For this portfolio presentation I have chosen to look at the mental illness ‘Schizophrenia’. My presentation in particular will concentrate on the nature/nurture debate. Whether Schizophrenia is caused by hereditary causes, or by environmental causes. Schizophrenia still remains a partically comprehended illness, with no one single cause (Website 1).I have read a great deal of literature from academics which will be discussed later, but I wanted to do my own field research, and discover first hand what the public thought of schizophrenia, whether they thought it was hereditary or environmentally caused.
So I completed a questionnaire, I was able to gain 38 respondents to the questionnaire, of the public’s awareness and thoughts of Schizophrenia. I felt this would help me to actually see what the public thoughts and ideas were, other than the academics ideas. I actually got a sense of what people that live day to day life have experienced when it comes to Schizophrenia, and actually how much they know about the illness. Details obtained from this questionnaire will be discussed later on.Schizophrenia is a common psychotic disorder. It is truly puzzling.
At times, people with Schizophrenia communicate clearly, have accurate views of reality, and function well in every day life. But at other times their speech and thinking and slurred and garbled, they kind of lose touch with reality, and are not able to care for themselves in the most basic of ways.The APA manual’s definition of Schizophrenia, as quoted from Salinger (1973) (cited in Website 1) in Schizophrenia: Behavioural aspects, regards the disorder as affecting thinking, mood, and behaviour. Concept formation is disturbed potentially leading to hallucinations and delusions, the mood often becomes emotionally inappropriate and apathetic, and the behaviour may grow to be reclusive and bizarre.90% of people with Schizophrenia seek treatment in a mental health facility or general medicine facility in any given year (Narrow et al 1993) (cited in Nolen-Hoeksema 2004).
In the USA 1 to 2 % of the population will develop Schizophrenia at sometime in their lives, there are currently 2 million Americans with Schizophrenia, we needs to look at this from two perspectives, are Americans hereditarily getting Schizophrenia or are Americans getting Schizophrenia from their environment? Is it the stress of life etc, the knowledge of the disease that makes people believe that they have the disorder through their own symptoms? Or is their no way of changing ones destination, and that if it is hereditary one cannot change their destiny.The argument about whether mental illness is caused by nature or nurture is one that has raged for years, with consequent splits between those who believe counselling and therapy rather than drugs or operations are the solution.Scientists recognise that Schizophrenia is linked to biological, environmental and genetics factors, the question is how much of each? (Website 5). It is a complex nature/nurture interaction (Website 7).From my own research I found that from a list of mental illnesses listed that all but one respondent recognised Schizophrenia as being a mental illness, and also Schizophrenia as more biologically than environmentally caused. With most respondents choosing a 80/20% ratio with genetics in favour.So from reading academic material, I found that with regard to the nature/nurture debate, and there was always a difference of opinion and reasons why how much Schizophrenia is influenced by genetics and/or the environment. Academics generally agreed that there was a mixture of both environment and genetics when it comes to the causation of the disease, but how much of each was the difference in opinion.
For example, Oades (1982) found that we need to better understand Schizophrenia by looking at the brain and systems within the brain that maybe involved.The one thing shared by biological and psychological models of Schizophrenia is that they both regard the origins of Schizophrenia as being located firmly in the brain or the mind of the individual, Thomas (1997).Oades (1982) quotes from many academic researchers and professionals that schizophrenia starts at young adulthood.Wyatt, Kirsch, Delisi (cited in Oades 1982), Nolen-Hoeksema (2004), found that there was a difference when it comes to Schizophrenia and the sex of the person, although the life time risk is roughly the same, the age for onset is generally younger in males. Women with Schizophrenia tend to have better premorbid histories than men, Goldstein & Lewine (2000), Jablensky (2000), (cited in Nolen-Hoeksema 2004).The outcome for males tends to seem poorer for males, as females tend to react better to the drugs (biological) they do not take the environmental factors of being different sexes into account, they assume it is biological.Academics swear on the point that because neuroleptic medication, which is what they use to help treat Schizophrenia, has proven that it works, that Schizophrenia must be biological, as we are treating it with biological means (Oades 1982).
Nolen-Hoeksema (2004) shows the reader of a new drug known as typical antipsychotics, which appears to be effective without involving as many side effects as previous drugs.Nolen-Hoeksema (2004), (Website 2), Yolken (2000), believe there is strong evidence for biological cause, abnormalities in the prefrontal cortex, ventricles in the brain. Also a number of prenatal difficulties, and problems at birth, can be said to have caused it also, e.g. prenatal hypoxia and exposure to influenza virus within the second trimester of gestation.Studies has shown that the increased size of brain ventricles, decreased size of tissue weight and the atrophy of the frontal lobes, a decrease in volume of the limbic system all goes towards proving that schizophrenia is hereditarily caused.
But these abnormalities, we cannot assume is due to the onset or cause of the disorder, but the failure for the brain to develop properly, so that the disorder is actually due to developmental failure.All these explanations explain the public’s assumption that Schizophrenia is mainly caused by genetics and biology. Also when given academic quotes within the questionnaire about the percentage of environmental and genetic influence, 80% of respondents agreed with academics that offered a higher percentage blame to genetics rather than environment.New techniques for biological explanations for schizophrenia prove how much academics believe that schizophrenia is biologically caused, i.e. the MRI Scan, CT Scan. But genetic advances would lead to better treatments for mental illnesses such as Schizophrenia and eliminate discrimination (Website 4).
Biological theories, such as Genetics theorists, structural brain abnormalities, neurotransmitter theories and birth complications all argue for a biological basis with regard to Schizophrenia.Genetics does not fully explain who gets the disorder, as some showing symptoms of the disorder show structural and functional abnormalities in specific areas of the brain, which may contribute, to this disorder.Family, twin and adoption studies show that biology does play a role. So far the gene for Schizophrenia has not been found so can this mean, that there is also an environmental factor? Gottesman (1991) found from his study that children with two parents with schizophrenia or monozygotic twin of people with Schizophrenia share the greatest number of genes with people with Schizophrenia and therefore have the greatest risk of developing it sometime in their life.
Of all children with parents with Schizophrenia, 87 % will not develop the disorder, but 63 % of people with Schizophrenia have no first or second degree relative with the disorder, and hence bends to a more environmental approach. Could the fact that children of people with Schizophrenia gained the disorder through the stress of having Schizophrenic parents?I felt through my research that the public did not really account for stress within the family as causing Schizophrenia, I feel that most respondents who did not have first hand experience of Schizophrenia, chose to believe the academics in that genetics is the main cause. 15 out of the 38 respondents that had had first hand experience of Schizophrenia and were more open minded when it came to the causation of the disorder. Most of them did explain, that when the person suffering from Schizophrenia was a relative, that Schizophrenia does have some environmental influences as well, as they only had one relative with the disorder, so how could it be genetic? One respondent had an uncle which suffered from schizophrenia and the family had noticed signs of his son developing the disorder and hence this respondent did put most of the explanation down to genetics, but also believed that the stress of having a father with the disease may have been a factor too.
Many academics and professionals believe that there is not one single genetic abnormality that accounts for this disorder. From a polygenic additive model perspective that believe it is a mixture of abnormal genes and not just one that causes Schizophrenia, Gottesman 1991, (cited in Nolen-Hoeksema 2004).Leonard Heston (1996) found 17% of adopted away children of the people with Schizophrenia developed Schizophrenia as adults, but this could be due to the mothers of the Heston study suffering from a more severe case of Schizophrenia, so each study has to be treated with caution.
The likelihood that both identical twins will suffer from Schizophrenia is 2 to 4 times greater than for fraternal twins (Website 11).Even if one has got genetic risks of developing Schizophrenia many other factors may influence whether or not the disorder is actually developed. For example the Genain quadruplets, they all shared same genes, all developed Schizophrenia, but all at different times and outcomes Mirksy et al (2000) (cited in Nolen-Hoeksema (2004).Inherited factors are relevant to understanding Schizophrenia but to what degree?Is seems that people that with no biological ties to Schizophrenia have the lowest risk of becoming Schizophrenic (Website 1).Ridley (2003) (cited in Website 3) believes that people have genes that can develop Schizophrenia, it just depends whether or not ones environment ‘switches’ these genes on.When I looked through my response papers, I found that people that really had a vague idea of Schizophrenia believed that environmental factors had a big influence.
12 out of the 38 respondents had heard of schizophrenia but really knew nothing about the disorder. When they were filling out the questionnaire many asked me what Schizophrenia actually was. For obvious reasons, I could not tell them, as this could have influenced their answers, so in fact I have to treat these answers with caution, as they may not be giving a proper reflection.
There are lots of different theories when it comes to trying to explain schizophrenia with regard to the environment, or ‘psychosocial’ factors. There is considerable evidence that the family, society, social economic and political factors are linked to Schizophrenia, Thomas (1997).Psychodynamic theories suggest that Schizophrenia results from very negative experiences in early childhood between child and their primary caregiver, when mothers are extremely harsh and withhold love from a child, and hence the child develops not being able to function between reality and non-reality. Arieti (1995) found that schizophrenic mothers tend to be over protective and rejecting of their children, not letting them have sense of self, making them feel worthless and unlovable, but studies did not confirm this theory, Nolen-Hoeksema (2004).More recent theories focus on the family life and how the stresses of that may cause increased stress or a relapse of Schizophrenia Nolen-Hoeksema (2004).The concept of a double bind theory has also arisen, that parents of children that become Schizophrenic constantly communicate in conflicting messages to the children, this develops distorted views about the world and others which contributes to Schizophrenia.
However this is just a theory and empirical evidence has not supported this.Many believe that the family is the root of mental illnesses, but this is highly controversial, this makes parents feel that they are to blame for their child’s illness (Website 4).It is true that people that live with Schizophrenia within their family experience more stress than others that do not. The symptoms of Schizophrenia interfere with a person’s ability to function properly, and tend to drift down a social class, Goldberg ; Morrison (1963) (cited in Nolen-Hoeksema 2004).
So if one is subject to experiencing a member of their family with Schizophrenia does this make them more prone to developing the disorder through the stress? Barrowclough (1998). ‘Research on the quality of the parent/adult child relationship in later life suggests that most older parents and adult children enjoy a close and supportive relationship, which enhances the psychological well-being of parents (Blieszner & Bedford, 1996; Rossi & Rossi, 1990) (cited in Greenberg 2004).Behavioural theorists suggest that the symptoms of schizophrenia can develop through operant conditioning Nolen-Hoeksema (2004).Cognitive theorists, accept that there is a biological vulnerability to Schizophrenia but see many symptoms as attempts to understand and cope with basic perceptual and attentional problems.Nolen-Hoeksema (2004) psychosocial therapists focus of teaching communication and living skills and also reducing isolation with people with Schizophrenia, which had also proven to work.Even though there is prove that Schizophrenia does vary between sexes, the rates vary amongst studies and with criteria used to diagnose Schizophrenia, hence this could have a psychosocial basis, Cannon et al 1998, Goldstein 1995, 1997, Hambrecht et al 1992, (cited in Nolen-Hoeksema 2004).Why does functioning people with Schizophrenia tend to improve with age? Is it due to treatments, or perhaps is it their families learn to recognise the early symptoms and seek aggressive treatment before their symptoms acuminate.
Or it might be due to a reduction over time of dopamine in the brain with age. As excess levels of dopamine have been implicated in Schizophrenia Breier et al 1991, (cited in Nolen-Hoeksema 2004).Culture seems to play a role in the onset of Schizophrenia; it tends to have a more benign course in developing countries than developed countries.
Can this be due to the more stress for people in developed countries? Jablensky 2000, Keff et al 1992, (cited in Nolen-Hoeksema 2004), Klar (1999). Other studies show that people that live in large cities are more prone to developing the disorder so could it be the stress of living in a big city that causes the disorder?Psychological interventions can help to increase social status and reduce isolation, can help to understand the disorder, appreciate the need to remain on the drugs and cope with the side effects that the drugs may give. Hence, social workers, psychologists and health professionals can assist people, Nolen-Hoeksema (2004).Family therapy is seen as having a positive effect in helping with Schizophrenia when drugs accompany it. But if one is treated for Schizophrenia with drugs, then if the explanation is all biological and this is being treated with drugs, how can one explain relapses? Surely the environment must play a role as well.From my research I received a very positive response from the respondents with regards to my questionnaire, most respondents claimed that the questionnaire made them think I great deal more about the subject and the disorder, and helped them to understand more about the subject. When asked in their own words whether they feel Schizophrenia is hereditary, not one respondent blamed Schizophrenia completely down the genetics, and they all believed, even though at different degrees, that the environment always played a role, whether it be society, family, politics etc.
I felt that people that had experienced Schizophrenia first hand obviously were more expressive of their opinions and voiced a great deal of detail. I feel that more research and information needs to be made available to the public to give awareness of mental illnesses.With regard to my research question, there is no one cause for Schizophrenia as I have backed up by empirical, academics and public research, it is truly a complex interaction of both nature and nurture. Each person voices their own studies or opinions about the cause of the disorder, I don’t feel that we will ever agree on the exact causation, which I feel will always be the case until one has a scientific break through to prove otherwise.