550 CHAPTER 12
behavior (a paranoid delusion) or else tries to minimize contact with others because
their behavior seems inexplicable.
In spite of the fact that they basically were genetically identical, the Genain
quads did not have the same level of social skills or ability to navigate the social
world. For instance, Myra was able to work as a secretary for most of her life—a
job that requires social awareness and social skills (Mirsky et al., 2000). She had
markedly better social skills and stronger social desires than Hester—qualities that
enabled her to have a boyfriend at school (Rosenthal, 1963).Stressful Groups
Orphanages are notoriously stressful environments, which may be a major reason
why being raised in an orphanage increases the likelihood of later developing schizo-
phrenia in those who are genetically vulnerable. In fact, children born to a parent with
schizophrenia are more likely to develop schizophrenia as adults if they were raised in
an institution than if they were raised by the parent with schizophrenia. In addition,
genetically vulnerable children raised by foster parents who do not have schizophre-
nia are even less likely to develop the disorder than are vulnerable children raised in
an orphanage or raised by a parent with schizophrenia (Mednick et al., 1998). These
fi ndings suggest that, of the three types of environments in which an individual with a
vulnerability to schizophrenia can grow up, a foster family is the least stressful.
Stress also contributes to whether someone who recovered from schizophrenia
will relapse (Gottesman, 1991; Ventura et al., 1989). Almost two thirds of people
hospitalized with schizophrenia live with their families after leaving the hospital.
These families can create a stressful environment for a person with schizophrenia,
especially if the family is high in expressed emotion. The concept of high expressed
emotion (high EE) is not aptly named: It’s not just that the family with this charac-
teristic expresses emotion in general, but rather that family members express critical
and hostile emotions and are over-involved (for example, by frequently criticizing
or nagging the patient to change his or her behavior; Wuerker et al., 2002). In fact,
hospitalized patients who return to live with a family high in EE are more likely to
have a relapse than patients who do not return to live with such a family (Butzlaff &
Hooley, 1998; Kavanagh, 1992; Vaughn & Leff, 1976). However, note that high EE
does not cause schizophrenia in the fi rst place.
The Genain quads certainly experienced significant stress, and—as you can
guess from what you’ve read so far—their family would be considered high in EE.
Psychologist David Rosenthal (1963) reported that the quads’ father was particu-
larly critical, almost constantly angry, and extremely controlling—in fact, so ex-
treme was his need to control his children that he forbade his daughters to close any
doors, even the one to the bathroom.
The relationship between high EE and relapse of schizophrenia is a correlation.
Although it’s possible that the critical and controlling behaviors of family members, in
part, cause a relapse, it is also equally possible that the causality goes the other way—
that people whose symptoms of schizophrenia are more severe between episodes elicitP SNHigh expressed emotion (high EE)
A family interaction style characterized by
hostility, unnecessary criticism, or emotional
overinvolvement.
People with schizophrenia may have diffi culty
accurately “reading” other people’s emotional
expressions, which can make social interac-
tions confusing and lead them to respond
inappropriately.Paul Exman, Ph.D http://www.paulekman.com Paul Exman, Ph.D http://www.paulekman.com Paul Exman, Ph.D http://www.paulekman.com Paul Exman, Ph.D http://www.paulekman.com