A strength of this theory is the supporting evidence from Berger. He found that SZ patients reported a higher recall of double bind statements (conflicting messages) by their mothers than non SZ patients. However this reliability of this study was criticised as patients recall may be affected by their SZ. There are said to be problems as it is called a retrospective recall, as the data is unreliable. For example, delusions may occur meaning that the patients are recalling things that didn’t happen.
Another criticism of the Double Bind theory is the inability to replicate the findings across studies. This is because of individual differences, and the fact that as most of the memories were from childhood, you cannot go back in time to assess the validity of the recollections.
An additional criticism is the fact that the Hawthorne Effect may have occurred. As it was an observation of the families, there is no proof that the parents will act as they normally do around their families, therefore the validity of the results reduces as the results will not show a true picture of how they really are as a parent.
Also, the families are studied retrospectively, meaning they are studied long after the mental disorder may have affected the family system. This means that various family routines will have been disrupted so you will be unable to see how the family acted before a child developed SZ. This is because living with someone with SZ is difficult and distressing for all the family as it has an impact on everyone, not just the patient of SZ.
A final criticism is that it is said to be an unconstructive theory as the theory blames the parents and families for a child developing SZ. By suggesting that a parent has caused SZ is at least unhelpful and at most highly destructive, as they not only have to cope with living with someone with SZ, but they are then told that it is their fault, which will lead them to feel guilty and hurt as they are blamed for a poor upbringing.
A second psychological explanation of SZ is Expressed Emotion. This was developed in the late 1970’s when psychologists were more interested in how the family might play a part in the course, rather than the cause of SZ. For example, Brown found that patients who returned to homes where there was a high level of expressed emotion, for example lots of hostility, criticism and over involvement, they showed a greater tendency to relapse in comparison to those who returned to homes where there was a lower level of expressed emotion. This was supported by Linszen who found this to be four times more likely. This study suggests that a high level of emotion in the family environment plays a role in the SZ patients’ disorder becoming worse.
There is also support for this explanation from Vaughn and Leff who also found that the level of expressed emotion had an affect on relapse rates amongst discharged patients. However they also studied the amount of face to face contact patients spent with relatives after discharge, and they found an increase in relapse rates as face to face contact increased, and even more so with higher levels of expressed emotion. This study suggests that the more time a SZ patient spends with a family with high levels of EE means that they are more likely to relapse.
On the other hand, this study has not been replicated therefore the validity of their results is questioned.
There is a lot of supporting research for this explanation, for example from Kalafi and Torabi (1996) who studied expressed emotion within families in an Iranian Culture, where mothers are extremely over protective and submissive, and fathers are more rejecting as they are not able to comfort their child as it is seen as weak in their culture. They found a higher prevalence of expressed emotion was one of the main causes of relapse, as there is a lot of negativity in the families which in the end leads to high levels of stress which they find it very difficult to cope with. This suggests that a mixture of emotion from parents in the Iranian culture plays a role in the SZ patient relapsing.
However this theory was criticised as it is not clear whether EE intervention was the key element of the therapy or whether aspects of the family intervention might have helped. Therefore this leads to confusion and eventual withdrawal. Therefore there are other aspects of intervention that could be useful as it is unclear as to whether EE is helping the family as a unit.
A second criticism is that many patients with SZ are either estranged from their families or have minimal contact, and yet there is no evidence that such people are less prone to relapse. Therefore it is unclear whether there is an impact.
On the other hand, there are several strengths to this theory. For example, there is a lot of supporting research conducted to make the theory more valid. The EE is a well established “maintenance” model of SZ and many prospective studies have been conducted which support the EE hypothesis across many cultures, therefore the theory is also applicable cross culturally. This is also because negative emotion will most likely be found in many different cultures.
There has also been an argument as to whether the EE model is a cause or an effect of SZ. The EE model has becoming widely accepted that research is now focussing on relatives of those with SZ in order to understand better which aspects of high and low EE relate to relapse. There is evidence to support that the family members are not held responsible for a person developing SZ, for example they tend to attribute positive symptoms such as hallucinations and delusions to the person’s mental illness. But on the other hand, there is also evidence that some attribute negative symptoms, for example social withdrawal, to the person’s personality characteristics and in the end they are said to become over critical in an attempt to change those behaviours.
Overall, it was concluded by Lopez that families characterised by negative affect (criticism) has much higher relapse rates in comparison to those with positive affect (warmth).
