The
multidisciplinary approach to schizophrenia yields more favorable outcomes than
psychotherapy alone. Various
antipsychotic drug therapies have precipitated research yielding biological and
physical explanations for the illness.
The multigenerational emotional and genetic influence on the limbic-HPA
system and neuropeptides exert a strong influence on the possibility of the
expression of any genetic predisposition.
Schizophrenia
and Family Systems
Introduction
Last
week this writer thought she was engaged in a conversation with a mentally disabled
twenty-year-old female[1]. Suddenly, the young woman turned and said,
“I’m schizophrenic[2]. Are you afraid of me?” Further, into the conversation it became
clear she was functioning well below the level achieved prior to the onset of
her disorder. She had dropped out of
nursing school and was currently living in her fifth group home. She was visibly upset when someone nearby
spoke her name to someone on the telephone.
The young woman also related the experience of hearing voices; her
speech pattern was awkward and not easy to follow. Flexing her left arm to demonstrate its jerky
motion, she explained why she was trying another medication and searching
desperately for symptom relief[3]. Through the large windows of the room, the
bus from the group home was visible as it came into the parking lot. It was time to say “Goodbye.”
“Today,
as they have been for centuries, the years from 18 to 25 is prime time for hard
physical work, athletic achievement, and reproduction (Berger, 2008,
p. 447) .” What will life be like for her? What might have been her fate, and that of so
many others suffering from mental disorders, if she had been born hundreds, or
even thousands of years ago?
The
Disorder in its Historical Context
In
the Stone Age, trephination[4] (Comer, 2011, p. 7)
was the cure of choice. In Greek and
Roman civilizations, the protocol was a quiet lifestyle, a diet of vegetables,
exercise, celibacy, and even bleeding in an attempt to relieve the
symptoms. In the Middle Ages, the clergy
cast out demons responsible for abnormal behavior. Had she been born in Europe in the 1500s,
perhaps, the local parish support system would enable her to remain home with
her family. In the sixteenth century,
asylums[5] (Comer, 2011, p. 9)
housed the mentally ill. In the 1800s,
state-run hospitals were in vogue. The
one in North Carolina bears the name of the impetus of this movement, Dorothea
Dix. The nineteenth century ushered in
reform and moral treatment. “Between
1907 and 1945 45,000 Americans were sterilized under eugenic sterilization
laws; 21,000 of them were in state mental hospitals (Comer, 2011,
p. 11) .” Public mental hospitals soon became
warehouses for the mentally ill. “By the
early twentieth century, psychoanalytic theory and treatment were widely
accepted throughout the Western world (Comer, 2011, p. 12) .”
From
1954 to 1959, Murray Bowen worked at the National Institutes of Mental Health
and studied the origin and development of schizophrenia (Bowen, 2004,
p. 45) . First, he studied the mother-child
relationship. Later he studied whole
families in an in-patient setting. At
that time, he adhered to Sigmund Freud’s theory of psychoanalysis[6]. It was two decades later that he pioneered Bowen
Family Systems theory[7].
Current
research as to the Cause of Schizophrenia
“[R]esearchers
have been far more successful in identifying the biological influences than the
psychological and sociocultural ones (Comer, 2011, p. 389) .” The diathesis-stress view posits a person
must first have a predisposition to a disorder and then be subjected to
immediate psychological stress in order to develop the disorder (Comer, 2011, pp. G-4) . Today’s knowledge of the neurobiology of
attachment and stress are consistent with Bowen theory. “When the anxiety in a system increases,
people tend to do more of what they have always done, creating a vicious cycle (Gilbert R. , 2006, p. 110) .” Bowen Family Systems theory views the family
as an emotional unit. The family of
origin has a strong emotional and genetic effect on the limbic-HPA system, “in
particular, the research in these areas indicates that behavioral interactions
in the maternal-offspring relationship can influence the neuroendocrine[8]
and behavioral development and adaptiveness of individuals (Noone, 2008) .” In other words, each generation passes to the
next its anxiety, individuation, and the level of ability to recover from
adverse circumstances as well as genetic traits.
Oxytocin
and vasopressin are among the more influential neuropeptides and hormones
involved in attachment. The experience
of the parent-offspring relationship has been found to play a part in the
genetic expression of oxytocin (Noone, 2008, 29). Thusly, current research
supports the observation that the family plays a central role in in determining
an individual’s responsiveness to the social environment. Biological factors combined with stress are
needed for schizophrenia expression.
Treatment
Approaches
The
preferred first line of treatment is one of the many antipsychotic drugs. As many as eighty-five percent experience
improvement of symptoms while taking the most currently developed atypical
antipsychotic drugs (Comer, 2011, p. 379) . The conversation with a young woman mentioned
earlier illustrates the difficulties of drug therapies. Unfortunately, had she been African American,
she would be less likely to have been prescribed the atypical antipsychotic
therapy (Corey, 2009, p. 378) . “No matter how compelling the evidence for
biological causation may be, a strictly biological approach to the treatment of
psychological disorders is a mistake more often than not (Comer, 2011, p. 389) .” Each approach has some valid points, but the
primary assumptions underlying the understanding of the human psyche is contradictory
(Enright, 2009, p. 19) .Therefore, a
multidiscipline approach is preferable, according to modern thinking.
If
treatment on an outpatient basis fails, short-term hospitalization may be
necessary. Aftercare may include partial
hospitalization, semihospital, or residential care. These combinations increase their
effectiveness when combined with psychotherapy.
One approach would seek to change how the schizophrenic reacts to his/her
hallucinatory experiences and thereby gain control and reduce the delusional
ideas. Family therapy has the potential
to create a healthier support system and reduce the chance of relapse. Social therapy will offer practical advice,
aiding in his day-to day needs such as housing, work, decisions, and social
skills and making sure he is taking his medication. For example, the conversation with the young
woman took place while she was volunteering in a United Methodist continuing
care retirement community as a part of her social training.
Research
as the Prevention of the Illness
Currently
early intervention is the only recourse.
Universal approaches include educational programs about mental illness that
are planned for implementation in this decade.
Some therapists are prescribing low doses of antipsychotic drugs to some
patients deemed high-risk (Preventing Schizophrenia - Risk Reduction Approaches, 2004) . Studies are currently in progress addressing
risk reduction. The National Institutes
of Health is the only United States study found in researching for this paper.
Prevention,
based on current knowledge, is far beyond our grasp and good healthcare from
conception (Comer, 2011, p. 369) to midlife is
currently the focus. Genetic factors are
indicative of risk, however less than 50% of the genetically predisposed will
develop schizophrenia (Comer, 2011, p. 365) . Given these limitations, the multigenerational
concept is likely to become the focus of preventive study (Noone, 2008, 31).
Cross-cultural
Issues
Bowen
Family Systems[9]
finds strong validation in the statistical facts[10]
concerning schizophrenia occurrence and outcomes among minority and global populations. More than twice as many African Americans are
diagnosed with the disorder but, as stated earlier, this population is less
likely to be prescribed the most effective drug therapy. They are also overrepresented in state
institutions. The emotional process in
society explains these phenomena.
Minority populations are more likely to live in poverty, live with
family emotional pressures, crowded conditions, and limited access to adequate
health care (from conception to the grave).
Interestingly,
the World Health Organization statistics indicate access to good healthcare may
not be the determining factor biological views tout. Developing countries tend to have better
recovery rates and less need for drug therapy, correlating with strong family
and social support systems. Minority
populations are less likely to project blame onto the schizophrenic than
Western populations. Sociocultural
theorists believe the diagnosis, or “label,” heightens and exacerbates
symptomology and global statistics support this premise. The nuclear family emotional systems of
various cultural traditions have a strong influence on which of the
biologically predisposed will develop symptoms.
A
Christian Worldview
The
ninth concept of Bowen Family Systems is of utmost importance to the
Christian. “A hallmark strength of
mental health practice involves engaging in the observation of relational
patterns within and between persons, families, and larger cultural systems (Thurston,
2009, p. 17) .” The history of mental illness treatments
provides ample evidence faith systems and beliefs about the supernatural can
both undermine and support the well-being of its members and the larger society. A major tenet of the faith is “love God by
serving others.” Jesus best describes
the Christian worldview:
36 Naked,
and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came
unto me.37 Then shall the righteous
answer him, saying, Lord, when saw we thee an hungred, and fed thee? or
thirsty, and gave thee drink?38
When saw we thee a stranger, and took thee in? or naked, and clothed thee?39 Or when saw we thee sick, or in prison, and came unto thee?40 And the King shall answer and say unto them, Verily I say
unto you, Inasmuch as ye have done it unto one of the least of these my
brethren, ye have done it unto me.
Matt 25:36-40 (KJV)
The cause is man’s fallen condition
(Gen. 3) and the treatment includes a holistic approach to mental health. Our faith informs the understanding of
behavioral sciences and knowledge of the various theories informs our faith (Thurston,
2009) . Faith in Jesus Christ runs counter to the
scientific assumption that reality is fundamentally physical (Talbot, 2009,
p. 29) .
Summary
Currently
risk reduction research is underway for schizophrenia. The causes, and therefore preventions, of the
illness remains largely a mystery.
Preventative research is in the distant future, indicating the
multigenerational concept of Bowen Family Systems theory may well turn out to
be the key to prevention. If so, Christian
psychology will prove to be the most successful avenue for prevention and
treatment for schizophrenics like the young woman volunteering in the United
Methodist Retirement Home.
The
strong correlations between genetic and emotional factors indicate a
multifaceted approach is appropriate.
The atypical antipsychotic drugs developed in recent years show promise,
improving symptomology eight-five percent of the time. When combined with the community approach
the care receiver is more likely to enjoy remission of the disease.
References
Preventing Schizophrenia - Risk Reduction Approaches. (2004). Retrieved July 1, 2011, from
schizophrenia.com: http://www.schizophrenia.com/prevention.htm
Berger, K. S. (2008). The Developing Person: Through the
Lifespan. New York: Worth Publishers.
Bowen, M. (2004). Family Therapy in Clinical Practice.
Lanham: Rowman & Littlefield .
Comer, R. J. (2011). Fundamentals of Abnormal Psychology.
New York: Worth Publishers.
Corey, G. (2009). Theory and Practice of Counseling and
Psychotherapy. Belmont: CENGAGE.
Enright, R. D. (2009). Can We Scientifically Test
Psychological Models which Contradict Each Other? EDIFICATION Journal of the
Society for Christian Psychology, 19-20.
Gilbert, R. (2006). The Eight Concepts of Bowen Theory.
Falls Church: Leading Systems.
Noone, R. J. (2008). The Multigenerational Transmission
Process and the Neurobiology of Attachment and Stress Reactivity. Family
Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences, 8,
21-34.
Talbot, M. R. (2009). Countering Naturalism. EDIFICATION
Journal of the Society for Christian Psychology, 29-33.
Thurston, A. B. (2009). Resisting a Separatist Position as a
"Distinctively Christian Psychology". EDIFICATION: Journal of the
Society for Christian Psychology, 16-18.
[1]
Formal thought disorders can make conversations difficult (Comer, 2011, p. 360) .
[2]Diagnostic
and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for
schizophrenia: 1) at least two of the following symptoms, each present for a
significant portion of time during a one-month period: (a) delusions. (b) Hallucinations. (c) Disorganized speech. (d) Grossly disorganized or catatonic
behavior. (e) Negative symptoms. 2)
Functioning markedly below the level achieved prior to onset. 3) Continuous signs of the disturbance for at
least six months, at least one month of which includes symptoms in full and
active form.
[3]Tardive
dyskinesia: late appearing movement disorder, usually manifests after the
patient has taken the drug for more than a year (Comer, 2011,
p. 379) .
[4]
Trephination: A stone instrument is used to remove a section of the skull,
presumably to release evil spirits.
[5]
Most became virtual prisons (Comer, 2011, pp. G-1) .
[6]
Psychoanalysis: The theory or treatment of abnormal mental functioning that
emphasizes unconscious psychological forces as the cause of psychopathology (Comer, 2011, p. 13) .
[7]
Family systems theory: A theory that views the family as a system of
interacting parts and proposes that members interact in consistent ways and
operate by unstated rules (Comer, 2011, pp. G-6) .
[8]
The author has a personal bias due to a rare neuroendocrine cancer and
participation in an NIH study for causality: http://www.clinicaltrials.gov/ct2/show/NCT00646022?term=carcinoid&rank=2.
[9]The
nine concepts are: 1) the nuclear family emotional system 2) the
differentiation of self scale 3) triangles 4) cutoff 5) family projection
process 6) mutigenerational transmission process 7) sibling position 8)
emotional process in society 9) the supernatural
[10]
All statistical evidence cited in this section is from the Comer textbook,
pages 371-373.
NOTES
"Since the beginning of our family study, I have come to regard schizophrenia as a process that requires three or more generations to develop." "The somatic reciprocation often includes definite physical pathology." ~ Murray Bowen
Blood samples taken after just one week of getting fewer than six hours of sleep a night showed changes to more than 700 genes due to sleep deprivation alone, according to the study. Researchers don't entirely understand the role of each of these genes and what the changes may mean, Bloomberg reported, but at least some affect our inflammatory, immune and stress responses, researchers noted. http://www.huffingtonpost.com/2013/02/26/sleep-deprivation-genes_n_2766341.html?icid=maing-grid7%7Cmain5%7Cdl21%7Csec3_lnk2%26pLid%3D276414
We show that one wk of insufficient sleep alters gene expression in human blood cells, reduces the amplitude of circadian rhythms in gene expression, and intensifies the effects of subsequent acute total sleep loss on gene expression. http://www.pnas.org/content/early/2013/02/20/1217154110
"Our results suggest that voltage-gated calcium signaling, and, more broadly, calcium-channel activity, could be an important biological process in psychiatric disorders," they argued.
The calcium-channel gene CACNA1C has been previously linked to bipolar disorder, schizophrenia, and major depressive disorder, they wrote, as well as to Timothy syndrome, a developmental disorder that can include autism. http://abcnews.go.com/Health/autism-depression-genetically-linked/story?id=18617381
Autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depressive disorder, and schizophrenia share common genetic underpinnings -- despite differences in symptoms and course of disease, researchers discovered. http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/37584
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