the theories including familial theoris of schizophrenia, social theories, stress vulnerability model and social labelling theory

1. BY
FATHIMA HASANATH K P
2nd MPHIL PSW

2.  Double-bind communication (Bateson, Haley and Weakland): It is a no-win kind of
communication. It emphasize on giving the child incomplete messages. The theory
hypothesized that repeated exposure to such dilemma generates or aggravates the
schizophrenic state. If a child subjected to this kind of communication over a long period of
time, it is easy to see how he could become confused.
 Schism and skew (Ruth Lide and Weakland): psychoanalytic oriented psychodynamic
perspective. In schism, there is a prominent power struggle between the parents and one
parent gets overly close to a child of the opposite sex. In skewed family, skewed
relationship with one parent involves a power struggle between the parents and the
resulting dominance of one parent.

3.  Pseudo-mutuality and pseudo-hostility (Lyman Wynne and Margaret Singer): emotional
expression in the families is suppressed by the consistent use of pseudo mutual or pseudo
hostile verbal communication. This suppression results in the development of verbal
communication that is unique to the family and not necessarily comprehensible to anyone
outside the family. problems arise when the child leaves home and has relate to other
people.
 Family interaction Pattern: Schizophrenic families communicate with less clarity and
accuracy than do normal families.
a. Communication deviance: the parent is unable to establish and maintain a shared focus
of attention during transaction with the child.

4. b. Affective climate: the climate and emotional interchange at the surface of the
family represents a sharp contrast with what goes on emotionally in depth.
c. Schizophrenogenic mothers: Characterised as rejecting, dominating, cold, over
protective, and impervious to the feelings and needs of others. thus the child is
deprived of a clear cut sense of his own identity, distorting, his views of himself
and his world and causing him to suffer from pervasive feelings of inadequacy and
helplessness.
d. Schizophrenogenic fathers: Inadequate, indifferent and passive father who
appears detached and humourless; a man who rivals the spouse in his
insensitivity to other’s feelings and needs. Often appears to be rejecting towards
his son and seductive towards his daughter. The daughter often develops severe
inner conflicts as she feels an incestuous attachment to her father.

5.  Family expressed emotion (George Brown): Expressed emotion (EE) refers to care giver's attitude
towards a person with a mental disorder as reflected by comments about the patient made to an
interviewer. That high family levels of EE are consistently associated with higher rates of relapse in
patients with schizophrenia.
a. Critical comments: Family caregiver may express in an increased tone, tempo, and volume that
patient frustrates them, deliberately causes problems for them, family members feel burden of
patient, living with him is harder, commenting that patient is ignoring or not following their advices.
b. Hostility: Caregivers state that patient causing problems for them, wishing to live away from the
patient, shouting at the patient, easily getting angry and getting irritation, patient can control
himself, he is acting.
c. Emotional over-involvement: Caregivers blame themselves for everything, feeling like everything is
their fault; showing pity, not allowing the patient to carry out his day-to-day activities, neglecting self,
giving less important personal needs rather than patient needs.

6.  Proposed by Dohrenwend and colleagues in 1992 demonstrated the social causation
and social selection mechanisms of the relationship between poverty and mental
illness.
a. Sociogenic/ social causation hypothesis: situational factors associated with low social
class contributes to schizophrenia.
b. Social selection/drift hypothesis: people living with mental illness drift into poverty
during the course of their lives, due to disability, reduced economic productivity,
increased stigma, increased health expenditure caused by their illness.

7.  Proposed by Scheff in 1966 in his book “Being mentally ill: a sociological theory”.
He mentioned two types of deviances;
1. Primary deviance: in contrast to the violation of explicit rules, which Scheff
attributes to the actions of criminals or delinquents, psychopathology that
violate implicit behaviours as referred to as primary deviance. It can lead an
individual to be diagnosed with a mental disorder.
2. Secondary deviance: Society members reaction to the diagnostic label produce
what Scheff called secondary deviance. It is the additional pathology or
behavioural disturbances that can cause or worsen mental illness.

8.  Thus the symptoms of schizophrenia are seen as deviation from norms.
 Therefore those who display unusual behaviour are considered deviant,
the label may be a self-fulfilling prophecy.
 Self fulfilling prophecy: it is a process through which an originally false
expectation leads to its own confirmation. An individuals expectation
about another person or entity eventually result in the other person or
entity acting in a way that confirms the expectations.

9.  Also known as vulnerability-stress model.
 Stress-diathesis model combines both biological and ecological factors to explain the
manifestation of mental disorders and it is one of the most significant models to
understand the development of psychopathology.
 In this model, the degree of vulnerability to a given psychiatric episode is determined by
each person’s tolerance to traumatic or stressful life events.
 Both patients and caregivers are involved in a system of mutual influence in which each
contributes to the stress that acts on the intrinsic vulnerabilities of the other; this
perspective emphasizes upon interactions between vulnerability and stress variables.

10.  A purely psychosocial explanation of schizophrenia is unlikely.
Nevertheless they appear to play an important role in the course of
schizophrenia illness at least in understanding its duration, severity,
course and prognosis.

11.  Amaresha, A. C., & Venkatasubramanian, G. (2012). Expressed emotion in
schizophrenia: an overview. Indian journal of psychological
medicine, 34(1), 12-20.
 Kumar, P., & Tiwari, S. C. (2008). Family and psychopathology: an
overview series-1: children and adults. Delhi Psychiatry Journal, 11(2),
140-149.