Although early schizophrenia researchers such as Bleuler and Kraepelin insisted that schizophrenia is, at its core, a disease caused by biological factors, many others believed that schizophrenia was caused by the family. Today, we know that no family can, by itself, “cause” schizophrenia. Research suggests, however, that the family environment does play an important role in a patient’s treatment. Some families may have qualities that increase the likelihood that a patient will relapse and experience another schizophrenic episode.
In the early 1900s, psychologists created the term “schizophrenigenic mother” to describe the cold, distant mothers of patients with schizophrenia. Before we had a good understanding of how the brain works, many therapists blamed family members for their schizophrenic children. This must have caused family members extreme stress. Not only did they have to live with a psychotic child, but also they had to suffer the guilt of being seen as the cause of the illness.
When schizophrenia patients leave the hospital and return to their homes, some fare better than others. Researchers became interested in figuring out why some patients relapse whereas others do not. Clinicians and researchers believed that there might be qualities of the family that protect the patient from relapse and other qualities that increase the likelihood that the patient will experience another episode.
As previously mentioned, a family’s communication deviance - vague and confusing speech - is a risk factor in schizophrenia. Another measure of the communication of family members is called expressed emotion. Expressed emotion, or EE, is a measure of the negative communication directed at a patient by family members. EE consists of three parts: criticism, hostility, and emotional overinvolvement. A family member who expresses criticism is expressing disapproval or dislike of the patient. Hostility is a more extreme form of criticism that involves a rejection of the patient. Emotional overinvolvement involves dramatic, overconcerned behaviors directed toward the patient. For example, when questioned about her schizophrenic son, an emotionally overinvolved mother might respond, “When he spends all day in bed, I just feel terrible. I
wish he knew how hard it was on me. Sometimes I lock him out of his room when he gets up to go to the bathroom. I just have to force him to get out and do something.” Not only does this mother emphasize how her son’s illness makes her feel, but also she forcibly locks him out of his room. In 1998, Ron Butzlaff and Jill Hooley at Harvard University found that patients living in a high EE home environment were more than twice as likely to relapse in the first year following a hospitalization compared with patients returning to a low EE home. The good news is that EE can be lowered with family therapy. When EE levels are lowered, relapse rates are reduced.
Why might the way a family communicates affect a patient’s recovery? Current understanding suggests that high EE or communication deviance creates a stressful environment for schizophrenic patients. When we are stressed, a substance called cortisol is released in the brain. Cortisol has been found to trigger dopamine activity and to affect glutamate release.
According to this theory, a stressful environment can directly affect the chemicals in the brain that are implicated in schizophrenic symptoms.
Schizophrenia is found at all socioeconomic levels. The lower the socioeconomic level, however, the more likely you are to find someone with schizophrenia. The sociogenic hypothesis holds that because living in poverty is more stressful, one’s risk for developing schizophrenia is increased. One can imagine that relative to a mother with more resources, an impoverished pregnant woman is less likely to receive adequate prenatal care, is more likely to be exposed to viruses, and is more likely to experience a complicated delivery. All three of these are risk factors of schizophrenia. Alternatively, the social drift hypothesis, also known as “downward drift,” suggests that people with schizophrenia drift down the socioeconomic ladder because of their social and occupational impairment. So which is true? Research shows that more cases of schizophrenia develop in families of lower socioeconomic status, but patients also drift downward because of their illness. Thus, both the sociogenic and the social drift hypotheses correctly predict schizophrenia.
Some of the risk factors of schizophrenia include a family history of schizophrenia, qualities of the prenatal environment, and family communication patterns. The next section discusses how clinicians treat schizophrenia.
Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.