14.3 PUTTING IT...together

Psychological and Sociocultural Models Lag Behind

Schizophrenia—a bizarre and frightening disorder—was studied intensively throughout the twentieth century. Only since the discovery of antipsychotic drugs, however, have clinicians acquired any practical insight into its course and causes. Theories abounded before that time, but they typically failed to find empirical support and, in fact, contributed to inaccurate stereotyping of people with schizophrenia and their parents.

As they do with most other psychological disorders, clinical theorists now believe that schizophrenia is probably caused by a combination of factors, though researchers have been far more successful in identifying the biological influences than the psychological and sociocultural ones. While biological investigations have closed in on specific genes, abnormalities in brain biochemistry and structure, and even viral infections, most of the psychological and sociocultural research has been able to cite only general factors, such as the roles of family conflict and diagnostic labeling. Clearly, researchers must identify psychological and sociocultural factors with greater precision if we are to gain a full understanding of schizophrenia. The exciting progress now being made in the biological study of schizophrenia is impressive, but it must not blind us to the significant gaps, uncertainties, and confusions that continue to obscure our view.

CLINICAL CHOICES

Now that you’ve read about schizophrenia, try the interactive case study for this chapter. See if you are able to identify Randy’s symptoms and suggest a diagnosis based on his symptoms. What kind of treatment would be most effective for Randy? Go to LaunchPad to access Clinical Choices.

SUMMING UP

  • THE CLINICAL PICTURE OF SCHIZOPHRENIA Schizophrenia is a disorder in which personal, social, and occupational functioning deteriorate as a result of disturbed thought processes, distorted perceptions, unusual emotions, and motor abnormalities. Approximately 1 percent of the world’s population suffers from this disorder. pp. 466–469

  • SYMPTOMS OF SCHIZOPHRENIA The symptoms of schizophrenia fall into three groupings. Positive symptoms include delusions, certain formal thought disorders, hallucinations and other disturbances in perception and attention, and inappropriate affect. Negative symptoms include poverty of speech, restricted affect, loss of volition, and social withdrawal. Schizophrenia may also include psychomotor symptoms, collectively called catatonia in their extreme form. Schizophrenia usually emerges during late adolescence or early adulthood and tends to progress through three phases: prodromal, active, and residual. pp. 469–476

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  • DIAGNOSING SCHIZOPHRENIA DSM-5 calls for a diagnosis of schizophrenia after symptoms of the disorder continue for six months or more. This diagnosis also requires that people have active symptoms for at least one of those months and show a deterioration from previous levels of functioning. Type I schizophrenia is often distinguished from Type II schizophrenia. Patients with the former type seem to be dominated by positive symptoms, and those with the latter type seem to display more negative ones. p. 476

  • BIOLOGICAL EXPLANATIONS The biological explanations of schizophrenia point to genetic, biochemical, structural, and viral causes. The genetic view is supported by studies of relatives, twins, adoptees, and genetic linkage, and by molecular biology. The leading biochemical explanation holds that the brains of people with schizophrenia, particularly those with largely positive symptoms, may contain an unusually large number of dopamine receptors, especially D-2 receptors, leading to excessive dopamine activity. Brain-imaging techniques have also detected abnormal brain structures in many people with schizophrenia, particularly those with a number of negative symptoms, including enlarged ventricles and abnormal blood flow in certain parts of the brain. Finally, some researchers believe that schizophrenia is related to a virus that settles in the fetus and perhaps lies quiet until adolescence or young adulthood. pp. 477–483

  • PSYCHOLOGICAL EXPLANATIONS The leading psychological explanations for schizophrenia come from the psychodynamic, behavioral, and cognitive models. In influential psychodynamic explanations, Freud theorized that schizophrenia involves regression to a state of primary narcissism and efforts to restore ego control, and Fromm-Reichmann proposed that schizophrenogenic mothers help produce schizophrenia. Contemporary psychodynamic theorists, however, ascribe the disorder to a combination of biological and psychodynamic factors. Behaviorists suggest that people with schizophrenia fail to learn to attend to appropriate social cues. And cognitive theorists contend that when people with schizophrenia try to understand their strange biological sensations, they develop delusional thinking. None of these theories have received compelling research support. pp. 483–485

  • SOCIOCULTURAL EXPLANATIONS One sociocultural explanation holds that multicultural differences may influence the prevalence and character of schizophrenia, as well as recovery from this disorder, both within the United States and around the world. Another sociocultural explanation says that society expects people who are labeled as having schizophrenia to behave in certain ways and that these expectations actually lead to further symptoms. Other sociocultural theorists point to family dysfunctioning—including such interactions as double-bind communications—as a cause of schizophrenia. Such specific family features have not been implicated by research, although general family stress and conflict have repeatedly been linked to schizophrenia. Finally, the theorist R. D. Laing has presented schizophrenia as a constructive process by which people try to cure themselves of the confusion and unhappiness caused by their society and family. pp. 485–490

BETWEEN THE LINES

In Their Words

“No great genius was ever without some tincture of madness.”

Aristotle

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