23 Mar 2015
Schizophrenia is a serious psychopathological condition resulting in severe disruption in rational thinking, emotional expression and interpersonal behaviour. It was originally identified as dementia praecox by Kraepelin (1896) who believed that the typical symptoms of delusions, hallucinations and attention deficits were due to mental deterioration originating in adolescence. Bleuler (1911) believed schizophrenia was different from Kraepelin's classification, it did not necessarily result in the deterioration of the mind and the disease could begin at any age. Bleuler coined the term schizophrenia (meaning split mind), with the belief that any thoughts in the mind are detached from an emotional or cognitive process. There are numerous debates about how schizophrenia develops. Some researchers have looked into how biological factors could be responsible for this illness, Lieberman, Kinon & Loebel, (1990) proposed the Dopamine Hypothesis. This theory suggests sensitivity to the neurotransmitter Dopamine may cause unusual behaviour often associated with schizophrenia. Genetic explanations, utilising family studies uncovered that the risk of developing schizophrenia increases as the genetic relationship between relatives gets closer (Kendler, Karkowski-Shuman & Walsh, 1996). Twin studies carried out on both (the identical and fraternal twins) have also given an indication on how the genetic factors give rise to the development of schizophrenia (Torrey, 1992). Children who are born by schizophrenic mothers yet reared from early infancy by adoptive parents with no schizophrenic history were often diagnosed with schizophrenia in adulthood (Heston, 1966). This seems to suggest the strong role of the gene in the formation of schizophrenia, yet these results do not consider the emotional and psychological effects that may occur from the initial separation of the biological mother. Genetic and biological factors i.e. the roles of inheritance and brain activity in the development of this illness have been identified as among the causes (Rosenthal, 1970; Heston, 1966). However the influence of environmental and sociological factors must be considered with relevance. This essay will explore these factors and the possible consequence in the development of schizophrenia. Initiating with the casual effects of stress, it will examine the role of child abuse as a contributing factor, the possible effects of post-traumatic stress and an underprivileged and financially deprived environment in to schizophrenia development will be explored.
Tienari, Wynne, Moring, & Lahti, (1994) investigated the role of the environment in the formation of schizophrenia on adopted children who were presumed to acquire the genetic traits. Their results suggested a significant increase in schizophrenic development if the environment was chaotic and unstable, supporting the notion that stress is an important factor in schizophrenic development. Studies to identify the importance of stress in the development of schizophrenia with the belief traumatic emotional events that occur generate a state of psychological stress, resulting in the individual regressing to an earlier stage of emotional development (Brown & Birley, 1970). Individuals adopt specific coping mechanisms for dealing with emotional stress and accumulation a possible trigger in psychosis development. An increase in negative life events occurred in the weeks prior to a schizophrenic episode (Finlay-Jones & Brown, 1981).
Schizotypal individuals may not encounter more daily stress within their lives but may react to these stressors with greater ease (Walker, Mittal, & Tessner, 2008). Many individuals are known to experience trauma during their lives, yet without developing schizophrenic symptoms. This seems to suggest that although stressful life experiences may trigger the disease, but only for those who are genetically endowed with the traits.
The notion that "class" differences affect the way individuals dealt with stress was developed by Kohn (1976). The author argued that financially poor individuals experience more difficulty in dealing with stress than their middle class counterparts. The Diathesis-Stress Model (Zubin & Spring, 1977) is a commonly applied model for the interaction of stress. This model suggests that any mental disorder is a combination of a predisposition towards the mental disorder (diathesis) combined with negative environmental events (i.e. causing stress) or certain positive life changing events (winning the lottery) which may trigger schizophrenia in vulnerable individuals. Individual differences account for a variance in the stress levels required to produce the disorder.
Attempts have been made to explore how the psychosocial stress during pregnancy affects foetal development and create the vulnerability of the mental disorder for the inborn (Grace & Moore, 1998). Findings have been limited, there are no direct psychological or neuroendocrine measures of stress and are based on events that are assumed to be stressful for the entire population with minimal consideration for individual differences. Child abuse (sexual, physical or neglect) has compelling evidence suggesting this may lead to a psychiatric disorder, which is believed to progress to an increased risk of mental health problems during adulthood (Boney-McCoy & Finkelhor, 1996). Hallucinations, which is a symptom of schizophrenia is associated with a history of childhood traumas (Hammersley, Dias, Todd, Bowen-Jones, Reilly, & Bentall, 2003). Post-traumatic stress and personality disorders may develop as a reaction to sustained trauma, with hallucinations as a symptom (Stampfer, 1990). Young individuals, who have suffered psychological trauma i.e. sexual abuse, have been identified with similar brain dysfunction/structural abnormalities that are recognized in adult schizophrenic patients (Read, Agar, Argyle, & Aderhold, 2003). However, it is unclear if these structural changes are the consequences of exposure to the trauma or they have developed as a complication following trauma.
Morrison (2001) developed an integrated model of trauma and psychoses, with the notion that traumatic experiences enhance defective self and social knowledge. This is believed to result in culturally unacceptable interpretations, which are maintained by cognitive, behavioural, emotional and psychological responses within their environment. In addition to looking at an individual's stress tolerance level, theorists have proposed that families may influence schizotypal personalities. The double -bind theory (Bateson, Jackson, Haley & Weakland, 1956) suggests that weak communication within families whilst demonstrating negative feelings and intrusiveness (expressed emotion) may result in later life with communication deviance that is consistent with a diagnosis of schizophrenia. However, this parental conduct may be a reaction to the difficult behaviour the children already exhibit.
Laing (1967) proposed that society lacks sympathetic understanding towards non-conformity resulting in individuals attempting to struggle towards an understanding of their self - being, that exacerbates symptoms of schizophrenia. Empirical evidence to substantiate this concept is weak. Modrow (1992) believed once conforming to social behaviour had failed the label of being a schizophrenic was assigned to the individual. This social label has a negative effect not only on how other individuals within society viewed them but also how they viewed themselves. The natural environment is a major influence in child development according to Bronfenbrenner (1979). Consisting of several systems ranging from immediate family settings through to media, neighbours etc. Each of the systems interacts in a way which influences the individual's development. An environment lacking positive communication (a manner to establish shared meaning or focus) may result in an individual receiving minimal support from surrounding societies with diminished relationship interaction, causing a progressive withdrawal from society and reality, a main characteristic of schizophrenia.
Rowe (1994) proposed the non - shared environmental influences were a major contribution to personality development, i.e. siblings may not be treated in the same manner by their parents, first born infants who are not treated the same as their later born siblings can result in different personalities, The largest area of research relating to family issues has concentrated on the relationship between expressed emotion and relapse. Expressed emotion considers hostility, criticism and emotional over involvement within a family, although not considered to be a cause of the disorder it may hasten the first episode.
The UCLA Family Project was a 15 year study which aimed to establish evidence that expressed emotion was predictive of schizophrenia (Goldstein, 1987). The findings discovered families with high expressed emotion (i.e. negative comments, rejection and poor emotional display) initiated an occurrence of schizophrenia. These findings have not yet concluded that family emotions cause schizophrenia as a suffering individual may disrupt the family life and create these problems (Woo, Goldstein & Neuchterlein, 1997).
Desolate individuals, with alienated friends and family, or poor support network would normally experience difficulty coping on their own.
This is believed to cause social dysfunction which then contributes to a poor quality of life, increasing the chance of developing the mental illness. A lack of social skills and non-conformity to society increases the chance of schizophrenic development being unable to develop a long - term relationship and establish a household which results in social withdrawal (Nimgaonkar, 1998).
The sociogenic hypothesis and the social selection or downward social drift theory has attempted to explain the correlation between the socioeconomic class and schizophrenia (Eaton, 1980). The sociogenic hypothesis suggests that stressors involved with living in an underprivileged and impoverished environment may contribute to schizophrenia development. The social selection theory (Eaton, 1980) proposes that as the illness develops the individual experiences difficulty in coping with his/her job and this in turn creates the risk of low income forcing the individual to move into a deprived neighbourhood. Meanwhile, this theory is problematic on the basis that it fails to put into account those individuals who already have poor socioeconomic backgrounds and have focused only on certain individuals who may have established a reasonable socioeconomic status. There is some empirical evidence to support both explanations (Castle, Scott, Wessely, & Murray, 1993).
Numerous countries including United Kingdom and United States have discovered the highest rate of schizophrenia is found in urban areas i.e. town/cities that are inhabited by the lowest socioeconomic status (Kohn, 1968; & Eaton, Kramer & Anthony, 1989). Urban environments can be more stressful places to live compared to rural environments which may be an influential factor (Peen & Dekker, 1997). However with the current economic climate, jobs within the countryside are reducing in numbers, forcing individuals to look further afield for work, future incomes leading to an increase in stress intensity. Psychiatric admission rates increased during economic recessions, (Brenner, 1973).
According to Pedersen & Mortensen (2001) the length of time spent living in an urban environment increases the risk of developing schizophrenia. The New Haven study by Hollingshead & Redlich, (1958) discovered that the poorest class of people i.e. those in unskilled professions with poor educational backgrounds were more likely to be diagnosed as schizophrenic than their educated and wealthy counterparts. This prompted Eaton (1980) to describe the relationship between schizophrenia and poverty as "one of the most consistent findings in the field of psychiatric epidemiology" (Eaton, 1980, p. 150 - 151)
Individuals who migrated to the United Kingdom have been found to develop a higher rate of schizophrenia than individuals in their own native countries (Cochrane & Bal, 1987). Assimilating a new culture and social pressure of trying to adapt to an unfamiliar environment will not be without its stresses and may contribute to these results. Recent research (Zolkowska, Cantor-Graae, McNeil, 2001) proposed the stressors specific to migration are unrelated to schizophrenia development, with mental illness rates increasing in second generation descendants than the individuals who migrated.
Attempts to investigate links between prenatal environment and exposure to nutritional deprivation, infection and chemical contact with relation to schizotypal development were proposed by Susser, Neugebauer & Hoek (1996). Their data discovered the possibility of developing schizophrenia doubled when nutrient deprivation occurred during early gestation, but caution should be exercised when interpreting these results as the use of natural environment conditions did not allow control of the trial resulting into individual's exposure to famine varying (i.e. extra rations through the black market). Prenatal infections such as rubella and influenza might contribute to schizophrenia development during adulthood (Crow, 1978). Lead (toxic agent) has been associated with juvenile delinquency and impaired attention (Stiles & Bellinger, 1993) and presumed to be a potential risk in prenatal schizophrenic development (Cory-Slechta, 1995). Research into individuals' exposure to disasters, such as earth quake, volcano, and tsunamis may offer some insight on schizophrenia development on the prenatal environment. However research in this area has been jeopardised as a result of the limited sample size and general ethics.
The stigma attached to a mental illness is a major challenge for an individual to overcome with incorrect myths enhancing negative attitudes from other individuals within the society (Farina, 1998). Being stereotyped as "mentally ill" can enhance the chances of physical abuse. For example 47% of the 778 service users diagnosed with a mental illness, had encountered either a physical attack including dog faeces pushed through letter boxes and/or verbal abuse including being called a "nutter" (Read & Baker, 1996). The media's misrepresentation of mental illness is believed to have contributed to the negative views of the society towards the schizophrenic population. Any individual subjected to harassment is likely to be reluctant in seeking support and treatment, in turn leading the individual into a downward spiral with a reduction of adherence to their treatment. Research conducted by Henry, Hippel, & Shapiro, (2010) concluded individuals whose mental illness is exposed within their community will result in deficient social skills.
Recognition of the effects of stigma has developed into understanding and exploring of strategies for how it can be reduced (Pinfold, Toulmin, Thornicroft, Huxley, Farmer, & Graham, 2003). However certain countries through the effect of war, poverty, political conflicts and religious beliefs are only recently able to identify the existence of mental illness e.g. certain areas of Sri Lanka still maintain an individual showing psychosis has been possessed by witch craft.
To conclude, this essay has given a detailed account of how schizophrenia is believed to be caused by both the sociological and environmental factors, such as the consequences of child abuse, post - traumatic stress and poor lifestyles. Scientists are generally in agreement that schizophrenia is caused by a multitude of factors rather than a single one. Studies have supported genetic and biological influence, yet adoptive studies have uncovered children with an inherited vulnerability to the illness has a greater chance of expressing schizophrenic episodes if they are exposed to a stressful environment. Current research has deflected from direct environmental factors i.e. social skills, poverty and concentrated towards identifying a single causation i.e. brain abnormalities. This may be due to the sensitive topics involved, funding, politics and/or the human race rationalising the disorder with a biological perspective to justify and make sense of the illness.
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