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David Baxter

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Schizophrenia: Psychological and Social Factors and Treatments
December 11, 2007

As we've reported in the past, research is revealing the specific aspects of family and environmental stress that interact continually over time with a biologically predisposed brain to produce 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 we've covered. 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 a genetic risk or family history of schizophrenia and/or other mental illnesses, certain environmental experiences (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, 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 judgement 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.

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 Summarizing Dr. McFarlane's Speech:
Psychosocial Interventions Beneficial in Schizophrenia. (Psychiatric News)

Related Reading:
 

HA

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Re: Schizophrenia: Psychological and Social Causes and Treatments

Personally I feel too much emphasis has been placed on high expressed emotion which seems to be the continuation of "blame the family" history of psychiatry's approach to looking at the "cause" of schizophrenia.

If high expressed emotion were such an important factor in causation then we would certainly have many more cases of schizophrenia. It would be interesting to see research that looks at high expressed emotion in relationship to all other mental illnesses. I would think that it could then be just as applicable in relation to causation of the other illnesses.

High expressed emotions ....conflict, judgement, pressure etc are not good for any of us vulnerable to mental illness or not!

Yes there "seems" to be an environmental/genetic vulnerability interaction but I think the majority of cases of "schizophrenia" will happen no matter what happens in the environment. It is also important to note that environment means many things of which stress is just one component. Most research points to environmental factors being something other than emotional......birth trauma, other physiological unknowns play a much larger possibility than emotional environment.

Not that the emotional environment does not play a role but research has already shown that this is just beating a dead horse to focus on the family environment any longer. It wastes valuable/scarce resources and fudning and really keeps us in the dark ages regarding stigma and education. Keep the vulnerable from stresses such as university or college and it would more likely be more effective than other stress factors at preventing or delaying the development of "schizophrenia".
 

David Baxter

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Re: Schizophrenia: Psychological and Social Causes and Treatments

Personally I feel too much emphasis has been placed on high expressed emotion which seems to be the continuation of "blame the family" history of psychiatry's approach to looking at the "cause" of schizophrenia.

I don't think it's a matter of either "blame the family" or suggesting that the "expressed emotion" factor is the "cause" of schizophrenia. Rather, I think it's a recognition that individuals with schizophrenia do not cope well with stress or anxiety and that they are often confused and frightened about and have difficulty accurately interpreting their own emotions as well as those of people around them. Thus, a family where people don't express feelings much or do it in a quiet cerebral manner is more easily tolertated by those with schizophrenia. Note that a "calm" family environment is not necessarily a healthy one for others in the family, and that "high expressed emotion" does not necessarily imply negative emotion. A happy boisterous talkative family may be just as difficult for someone with schizophrenia as a family where there is a lot of anger and negative yelling.

If high expressed emotion were such an important factor in causation then we would certainly have many more cases of schizophrenia.

No, because in order for this to be an added risk factor there must first be the genetic vulnerability.

It would be interesting to see research that looks at high expressed emotion in relationship to all other mental illnesses. I would think that it could then be just as applicable in relation to causation of the other illnesses.

And indeed there is evidence that this may be the case, especially for anxiety and depression, again where there is an initial vulnerability. Mental illness is, I think, always an interaction between vulnerability and success in adapting to one's environment.

High expressed emotions ....conflict, judgement, pressure etc are not good for any of us vulnerable to mental illness or not!

Again, remember that high expressed emotion is not necessarily negative emotion.

Yes there "seems" to be an environmental/genetic vulnerability interaction but I think the majority of cases of "schizophrenia" will happen no matter what happens in the environment.

Perhaps, or perhaps not. But I think the more important issue is recognizing that someone with the diagnosis of schizophrenia needs a certain type of environment to function optimally. It's imprtant both for the individual and for the family to understand this. The individual may feel a need to avoid or withdraw from even happy family gatherings - Christmas, Thanksgiving, Easter, birthdays, etc. - because s/he may feel overwhelmed by all of the people and their chatting.

Not that the emotional environment does not play a role but research has already shown that this is just beating a dead horse to focus on the family environment any longer. It wastes valuable/scarce resources and funding and really keeps us in the dark ages regarding stigma and education. Keep the vulnerable from stresses such as university or college and it would more likely be more effective than other stress factors at preventing or delaying the development of "schizophrenia".

Again, I don't think this sort of research is about what "causes" schizophrenia, but rather about (1) why some individuals with very similar genetic makeup do not develop the illness while their siblings do; and (2) how we match someone with schizophrenia to an evironment where s/he will best function.
 

HA

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Re: Schizophrenia: Psychological and Social Causes and Treatments

Please note that I am responding to the article that clearly states...:psychological and social causes.

And the reference I am making to research for other mental disorders regarding high expressed emotion and it's realtionship to causing mental disorders I am thinking along the lines of OCD, autism, bipolar...
 

David Baxter

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Point taken. However, the use of the word "cause" was in the title of the article. The article itself makes it clear that they are talking about triggers or contributing factors:

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 a genetic risk or family history of schizophrenia and/or other mental illnesses, certain environmental experiences (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]."​

I have changed the thread title to more accurately reflect what the article is saying.
 

HA

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:fixed: Thank you! Whew...broke a sweat over those words.
 

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