Paradigms of Schizophrenia

Psychodynamic

Freud, the founder of the psychodynamic theory asserted that the Psychodynamic theory did not explain the disease very well and really does not seem to have a place using subsequent treatments. According to the psychodynamic approach, schizophrenia is the result of the id taking over the ego with its primitive sexual and aggressive drives (Nevid, 2011). During the disease, the person retreats back to the early stages of development in which the Id is most dominant. In particular, the paradigm maintains that the person is trapped within the early period of the oral stage present in infants. It is within this stage the infant has not yet learned that that world is distinct from itself (Nevid, 2011). The id is preoccupied with the self, and the superego with the outside world, and the ego mediates between the two, ensuring that the person experiences reality and its place in it rationally. Given that that Schizophrenia causes the breakdown in function in the ego, the id is in a sense allowed to run amok. The person detaches from reality causing “fantasies to become mistaken for reality” presenting hallucinations and delusions (Nevid, 2011).

Proponents of the theory attribute the disease to a poor relationship with the mother early on in childhood. They maintain that tumultuous relationships that cause anxiety prompt the child to retreat into their own fantasy world (Nevid, 2011). From there, a “vicious cycle ensues: the more the child withdraws, the less opportunity there is to develop a sense of trust in others and the social skills necessary to establish intimacy. This cycle continues until young adulthood. Then faced with increasing demands at school or work and in intimate relationship, the person becomes overwhelmed with anxiety and withdraws completely into a world of fantasy” (Nevid, 2011). As the book also states, psychoanalysts have been unable to show this hypothesis is true, in fact recent studies suggest that this hypothesis is false.

Learning

This paradigm readily admits that it does not provide a full explanation of the disease of schizophrenia. The paradigm believes that schizophrenic behavior is a result of individuals being reinforced for bizarre behaviors rather than normal behaviors (Nevid, 2011). It relies on classic conditioning and observational learning as avenues for explaining these reinforced bizarre behaviors. Constant reinforcement of the individual behaviors characteristic of schizophrenia will result in what we see when we look at the disease on the whole.

Some learning therapists even go as far to say that individuals who have developed schizophrenia obtained the behaviors from have modeling themselves after other schizophrenics they have come in contact with, and were reinforced for this new displayed behavior. These clinicians, also known as Social-Cognitive therapists, claim this is most likely to happen in mental hospitals (Nevid, 2011).

Biological Perspectives

Many clinicians are looking more towards the biological perspectives to really enlighten this still not very well explained disease of Schizophrenia. The genetic, and biochemical explanations are providing the best science and breakthrough of the disease.

  • Genetic Factors: An individual is tenfold more likely to have schizophrenia if a first-degree family member has the disease; in fact the closer the relationship the greater the chance of having schizophrenia. Longitudinal twin studies, lend strong support towards the genetic inheritance of the disease. There is a 48% concordance rate between identical twins and a 17% concordance rate between fraternal twins. This suggests that there is something about schizophrenia that may be a result of genetic factors.  With both of these studies, we should be weary of environmental factors. Families and especially twins often share the same living environment. But the high concordance percentage cannot solely be explained by environmental factors (Nevid, 2011).
  • Biochemical: The current leading biochemical model is the Dopamine Hypothesis (Nevid, 2011). The Dopamine Hypothesis rests on the idea that schizophrenia is a result of an over-activity of the neurotransmitter dopamine in the brain. Anti-psychotic drugs are the best evidence for this theory. Anti-psychotic drugs, also known a Neuroleptics, block dopamine receptors in the brain. In doing so, it reduces the amount of dopamine activity in the brain (Nevid, 2011). Neuroleptic drugs work, leading to the conclusion that Schizophrenia is in someway affect by dopamine levels in the brain. Neuropletic drugs include Thorazine, Mellaril, and Prolixin.
  • Brain Abnormalities: Brain images have found there are some structural differences in the brain of schizophrenics and their normal counterparts. Schizophrenics show enlarged fluid filled ventricles in the brain and a smaller hippocampus in comparison. Clinicians have also found a loss of brain tissue in the schizophrenic brains of about 5% (Nevid, 2011). The loss of brain tissue seems to be concentrated in the abnormal ventricles. Clinicians have also found both loss of brain tissue and abnormal functioning in the prefrontal cortex (Nevid, 2011). This explains some of the underlying characteristics of schizophrenia, namely “memory, learning, reason, and attention” (Nevid, 2011). Whether this is a result of the schizophrenia or causes the schizophrenia is unknown at this point, but clinicians do believe that there may be several forms of schizophrenia all with individual causes; prompted by the fact that not all forms of schizophrenia have structural brain tissue (Nevid, 2011). But Brian abnormalities do go a long way in explaining many of the underlying elements of the disease.

Family Theories

Family theories hinge on the diathesis-stress model, and it also subscribes to the idea that there is a genetic predisposition to the disease. Family theorist maintain that a nurturing, caring family can help prevent relapses by decrease the number of episode, or prevent or prolong the occurrence of schizophrenia for vulnerable family members. With communication Deviance, family members, and particularly parents, communication with the schizophrenic is offensively verbal rather than constructive. The often speak for the individual rather than let the individual formulate their own thoughts (Nevid, 2011). Expressed Emotion is when family members respond to the schizophrenic in an unsupportive or hostile manner. Family members that participate in these behaviors tend to also show less tolerance or empathy for the schizophrenics situation. In families who show either high levels of Communication Deviance or Expressed Emotion, the schizophrenic could engage in schizophrenic episodes more often, or is put at greater risk for developing the disease (Nevid, 2011). Evidence shows that families with low levels of expressed emotions and communication deviance can act as a “buffer” to the external stress that can cause schizophrenics to relapse, or to develop the disease entirely.

Bibliography

Nevid, J. S., Rathus, S. A., & Greene, B. (2011). Abnormal psychology in a changing world. (eighth ed.). Upper Saddle River: Prentice Hall.

Karagianis, J., Novick, D., Pecenak, J., Haro, J. M., Dossenbach, M., Treuer, T., Montgomery, W., Walton, R. and Lowry, A. J. (2009), Worldwide-Schizophrenia Outpatient Health Outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients. International Journal of Clinical Practice, 63: 1578–1588. doi: 10.1111/j.1742-1241.2009.02191.x

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