Causes of schizophrenia
For many years one hypothesis was sought that could explain the cause of schizophrenia. Today, science is certain that there is no single cause for the disease. Rather, it is now believed that there are a number of causative factors that contribute to triggering schizophrenia.
This theory considers the patient to be more vulnerable if he or she has some of the factors listed below.Factors that increase a person’s vulnerabilityVulnerability are:
- Heredity (genetic factors): It is considered certain that people who have schizophrenic relatives have an increased risk of disease. The probability if one parent is ill is about 10-13%, if both parents are ill the probability increases to about 40%. On the other hand, however, this shows that this can by no means be the sole cause of the disease, since 60% of the relatives do not develop schizophrenia.
- Biochemical factors: It is known today that the nerve cells in the brain (neurons) communicate with each other with the help of messenger substances (transmitters).
With regard to schizophrenia, we now know the so-called “dopamine hypothesis”, according to which the messenger substance dopamine is excessively active and thus brings the entire brain metabolism out of balance. (This is exactly where the drug therapy of schizophrenia comes in). Recent research shows that other messenger substances also show altered activity.
- Changed shape of the brain: There are research results that show that the structure of the brain in sick people shows changes.
Changes have been detected both at the microscopic cell level (changes in the cell arrangement in the hypocampus, etc.) and in large structures (enlarged 3rd ventricle, reduced frontal lobe, etc.). These mentioned changes also do not occur in all patients.
- A viral infection before birth: There is a hypothesis that a viral infection of the mother in the second third of pregnancy can promote the development of schizophrenia.
Family theory models of the development of schizophrenia summarized the disrupted communication in the family as the cause.
However, the following theories could not be scientifically proven:
- In 1924, Siegmund Freud saw the development of schizophrenia as a two-step process. In the first stage, he saw a regression of the patient to a state before the actual differentiation of the ego. (higher development of the personality).
In the second stage, Freud saw an attempt by the patient to regain control over his or her own ego. He blamed an environment of numerous deprivations for the patient’s regression to an earlier state of so-called “primary narcissism.
- Fromm-Reichmann put forward the hypothesis of the so-called “schizophrenogenic mother” in 1948. According to this hypothesis, the mother of schizophrenic patients is emotionless and cold.
She cannot respond to the needs of her child. Instead, the mother uses the child to satisfy her own needs.
- Bateson wrote the hypothesis of the so-called “double-bind” in 1978. Here, parents constantly convey double messages and thus plunge their children into great difficulty in making decisions.
- In 1973, Litz added the hypothesis of the “marriage schism” in which father and mother live in open conflict and vie for the affection of the child.
However, the fact that these older family theory schizophrenia explanations have not been scientifically confirmed does not mean that family members’ behaviors have nothing to do with the development of schizophrenia.
For example, there was a well-known study that showed that family members’ behaviors had a significant impact on the likelihood of relapse in schizophrenic patients 9 months after discharge from hospital. This concept of “High-Expressed Emotions” could be proven: The concept of “High-Expressed Emotions” High-Expressed Emotions (High EE) can be described as an emotionally charged atmosphere in the family. This includes not only criticism, devaluation, anger and hostility, but also emotional over-engagement and extreme concern and care, as well as constant brooding, anxiety, dependence of one’s own condition on the patient.
“I constantly think about what is to become of him”, “I do everything for him, if only he is well! The research group around this concept conducted interviews with the families of schizophrenic patients and then evaluated the statements with the help of a tape recording, so that in the end a classification into “low” and “high” emotionality in the sense of the EE concept was possible. The result was the following: In the families with high stressful emotionality 48% of the patients had a new psychotic relapse, in the families with low stressful emotionality only 21%.
This finding was integrated into the following model and is thus part of the current model of the development of schizophrenia.It was also important for the psychological therapy of schizophrenics in the sense that a program for family communication training was developed, which is used to prevent relapses in schizophrenic patients. As mentioned above, the VSM is now considered the most likely primary cause of schizophrenia. Various factors (biological, social, family, etc.) lead to increased “vulnerability”. The vulnerability stress model according to Libermann (1986)
- An unfavorable environmental factor creates stress
- Due to insufficient coping strategies, autonomous hyperexcitation occurs
- Cognitive deficits are increased, which in turn increases social stress
- Prodromal stage (without interventions or own attempts to cope with the situation, the deficit continues to increase)
- Outbreak of schizophrenic symptoms with further impairment of social and professional performance
- The further course depends on the stress factors, as well as coping skills and neuroleptic medication
