Locus of control: Relation to schizophrenia, to recovery, and to depression and psychosis — A 15-year longitudinal study
Introduction
The present longitudinal research studying patients with severe mental disorders was designed to examine whether one's outlook towards life events relates to diagnosis, to depression and psychosis, to functioning and recovery, and to personality, with a focus on schizophrenia and also depressive disorders and other major diagnostic groups.
An important dimension of personality is a variable called locus of control (LOC). This construct, generated through Rotter's social learning theory, refers to the extent to which an individual perceives events in his or her life as being a consequence of his or her actions, and thus under his or her perceived control. It is assessed in terms of whether one believes that events in people's lives result from their own efforts, skills, and internal dispositions (internal control) or stem from external forces such as luck, chance, fate or powerful others (external control) (Rotter, 1966, Rotter, 1990).
The dimensions of an individual's orientation toward the world has been investigated in many different normal populations and in various types of disordered populations including eating disorders (Dalgleish et al., 2001) and depression. Thus LOC has been found to be related to a wide array of affective mood states and personality variables including depression, coping ability, and perceived competence. Depression is one of the most frequently studied concepts in relation to a more external locus of control. The relation between a more external locus of control and increased depression has been supported by studies examining college students (Twenge et al., 2004), cancer patients (De Brander et al., 1997), children (Dunn et al., 1999), caregivers (McNaughton et al., 1995), and other populations. Various factors have been proposed as involved in this relation, with this including depressive affect and other elements of depression such as pessimism, low self-esteem, and hopelessness (Abramson et al., 1989, Alloy et al., 1999).
While there has been extensive interest in broadening knowledge about LOC and its relation to depression (Lester, 1999), and to severity and potential improvement in depression (Bann et al., 2004), less research has been conducted with severely disordered psychiatric patients. It would be of value to determine the extent to which individuals with severe mental disorders feel that events in their lives are a consequence of their own behavior.
There has been some research on LOC and psychosis. This includes research by Bentall and Kaney (2005), Melo et al. (2006), Warner et al. (1989), Hoffman et al. (2000), Hoffman and Kupper (2002), our own group (Harrow and Ferrante, 1969), and others. One might expect an external locus of control in a severe disorder such as schizophrenia, with various factors contributing to this, such as the severity and chronicity of the disorder, the persistence over time of major symptoms for some patients with schizophrenia and the frequent work disability found in most of these patients.
Both consumers and mental health professionals have reported that various personality factors may influence outcome and potential recovery in schizophrenia. Among these, a number of theorists have noted that more external beliefs could reduce the extent of personal efforts towards recovery in schizophrenia and internal approaches could increase the chances of rehabilitation and recovery (Tooth et al., 2003, Bender, 1995, Warner et al., 1989, Hoffman et al., 2000, Hoffman and Kupper, 2002). In general, potential periods of recovery for some or many patients with schizophrenia, and factors which may facilitate it, have become a major issue. Thus, recent evidence has shown that while schizophrenia is still a relatively poor outcome disorder, some or many patients with schizophrenia experience periods of recovery, with some showing the potential for long periods of recovery (Harrow et al., 2005; Liberman, 2002). Needed in the field is more information on factors which play a role in recovery, including the potential for personality factors to exert an influence. Personality and attitudinal approaches may influence both LOC and recovery (Bender, 1995, Tooth et al., 2003). Viewed from this perspective, LOC orientation could influence long-term global outcomes and probabilities for recovery. As a result, study of the relation between an external LOC and subsequent outcome and recovery over a prolonged period in schizophrenia could be of considerable importance.
One study that used psychotic patients (Warner et al., 1989) found that a combination of acceptance of the diagnosis of mental illness and internal locus of control was associated with a better outcome in psychosis. This lstudy, however, did not determine whether patients with schizophrenia, or certain subtypes of schizophrenia patients, were any more or less likely to be internal than other types of disordered patient populations. In earlier research using an acute inpatient sample, the current team found some tendency for more externality among the schizophrenia patients, although the differences were only moderate (Harrow and Ferrante, 1969, Hansford et al., 2004).
In addition, the relation in psychiatric patients between LOC and various dimensions of personality and other important characteristics of the patients (e.g., premorbid developmental achievements, anxiety, anomie, and self-esteem) was not explored fully, even though there is evidence that some personality dimensions may contribute significantly to patients' locus of control orientations and contribute to subsequent outcomes. While previous research has shown the relation between LOC and other personality dimensions (e.g., DeNeve and Cooper, 1998, Judge et al., 2002), research studying the relations between LOC and personality dimensions in severe mental disorders is scant. Because of this paucity, the current research provides a beginning exploration of these relations in patients with severe mental disorders. It also is of importance to further investigate factors such as psychosis and depression, which may be related to the development and maintenance of either a more external or internal LOC. A comprehensive investigation of the LOC construct in psychiatric patients would be of interest to both the personality theorist and the clinician.
Overall, the current research, employing a large sample of patients studied on a longitudinal basis, investigated the following major questions: 1) are patients with schizophrenia more external than other disordered patients?; 2) is internality related to better global functioning and to potential recovery in schizophrenia?; 3) is externality related to depression in severely disordered patients?; 4) is externality related to psychosis?; and 5) is LOC in severely disordered patients related to various personality dimensions and other characteristics of these disordered patients?
Section snippets
Patient sample
The present research is based on the data from the Chicago Follow-up Study, a prospective multi-year follow-up research program investigating schizophrenia and affective disorders longitudinally. One of the goals of the study was to provide longitudinal data on functioning, adjustment, potential recovery, and major symptoms (e.g., psychosis, thought disorder, negative symptoms and depression) in schizophrenia and mood disorders (Harrow et al., 1990, Carone et al., 1991, Harrow et al., 2003,
Relation between externality and diagnosis
Table 1 presents data on diagnosis for the three main patient populations, schizophrenia patients, non-psychotic depressed patients, and other types of psychotic disorders. Diagnosis was not closely related to externality on LOC. The means indicated that at the 4.5 year follow-up assessments schizophrenia patients were not more external than other disordered groups, such as patients who earlier, at the acute phase, had a non-psychotic depressive disorder. The means for the schizophrenia
Locus of control and a diagnosis of schizophrenia
Are patients with schizophrenia significantly more external? The issue of whether a diagnosis of schizophrenia is significantly related to LOC, specifically an external LOC, has been approached by comparing schizophrenia patients against other diagnostic groups, including non-psychotic depressive patients and other psychotic patients. The question of LOC being related to diagnosis has been explored within different subtypes of schizophrenia (Cash and Stack, 1973, Pryer and Steinke, 1973), such
Acknowledgements
The research reported was supported, in part, by USPHS Grants MH-26341 and MH-068688 from the National Institute of Mental Health, USA (Dr. Harrow).The authors are indebted to Robert Faull for his assistance with data preparation and statistical analysis.
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