The purpose of this essay is to look at how the psychodynamic, biological, and

cognitive perspectives can be utilised, and how they have been applied to the
explanation of schizophrenia. Depression and schizophrenia are both mental
illnesses, but despite being distinct mental health disorders, they do share some
similarities, such as impact on daily functioning, and an overlap in symptoms.
Depression is a widespread mental health condition characterized by persistent
feelings of sadness or disinterest, lasting at least two weeks, and affecting daily life.
Symptoms include changes in sleep and appetite, low self-esteem, and thoughts of
death. It stems from a mix of social, psychological, and biological factors, with
trauma, loss, and stress as common contributors (World Health Organisation, 2024).
Young adults aged 18–29 have the highest rates of depression (21.0%), while
women are more affected than men. (Villarroel and Terlizzi, 2020)
Schizophrenia, affecting about 1% of the global population, is more common in men,
urban residents, and those from lower socio-economic backgrounds. Typically
diagnosed in late teens to early thirties, but it often emerges earlier in males.
Symptoms severely disrupt daily life, leading to homelessness or hospitalization for
many. Symptoms include positive experiences like hallucinations and delusions, and
negative symptoms like reduced speech quality and difficulty initiating activities
(Flanagan, Jarvis, & Liddle, 2022).
The psychodynamic theory, pioneered by Sigmund Freud et al., explains human
behaviour's origins by considering internal drives and forces, especially within the
unconscious mind. Freud's model suggests that abnormal behaviours stem from
unresolved conflicts, often from childhood experiences (Malim & Birch, 1998). The
unconscious mind stores repressed memories that influence conscious thoughts and
behaviours. Freud posited that much of the mind operates unconsciously. Ruffalo
(2023) stated that schizophrenia arises from unresolved conflicts in childhood,
overwhelming stress leading to regression and personality disintegration, resulting in
psychotic symptoms like delusions and hallucinations. Psychodynamic theory
suggests schizophrenia involves ego dysfunction, blurring internal thoughts and
reality. Some theorists link family interactions, including the "schizophrenogenic
mother" concept, to triggering the disorder. (Flanagan, Jarvis, & Liddle, 2022)
One potential advantage of the psychodynamic approach is its groundbreaking
nature in reshaping psychological perspectives. For instance, it introduced innovative
methodologies for gathering case studies instead of solely relying on introspection.
Moreover, it pioneered psychological treatments rather than focusing solely on
biological approaches, thereby broadening the understanding of disorder origins.
However, its untestable nature renders it unscientific; concepts like drives to explain
conditions such as depression or anxiety cannot undergo empirical testing.
Freud proposed that individuals go through psychosexual stages in childhood, each
needing resolution to prevent lasting effects. The first stage, the oral stage, happens
from birth to about one year old, with pleasure focused on the mouth, often the
mother's breast. Failure to resolve conflicts here can lead to oral fixations like
smoking or nail-biting, or personality traits such as sarcasm or criticism. Freud
suggested that schizophrenia could involve a regression to the oral stage. When
faced with overwhelming stress or trauma, individuals might retreat to this infantile
state where they seek security and comfort. This regression could lead to behaviours
and thought patterns typical of the oral stage, such as dependency and an inward
focus on internal fantasies rather than external reality. Next is the anal stage, from
one to three years old, focusing pleasure on the anus, particularly through
withholding or expelling faeces. Unresolved issues here may show as anal
retentiveness, associated with perfectionism, or anal expulsiveness, linked to
carelessness or messiness. While Freud primarily linked schizophrenia to the oral
stage, some theorists extended the idea to the anal stage. Here, issues of control
and order might manifest in symptoms like obsessive behaviours or rigidity.
However, this connection is less emphasized in Freud’s original theory. (Flanagan,
Jarvis, and Liddle, 2022)
The third stage, the phallic stage, spans ages three to six, highlighting pleasure in
the genital area. Failure to resolve conflicts here may lead to narcissistic or reckless
behaviours, known as a phallic personality. Key aspects include the Oedipus
complex and castration anxiety for boys, and the Electra complex and penis envy for
girls. Following this is the latency stage, from age six to puberty, characterized by
socializing mainly with same-sex peers. The final stage, the genital stage, emerges
at puberty, marking the conscious awakening of sexual desires. Unresolved conflicts
here may hinder the formation of heterosexual relationships. (Flanagan, Jarvis, and
Liddle, 2022)
Freud described personality as a “tripartite”, composed of three parts. The Id
represents the primal aspect of our personality, operating on the pleasure principle,
where immediate gratification is sought without consideration for consequences. It
constitutes a mass of unconscious drives and instincts, present from birth – Freud
called infants "bundles of Id". Throughout life, the Id remains selfish, prioritizing its
needs above all else. The Ego, emerging around the age of two, functions on the
reality principle, serving as a mediator between the Id and the Superego. Its primary
role is to mitigate conflicts between these two aspects by employing various defence
mechanisms. The Superego forms towards the end of the phallic stage, around age
five, embodying our internalized moral compass. Governed by the morality principle,
it reflects the ethical standards of the child's same-gender parent and punishes the
Ego for transgressions through feelings of guilt (Cardwell et al, 2000). Freud believed
that schizophrenia involves a fundamental breakdown in the ego's ability to mediate
between the id (primitive impulses) and the superego (moral standards). In the face
of severe stress or unresolved early conflicts, the ego might regress to an earlier
psychosexual stage, most commonly the oral stage. This regression results in a loss
of mature defence mechanisms and a reliance on more primitive, infantile ones.
The final theory that Freud developed extensively was his work on defence
mechanisms. These are strategies which people use to protect themselves from
painful emotions. This is usually caused by conflict among the three parts of the
personality (Cardwell et al, 2000). An example of an event which may cause conflict
amongst the three parts is working out when tired The Id would want to skip the
workout because it feels lazy and just wants to relax, the superego wouldn’t want to
skip the workout because it is essential to their health and discipline, and the ego
would just have the workout be shorter workout and make up for it the next day with
a longer workout.
One defence mechanism is referred to as repression. It is an unconscious defence
mechanism employed by the ego to keep disturbing or threatening thoughts from
becoming conscious. An example of this is the Oedipus complex: aggressive
thoughts about the same-sex parent are repressed and pushed down into the
unconscious. The repressed material doesn't disappear but instead influences
behaviour and thought processes unconsciously. As the repressed thoughts and
emotions build up, they can cause significant psychological stress. Eventually, the
repressed material may break through into consciousness in a distorted form,
manifesting as psychotic symptoms such as delusions and hallucinations in
schizophrenic individuals. Another defence mechanism is displacement. This is the
redirection of feelings from the true object of anxiety onto a substitute target or
object. An example of this is slamming the door after a row with a parent. People
with schizophrenia might project their own negative feelings or thoughts onto others.
This can result in paranoid delusions, where the individual believes others are
plotting against them or harbouring hostile intentions. (Cardwell et al, 2000)
A further defence mechanism is regression. This is where the ego reverts to an
earlier stage of development, usually in response to stressful. An example of this is a
child wetting the bed when their parents are fighting. Individuals with schizophrenia
may regress to an infantile or childlike state. This can result in behaviours and
thought patterns that are more primitive and less reality-oriented, contributing to
symptoms like disorganized thinking, inappropriate emotional responses, and
childlike behaviour. The last defence mechanism is denial, where the individual fails
or refuses to acknowledge some aspect of reality. An example of this is continuing to
turn up for work even though they have been fired. In schizophrenia, denial might
manifest as an inability to accept the external world, leading to the creation of a
distorted internal reality. This can contribute to delusions and hallucinations, where
individuals refuse to acknowledge the true nature of their perceptions and
experiences. (Cardwell et al, 2000)
One of the criticisms of the theories proposed by Freud is that there is a lack of
empirical evidence, as much of the work carried out relies upon case studies to
provide evidence. A case study is a detailed investigation of a particular subject,
such as a person, group, organisation, etc. The main problem with case studies is
that there is limited generalisability, as it focuses on a specific individual in detailed
context. Another criticism is that they heavily rely on the researcher’s interpretation
and selection of data, which could be influenced by assumptions and their personal
views.
Freud and Breuer (1895, as cited in Eysenck, 2009) conducted a case study aiming
to understand the origins of a woman's "hysteria". She exhibited symptoms similar to
schizophrenia, such as hallucinations, disorganized speech, abrupt mood swings,
and social withdrawal, which emerged during her taking care of her ailing father who
subsequently passed away. The methodology involved Breuer engaging in a form of
talk therapy with the patient, a precursor to Freud's psychoanalysis. Through their
analysis, they uncovered a traumatic childhood event, positing that the stress of
caring for her father triggered a regression to an earlier psychosexual stage. Freud
proposed that "hysteria" stems from the Id reverting to a previous developmental
stage, with hallucinations arising from the conflict between the Id and the ego's
endeavour to reestablish contact with reality. A strength of this case study is that it
provided deep insights into the individual’s experiences and helped establish
psychoanalytical principles. Another possible strength of this study is that it
combined medical, psychological, and psychoanalytical perspectives, enriching the
understanding of mental health. A limitation of this study, however, is that as it is a
case study, it has very limited generalizability. Another weakness is that it relies
heavily on subjective interpretation, significantly lowering the validity of the study.
Ethical guidelines were breached in this study, as the patient experienced high levels
of anxiety and distress during the talk therapy. Freud and Breuer's case studies
revealed the importance of early childhood experiences, including traumatic events
and repressed memories, in the development of psychological symptoms. They
proposed that unresolved conflicts from childhood could continue to influence
individuals' thoughts, feelings, and behaviours into adulthood.
Another psychological viewpoint is the biological perspective, which offers two
primary explanations for schizophrenia: the neurochemical approach and the
neuroanatomical approach. As described by Hayes (2000), the biochemical
explanation of schizophrenia posits that mental disorders result from physiological
dysfunctions and can thus be treated with medical interventions like medication. This
theory relies on biochemistry to investigate abnormalities, suggesting that
irregularities may stem from imbalances in neurotransmitters – chemicals released
by neurons that should bind to receptor sites on other neurons. When the equilibrium
of these chemicals is disrupted, it can lead to atypical behaviour. Additionally, the
biological approach examines abnormalities through neuroanatomy, focusing on the
physical structure of the brain to identify issues such as brain damage or
deterioration. The biological approach to explaining schizophrenia focuses on
genetic predispositions, neurochemical imbalances, and structural brain
abnormalities. Genetic studies indicate a significant hereditary component, while
neurochemical research highlights the role of dopamine and other neurotransmitters.
Structural brain abnormalities, such as enlarged ventricles and reduced grey matter,
further support the biological basis of schizophrenia. Additionally, prenatal, and
perinatal factors can contribute to the risk of developing the disorder. This
comprehensive biological perspective helps in understanding the complex ethology
of schizophrenia and informs the development of effective treatments, including
antipsychotic medications that target neurochemical pathways.
One advantage of the biological approach lies in its practical applications in the real
world. For instance, delving into the biological mechanisms underlying human
behaviour has facilitated the development of psychoactive medications effective in
treating severe mental disorders like depression. This practical utility has enabled
many individuals to reintegrate into society. Moreover, it has enhanced our
comprehension of human behaviour, bolstering the overall credibility of the
approach. Additionally, the biological perspective employs a variety of highly
scientific and precise methodologies, including scanning techniques such as fMRIs,
EEGs, and drug trials. These methods ensure objective and accurate
measurements, thereby enhancing the reliability of data and bolstering the
approach's internal validity. (Malim and Birch, 1998)
The biological theory heavily depends on information about the brain's physical state,
including any damage or chemical imbalances. Positron emission tomography (PET)
scans involve tagging a substance in the brain with a short-lived radioactive isotope,
making it an invasive procedure. These isotopes emit positrons detected by the
scanner, which are then analysed and converted by a computer into a moving image
of the brain. These images, often displayed in colour, provide detailed information
not only about injuries and tumours but also about chemical levels and processes
within the brain (Malim and Birch, 1998). PET scans provide a detailed picture of the
metabolic and neurochemical abnormalities in the brains of individuals with
schizophrenia. Key findings include heightened dopamine activity in the mesolimbic
pathway, reduced glucose metabolism in the prefrontal cortex, and abnormalities in
other neurotransmitter systems like serotonin and glutamate. These insights support
the dopamine hypothesis and the role of other neurotransmitter systems in
schizophrenia, helping to explain the positive, negative, and cognitive symptoms of
the disorder. Additionally, PET scans highlight disruptions in brain connectivity,
offering a comprehensive view of the functional brain abnormalities associated with
schizophrenia. These findings are crucial for developing targeted treatments and
understanding the complex neurobiology of schizophrenia. (Patel et al., 2010)
A strength of using a PET scan to gather data regarding the brain is early detection.
PET scans can detect abnormalities at an early stage, even before structural
changes occur, aiding in the early diagnosis of conditions like Alzheimer’s disease,
epilepsy, and certain types of cancer. Another strength is that the data from PET
scans are quantifiable and objective, reducing the potential for human error and
increasing the reliability of the results. A weakness, however, is that the procedure
involves injecting radioactive isotopes into the bloodstream, which carries risks and
can be uncomfortable for the patient. This invasive nature also limits the frequency
with which PET scans can be performed. Another limitation is the cost. PET scans
are expensive due to the specialized equipment and materials required, as well as
the need for specially trained personnel, which can limit their accessibility and use in
routine clinical practice.
Iversen (1979, cited in Gross, 2020) conducted a study to explore the potential
chemical causes of schizophrenia. Using a controlled laboratory experiment with a
cross-cultural approach, he compared dopamine levels in individuals with
schizophrenia to those in individuals without the condition. This comparison was
made through post-mortem examinations of recently deceased individuals. Iversen
discovered that those with schizophrenia had significantly higher dopamine levels
than those without the disorder. He concluded that elevated dopamine levels cause
schizophrenia, a conclusion that led to the formulation of the dopamine hypothesis.
A possible strength of this study is the post-mortem examinations’ ability to offer a
detailed analysis of the brain's anatomical structure and neurochemical properties,
which other scanning techniques (e.g., EEG, ERP, and fMRI) cannot achieve. These
examinations can access deeper brain regions like the hypothalamus and
hippocampus, providing researchers with valuable insights that are not possible with
other methods. For instance, Iversen discovered a higher concentration of dopamine
in the limbic system of patients with schizophrenia, which has spurred extensive
research into the neural correlates of this disorder. However, one potential major
limitation of this study is the issue of causation in the post-mortem examinations. A
patient's deficits observed during their lifetime (e.g., an inability to speak) may not be
directly related to the brain abnormalities found (e.g., damage to Broca’s area). The
observed deficits might have resulted from another condition, making it difficult for
psychologists to conclusively link the deficits to the brain damage identified post-
mortem. There are also ethical concerns regarding informed consent and whether a
patient consents before their death. Additionally, many post-mortem examinations
are conducted on patients with severe psychological deficits (e.g., patient Henry
Molaison, who suffered from severe amnesia) who are incapable of providing fully
informed consent, yet their brains are still examined post-mortem.
The final psychological perspective discussed in this essay is the cognitive
approach. Unlike the behaviourist approach, the cognitive approach asserts that
internal mental processes can and should be studied scientifically. Consequently, it
has explored areas of human behaviour overlooked by behaviourists, such as
memory, perception, and thinking. These processes are 'private' and cannot be
observed directly, so cognitive psychologists study them indirectly by inferring what
is happening in people's minds based on their behaviour. Cognitive processes are
often influenced by a person's beliefs or expectations, known as 'schemas.'
Schemas, or schemata, are 'packages' of ideas and information formed through
experiences, serving as a mental framework for interpreting incoming information.
For instance, the schema for a chair includes the idea of something with legs that
you can sit on, a concept learned through experience that aids in appropriately
responding to the object (Flanagan, Jarvis, and Liddle, 2022). Cardwell et al (2000)
further outline that Aaron Beck and Albert Ellis, the pioneers of this method,
acknowledge that everyone encounters flawed or irrational cognitive processes
occasionally. However, it's when these patterns become predominant and begin to
affect our daily functioning that they pose a concern. The cognitive approach to
schizophrenia emphasizes the role of cognitive processes and biases in the
development and maintenance of the disorder. Information processing deficits,
memory impairments, cognitive biases, metacognitive impairments, and social
cognitive deficits contribute to the various symptoms and experiences associated
with schizophrenia, including hallucinations, delusions, disorganized thinking, and
social dysfunction. Understanding these cognitive mechanisms is crucial for
developing effective interventions, such as cognitive-behavioural therapy (CBT), that
target specific cognitive deficits and distortions in individuals with schizophrenia.
(Batinic, 2019)
One potential advantage of the cognitive approach lies in its utilisation of objective
and scientific methodologies. Cognitive psychologists employ highly controlled and
rigorous research techniques, enabling the deduction of cognitive processes in
operation. This typically involves conducting laboratory studies to yield reliable and
objective data, thereby establishing a credible scientific foundation for the study of
the mind. However, given that cognitive psychology relies on inferring mental
processes rather than directly observing behaviour, it occasionally becomes overly
abstract and theoretical. Additionally, research into mental processes often employs
artificial stimuli that may not accurately mirror real-world experiences, potentially
compromising the external validity of cognitive process studies.
Faranone et al (1999, as cited in Cardwell et al, 2000) undertook an investigation
aiming to see whether faulty cognitive processes could account for schizophrenia.
This study, conducted in a laboratory setting, examined the working memory and
auditory attention of individuals diagnosed with schizophrenia as well as their non-
schizophrenic parents. The findings revealed deficiencies in both working memory
and auditory attention among the participants, implicating these deficits in the
occurrence of schizophrenic episodes. The researchers concluded that there exists a
genetic predisposition to schizophrenia, linked to impairments in working memory
and auditory attention. However, they were unable to elucidate why not all
participants with such impairments developed schizophrenia.
A possible strength of this study is that it has good control over confounding
variables, as it was conducted as a lab experiment. This allows for potential future
retesting for reliability. However, the study notes that not all individuals with deficits in
working memory and auditory attention develop schizophrenia. This unexplained
variability suggests that additional factors may influence the manifestation of the
disorder, highlighting the complexity of understanding the causes of schizophrenia. A
possible ethical guideline that may have been breached is informed consent. It is
essential to ensure that all participants, including individuals diagnosed with
schizophrenia and their non-schizophrenic parents, provided informed consent
before participating in the study. Given the potentially vulnerable nature of individuals
with schizophrenia, it is possible that they did not give proper informed consent.
All three approaches to understanding schizophrenia highlight its complexity and the
involvement of various factors. They all emphasize abnormal brain functioning, but
from different angles. The psychodynamic approach focuses on unconscious
conflicts and early experiences, while the biological approach highlights genetic and
neurobiological factors. The cognitive approach underscores cognitive deficits and
biases in information processing. While psychodynamic and cognitive approaches
stress psychological processes, the biological approach emphasizes physiological
mechanisms. There's no consensus on the best explanation for schizophrenia, as
each approach offers valuable insights. The biological approach has strong empirical
support, especially in genetics and neurobiology, while the cognitive approach
highlights cognitive impairments. Though less empirically supported, the
psychodynamic approach offers a deep understanding of psychological factors.
Integrating elements from all three perspectives may provide a more comprehensive
understanding of schizophrenia due to its multifaceted nature.

REFERENCES

Batinic, B. (2019). Cognitive Models of Positive and Negative Symptoms of

Schizophrenia and Implications for Treatment. Psychiatria Danubina, [online]
31(Suppl 2), pp.181–184. Available at:
https://pubmed.ncbi.nlm.nih.gov/31158119/#:~:text=Cognitive%20models%20of
%20schizophrenia%20posit.

Cardwell, M., Clark, L. and Meldrum, C. (2008). Psychology for A2 level for AQA (A).
London: Collins Educational.

Eysenck, M.W. (2009). Fundamentals of psychology. London; New York: Psychology

Press.

Flanagan, C., Jarvis, M. and Liddle, R. (2022). AQA Psychology for A Level Year 2
Student Book: 2nd Edition. 2nd ed. Hachette UK.

Gross, R. (2020). Psychology: The Science Of Mind And Behaviour. 8th ed. London:
Hodder Education.

Hayes, N. (2000). Foundations of psychology. 3rd ed. London: Thomson Learning.

Malim, T. and Birch, A. (1998). Introductory Psychology. Basingstoke: Palgrave.

Patel, N.H., Vyas, N.S., Puri, B.K., Nijran, K.S. and Al-Nahhas, A. (2010). Positron
Emission Tomography in Schizophrenia: A New Perspective. Journal of Nuclear
Medicine, [online] 51(4), pp.511–520.
doi:https://doi.org/10.2967/jnumed.109.066076.

Ruffalo, M. (2023). Schizophrenia from the Psychodynamic Perspective. [online]

Psychiatric Times. Available at:
https://www.psychiatrictimes.com/view/schizophrenia-from-the-psychodynamic-
perspective.

Villarroel, M. and Terlizzi, E. (2020). Products - Data Briefs - Number 379 -

September 2020. [online] www.cdc.gov. Available at:
https://www.cdc.gov/nchs/products/databriefs/db379.htm#:~:text=The
%20percentage%20of%20adults%20who%20experienced%20any%20symptoms
%20of%20depression.

World Health Organization (2024). Depression. [online] World Health Organization.

Available at: https://www.who.int/health-topics/depression#tab=tab_1.