The Psychosocial Elements of Schizophrenia

Abstract

Schizophrenia is not a common mental illness so scientists today still do not know how exactly schizophrenia manifests. The main theory of how schizophrenia comes about is through genes. Although there is no specific gene that causes the disorder itself, it is believed theinterplay of genes plus an individuals environment combine to determine if schizophrenia develops. The environmental factors that can have an effect are malnourishment before birth, problems during birth, and the most influential, psychosocial factors. This study analyzes how schizophrenia develops through childhood abuse and the object relation deficits that are created through PTSD. It also looks at how the relative roles of hereditary risks and childhood abuse play into the development of schizophrenia. Lastly, the study will look at how anticipated pleasure deficits in people with schizophrenia are actually a heightened anticipated negative emotion and that inaccurate forecasting of emotions can be linked to a decreased motivation for social interaction. It’s goal is to increase awareness that children in families who experience child abuse are at the most at risk group for the development of schizophrenia and ultimately increase treatment to combat object relation deficits early on to heal children before schizophrenia can develop or at the very least, decrease its severity.

Review of Literature

Schizophrenia is an illness that effects one percent of the nation’s population, as well as one percent of the world’s population. Today it is still not possible to use genetic information to predict who will develop schizophrenia. Family history can be used to determine your genetic predisposition of developing the illness, but that alone is not enough to predict your odds of developing the illness. The following review of literature confirms that a person’s genes and the interplay of one’s environment are far better indicators of who is at risk of developing schizophrenia, how environmental factors shape an individual’s object relations, and proposing and reaffirming the best ways to go about prevention and rehabilitation of the illness.

Distorted Social Anticipation

People who have schizophrenia have a distorted view of reality, which can be attributed to the accumulated effect of previous negative life experiences. Martin, Castro, Li, Urban, and Moore (2019) conducted a study on the emotional responses, predicted and experienced, in schizophrenia using the “36 questions that lead to love.” They wanted to create a live social interaction that minimized higher order cognitive functions to see if the decreased motivation to socialize is due to the actual interaction. Confederates were used as the other person playing the game with both groups, but the groups were deceived into believing the confederate was a person of the same group. The study then followed by collecting data from both schizophrenia and control groups about their current mood before the interaction, the anticipated response of how the interaction will go, as well as their final thoughts on how the interaction went. The group with schizophrenia anticipated more negative emotion and were also less accurate with forecasting negative emotion (2019). This study shows that “anticipatory pleasure deficits” in people with schizophrenia could quite possibly be inaccurate forecasting of negative emotions, which can be linked to decreased social motivation.

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Object Relation Deficits

Object relations refer to the ideas one forms of themselves and the ideas that are formed of other people, and the relationship these ideas have synchronically in forming healthy human development. The relationship between schizophrenia and object relation deficits is significant and is associated with the source of the disease as well as the recovery. Within a certain group of persons diagnosed with schizophrenia, those with early-onset schizophrenia have worse object relation deficits than those with a later onset (Chapleau, Bell, & Lysaker, 2013). The study used Positive and Negative scale, Post-Traumatic Stress Disorder Checklist, and Bell Object Relations Inventory and administered them to 60 people. Using four hierarchical regressions and controlling for schizophrenia symptoms, diagnosis type, and relevant demographic features, PTSD correlated with three out of the four types of object relation deficits (2013). Insecure attachment, alienation, and egocentricity could all be attributed by PTSD symptoms in persons with schizophrenia. Having social incompetence, the fourth object relation, could be better explained by the core symptoms of schizophrenia rather than PTSD (2013). If PTSD is related to object relation deficits in persons with schizophrenia, then psychotherapy would be beneficial in treating the interpersonal deficits that are present in the individual.

Hereditary Risk and Child Abuse

Genetics can indicate whether someone has higher chance of the manifestation of schizophrenia in their phenotype, but environmental and psychosocial factors are more important to consider in determining development of schizophrenia. Gallagher and Jones (2016) conducted a study that looked at hospital data from a large state hospital in the northeastern U.S. the from 1984 to 1990, which had detailed information on patients' diagnosis of schizophrenia (positive vs negative symptoms), as well as first-hand family accounts of childhood abuse separated between physical and emotional. The study also took into account family history of mental illness which were also included in the hospital medical records. After analyzing the medical records, they concluded that risk for positive symptoms of schizophrenia are elevated by history of childhood abuse in combination with no history of serious mental illness in the family (2016). Due to the implications that the etiological role childhood abuse has on positive symptoms of schizophrenia, treatment should look at family background and design therapeutical approaches on dealing with the trauma that comes from childhood abuse.

Knowing that schizophrenia causes alterations to your world view, and that these changes come about from childhood trauma that can produce PTSD, which in turn damages object relations, forming good patient relations and a focus on repairing said interpersonal defects is an effective way of treating and rehabilitating people with schizophrenia. Learning more about how people with schizophrenia view the world, and sympathizing with the fact that these are traumatized people who have developed an unhealthy way of coping with such trauma can lead to more effective ways of approaching and dealing with the people suffering from the illness.

References

1. Chapleau, K. M., Bell, M. D., & Lysaker, P. H. (2014). The relationship between post-traumatic symptom severity and object relations deficits in persons with schizophrenia. British Journal of Clinical Psychology, 53(2), 157–169. https://doi.org/10.1111/bjc.12033
2. Gallagher, B., & Jones, B. (2016). Hereditary Risk and Child Abuse: Their Relative Roles in Type of Schizophrenia. Journal of Child & Adolescent Trauma, 9(3), 255–261. https://doi.org/10.1007/s40653-016-0078-z
3. Martin, E. A., Castro, M. K., Li, L. Y., Urban, E. J., & Moore, M. M. (2019). Emotional response in schizophrenia to the “36 questions that lead to love”: Predicted and experienced emotions regarding a live social interaction. PLoS ONE, 14(2), 1–13.
4. https://doi.org/10.1371/journal.pone.0212069
5. https://doi.org/10.1111/bjc.12033
6. https://doi.org/10.1371/