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Expressed Emotion and the Double-Bind: Communication of Specific Emotions in Schizophrenia
Unformatted Document Text:  Page 16 impersonal social rules and expectations to being governed by more specific expectations intrinsic to the relationship. Dyad members P and O become increasingly adept at predicting how the other will respond in different situations, and this learning extends to the realm of emotion. Rules about emotion develop, such that P becomes a more reliable (albeit not necessarily more valid) source of emotional biofeedback to O, and O becomes a more reliable source to P in turn. The effects of these rules depend critically upon whether the feedback is valid as well as reliable. If it is valid, the social biofeedback will reflect the “true feelings” of the responder, and P’s ability to predict the response of O should increase P’s understanding of P’s own subjective experience. This may increase P’s ability to cope with stressful events: P may become better able to label and verbally acknowledge the feelings, and know what sorts of emotional responses are appropriate and which are not. Therefore P will not feel confused and helpless about how to respond. The result is emotional competence: the ability to recognize and appropriately express feelings and desires in an intentional and controlled way. Moreover, valid emotional communication between P and O will be enhanced. On the other hand, social biofeedback may be reliable but invalid, in which case P may not learn, or may learn not, to label and verbally acknowledge certain subjective feelings and desires. P may learn that the expression of certain feelings and desires will reliably result in punishment, rejection, and humiliation from O. For example, expressions of anger in a little girl might result in being called a “bad girl,” and expressions of caring or fear in a little boy might result in being called weak. Such learning may encourage a child to associate certain emotional experiences with feelings of anxiety and shame, resulting in a distorted view of emotional expression and experience and, perhaps, repression of one’s true feelings. This may in turn produce emotional incompetence and stress, and interfere with valid emotional communication. Paradoxically, these very distortions may make P dependent upon O, and P may later actually come to seek out relationships that maintain these distortions. For example, experience in an abusive relationship may be followed by tendencies to enter other abusive relationships. The examples in the foregoing paragraph illustrate how emotional education may be distorted in a variety of ways, but they are not in themselves DBs. In Western culture, patterns of social biofeedback associated with EE—a combination of hostility, criticism, and emotional overinvolvement—may often tend to produce DBs. As noted, in other cultural settings, these same patterns may not produce DBs, although they may produce other kinds of distortions in emotional education. This analysis, then, leaves open the possibility that, in combination with genetic predispositions, the DB may yet be a source of specifically schizophrenogenic stress. It should be emphasized that this does not imply that any one person, such as the mother, is the sole source or cause of schizophrenogenic stress. Indeed, the expressive behavior of persons with genetic predispositions for schizophrenia may exhibit expressive behaviors that encourage DBs: for example, that encourage EE patterns in Western cultures (King, 2000). In any event, understanding emotional DBs may clarify the bases for the demonstrated effects of EE, including the ameliorative effects of lowering EE, and may suggest how specific sorts of manipulations of the socioemotional environment of schizophrenia patients may have therapeutically beneficial effects.

Authors: Buck, Ross., Sheehan, Megan., Cartwright-Mills, Jacquie., Ray, Ipshita. and Ross, Elliott.
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impersonal social rules and expectations to being governed by more specific expectations
intrinsic to the relationship. Dyad members P and O become increasingly adept at
predicting how the other will respond in different situations, and this learning extends to
the realm of emotion. Rules about emotion develop, such that P becomes a more reliable
(albeit not necessarily more valid) source of emotional biofeedback to O, and O becomes
a more reliable source to P in turn. The effects of these rules depend critically upon
whether the feedback is valid as well as reliable. If it is valid, the social biofeedback will
reflect the “true feelings” of the responder, and P’s ability to predict the response of O
should increase P’s understanding of P’s own subjective experience. This may increase
P’s ability to cope with stressful events: P may become better able to label and verbally
acknowledge the feelings, and know what sorts of emotional responses are appropriate
and which are not. Therefore P will not feel confused and helpless about how to respond.
The result is emotional competence: the ability to recognize and appropriately express
feelings and desires in an intentional and controlled way. Moreover, valid emotional
communication between P and O will be enhanced.
On the other hand, social biofeedback may be reliable but invalid, in which case P
may not learn, or may learn not, to label and verbally acknowledge certain subjective
feelings and desires. P may learn that the expression of certain feelings and desires will
reliably result in punishment, rejection, and humiliation from O. For example,
expressions of anger in a little girl might result in being called a “bad girl,” and
expressions of caring or fear in a little boy might result in being called weak. Such
learning may encourage a child to associate certain emotional experiences with feelings
of anxiety and shame, resulting in a distorted view of emotional expression and
experience and, perhaps, repression of one’s true feelings. This may in turn produce
emotional incompetence and stress, and interfere with valid emotional communication.
Paradoxically, these very distortions may make P dependent upon O, and P may later
actually come to seek out relationships that maintain these distortions. For example,
experience in an abusive relationship may be followed by tendencies to enter other
abusive relationships.
The examples in the foregoing paragraph illustrate how emotional education may be
distorted in a variety of ways, but they are not in themselves DBs. In Western culture,
patterns of social biofeedback associated with EE—a combination of hostility, criticism,
and emotional overinvolvement—may often tend to produce DBs. As noted, in other
cultural settings, these same patterns may not produce DBs, although they may produce
other kinds of distortions in emotional education.
This analysis, then, leaves open the possibility that, in combination with genetic
predispositions, the DB may yet be a source of specifically schizophrenogenic stress. It
should be emphasized that this does not imply that any one person, such as the mother, is
the sole source or cause of schizophrenogenic stress. Indeed, the expressive behavior of
persons with genetic predispositions for schizophrenia may exhibit expressive behaviors
that encourage DBs: for example, that encourage EE patterns in Western cultures (King,
2000). In any event, understanding emotional DBs may clarify the bases for the
demonstrated effects of EE, including the ameliorative effects of lowering EE, and may
suggest how specific sorts of manipulations of the socioemotional environment of
schizophrenia patients may have therapeutically beneficial effects.


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