What you'll learn

• How family dysfunction may contribute to the development or maintenance of schizophrenia.
• How cognitive explanations link schizophrenia symptoms to problems in attention, reasoning and self-monitoring.
• How to apply these explanations to scenario questions.
• How to evaluate them using research evidence, causality issues, ethics and real-world applications.

Big picture: what counts as a psychological explanation?

A psychological explanation explains behaviour and experience in terms of mental processes, social experiences and learning, rather than purely biological factors such as genes, dopamine or brain structure.

For schizophrenia, psychological explanations do not usually claim that “bad parenting” or “faulty thinking” is the only cause. A better way to think about them is as risk factors or maintenance factors.

Schizophrenia includes positive symptoms, such as hallucinations and delusions, and negative symptoms, such as avolition and speech poverty. Psychological explanations mainly try to explain how unusual family environments or dysfunctional thought processing could contribute to these symptoms.

Family dysfunction

Family dysfunction refers to abnormal or unhealthy patterns of communication, emotion and relationships within a family. In schizophrenia, the main family-based explanations are:

• the schizophrenogenic mother
• double-bind theory
• expressed emotion

These are not equally accepted today. Some are historically important but ethically and scientifically problematic.

The schizophrenogenic mother

The idea of the schizophrenogenic mother was proposed by Fromm-Reichmann in 1948. She suggested that some mothers were cold, rejecting and controlling, while also being overprotective. This was argued to create a family climate of tension and mistrust, increasing the child’s risk of developing schizophrenia.

This explanation is rarely accepted as a serious cause today, but it is useful for understanding the history of psychological explanations.

Evaluation of the schizophrenogenic mother

A major weakness is that the explanation is socially sensitive. It appears to blame mothers for a severe mental disorder, which could increase guilt, stigma and family conflict. It is also gender-biased because it focuses blame on mothers rather than fathers, wider family systems or social stressors.

There is also little convincing evidence that this parenting style causes schizophrenia. Many people with schizophrenia have not had this kind of mother, and many people with difficult parents never develop schizophrenia.

Double-bind theory

Double-bind theory was proposed by Bateson et al. in 1956. A double bind occurs when a child receives contradictory messages from a caregiver but cannot comment on the contradiction or escape the situation.

For example, a parent might say “I love you” while using a cold or rejecting tone. If the child moves closer, the parent may reject them; if the child moves away, the parent may accuse them of being unloving. The child is “trapped” because whatever they do seems wrong.

Bateson et al. argued that repeated exposure to double binds could make it hard for a child to develop a coherent view of reality. This might contribute to symptoms such as paranoia, disorganised thinking or delusions.

Evaluation of double-bind theory

One strength is that the theory links quite clearly to symptoms: confusing communication could plausibly contribute to confusion, suspiciousness and difficulty interpreting others’ intentions.

However, evidence is mainly correlational. Families of people with schizophrenia may show unusual communication patterns, but this does not prove that the communication caused the disorder. The direction could be reversed: living with a person who has severe symptoms may make family communication more strained or contradictory.

Expressed emotion

Expressed emotion, often shortened to EE, is the level of negative emotion expressed by carers towards a person with schizophrenia. It is especially important as a maintenance explanation because it is linked to relapse.

High expressed emotion includes:

• criticism: frequent negative comments about the person’s behaviour
• hostility: treating the person as the problem, rather than seeing symptoms as part of an illness
• emotional over-involvement: excessive concern, self-sacrifice or overprotectiveness

Brown et al. in 1972 found that patients returning to families with high expressed emotion were more likely to relapse. Vaughn and Leff in 1976 also found that relapse rates were higher when patients had high contact with high-EE relatives.

This does not mean families are “to blame”. High EE may be a response to stress, fear, lack of support and poor understanding of the disorder.

AO3: evaluating family dysfunction explanations

Research support

There is good evidence that expressed emotion predicts relapse. This is useful because it has real-world applications: family therapy aims to reduce criticism, hostility and over-involvement, and it is associated with lower relapse rates when combined with drug therapy.

Tienari et al. in 2004 studied adopted children whose biological mothers had schizophrenia. They found that a disturbed adoptive family environment was linked to increased risk, but mainly in children with genetic vulnerability. This supports an interactionist view: family factors may matter most when biological risk is already present.

Causality problems

A major weakness is that much of the evidence is correlational. High expressed emotion and schizophrenia relapse may occur together, but this does not prove that high EE causes relapse. Symptoms may increase family stress, which then increases criticism or over-involvement.

Ethical issues

Research into family dysfunction is socially sensitive. Researchers must avoid increasing blame or stigma. When studying families and patients, ethical issues include informed consent, confidentiality, the right to withdraw, protection from psychological harm, and careful debriefing, especially because participants may be vulnerable.

Cognitive explanations

Cognitive explanations focus on faulty mental processes. Cognition means mental processes such as attention, perception, memory, reasoning and language.

In schizophrenia, cognitive explanations suggest that symptoms come from dysfunctional thought processing — abnormal ways of processing information.

Frith’s cognitive model

Frith in 1992 argued that schizophrenia involves problems in key cognitive systems, especially metarepresentation and central control.

Metarepresentation

Metarepresentation is the ability to reflect on your own thoughts and recognise them as yours. It also helps you understand other people’s intentions.

If metarepresentation is impaired, a person may misattribute their own inner speech to an external source. This could help explain auditory hallucinations, such as hearing voices. It may also help explain delusions of control, where a person believes their thoughts or actions are controlled by someone else.

Central control

Central control is the ability to suppress automatic responses and carry out deliberate actions. If central control is impaired, a person may struggle to organise thoughts and behaviour.

This could help explain disorganised speech, because the person may have difficulty controlling the flow of ideas and selecting relevant responses.

Other cognitive ideas: attention and reasoning biases

Some cognitive explanations focus on attention. If a person cannot filter out irrelevant information, they may feel overwhelmed by sensory input. This could contribute to confusion, paranoia or disorganised behaviour.

Other explanations focus on reasoning biases. For example, paranoid delusions may involve a tendency to jump to conclusions or to attribute negative events to external causes.

AO3: evaluating cognitive explanations

Research support

Stirling et al. in 2006 compared people with schizophrenia and a control group using cognitive tasks such as the Stroop test. People with schizophrenia took longer to name the ink colours, suggesting difficulty suppressing automatic processing. This supports the idea of impaired central control.

There is also evidence that people with schizophrenia show deficits in attention, memory and reasoning. This gives cognitive explanations scientific credibility because the proposed processes can be tested in controlled studies.

Explains symptoms in detail

A strength of cognitive explanations is that they explain the proximal mechanisms behind symptoms. A proximal mechanism is the immediate process that produces a symptom. For example, metarepresentation problems can explain why a person might experience their own thoughts as voices.

This is useful for treatment. Cognitive behavioural therapy for psychosis, often called CBTp, tries to help people evaluate unusual beliefs and reduce distress linked to hallucinations or delusions.

But cause and effect are unclear

A weakness is that cognitive deficits may be a consequence of schizophrenia rather than a cause. For example, hallucinations, medication, stress or long-term hospitalisation could affect performance on cognitive tasks.

Also, cognitive explanations are better at explaining some symptoms than others. They are especially useful for hallucinations, delusions and disorganised speech, but less complete for negative symptoms such as avolition.

Methodological and ethical issues

Cognitive studies often use lab tasks, which allow good control over variables. However, these tasks may lack ecological validity because naming ink colours or completing memory tests is not the same as coping with real-life psychotic symptoms.

Ethically, researchers must consider protection from harm because cognitive tasks may be frustrating or distressing for participants. Confidentiality is also crucial because a diagnosis of schizophrenia can carry stigma.

Comparing the two explanations

Family dysfunction explanations focus on the person’s social environment, especially communication and emotional climate. Cognitive explanations focus on the person’s internal mental processing.

They can work together. For example, a person with cognitive vulnerability may misinterpret criticism as threatening, while a high-EE family environment may increase stress and relapse risk. This fits the broader diathesis-stress model, where biological or psychological vulnerability interacts with environmental stress.