Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 553

The collectivist characteristics of a culture may help a patient to recover for

several reasons. Consider that people in collectivist countries may:

1. be more tolerant of those with schizophrenia and therefore less likely to be
   critical, hostile, and controlling toward those individuals. That is, the families
   of patients with schizophrenia may be more likely to have lower levels of
   expressed emotion, decreasing the risk of relapse and leading to better recoveries
   (El-Islam, 1991).


2. elevate the importance of community and, in so doing, provide a social norm
   that creates more support for people with schizophrenia and their families.


3. have higher expectations of people with schizophrenia—believing that such in-
   dividuals can play a functional role in society—and these expectations become
   a self-fulfi lling prophecy (Mathews, Basily, & Mathews, 2006).

Thus, collectivism and strong family values may best explain the better recovery

rates in less developed countries, which are generally more collectivist (Weisman,

1997). In such countries, to preserve family harmony, family members may be more

tolerant of odd behaviors in a relative with schizophrenia, and they may be more

willing to live with that person. In fact, for Latino patients, increasing their per-

ception of the cohesiveness of the family (increased collectivism) is associated with

fewer psychiatric symptoms and less distress (Weisman et al., 2005).

FEEDBACK LOOPS IN ACTION: Schizophrenia

No individual risk factor by itself accounts for a high percentage of the cases of

schizophrenia. It is true that genetics, prenatal environmental events (such as ma-

ternal malnutrition and maternal illness), and birth complications affect fetal

development (neurological factors) and can increase the likelihood that a person will

develop schizophrenia. But many people who have these risk factors do not develop

the disorder. Similarly, a dysfunctional family or another type of stressful environment

(social factors) can contribute to, but do not cause, schizophrenia. And cognitive

defi cits (psychological factors) can contribute to the disorder because they create

cognitive distortions but, again, such factors do not actually cause schizophrenia.

As usual, in determining the origins of psychopathology, no one factor reigns

supreme in producing schizophrenia; instead, the feedback loops among the three types

of factors provide the best explanation (Mednick et al., 1998; Tienari, Wahlberg, &

Wynne, 2006). To get a more concrete sense of the effects of the feedback loops,

consider the fact that economic factors (which are social) can infl uence whether a

pregnant woman is likely to be malnourished, which in turn affects the developing

fetus (and his or her brain). And various social factors create consistently high levels

of stress among immigrants or among children raised in an orphanage. Thus, social

events infl uence the degree of stress the individual experiences (a psychological fac-

tor), which can trigger factors that affect brain function, including increased cortisol

levels. Coming full circle, these psychological and neurological factors are affected

by culture (a social factor), which infl uences the prognosis, how people with schizo-

phrenia are viewed, and how they come to view themselves (psychological factors).

Numerous studies have documented specifi c ways in which the three types of

factors affect one another. For example, in one study (Tienari, Wahlberg, & Wynne,

2006), the researchers tracked adopted children over 21 years; some of them had

biological mothers who had schizophrenia (genetic/neurological factor), others had

biological mothers without schizophrenia. Some adoptive families exhibited a par-

ticular type of dysfunctional communication (social factor), in which the adoptive

parent’s way of communicating leaves the child puzzled and unsure what the parent

means. This style of communication tends to be confusing and stressful to the chil-

dren (neurological and psychological factors).

Among these adopted children, those with a low genetic risk of schizophrenia

were unlikely to develop any schizophrenia spectrum disorder regardless of whether

the adoptive parents’ style of communication was healthy or dysfunctional. In con-

trast, the parents’ style of communication made a big difference for those children

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