Clinical Schizophrenia: Etiology and preventive measures.

1. Created by: Bidisha Haque

3. Based on its available literature one can formulate
the aetiology of Scizophrenia under the broad
headings of
 Genetic.
 Biological.
 Psychological and
 Psychosocial and cultural.

4. A person’s first exposure to the influences of
culture occurs in the family.His personality unfolds
over the years of infancy through childhood till
adolescence as the consequence of the ongoing
transaction between his parents and also those
others who relate with him.

5.  A significant number of schizophrenic patients
have spent their childhood in seriously disturbed
family groups in which both parents were found to
have personality disturbances.
 In their study, Lidz, Fleck and Cornelison (1965)
found that two-thirds of the families contained one
schizophrenic parent. Such families were full of
conflicts and were described by the author as un-
integrated.

6.  In India poor social support and poor family
support system has been found to be associated
with this disorder.
 In the families of schizophrenia children mostly
experience abandonment or rejection, which leads
to absence of identity and the person, does not find
his own existence in reality.
 In a study Sathyavathi(1977) found that female
schizophrenic patients perceived their mother as
resentful , whereas male schizophrenic perceived
their mother as co-operative, considerate, warm
and friendly. But both showed father as loving.

8.  A Schizophrenogenic mother’s cold and aloof
behavior was the root cause of schizophrenia and was
influential in many clinical circles (Fromm- Reichman,
1948).
 DOUBLE-BIND HYPOTHESIS (Bateson, 1959, 1960)
When the parent presents the child with ideas,
feelings and demands that are mutually
incompatible, the child tends to withdraw into a
psychotic state to escape the unsolvable confusion of
the double bind.
 An example of a double bind is the parent who tells
the child to provide cookies for his or her friends and
then chastises the child for giving away too many
cookies to playmates.

10.  Theodore Lidz(1965) described two abnormal
patterns of family behavior:
 In one family type, with a prominent schism
between the parents, one parent is overly close to a
child of the opposite gender.
 In the other family type, a skewed relationship
between a child and one parent involves a power
struggle between the parents and the resulting
dominance of one parent.
These dynamics stress the tenuous adaptive
capacity of the schizophrenic person.

11.  As described by Lyman Wynne, some families suppress
emotional expression by consistently using pseudo
mutual or pseudo hostile verbal communication.
 Pseudomutuality and pseudohostility are family myths,
that deviation from fixed expectations is dangerous. The
shared dread and avoidance of intrafamilial conflict or
separation generates the façade of harmony of
pseudomutuality; the fear of intimacy and closeness
generates the persistent bickering (without genuine
separation) of pseudohostility.
 In such families, a unique verbal communication develops,
and when a child leaves home and must relate to other
persons, problems may arise. The child's verbal
communication may be incomprehensible to outsiders.

13.  The expressed emotion (EE) is considered to be an
adverse family environment, which includes the
quality of interaction patterns and nature of family
relationships among the family caregivers and
patients of schizophrenia and other psychiatric
disorders. Influence of EE has been found to be one
of the robust predictors of relapse in schizophrenia.
 In a study, conducted by George Brown(1956), it was
observed that the strongest link with relapse and
readmission was the type of home to which patients
were discharged. The patients who discharged from
hospital to stay with their parents or wives were more
likely to get relapse and needed readmission than
those who lived in lodgings or with their siblings.It
was also found that patients staying with their
mothers had reduced risk of relapse and readmission
if patients and/or their mother went out to work.

14. The Learning Theories
 according to learning theorists, children
who later become schizophrenic learn
irrational reactions and ways of thinking by
imitating parents who have their own
significant emotional problems.
 The poor interpersonal relationships of
persons with schizophrenia develop
because of poor models for learning during
childhood.

15.  However, today things are very different. Theories
that were popular 40 years ago have found for lack of
empirical support –like the idea that schizophrenia
was caused by destructive parental interactions (Lidz
et.al., 1965).
 Modern studies suggest that disturbances and conflict
in families that include an individual with
schizophrenia (Hirsch and Leff, 1975) may well be
caused by having a severely ill and psychotic person in
the family.
 Current thinking is that these amorphous and
fragmented communications may actually reflect
genetic susceptibility to schizophrenia on the part of
the relative (Hooley and Hiller, 2001).

16. Based on a social approach, in 1960, Laing and
his colleagues had proposed a theory of
schizophrenia and opined that social tensions,
exploitations, and estrangement of a divided and
oppressive society may be responsible for this.
Some of the different aspects of such cases are
as follows:
 Social disorganization
 Social isolation
 Social class

17. Social disorganization
 This theory assumes that chaos created by
social changes or disruption causes
psychopathology. Thus unstable communities
foster more schizophrenic children than
stable ones.
 For example, using high crime rate, poverty
level, cultural confusion, and absence of
religious values as indices of social
disintegration, Leighton et al (1963) reported
a considerably higher percentage of
individuals with psychopathology in socially
more disorganized regions.

19.  Limitation: One basic limitation of these
theories is that causalities could not be
separated distinctively. Some theorists,
like Roman and Rice (1967) proposed
that disorganized societies do not
influence psychopathology directly;
rather it is the family’s outlook that in
turn influences personality of an
individual.

20. Social isolation
 Faris suggested that being rejected or
restricted from contacts with persons
outside the individual’s family leads to the
‘shut in’ personality pattern of
schizophrenia (Faris, 1969).
 Enforced social isolation like that of induced
sensory deprivations likely to land to
schizophrenic breakdown.
 However, Kohn and Clausen (1955) considered
social isolation as a symptom rather than a
cause of schizophrenia and emphasized the
concept of one’s predisposition to
schizophrenia.

22. Social class
 Schizophrenia is over-represented among people of lower
social class. In Chicago, Hollingshead and Redlich (1958)
found both the incidence and the prevalence of
schizophrenia to be the highest in the lowest socio-
economic groups. This can also be a consequence of
schizophrenia.
 Goldberg and Morrison (1963) found that people with
schizophrenia were of lower social status than their fathers
as they had changed status after the onset of the illness.
 However, Castle et al. (1993) found that, compared with
controls, patients with schizophrenia were more likely to
have been born into socially deprived households.
 Some have pointed out that child rearing practices may
predispose lower class children to more intense stress.

23.  Culture helps shaping its members beliefs,
attitudes and thinking. In psychoses
numerous culture-bound and unique
syndromes have been described by
researchers.
 The delusional content in schizophrenics has
been reported to be significantly different in
varying cultures.
 Some examples are briefly described below:

24.  A unique behavioral pathology related to
scizophrenia, “koro” or “suo-yang” occurs only in
South East Asia, and Chinese people believe that Koro
is due to an excess of what they call “yin” or “the
female factor” and must be treated with “yang” or
“the male factor".
 In some places of india, similar symptom is termed
“jhinjhinia”. These anxiety states resemble what
psychoanalysts call “castration anxiety”, commonly
seen in west.
 In rural population of india, preponderance of
hallucinatory themes of magic and religion are noted,
particularly in less educated females (Sharma and
Agnihotri, 1986).

25.  Indian patients have shown some specificity in symptom
manifestation compared to patients of other cultures. For
examples, delusions of bodily control and being poisoned
were reported to be more common in Indian patients than
those of the western culture (Kala and Wig, 1982).
 “Amok” is characterized by withdrawal and passive, gentle
behavior followed by excited rage, occurs among Malayans
and in some parts of Africa. Schizophrenic symptoms in some
African societies contain mythological contents in delusions.
 Irish-American people having schizophrenia were reported to
be less hostile and more subdued than their Italian-American
counterparts. Similar ethnic diversity in symptoms was
reported between Japanese raised in Japan and Japanese
descendants in Hawaii.

26.  According to a study by Faris and Dunham
(1939) on mental ill people in Chicago,
schizophrenics were over-represented in the
disadvantaged inner city areas. This distribution
has been confirmed in other cities, and it has
been suggested that unsatisfactory living
conditions can cause schizophrenia.
 However, recent data suggest that
schizophrenia is associated with place of birth
and upbringing, findings which cannot be
explained as a consequence of illness.
Specifically, population-based studies in several
countries show that urban birth is associated
with an increased risk of schizophrenia.

27.  According to Pedersen and Mortensen,
2001, larger cities carry a higher odds ratio
than small towns or suburban areas.
 The cause of the association remains
unclear, and may relate to social
deprivation, migration, infections, stress, or
interactions between genetic vulnerability
and urban environments (Peen and Dekker,
2004).
 Being raised in an urban environment
seems to increase a person’s risk of
developing schizophrenia as studied by
Pedersen and Mortensen (2001). However,
what is so problematic about urban living is
still unknown.

28.  High rates of schizophrenia have been reported
among migrants. In a study, Norwegians who had
migrated to Minnesota, Odegaard (1932) found that
the inception rate for schizophrenia was twice that
of Norwegians living in Norway.
 ‘Social selection’ and ‘Social causation’ may both
contribute to an excess of schizophrenia among
migrants.
 A meta-analysis of 18 studies has confirmed that
migration is a risk factor for schizophrenia, and that
this can not be explained solely by selection
(Cantor-Grae and Selten, 2005).