblings. It was also found that patients staying with their mothers had a reduced risk of relapse and readmission if patients and/or their mothers went out to work. It suggested that relapse was probably due to the adverse influence of prolonged contact of patients with their family members.
Theoretically, then, a high level of EE in the home can worsen the prognosis in patients with Schizophrenia (Brown et al., 1962, 1972) or act as a potential risk factor for the development of psychiatric disease.
COMPONENTS OF EXPRESSED EMOTION
The five components of Expressed Emotion are
Critical Comments
Hostility
Emotional Over involvement
Warmth
Positive Regard.
High Expressed Emotion
Family members with highly expressed emotions are hostile, very critical and not tolerant of the patient. They feel like they are helping by having this attitude. They criticise not only behaviours relating to the disorder but also other behaviours that are unique to the patient's personality. High-expressed emotion is more likely to cause a relapse than low-expressed emotion.
HIGH EXPRESSED EMOTION
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, and the patient has trouble problem-solving in the family. The family believes that the cause of many of the family’s problems is the patient’s mental illness, whether they are or not.
EMOTIONAL OVER-INVOLVEMENT: Emotional over-involvement reflects a set of feelings and behaviours of a family member towards the patient, indicating evidence of over-protectiveness or self-sacrifice, excessive use of praise or blame, preconceptions and statements of attitude. Family members who show high emotional involvement tend to be more intrusive. Therefore, families with high emotional involvement may believe that patients cannot help themselves. Thus high involvement will lead to strategies of taking control and doing things for the patients. In addition, patients may feel very anxious and frustrated when interacting with family caregivers with high emotional involvement due to such high intrusiveness and emotional display towards them. Overall, families with high EE appear to be poorer communicators with their ill relatives as they might talk more and listen less effectively.
CRITICAL COMMENTS: Careful observations of direct communications between patients and caregivers prove that critical caregivers get involved in angry exchanges with the patient whom they seem unable to prevent or to step away from. These potentially lead to physical violence, and it is the nature of some families with high EE. Patients who are unable to get up in the morning, who fail to wash regularly, or who do not participate in household tasks are criticised for being lazy and selfish; unfortunately, in this context, the caregivers fail to understand that these could be potential manifestations of negative symptoms of schizophrenia or any other psychotic disorder. By contrast, low EE caregivers are more capable of recognizing aspects of the patient’s behaviour that manifest the illness. Examples: Family caregivers may express in an increased tone, tempo, and volume that the patient frustrates them, deliberately causes problems for them, family members feel the burden of the patient, living with him is harder, commenting that the patient is ignoring or not following their advice.
LOW EXPRESSED EMOTION: Low expressed emotion is when the family members are more reserved with their criticism. The family members feel that the patient doesn't have control over the disorder. When the family is more educated they are more likely to have low expressed emotion.
WARMTH: It is assessed based on kindness, concern, and empathy expressed by the caregiver while talking about the patient. It depends greatly on vocal qualities with smiling being a common accompaniment, which often conveys an empathic attitude by the relative. Warmth is a significant characteristic of the low EE family. Examples: Caregivers state that the patient tries to get along with everyone, he makes a lot of sense, he is easy to get along with, and it is good to have him around; the patient’s behaviour is appropriate since it is not his/her pre-morbid self.
POSITIVE REGARD: Positive regard comprises statements that express appreciation or support for the patient’s behaviour and verbal/nonverbal reinforcement by the caregiver. Examples: Family states that they feel very close to the patient, they appreciate the patient’s little efforts or initiation in his day-to-day functioning, they state that they can cope with the patient and enjoy being with him/her.
HOW DO YOU MEASURE EE?
Expressed emotion (EE), is a measure of the family environment that is based on how the relatives of a Schizophrenic patient spontaneously talk about the patient. It is a psychological term specifically applied to psychiatric patients.
Typically, it is determined whether a person or family has high-expressed emotion or low-expressed emotions through a taped interview known as the Camberwell Family Interview (CFI). Answers to questions and non-verbal cues are used to determine if someone has highly expressed emotion.
There is another measurement that is taken from the view of the patient. It rates the patient's perception of how his family feels about him and the disorder. If the patient feels that the parents are too protective or not caring the patient feels that his parents don't care about his independence or trust his judgement. This attitude may cause the patient to relapse, and patients who rate their parents poorly in this test have a harder time coping with their illness if too much time is spent with the parent.
An alternative measure of expressed emotion is the Five Minutes Speech Sample (FMSS), where the relatives are asked to talk about the patient for five uninterrupted minutes. Although this measure requires more training, it becomes a quicker assessment form than the former method.
A01 RESEARCH EXPRESSED EMOTION
It is well established that high family levels of Expressed Emotion are consistently associated with higher rates of relapse in patients with schizophrenia. The first study to undertake the EE measure and connect it to the course of schizophrenia was investigated by Brown et al., where the patients were followed up for nine months after they were discharged and sent to their home from the hospital. It was found that prolonged contact with patients with critical caregivers determines the relapse in schizophrenia.
Btzlaff and Hooley (1998) meta-analysis
Kavanagh reviewed 26 studies on EE and found that the mean relapse rate was 48% for patients residing with high EE families and 21% for those in low EE families.
A comprehensive analysis by Bebbington and Kuipers of data from 1,346 patients established the relationship between family caregiver’s EE and relapse, and also the protective factor of reduced face-to-face contact for patients in high EE families.
These studies have been supported by Linszen who found relapse to be four times more likely in high EE homes. This study suggests that a high level of emotion in the family environment plays a role in the SZ patients’ disorder becoming worse.
There is also support for this explanation from Vaughn and Leff who also found that the level of expressed emotion had an effect on relapse rates amongst discharged patients. However, they also studied the amount of face-to-face contact patients had with relatives after discharge, and they found an increase in relapse rates as face-to-face contact increased, and even more so with higher levels of expressed emotion. This study suggests that the more time an SZ patient spends with a family with high levels of EE the more likely they are to relapse.
Kalafi and Torabi (1996) studied expressed emotion within families in an Iranian culture. They found a higher prevalence of expressed emotion was one of the main causes of relapse, this suggests that a mixture of emotions from parents in the Iranian culture plays a role in the SZ patient relapsing.
A03: EVALUATION OF EXPRESSED EMOTION
There are several strengths to this theory. For example, there is a lot of supporting research conducted to make the theory more valid. The EE is a well-established “maintenance” model of SZ and many prospective studies have been conducted which support the EE hypothesis across many cultures, therefore the theory is also applicable cross-culturally.
The EE model has become widely accepted, and research is now focussing on relatives of those with SZ in order to understand better which aspects of high and low EE relate to relapse. For example, there is evidence to support that the family members do not display High EE when their relative displays positive symptoms such as hallucinations and delusions as they think these are part of their relative’s mental illness. They cannot control them through free will. On the other hand, there is also evidence that family members attribute negative symptoms, for example, social withdrawal, to the person’s personality characteristics, and it has been observed that they become over-critical in an attempt to change those behaviours. In other words, family members think negative symptoms are thought to be due to the free will of the schizophrenic. As a result, family members will display high EE to get their relatives to stop behaving with negative symptomology.
Which EE variable is the most damaging? Overall, it was concluded by Lopez that families characterised by negative affect (criticism) have much higher relapse rates in comparison to those with positive affect (warmth).
Another criticism of this theory in general, is that many patients with SZ are either estranged from their families or have minimal contact. Yet, there is no evidence that such people are less prone to relapse. Therefore it is unclear whether there is an impact.
What is not yet clear is exactly how to interpret the effects of EE. Is EE causal, or does it reflect a reaction to the patient’s behaviour? It should be remembered that relationships within the family work both ways and that there is some evidence that certain aspects of High EE behaviour are now associated with the abnormalities in the patient. For example, if the condition of a patient with schizophrenia begins to deteriorate, a family member’s concern and involvement might increase. Indeed disorganised or dangerous behaviour by the patient would warrant limit setting and other family efforts that could raise the level of EE.
There has also been an argument about whether the EE model is a cause or an effect of SZ. Indeed, it has been found that high EE is less common in the families of first-episode patients than in those of first-symptom patients. This suggests that High EE may well develop as a response to the burden of living with a Schizophrenic.
A03: ALL PSYCHOLOGICAL EXPLANATIONS
DETERMINISM VERSUS FREE WILL
All psychological theories are deterministic and suggest that you have no free will against developing or personally overcoming Schizophrenia. There are negative and positive aspects to this. On the negative side, parents will be blamed for causing Schizophrenia. Family and theories are unconstructive as they blame the parents and families for a child developing SZ. Suggesting that a parent has caused SZ is at least unhelpful and, at most, highly destructive, as they not only have to cope with living with someone with SZ but are then told that it is their fault, which will lead them to feel guilty and hurt as they are blamed for a poor upbringing.
On the positive side, your family may see it worthwhile in trying to change their behaviour and individuals will not be perceived to be at fault as their illness is a result of their upbringing. Matthijs Koopmans of City University in New York states: "There is a very persistent misconception that models connecting family processes to schizophrenic symptomatology in effect blame the parents for their children's ills, rather than recognising the potential of such models to empower parents and caretakers to modify their interactive patterns to better accommodate the identified patient, and perhaps even prevent dysfunctional patterns of interaction from occurring in the first place."
NATURE VERSUS NURTURE (DIATHESIS STRESS MODEL).
Psychological theories are nurture yet nurture cannot be the only answer as MZ twins have a 48% concordance rate and DZ twins have a 17% concordance rate. If it was purely psychological then MZ and same-sex DZ twins would have the same rate. This means nature must play a role too. Indeed, current thinking now believes that both nature and nurture play a role in the aetiology of Schizophrenia, e.g. that individuals are born with a genetic predisposition or biological trigger but may not develop the disorder unless they are exposed to an environmental or psychological trigger. These triggers can be Psychological factors that include disturbing family dynamics and stress. This is known as the Diathesis Stress Model (DSM). Tienari’s ‘Finnish adoption study’ supported the DSM as only children of schizophrenic mothers developed schizophrenia themselves if their adopted family was disturbed. Genes alone did not cause the illness. However, if there was a high genetic risk and it was combined with mystifying care during upbringing or abuse, the likelihood was greater. This suggests that genes can be implicated, but only if the family environment is of the kind that fulfils schizophrenic genetic potential.
ALTERNATIVE THEORY: The fact that some two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse is shown to be a major cause of the illness.
John Read (2004) collected 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see also Read's book, Models of Madness). A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest. Importantly, psychiatric patients or schizophrenics who report abuse are much more likely to experience hallucinations. Read believes the content of these often relates directly to the trauma suffered. At their simplest, they involve flashbacks to abusive events which have become generalised to the whole of their experience. For example, an incest survivor believed that her body was covered with sperm. The visual hallucinations or voices often scare and belittle the patients, just as their tormentors did in reality, creating a paranoid universe in which people/family/friends cannot be trusted.
JOINT A03 DEBATES: IS PSYCHOLOGY A SCIENCE? CLASSIFICATION ISSUES
Theories that are psychologically based have not gained much support, for they are considered to be less scientific, for example, poorly controlled studies, no controls, retrospective data, internally invalid, and not the same results when replicated.
Family studies are harder to conduct experimental procedures less possible because real-life/individual family dynamics are difficult to control. Cause and effect conclusions are not possible then; therefore, psychological research is often correlational.
What really clouds the validity and reliability of any of the psychological theories is the fact that many researchers (Bentall, 1990, Rosenhan) believe that Schizophrenia is an impossible illness to classify. Since 1911, when the illness was first described, there has been great controversy concerning what symptom and description should be used to define the illness. Indeed, DSM IVR and ICD 10 have different criteria for the diagnosis and classification of Schizophrenia. Moreover, the last few years have been particularly important in the evolving definition of Schizophrenia as the criteria for the illness have slimmed down considerably. Not only have two distant subtypes emerged, type one and type two (which incidentally have had psychologists arguing that two very different illnesses may exist and not one!), but the condition has many categories, e.g. Paranoid and Hebephrenic. If we cannot rely on what the ever-changing definition of schizophrenia is, then how can research test its prevalence? Especially research conducted in the 1960s when the definition bore little resemblance to what the illness translates to today.
