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Wednesday, November 11, 2009

Psychology in Fiction Q&A: Schizophrenic Families

Disclaimer: The information provided in this post is intended for writing purposes only and does not represent psychological advice.
QUESTION: What would a sibling of a person with schizophrenia function like? What are the traits of a schizophrenic family bind that I used to hear about?
ANSWER: Because schizophrenia is a biological disease, siblings of people with schizophrenia are 10 times more likely to develop the disorder than other people;  they are also at greater risk for schizophrenic spectrum disorders like schizotypal personality disorder and schizoaffective disorder.  In other words, some siblings may have schizophrenia-like tendencies of their own, even if they don't have the full-blown disorder.

Double-bind theory is Gregory Bateman's 1950's-era proposition that what causes schizophrenia is repeated no-win dilemmas in the child's family life.  In other words, the child was repeatedly confronted with statements that contained two contradictory statements (i.e. a double bind).  Because of the child's attachment to the caregiver, he was eager to do as the caregiver asked -- the problem was that by meeting one demand, he would be defying the other.  Because he was presented with such double binds on a regular basis, and because he doesn't have the cognitive maturity to know how to choose one statement over the other to escape the double bind, he eventually escapes from the extraordinary stress the double bind causes by retreating from the "real world" and into psychosis (i.e. delusions and hallucinations).

Double-bind theory has fallen out of favor with regards to schizophrenia for two reasons.  First, we have so much data that demonstrates a biological cause for schizophrenia, not an environmental one (though typically the biological tendency is triggered by environmental stressors).  Second, double-bind theory is nearly impossible to test, so there is little empirical research that can support it.

There is research, however, to support the idea that a problematic family environment can contribute to the relapse of someone who's been treated for schizophrenia. Most notably, people with schizophrenia are likely to relapse when their family is high in expressed emotion (EE).  Expressed emotion consists of three parts: criticism, hostility, and emotional overinvolvement.

People with schizophrenia are extremely sensitive to stress, and being treated with constant dislike, disapproval, rejection, disrespect, and the assumption that they are not capable human beings is enough to stress anyone out!

So even if the siblings in your story don't have schizophrenic tendencies themselves, you could make them somewhat critical and hostile people who show a lot of expressed emotion toward their brother or sister!

Hope that's helpful!

Remember, if YOU have a psychology in fiction question you want to see answered here, use the Q&A form on the Archetype site (note in the "extra information" area that you'd like to see the question answered on the QueryTracker Blog) or send me an email at c k a u f m a n (AT) querytracker (DOT) net. (Take out the spaces in the first word and please use Q&A in your Subject Line!).


5 comments:

Suzette Saxton said...

I LOVE it when you do these posts, Carolyn. Not only do they help me with my writing, they are interesting in relationship to life in general!

Kristi said...

As a clinical psychologist, I've seen hundreds of people with schizophrenia and many of them fit into the stress-diathesis model you discuss here. They had a genetic predisposition, or vulnerability, to the disorder (e.g. had relatives with schizophrenia), but didn't display symptoms of it themselves until experiencing a stressful event or events (e.g. ongoing abuse, starting college, etc.)

Great post! You wouldn't believe how many people out there still think schizophrenia means the person has multiple personalities, so education like this is so important.

Carolyn Kaufman said...

Thank you both for your comments! Kristi, I always appreciate the input of other psychologists...it helps keep me honest, and sometimes they emphasize a point I didn't talk about very specifically or explicitly (like the stress-diathesis model -- your brief definition is a great addition to this post!)

Philangelus said...

Carolyn, since genetics are a component, is it possible that a parent with the genetic predisposition to schizophrenia suffers from compromised parenting anyhow, resulting in double-bind situations? Then the child, who's already predisposed genetically, finds himself resorting to delusion and hallucination?

I have relatives whose mother has schizophrenia, and I've witnessed the pain in their lives because of her illness. Thank you for addressing this.

Carolyn Kaufman said...

Philangelus -- Yes, certainly a parent with schizophrenia (or even milder distorted behaviors like schizotypal personality) can have compromised parenting skills. If her behaviors create stressful and confusing situations for her children, the disorder is more likely to be triggered in them if they also have the genetic predisposition.

Just as a side note, schizophrenia can develop in people who don't have relatives with the disorder. Many researchers believe that if brain development is compromised in certain ways during the second trimester, this also creates a predisposition to the disorder at the biological/genetic level.