Understanding schizophrenia and social factors

Research consistently shows a higher incidence of schizophrenia among people in lower socio-economic groups compared to those in higher groups.

Social causation theory

Social causation theory proposes that the stresses and challenges associated with low socio-economic status increase vulnerability to schizophrenia. People in lower classes often face greater hardships, such as poverty, unemployment, and poor living conditions, which could heighten the risk of developing the disorder.

Evidence supporting social causation

• Higher incidence in lower classes - Studies indicate that schizophrenia is much more common among the lowest socio-economic groups than in middle or upper classes. For example, rates are particularly elevated in urban areas where the poorest populations live.
• Stress as a trigger - The theory argues that chronic stress from these environments makes individuals more susceptible, as it may overwhelm coping mechanisms and contribute to the onset of symptoms.
• Lack of smooth progression - The relationship is not gradual; there is a sharp increase in prevalence in the very lowest classes, suggesting that extreme deprivation plays a key role.

However, this theory has limitations. If social causation were the primary factor, we might expect a steady rise in schizophrenia as socio-economic status declines, but the evidence shows a more abrupt jump in the lowest groups.

Social drift hypothesis as an alternative explanation

The social drift hypothesis offers a different perspective, suggesting that schizophrenia itself causes people to "drift" down the socio-economic ladder, rather than low status causing the disorder.

Key evidence for social drift: Turner and Wagenfeld (1967)

• Aim - To test this, researchers have compared the socio-economic status of people with schizophrenia to that of their family members.
• Method - The researchers examined the socio-economic status of individuals diagnosed with schizophrenia and compared it to that of their fathers.
• Results - People with schizophrenia tended to belong to lower socio-economic groups than their fathers, supporting the idea that the disorder leads to a decline in status. However, the fathers themselves were often in lower groups than the general population, which aligns partially with social causation.
• Evaluation - This mixed finding highlights the complexity; social drift explains some downward movement, but initial family status suggests causation might also play a role. Halgin and Whitbourne (1997) noted that insufficient research exists to fully resolve the debate between these viewpoints.

Cross-cultural evidence challenging social causation

Sartorius (1986) conducted a study across various cultures and found that schizophrenia rates are relatively similar worldwide, despite vast differences in factors like poverty and physical health – elements central to social causation. This consistency implies that social stressors alone may not account for the disorder, lending more weight to alternatives like social drift or biological causes.

Current thinking on social and biological influences

Today, schizophrenia is widely understood to have a biological and genetic basis, meaning it often runs in families due to inherited vulnerabilities. However, social experiences and environment can trigger symptoms or influence the course of the disorder.

A key social factor in this model is the communication patterns within a person's living environment, which can affect the likelihood of relapse – a return of symptoms after a period of improvement.

The role of expressed emotion in relapse

Expressed emotion (EE) is a critical variable in determining whether a relapse would occur, focusing on the level of criticism, hostility, or emotional over-involvement shown by family members or caregivers towards someone with schizophrenia. EE can be positive or negative, and high levels of negative EE are linked to increased stress for the individual and are usually associated with higher relapse rates.

Evidence from family intervention studies

Family therapy research has shown that dysfunctional communication patterns contribute to schizophrenia's progression. Family intervention studies highlight that the family plays a role in the schizophrenic condition, particularly drawing attention to faulty communication patterns.

Importantly, the impact of EE extends beyond families. Studies of patients in community care settings have found similar links: high negative EE from caregivers or housemates correlates with higher relapse rates, indicating that any close living situation with poor communication can be a risk factor.

Cultural factors influencing expressed emotion

Cultural background can shape how EE is expressed and its effects on schizophrenia. While the link between high negative EE and relapse holds across cultures, the prevalence and style of EE vary. Research shows that Indian and Mexican-American families often display lower levels of negative EE compared to Anglo-American families.