December 11, 2007

Schizophrenia: Psychological and Social Causes and Treatments

As we've reported in the past, research is revealing the specific aspects of family and environmental stressors that interact continually over time with a biologically predisposed brain to eventually trigger schizophrenia.

Related to this topic, Researcher William McFarlane, M.D., a Maine Medical Center-based researcher we've mentioned before, was recently awarded the APA/American Psychiatric Foundation 2007 Alexander Gralnick Award for Research in Schizophrenia. After receiving the award, Dr. McFarlane presented a lecture, titled "Biosocial Treatment of Schizophrenia". In his lecture Dr. McFarlane made some interesting points on the subject of the development and outcomes in schizophrenia. Some of his points are very relevant to past findings on the causes, preventative actions, and treatments for schizophrenia we've covered before. Here's a summary:

Dr. McFarlane discussed the fact that it is now known that schizophrenia is a disorder that develops overtime as a result of genetic / biological and environmental factors. So for example, if a child already has increased genetic risk due to a family history of schizophrenia and/or other mental illnesses, certain environmental stressors (such as a home environment that is frequently highly emotional, or judgemental), combine with these genetic susceptibilities and result in the development of mental disorders.

One important point that Dr. McFarlane stressed was that:

"a decade's worth of research on microcomponents of environmental stress affirms the genetic nature of schizophrenia and does nothing to revive long-discredited theories blaming families or "schizophrenogenic" mothers.

Time and again research has shown that family and environmental stressors — encompassing very subtle interactions common to many families — work only in tandem with biological determinants to produce psychosis [and schizophrenia]."

Dr. McFarlane discussed that even until recently, environmental triggers were thought of as discrete events (for example, extreme stress due to a single event such as a loss of a mother, or extreme abuse), however current research demonstrates that some environmental triggers are continuous. (An example of a "continuous" environmental trigger might be again, a family environment where there is frequent highly emotion levels, high anxiety and conflict (or judgment and pressure) and therefore significant levels of stress in the home).

Dr. McFarlane further explained that continuous triggers can combine with inherent susceptibilities to mental disorders and result in the development and then worsening of prognosis after development of mental disorders. A model Dr. McFarlane used, that he believes does a good job of explaining this relationship, is that of a helix; that is, the cause and effect are closely entwined.

Of all the biologically determined psychosocial sensitivities believed to contribute to the development of schizophrenia and psychosis, the most subtle are negative emotional experiences.

It is especially the family with high "expressed emotion" for which there is the most research studies and data. High expressed emotion refers to the rejection, criticism, and anxious over-involvement that can occur between children and parents and other family members. It isn't that anyone is to "blame" for this - its simply that sometimes there is a negative dynamic between parent and child that causes a great deal of stress. Its important for parents to try to avoid these situations or minimize them.

As Dr. McFarlane says, some people predisposed to schizophrenia or just developing "symptoms seem to elicit certain kinds of rejecting or anxious responses, which in themselves elicit more symptoms," ... "Who do you blame? It's really a no-fault situation—the family is doing something, but they are only responding to the disorder. The negativity is reciprocal."

The key message here is that the psychological and social environment affects the biology of a person and vice-versa, so that both are in constant, continual interaction. This idea brings up the issue of less controllable versus more controllable factors of a mental disorder.

For example, the genetic vulnerability to a mental disorder isn't controllable, but certain environmental factors are: One of the most widely examined continual environmental triggers of mental illness and as mentioned above is the frequent experience of a highly emotional environment. In an attempt to combat this problem, researchers have studied preventative methods and found that adopting the growth, mindset approach is one way to effectively control stress factors in the environment. (Stress is known to increase the likelihood of the development of mental disorders.)

Dr. McFarlane also emphasized the importance of psychoeducation, stating that psychoeducational "...groups are designed to empower family members with information about the disease and the kind of social interactions that can exacerbate symptoms in the affected family member...In highly structured sessions, multifamily groups are taught specific strategies for lowering anxiety, conflict, and expressed emotion."

Read the full Article: Psychosocial Interventions Beneficial in Schizophrenia. (Psychiatric News)

Related Reading:

How to Prevent Schizophrenia - Strategies and Tactics

Is Schizophrenia Psychological Or Biological?

Schizophrenia: The Value of Realizing Risk Factors Before Becoming a Parent

Social Stress Factors in the Development of Schizophrenia: A Review of Recent Findings

Child and Teen Brains Very Sensitive to Stress, Likely a Key Factor in Mental Illness

A Healthy Family Social Environment May Reduce Schizophrenia Risk by 86% for High Genetic Risk Groups

How Stress in Early in Life Changes Stress Response for Many Years Afterward


My understanding has been that schizophrenia has a genetic component and can be triggered by environmental stress...that’s why my wife and I are taking a proactive approach with our son and trying to ensure he isn't exposed to high amounts of environmental stress...that seems to be my doctors view as well, when my wife asked her if my son was likely to develop schizophrenia from me.

Posted by: heywood at December 12, 2007 05:10 AM

Adversity in the lives of our generation is what made us strong and capable human beings. It is what enabled us to handle the stress of adulthood. To be the men and women we are today.

What will happen to a generation of children that we keep home so they will not be bullied, or we let do whatever they want so they will not be stressed? How do we stop the gandmomma from dying? How do we prevent the child from breaking a leg?

There must be something very wrong already with a child who breaks when all others get strong.

Posted by: Rich at December 13, 2007 07:23 AM

Not to worry Rich, it is not so psychological. Many get these illnesses and they are strong healthy individuals with food family. It is brain illness. They write books. Two in English are The Center Cannot Hold: My Journey Through Madness by Saks and also I think I Scared Her: Growing up with Psychosis by Katz. Both strong normal people very loved and they got this illness and wrote.

Posted by: Br at December 13, 2007 08:37 AM

Hi Rich,

I talk with many scientists each month about schizophrenia and I think that neuroscience and schizophrenia researchers (and child development specialists like Dr. Carol Dweck) would say the following to you, regarding your comments.

Adversity doesn't make us stronger - if that was true, the poorest and most deprived families in America would rise to the top of the academic and economic mountain each generation - instead, the opposite tends to happen. But some people who do encounter great adversity end up succeeding anyway - that is the key question to ask - and it is precisely what the researchers have asked, and answered.

What is important, say the reseachers is:

1. A positive mindset (or view) of failure, mistakes and difficulties - that it is part of life and a learning experience and persistence that is important for overcoming of adversity (and perhaps more importantly the lack of judgment from parents and teachers if a child fails - so the child doesn't become afraid of making a mistake or experiencing a "failure"). The best "Mindset" or perspective to take on life, researchers now say, is to encourage children to look at every mistake or setback or failure as simply a learning experience - and the important thing to encourage in children is to keep trying. mental activity and effort makes a child's brain stronger. It is not the adversity it self, or even the process of succeeding over adversity that makes people stronger. It is the mindset that mistakes are opportunities for learning and future success.

If any person is pushed into ongoing adversity and stress and they are not taught or not able to get themselves out of that adversity (whether that adversity is stress in the school or stress in the home) the person could eventually suffer significant stress and (new research shows) brain damage from the stress hormones that are released into the brain. Research shows that if parents and teachers are able to teach children positive coping skills for stressful situations (see the "mindset" information above) they will have a lower risk of mental illness.

Your second question was "What will happen to our next generation of children if we keep them at home...". No researchers are suggesting that parents keep their children at home. What psychiatric researchers are suggesting is that parents spend a lot of time nurturing in children a positive and non-judgmental, non-critical environment at home and help teach children the skills of persistence and dedication (without punishing them for failure or difficulties) so that they learn to persist in the face of difficulties. Children (especially children who have family members who are mentally ill, and who are therefore known to be more sensitive to stress) need to be taught that persisting in the face of adversity is a growth experience, and that failure is simply a learning experience along the way that everyone goes though - it is not a permanent label.

What science is telling us is that because of genetics and biology (e.g. nutritional environment in the womb before birth) some children are more sensitive to stress. Because of this, if we want these children to live normal healthy lives, we need to put extra effort into making the home a low stress and nurturing environment, and also put extra effort into teaching children in a non-judgemental, positive and gentle way how to learn from mistakes and difficulties.

You're absolutely right that children who develop mental illness have "something wrong" with them already - and what scientific research has shown is that they have a genetic and biological sensitivity to stress and ongoing stressful situations - that is why learning how to teach children a positive approach to adversity is so important. I encourage you to read Carol Dweck's research we have linked to in the above story. Just because a child and the rest of the family members have an increased sensitivity to stress doesn't mean that they have to get a mental illness or schizophrenia - read the research links above, and you can read about how a healthy, positive family environment can reduce risk of schizophrenia in these children by up to 86%! This is really good news for families - because recent scientific research suggests that there are things that we can do to lower the risk of future generations getting schizophrenia.

Posted by: SzAdministrator at December 13, 2007 10:02 AM

Rich don't confuse healthy stressors with traumatic stress, my son is a black belt in ju-jitsu , my wife and I consider it healthy to promote competitive spirit etc he loves it, as apposed to traumatic stress caused by hardship such as broken and abusive homes , which is unhealthy stress.

Posted by: heywood at December 13, 2007 12:02 PM

If it is biology and brain damage why is this listed under a psychological type problem. brain damage is brain damage. we had a good home but my brother got it so now i am thinking maybe he was sexually abused. He says no, but could the brain damage maybe made him forget.

The other 14% still sick even with no home problems, maybe they don't really have schizophrenia, maybe it is something else?

Posted by: lang at December 13, 2007 05:09 PM

Rich, I am schizophrenic, but I also became a law enforcement officer. I was really good! I could be trusted to handle weapons by my psychiatrist because I was committed to taking my medicine. I was just like any of the other ordinary officers (I even weighed a lot). Rich, eventually there will be side-effect free medicine and/or a cure for schizophrenia. Is it the fault of the Alzheimer's patient that they say and do weird things? Remember, schizophrenia was once known as dementia praecox, i.e. premature dementia. The medicine removes a lot of the dementia, so much so that you realize you have to continue taking the drug. I realized that and was able to accomplish great things.

Posted by: hmmned at December 14, 2007 03:25 PM

I find that talking about stress in relationship to triggering schizophrenia is perhaps a little vague. Could there possibly be certain types of stress that could trigger a breakdown, rather than just pointing the finger at stress itself ? The German judge Daniel Paul Schreber broke down when he was 52 years old, after being appointed to the highest office of the magistrature in the country. Often breakdown occurs in situations where the individual is at an important passage of his/her existence : getting ready to leave home for the first time, having a child, etc. This is not just any type of stress.
I also think it is rather naïve to imagine that by telling yourself and your children that you love them, by being uncritical, you are controlling a situation that is much more complex than what you consciously perceive of it. And what about that extremely negative and naïve word, "blame" ? Are we so childish and infantile that we are looking at this problem in terms of "whose fault it is" ? Where will that get us, patients, care-givers, families ?

Posted by: Debbie at December 16, 2007 01:53 AM

Is that from validated international research? I thought some European studies showed about 25% of their cases came from drug use, and twin studies showed about 50% was wholly genetic.
I am all for nurturing babies and children. Stress seems to contribute to a lot of damage all over our bodies. If the baby's brain is genetically flawed to be very sensitive to stress, that is very bad. Most children around the world have severe stress that makes the little family stresses in the united states, canada, and much of Europe look like a fun day in the park. Apparently there is a lot more going on than family abuse as a source of stress or else there would not have been an increase after major hurricanes and earthquakes as well as all the people writing books who have good families.
By the way, can anyone say if this upbringing theory also applies to bipolar and schizoaffective?

Posted by: Ka at December 16, 2007 09:43 AM

I get the point of this article but surely parents (or some parents) are somewhat to blame for causing too much stress in the home.

I don't understand why he seems to bend over backwards for the caregivers while stating that we pre-mentally ill people illicit stressful responses from our parents.

These are dissapointing generalizations IMHO.

Posted by: C K Yap at January 12, 2008 06:04 PM

Schizophrenia: the price that Homo sapiens pays for an oral language with hearing deficit

In accordance with the research in recent years, I posit that schizophrenia is caused by Congenital Phoneme Deafness. It is central in any explanation of the cognitive deficits found in the Schizophrenic Spectrum Disorders. Oral language acquisition depends solely upon the ability to hear the phonemes.

Failure to take hearing as seriously as vision is remarkable in that human beings depend upon the auditory sense for primary enculturation and language acquisition, as well as maintaining human connectiveness throughout life. Sociability is oral language depended.

Psychological tests and brain studies are comparable among those in the Deaf community and those person with Schizophrenic Spectrum disorders.

Furthermore, there is a sex-specific hearing deficit in the ability to hear; females tend to have better hearing acuity than males starting at birth and continuing throughout life.

To quote Tim J. Crow’s (of the U. K.) ‘hypothesis that the predisposition to schizophrenia is a component of Homo sapiens-specific variation associated with the capacity for language‘ - oral language.

Judith Wible, M.D.
Sugar Land TX

Posted by: Judith L. Wible, M.D. at January 21, 2008 08:11 AM

I think the theory of enviromental stressers playing a part in causing schizophrenia is very valid. I have childhood-onset schizophrenia and also experienced child abuse. This abuse only increased the severity of the illness. It lead me to being diagnosed at the age of 12. So don't tell me that the two don't have a connection. I know better.

Posted by: Karen J at February 11, 2008 01:53 PM

I know someone who once had delusions that there were secret messages planted in the electric outlets by God that she had to decode or else ... well... and i was considering leaving hidden messages in her macaroni and cheese that I would suggest were from aliens or the government that would have to be decoded or else.... do you think this might help her get a grip on reality and help calm her paranoia?

Posted by: ResearchRat at February 16, 2008 08:31 PM

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