A Family Concept of Schizophrenia

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.

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[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 

The Ban on Assault Weapons is a Threat to the Freedom of Religion

Thinking readers well versed in church history understand how a chaplain posits a free democratic society has a Second Amendment right, an obligation, to keep and bear arms and that the reinstitution of the ban on assault weapons is a threat to the freedom of religion.  “Instances of the licentious and outrageous behavior of the military conservators of the peace still multiply upon us” (Townshend Acts).  

In 1972, the Environmental Protection Agency invited psychoanalyst Murray Bowen, M.D. to do a paper on human reaction to environmental problems.  He identified a link between the family and society.  The link had to do, first, with the delinquent teenage youngster, who is a responsibility for both parents and society, and secondly, with changes in the way both the parents and the agents of society deal with the same problem.  We are in a period of increasing chronic societal anxiety. Society responds to this with emotionally determined decisions to allay the anxiety of the moment; this results in symptoms of dysfunction; the efforts to relieve the symptoms result in more emotional Band-Aid legislation, which increased the problem.  We keep repeating the cycle, just as the family goes through similar cycles, regressing to the states we call emotional illness. Modern Americans assert it is more urgent to pass new gun control legislation after a mass shooting of children while simultaneously insisting a woman has the right to kill a child in the womb.  It is irrational to have such incongruent and radically opposing policies within the same society.  A government that fails to hold authorities accountable for Fast and Furious and Benghazi and considers it their responsibility to disarm her citizens is schizophrenic.

ATF "gunwalking" operations were, in part, a response to longstanding criticism of the bureau for focusing on relatively minor gun violations while failing to target high-level gun smuggling figures.  It is one of the many examples of emotional response to societal anxiety and the lack of maturity of both citizens and the political leaders they elect.

42 weapons recovered by Mexican military in Naco, Sonora, Mexico, 20 Nov 2009; these weapons were investigated by U.S. ICE.  Operation Fast and Furious; suspect Uriel Patino bought 19 of the weapons pictured one to two weeks earlier. http://www.justice.gov/oig/reports/2012/s1209.pdf

The Second Amendment

As ratified by the States and authenticated by Thomas Jefferson, Secretary of State:

A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.

The concept is an extension of European thought during a period of conflict between Protestants and Catholics.  In an effort to oppress the Protestants, their weapons were confiscated, rendering them defenseless.  When less anxious leaders triumphed, a rational policy was based on six foundational assumptions universally necessary to a free people to maintain a healthy balance between the governed and the government:  

• deterring tyrannical government;
• repelling invasion;
• suppressing insurrection;
• facilitating a natural right of self-defense;
• participating in law enforcement;
• enabling the people to organize a militia system.

 

 

HAS AMERICA REGRESSED TO AN EMOTIONAL QUASI-INTRAUTERINE STATE?

 

And, the children struggled together within her.  Gen. 25:22 (ASV) 

 

Incessant discussions across all media forms are centered on the perception, the theory really, that Americans have become an entitlement society.  The prevailing concept of the ultraconservative is that barely more than half the nation’s adult population is gainfully employed and forty seven percent of United States households are recipients of government assistance at one level, or multiple levels.  Is this proof of an entitlement society and, if it is, does it indicate an emotionally regressive state as defined by Murray Bowen?  Is it possible that the population as a whole has reached the point one might think of it as symbiotic?  Has our country devolved into something that resembles the governmental womb of peoples so interconnected, adversarial, and dependent that it would be appropriate to apply the analogy of Jacob and Esau in Rebekah’s womb?  As I process the current events, I work within the parameters of biblical teaching and family systems theory.

According to news reports a young adult, twenty years of age, shoots the mother he cohabits with in the face then proceeds to the nearby elementary school and shoots the principle and psychologist after an altercation.  Next, he enters the kindergarten classroom his mother teaches and kills twenty of her students.  The shooter is misidentified initially based upon the fact that he is in possession of his elder brother’s identification.  The tragedy ends with the perpetrators suicide.  Investigators find it remarkable that his home indicates the young man is meticulously keeping his personal space in order.  The parents are divorced.  The father and elder brother reside in a neighboring state.  The shooter is allegedly developmentally impaired.  

Are the cohabitation, impairment, assumption of a brother’s identity, and choice of targets an indication of symbiosis within the family or something else?  Is it possible he feels entitled to kill his mother’s students in retribution for some perceived error committed by his mother?  Alternatively, given the intrafamily dynamic, has he regressed to a nearly nonexistent level of differentiation of self and taken on a misguided persona of an angry brother and killed out of an anxious undifferentiated family ego mass?

 The cyclical nature of the symbiotic relationship between the mother and son is so intertwined that they are emotional Siamese twins, or so distant and hostile that they repel each other.  The symbiotic mother-son relationship is intense, not circumscribed or confined to the two but rather a fragment of the larger emotional field, fluid, and shifting, the family emotional system extending beyond the central family unit to nonrelatives and institutions.  In the undifferentiated emotional unit, one family member accurately knows the thoughts, feelings, fantasies, and dreams of another family member.  This “fusion of selfs” could involve every area of ego functioning.  One ego could function for that of another.   Is it understandable only from the family systems perspective — confusion with or the assumption of the brother’s identity?  Is this another level of entitlement mentality?

A biblical perspective might assume humans in the fallen state inherently possess an entitlement, adversarial worldview.  Therefore, any perceived regression and symbiotic functioning is not confined to the United States of America; it is a function of the common human experience from the beginning of time and must be understood as such.  The answers to the above perplexing questions ultimately exist only within the Creator.   A redeemed people cannot hope to comprehend the extent of our interrelatedness and the repercussions of an all-encompassing unseen warfare between spiritual good and evil.

Twins Fight in Womb (video)

 http://abcnews.go.com/Health/video-shows-twins-fighting-womb/story?id=17848740 

 

     

Murray Bowen was less optimistic than he may have been if he had the advantage of current research.  Real, perhaps lasting, change is possible much more quickly than he anticipated in his writings.  Perhaps when our parents and grandparents warned us to be careful choosing our friends we would be wise to listen more carefully.

April 23, 2012

Molecular Effects of Social Stress

Social rank has broad effects on gene regulation, particularly in the immune system, according to a new study in rhesus macaques. The findings help explain how social status gets under your skin.

Rhesus macaques at the Yerkes National Primate Research Center were used in the study. Image courtesy of Yerkes National Primate Research Center, Emory University.

Many species, including humans, have social hierarchies that affect mating and other behaviors that are important for survival. A growing body of evidence suggests that the stress of a low social ranking can also influence mental and physical health in a variety of ways. These include suppressed immune function and elevated risk for cardiovascular problems like hypertension, heart disease and stroke. Yet little is known on a molecular level about how social stress translates into physiological changes.
In the new study, researchers investigated whether social status affects gene regulation. The work, funded by several NIH components, was led by University of Chicago researchers Dr. Jenny Tung (now at Duke University) and Dr. Yoav Gilad. It was described in the April 9, 2012, advance online edition of the Proceedings of the National Academy of Sciences.
The researchers examined social groups of female rhesus macaques. In the wild, female macaques generally inherit their social rank from their mothers and stay in the social group they were born into. The scientists, however, constructed 10 groups with 5 macaques each. In this situation, the order of introduction determines rank, with later admission bringing lower status. The scientists took blood samples and used DNA microarray chips to analyze the blood cell expression levels of over 6,000 genes.
The team identified almost 1,000 genes whose expression levels varied with social rank. Over 500 were more highly expressed in high-ranking macaques; about 450 were more highly expressed in low-ranking animals. The largest functional group, with 112 genes, related to the immune system. The researchers found that, by looking at these expression levels, they could correctly predict social rank for 80% of the macaques they tested.
The social status of 7 macaques changed during the study, giving the scientists an opportunity to confirm that gene expression changes with social rank. They found that gene expression levels could correctly determine the social rank of 6 out of the 7 females.
The scientists also explored whether DNA methylation—an alteration that affects gene expression without changing the genetic sequence­—might mediate these effects. They found that the DNA methylation differences were modest but corresponded with expression. The finding provides at least a partial explanation for how the body might quickly change expression in response to social rank.
“There's a spooky side to this kind of research, in that an individual's social rank is partially determining health status,” Tung says. “But there's also a hopeful side. For the 7 females that changed ranks, their gene status changed with them. They're not stuck in place, and I think that says something more broadly about the capacity for change.”
This study provides insight into the links researchers have long observed between social stress and physiology. More work will be needed to fully understand the mechanisms by which social status affects gene expression and health outcomes.
—by Harrison Wein, Ph.D.
http://www.nih.gov/researchmatters/april2012/04232012social.htm

If this study can be replicated, the biblical admonitions in the O.T. take on a new way of thinking.  The harsh (by current American standards) punishments prescribed by Moses in the Wilderness for antisocial behavior are more reasonable than "civilized" writers and television news anchors and commentators would have us believe.