Recent years have seen an influx of numerous studies providing an undeniable link between childhood/ chronic trauma and psychotic states. Although many researchers (i.e., Richard Bentall, Anthony Morrison, John Read) have been publishing and speaking at events around the world discussing the implications of this link, they are still largely ignored by mainstream practitioners, researchers, and even those with lived experience. While this may be partially due to an understandable (but not necessarily defensible) tendency to deny the existence of trauma, in general, there are also certainly many political, ideological, and financial reasons for this as well.
Many have called for the trauma and psychosis fields to join forces. So many valuable findings have come out of the trauma field that could inform practitioners and lay people alike in understanding how one might come to be so overwhelmingly distressed and behave in such seemingly strange ways (see Read, Fosse, Moskowitz, & Perry, 2014, for an informative overview of how trauma affects our bodies). Studies looking at how the non-disordered brain adapts to chronic stress, how cumulative adverse events affect how people perceive and react to the world around them, and how many creative ways people come up with to defend against their own awareness of their distress all can help others to understand the un-understandable. More importantly, the trauma field has shown time and again how trauma-informed care can help a person slowly heal from horrid life experiences.
John Read on “Childhood Adversity and Psychosis: From Heresy to Certainty”
Yet, the trauma and dissociation field often goes to great lengths in an apparent effort to draw a decisive line in the sand between “real” trauma “disorders” and “schizophrenia.” This largely is done by insinuating that “dissociation” is trauma-based and explains the bizarre behaviors of so many distressed individuals labeled with “borderline” or “dissociative identity disorder”, while some cognitive or brain-diseased factor contributes to “real” psychosis. Somebody with “schizophrenia” may have experienced trauma, but it is largely irrelevant to the present distress. Is this true? Is there any actual evidence for this beyond ideology? It may be helpful to look at the overlap and separation between “dissociation” and “psychosis” to get a better understanding.
Brief History of Trauma Research
Over 100 years ago, Pierre Janet became the first major figure to identify and treat the vast array of the effects of trauma. In fact, he considered almost all “psychopathology” to be the result of childhood trauma and dissociation (Janet, 1919/25). Under the large umbrella term of “hysteria”, Janet identified the following symptoms: hallucinations in all senses, fugue states, amnesia, extreme suggestibility, an odd disposition, nightmares, psychosomatic and conversion symptoms, reenactments, flashbacks, paranoia, subjective experiences of possession, motor agitation, mutism, catatonia, thought disorder (or disorganized speech), and/or double personalities (Janet, 1907/1965). He believed that treatment consisted of a phase-based approach involving stabilization, trauma processing, and recovery. Fatefully, Janet’s use of hypnosis provided the main basis for his eventual expulsion from the psychiatric community. He responded to his exile by pointing out that the medical establishment denied the existence of trauma and its effects, to the point of focusing too much on the physiological and biological domain.
For the next 8 decades or so, the mental health field became more and more narrow in its focus on and recognition of trauma to the point of neglecting it completely in the more biological domains. It was not until the late1970’s, when a massive influx of veterans gained political clout and women began to speak out and be heard, that trauma was once again recognized as a major factor in extreme emotional distress. This also was the time when the DSM became psychiatry’s new bible; and so, while trauma was once again recognized, it was also separated into narrowly defined disorders that included PTSD, adjustment disorders, and dissociative disorders (including multiple personality disorder, as it was then known). It was then that the modern-day lines were drawn.
So what are people talking about when they speak of “dissociation”? Well, not too many people agree on this. It also appears as though the more professionals attempt to come to a consensus on what this term means, the more they do so in an effort to delineate it from any possible association with “psychosis”; their attempts to define dissociation are done by disassociating.
Wikipedia defines dissociation (in the broad sense) as: “an act of disuniting or separating a complex object into parts.” I do not believe that many mental health professionals, particularly dissociation researchers, would entirely disagree with this definition. Rather, it is the interpretation of this meaning that is a hotly debated topic within psychiatry (a general term I use to describe the entirety of the mental health field). In general, it may be used to describe a process, a multitude of symptoms, specific disorders, a division of the personality (or lack of integration), and/or a psychic defense. Many believe that it refers to disconnection from one’s thoughts, feelings, environment, self, others, etc. The term is also used to refer to a process of entering a trance-like state or extreme detachment. Most agree that dissociation lies on a continuum from “everyday dissociation” (i.e., losing track of time while driving, becoming absorbed in a book) to severe dysfunctional dissociation (i.e., “multiple personalities”). Lately, it appears as though trauma researchers and practitioners are interpreting dissociation as solely meaning a separation of identity states or ego functioning that is based in trauma and is clearly understandable (i.e., not psychosis).
If nobody agrees on what it means, then why do we really care? Because the political implications and resulting effects on treatment options are directly related to how one interprets this meaning. We can see by looking at the DSM how this might work…
DSM and all its Fancy Terms
Akin to many religions throughout time, psychiatry makes up many technical terms and then create circular and eccentric definitions to confuse lay people into believing that mental health issues can only be dealt with by an educated professional. Putting this political maneuvering aside, I would like to focus for a moment on key terms related to the topic at hand: trauma, dissociation, dissociative symptoms, psychosis, psychotic symptoms, dissociative disorders, and schizophrenia.
Trauma: Trauma is technically defined as an event that provokes death-related fears in an individual. It is also agreed upon that trauma is defined by the person’s response to such an event, rather than the event itself. But, what of the child whose parents are cold and over-protective? Or the child who is “only” bullied verbally? Or the child who is chronically invalidated? Or poverty? Or the person in existential crisis? Are these not a form of “trauma”? Certainly, they are shown to be chronically stressful which, physiologically, is not any different than “trauma” defined in the DSM-sense. Although it is understood that trauma is subjective, the DSM insists on narrowly defining it anyways.
Dissociation: As stated previously, very few professionals in psychiatry agree on what this term means. Instead of just saying “absorption”, “feeling unreal”, “feeling one’s surroundings are not real”, “lack of integrated sense of self”, or “detachment” (all considered in different circles as varied forms of dissociation), scholars instead argue over its meaning until it has no meaning at all. Often, it is an ideological term that is used to say “trauma” vs. “not trauma”, whether this is explicitly acknowledged or not. Therefore, when one’s “symptoms” are considered non-dissociative, the assumption generally tends to be that they also are not trauma-based.
Dissociative symptoms: Although dissociative symptoms are acknowledged as existing in a multitude of different DSM categories, they mostly are usurped by the dissociative disorder classifications. In this case, as I will discuss in a moment, dissociative symptoms often seem to take on the meaning of “not psychotic” rather than having any distinct meaning in and of themselves.
Psychosis: Psychosis is another technical term with no precise meaning. It tends to refer to a state in which a person appears to not be aware of or in touch with consensual reality. This can be for 5 minutes or 5 years, but the term itself is non-time specific. In practice, it tends to be used when the professional comes to a point where they say “I don’t understand you or agree with your interpretation of reality.”
Psychotic symptoms: Most people tend to think that psychotic symptoms clearly refer to things such as hearing voices, seeing visions, having strange beliefs, or disorganized thinking/speech. However, “psychotic symptoms” specifically refers to symptoms of psychosis. What is psychosis? Having psychotic symptoms. If you don’t have psychosis, then you may have “psychotic-like” symptoms or “quasi-” insert what you like here. What makes these symptoms psychotic-like instead of truly psychotic? Whether or not your therapist understands you.
Dissociative disorders: While there are 5 dissociative disorders, the one that is most intertwined with the idea of psychosis is dissociative identity disorder (DID). People who might meet the criteria for DID often experience what is inarguably the core of the term “dissociation”; namely, having a fragmented sense of self. In addition, they also experience periods where they cannot remember large gaps of time. This amnesia is certainly not an experience that is universal to many or even most individuals suffering extreme states; however, the other experiences common in DID are definitely non-specific to this classification. These include: hallucinations in all senses, incoherence, bizarre beliefs, impaired reality testing, lack of awareness of the present moment, paranoia, and paranormal experiences. However, these are reframed as: hearing voices of an “alter”, body memories, flashbacks, intrusions of trauma and/or “alters”, beliefs attributed to “alters”, not being grounded, and hypervigilence. These words do not necessarily indicate any difference in the lived-experience, but rather a difference in how psychiatry interprets the experience. And who wouldn’t rather say “I have body memories and intrusions” then “I have hallucinations and delusions”?
Schizophrenia: The category of schizophrenia, and all its sister disorders, is one that is assumed to be a largely biological, genetic brain disease. What differentiates it from DID? No one seems to be able to define where this distinction lies, but those in the dissociative disorder field will state that the difference is based on the existence of “delusions” and/or “thought disorder”. A delusion, of course, is a belief that society deems unacceptable. Yet, nobody seems to be able to explain where the line is separating a delusion from an acceptable belief. More specifically, nobody will explain what the difference is between believing “I have a bunch of people living inside of my body who are not me” (DID) and “I am God” (psychotic). But questionnaires that measure dissociation use this very distinction to say whether one has dissociation or not. And then they say “delusions are not related to dissociation” because they just ruled out dissociation by the fact that a person did not endorse an interpretation of their experience that the questionnaire makers deemed dissociative.
“Thought disorder” has been convincingly described by Richard Bentall as a problem in communication, rather than an indication of any true cognitive impairment (Bentall, 2003). Yet, the theory adopted by mainstream psychiatry remains that “thought disorder” is a neurological disease. And so, if one is considered to have DID, any indication of thought disorder is instead interpreted as “intrusions” or “rapid-switching” of altered identity states. Only those with “real” psychosis have a “real” thought disorder.
On the other hand, psychosis researchers solve the problem by simply saying DID just does not exist. People who present with altered identity states and memory problems (not attributed to an actual neurological problem) are considered as just “borderline” or “attention-seeking”. I honestly cannot think of much that is worse than experiencing such emotional turmoil and distress to the point of a break-down and then being told I am making it up for attention. But, then, of course, that is just my perspective.
In spite of these ideological battles, studies still have shown that individuals meeting criteria for schizophrenia endorse a greater level of dissociative symptoms than any other clinical group, discounting PTSD and dissociative disorders (Ross, Heber, Norton, & Anderson, 1989). Approximately two-thirds of individuals diagnosed with DID who are hospitalized also meet structured interview criteria for schizophrenia or schizoaffective disorder (Ross, 2007), 25-50% of anybody diagnosed with DID has received a previous diagnosis of schizophrenia (Ross & Keyes, 2004), and approximately 60% of those diagnosed with schizophrenia meet criteria for a dissociative disorder (Ross & Keyes, 2004). Up to 20% of individuals diagnosed with DID have been found to exhibit communication styles indicative of thought disorder (Putnam, Guroff, Silberman, Barban, & Post, 1986), and levels of dissociation are highly correlated with thought disorder (Allen, Coyne, & Console, 1997). Bizarre explanations for anomalous experiences are not rare in those diagnosed with DID; indeed, one study discovered that 41% of individuals diagnosed with DID have been found to believe they were possessed by demons, and 36% experienced possession by some other outer power or force not attributed to part of the self (Ross, 2011). In addition, the original concept of ‘schizophrenia’ (as it was discussed by Kurt Schneider, Eugen Bleuler, Harry Stack Sullivan, and Harold Searles) appears to emphasize presentations indicative of a dissociative disorder.
On the other hand, it has been found that dissociatively detached individuals are not necessarily chronically psychotic and can function at a high level (Allen et al., 1997). Individuals diagnosed with DID are often able to maintain reality testing despite experiencing “psychotic” phenomena (Howell, 2008). Another difference is that persons diagnosed with DID also report higher levels of dissociation, and more child, angry, persecutory, and commenting voices (Dorahy et al., 2009; Laddis & Dell, 2012). They also generally report a higher rate of more severe childhood trauma than any other clinical group (Putnam et al., 1986).
What Does This all Mean???
It is often purported that “delusions” and “schizophrenia” are not dissociative, when using the narrow definition of dissociation; when dissociation means dis-integration of identity. I would argue that when one is so distressed so as to be labeled as having delusions or schizophrenia, the person has experienced such a high level of dissociation so as to have a completely shattered identity; dis-integration to the point of disintegrated oblivion. But, this is not acknowledged as dissociative, and so then is considered somehow something completely different and separate.
I do not believe it is possible to separate psychosis and dissociation; to me this is like attempting to separate a headache and a fever when I have the flu. Where does the headache begin and the fever end? And should I focus on “treating” my headache, fever, or maybe the virus that infected me and is creating an interconnected process of events in my body? While psychosis and dissociation are not the same thing, I believe that one does not have psychosis without dissociation or dissociation without psychosis. Often the difference simply boils down to: who can frame things the way that the professional wants to hear or agrees with.
Certainly not all those who experience altered identity states experience strange beliefs, voices, or incoherence, but most do. Not all those who experience extreme states also experience altered identity or memory loss, but some do. These experiences are not separate, even if they are different. Although one may appear more reality-based and “dissociative” while another may appear more out of touch with reality and incomprehensible, I believe both stem from the same underlying process of attempting to deal with overwhelming life experiences. And this is where “treatment” should be focused.
Of course, this belief comes with the caveat that some presentations of emotional distress (whether it is psychosis, depression, dissociation, or any other term or category one might like to think of) are dietary, biological, and/or neurologically based. These are not psychological or psychiatric problems, then, and should be dealt with in the medical realm. All individuals suffering from extreme states should evaluate their diet, exercise, and overall physical health; when these are shown to be a non-issue, however, it should be assumed that some difficulty with life has led to whatever the person is suffering through in the present rather than blaming a faulty brain or neurochemicals without any evidence to back up such assertions.
I do not have all the answers. But, I do ask why it is that mental health professionals do not start with just saying what they mean? We can talk about altered identity states, memory loss, feeling unreal, not knowing what is real or not, being terrified of others, etc. Mental health professionals can own the fact that “I do not understand this person” instead of taking this as equivocal evidence of some brain-diseased process of “psychosis.” Each of these experiences do not make a distinct disease. People are complex. People do not fit in nice, neat boxes. People suffer, and when they do this is not necessarily a disease. People adapt to unbearable life circumstances in a number of complex ways that cannot be categorized, no matter how much psychiatry insists that it can. And none of these labels can tell anybody much of anything about a person beyond the stereotypes and confirmation biases they elicit.
At the end of the day, extreme states and anomalous experiences are terrifying; they are terrifying to the people experiencing them and to all those around those people. Doctors are human beings (much as many might like to state otherwise) and they too often act out of that fear. Certainly, nobody wants to get labeled with being psychotic, and there is benevolence in the efforts of those who try to save many from being so doomed. Being recently labeled with “schizophrenia” appears to be enough to increase the likelihood somebody will commit suicide (Fleischhacker et. al, 2014).
Instead of trying to understand people through labeling and insisting on enforcement of an authoritarian dictation of what the experience “really” is, perhaps psychiatry can listen to those who have actually been there. The Hearing Voices Network has given us tools to work with voices and other anomalous experiences; the National Empowerment Center has given us tools on how to work with crises and extreme states; I am working to try to get first-person perspectives on how to work with altered identity states and memory loss; so many individuals (most famously Marsha Linehan) have given us tools on how to work with self-harm and suicidality.
Why does psychiatry then continue to insist on abiding by a broken and invalid system of disease mongering? Why do we not allow the experiencer to make sense of their experience through their own framework? Why must we be so evangelical and insist that they see things our way? There is NOTHING that truly, scientifically can say that one diagnosis is more “accurate” than another. All of these diagnoses are just checklists of behaviors- there is nothing that anybody “has” and until some biological test shows otherwise than nobody can claim that there is. What matters is being with a person in their world where they are at and understanding the MEANING behind the experience, not attempting to define the experience itself in a way that makes sense to us. This is nothing more than social control and perpetuation of the status quo, not science.
Even the most biologically-based medical doctor knows that treatment can only be effective when the underlying disease is recognized and addressed. In my opinion (and it is only that), the underlying “disease” is trauma, overwhelming emotions in reaction to an un-understandable and terrifying world, and/or fear of death/annihilation. If this is the issue, and logically then the issue that needs to be “treated”, then why do we spend so much time splitting hairs over differentiating what behaviors or beliefs belong in what technical categories? In the heart of the Hearing Voices Network, why are we not focusing all of our time on understanding what happened to the person, not what’s wrong with the person?
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Disclaimer: The views presented here are constructed from my biased interpretation of the vast literature associated with the various topics discussed. This is based on my on-going dissertation work as well as personal and clinical experiences that influence my views. In no way is any of this meant as a criticism towards any individual organization or researcher. I have a great appreciation for the work done in both the trauma and psychosis fields, and recognize that we all cling to views that help us make sense of the world. I just hope that one day we might be able to move past some of these partialities and work towards improving options for people who are in extreme distress without further traumatizing them in the process.
Allen, J. G., Coyne, L., & Console, D. A. (1997). Dissociative detachment relates to psychotic symptoms and personality decompensation. Comprehensive Psychiatry, 38, 327-334.
Bentall, R. (2003). Madness Explained: Psychosis and Human Nature. London: Penguin.
Dorahy, M. J., Shannon, C., Seagar, L., Corr, M., Stewart, K., Hanna, D., . . . Middleton, W. (2009). Auditory Hallucinations in Dissociative Identity Disorder and Schizophrenia With and Without a Childhood Trauma History: Similarities and Differences. Journal of Nervous and Mental Disease, iii-x(12), 892-898.
Fleischhacker, W. W., Kane, J. M., Geier, J., Karayal, O., Kolluri, S., Eng, S. M., …Strom, B. L. (2014). Completed and Attempted Suicides Among 18,154 Subjects With Schizophrenia Included in a Large Simple Trial. Journal of Clinical Psychiatry, 75(3), e184-190. doi: 10.4088/JCP.13m08563.
Howell, E. (2008). From Hysteria to Chronic Relational Trauma Disorder: The History of Borderline Personality Disorder and its Links with Dissociation and Psychosis. In A. Moskowitz, I. Schafer & M. J. Dorahy (Eds.), Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology (pp. 105-115). West Sussex, UK: John Wiley & Sons, Ltd.
Janet, P. (1907/1965). The Major Symptoms of Hysteria. New York: Hafner Publishing Company.
Janet, P. (1919/25). Psychological Healing. New York: Macmillan.
Laddis, A., & Dell, P. F. (2012). Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia. Journal of Trauma & Dissociation, 13(4), 397-413.
Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Post, R. (1986). The Clinical Phenomenology of Multiple Personality Disorder: A Review of 100 Recent Cases. Journal of Clinical Psychiatry, 47, 285-293.
Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The Traumagenic Neurodevelopmental Model of Psychosis Revisited. Neuropsychiatry, 4, 65-79.
Ross, C. A. (2007). The Trauma Model: A Solution to the Problem of Comorbidity in Psychiatry. Richardson, TX: Manitou Communications, Inc.
Ross, C. A. (2011). Possession Experiences in Dissociative Identity Disorder: A Preliminary Study. Journal of Trauma & Dissociation, 12(4), 393-400.
Ross, C. A., Heber, S., Norton, G. R., & Anderson, G. (1989). Differences Between Multiple Personality Disorder and Other Diagnostic Groups on Structured Interview. Journal of Nervous & Mental Disease, 177(8), 487-491.
Ross, C. A., & Keyes, B. (2004). Dissociation and schizophrenia. Journal of Trauma & Dissociation, 5(3), 69-83.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
Thank you for raising this discussion. I spend most of my time working on issues related to trauma and especially to trauma-informed peer support. It’s clear that most people with psychiatric labels are trauma survivors, and the way the DSM manufactures diagnoses tends to keep that fact from being obvious to professions and people who would just as soon not have to deal with this issue. I think there are plenty of possible reasons why the field chooses to ignore the evidence, including financial interests and the fact that many professionals are also trauma survivors and may have not addressed the ramifications of that. A larger issue is that to deal with the impact of trauma, we would have to address the root causes of violence in our world, which is an overwhelming thought.
“to deal with the impact of trauma, we would have to address the root causes of violence in our world” – indeed, and this is partly why Psychiatry is so repressive, in every sense of the word
Very well said.
Not mentioning that getting tangled up in the psychiatric system usually means re-victimization and more trauma, staring from the labelling and ending on forced drugging and physical torture mascarading as “treatment”.
“Trauma is technically defined as an event that provokes death-related fears in an individual. (…) Although it is understood that trauma is subjective, the DSM insists on narrowly defining it anyways.”
I believe that one of the reasons for such narrow definition may be that this excludes the effects of the “treatment” as trauma-inducing, hence you can’t experience PTSD from being locked up and drugged.
B: I have documented the trauma I experienced in the state hospital system else where on this site. Essentially the events leading up to the involuntary commitment, suggest that I should have paid closer attention to maintaining regular sleeping patterns and exercise. I can understand why people close to me were concerned about my state of mind, but in my experience, the cure was worse than the disease. Part of the problem at the first state hospital was a snoring roommate and light coming into the room at night. Couple this with the fact that when I got up in the middle of the night to go to the bath room, I had to find an orderly to let me into the bath room. Altogether, this contributed to an irregular sleeping pattern, something that greatly inhibited my ability to return to some type of equilibrium.
When I was introduced and initiated to biological psychiatry 25 years ago, no countervailing opinions were given to me, nor did I have any idea where to find them. I have lowered my medications to a level where I have energy to read, exercise, engage in civil society and maintain employment. I would like to be completely free from psychiatry, but having read many post on psych drug withdrawal, I realize that reducing the medications to the lowest level possible maybe where I end up. I successfully tapered from Lithium and Lamictal, but I still take 1.5mg Zyprexa and .5 klonopin.
“Part of the problem at the first state hospital was a snoring roommate and light coming into the room at night.” I’ve heard complaints like that from a fellow inmate (a guy in late teens or early 20s locked up for marihuana possession as a deal not to go to prison). He was in one room with7 other guys and lo and behold could not sleep well. He was given heavy duty sleeping pills which are dangerous and addictive and I remember him telling me “I’m here for pot and they are giving me the kind of drugs I’d be normally scared to even try”.
“in my experience, the cure was worse than the disease. ” – I usually call that “treatment was effective but the patient died. It was the same for me, except the “cure” part – they actually made me significantly worse.
Thank you for your comment and the very important work you are doing. It’s an interesting point you raise regarding the un-dealt with trauma histories of professionals- this is an area that I have actually spent most of my time researching and writing about. I don’t believe that professionals are “evil” or intentionally harming others- I think they really do have good intentions. The problem is that most suffering in the world is the direct result of some person, country, or group responding to their own need to protect themselves against some perceived threat (that most often is not really any threat at all). If professionals could recognize their own vulnerabilities and acknowledge their own fears, we might actually progress one day in changing things. But, perhaps that is just wishful thinking…
The road to Hell is paved with good intentions.
“I don’t believe that professionals are “evil” or intentionally harming others-”
Certainly not all but are there people who are bad and driven to this profession for it’s power over patients and being able to experiment on them? I do believe that’s the case.
I believe that [just as feminists helped expose the sexism, & writers like Alexander Thomas M.D. helped expose the racism in psychiatry] people will expose all the isms which have prevented the founders and teachers of psychology from truly understanding clients ~ even with good intentions, they often alienate clients by treating them as “other” if not ‘inferior’ ~ they are oblivious to tjeir own transference issues because their training does little to address issues of eg classism and fear of death, etc. I think the very foundations of the field of psychiatry need replacing and the training of therapists should include in depth studies of social issues ~ unfortunately that would not please those who like ‘society’ the way it is, hence its unlikely to happen soon, at least not without some major turmoil which will no doubt leave some clients and therapists in a state of panic…or worse. However, as a client not benefitting from the present diagnostic / treatment system, i’m happy to challenge those people …even if that does ‘prove’ that i am ‘the problem’.
I liked what you wrote. I work mostly with foster care kids who have endured who knows what in their family of origin and are plopped down with a family they are expected to be comfortable with. If they are triggered by something and show extreme emotions of rage, they get diagnosed with bipolar disorder or ADHD or sometimes not even a diagnosis and are expected to take whatever is prescribed to treat their condition. Forever, amen. I just met a new client who is 11 and takes Trazodone, Risperdal, methyphenidate and one other I can’t recall. He has trouble sleeping. He showed me the scar on his back where his father burned him with a cigarette when he was two. He endured much. He has been in 11 placements and now is in a home that is beginning to realize that drugs don’t really fix anything and they are willing to wean him. A very bright kid who scares the hell out of people when he is triggered. I believe that writing and engaging in discussions about how what has happened to people influences their behaviors is the right direction to take. Keep challenging the standard operating procedures and question authority, as the button says.
I think some people have a hard time discussing these things because they cant figure out which came first, the chicken or the egg / the abused or the abuser ~ they dont know that there are conditions which sometimes make people behave without compassion even if they are usually sensitive, and the present system does little to make the public aware of that …partly because it has a hard time accepting that itself (still being a tad inclined to think of abusers as inherently ‘evil’), and partly because it knows that the public would then expect more from doctors and therapists (and many other professionals, too). It is simply easier to stick a plaster / label on a client, give them ‘pain relief’ / mind numbing drugs, and leave the real caring to people like yourself …which sometimes works, because you know that without such care young sensitive but scarred kids can become adults with debilitating ptsd (and maybe even psychosis), whose only real issue is one of confusion…with regards a world that hurts and condemns and explains nothing. Too much ‘specializing’ / not enough sharing, if you ask me.
Thanks for this post, Noel and welcome. Like you, I have found the profound disconnect bewteen trauma adaptations and DSM symptom categories to be bewildering.
I suspect that your statement about the “understandable (but not necessarily defensible) tendency to deny the existence of trauma” is likely true. (I’ve heared Bessel van der Kolk say much the same thing.)
I heartily agree with the call for “trauma & psychosis fields to join forces”. When that happens, we could shift away from the meds first & last approach and move towards true healing.
Right now PTSD is the diagnosis de jour of returning veterans. They qualify for benefits. If I am getting the story straight,veterans diagnosed with borderline personality disorders are denied benefits because it a pre-existing non-service related disorder. (From reading Szasz many years ago, two of the diagnosis he found most troubling were shell shock and hysteria. I think that it is important to do our best to reintegrate veterans into society.) But I also have qualms as to how this is playing itself within the institution of psychiatry.
“eterans diagnosed with borderline personality disorders are denied benefits because it a pre-existing non-service related disorder”
Which is ridiculous in and of itself – if they were able to serve and went through screening and training they should be given the benefits, pre-existing condition or not. It’s just so disgusting – using people and then leaving them like trash at the side of the road.
Reminds me of a character from “Animal Farm”:
I share some of your misgivings, chrisreed, about trauma theory. The question is, what is it that separates the resilient folk from the non-resilient folk, and how can we change the situation for people who are less than resilient. Resiliency training maybe? Or perhaps some kind of de-sensitivity training? Better parenting? I don’t know. There is a lot of “non-recovery”, even “non-recovery” that goes by the name of “recovery”, in the mental health field. I think a lot of these problems are likely systemic in origin. “Mental health” is all about “mental illness”, and encouraging dependency doesn’t get people out of that system, but, all the same, trauma victim claims may serve an individual as a survival technique.
Seeing “trauma” in “adverse childhood experience” is a bit far fetched. Imagine how long you could be waiting for “psychological scars” to “heal”. I’m not saying that such experiences wouldn’t set a person back a good bit, I’m just saying that the problem from my end of the matter seems more situational rather than, strictly speaking, medical. Electro-shock treatment does, on the other hand, produces symptoms identical with head trauma, and I’ve read Peter Breggin write about what he calls ‘psychiatric drug chronic brain injury’. I think it possible we could be, in some instances, confusing one thing for another.
Truama and resiliancy – it’s easy. When something bad happens do you take it personally or do you shrug it off? When you were a child and someone treated you badly did you have a friendly parent or granny who gave you a big hug and made it all better?
Truama, ie bad things happening, effect people depending on thier individual personality and how well the people around them support them.
If you had a lot of bad things happen to you and you tend to take things personally and everyone ignored how hurt you were or even worse, demeaned you for showing how distressed you were, then you need a lot more support in getting over things than someone who understanding parents, good friends and tended to shrug things off.
Guess what, the poor, women and ethnic minorities, ie those who have harder lives, are more likely to be long term chronically distressed, presumably because they have more to deal with and less people saying, “Sorry you are having a hard time, fancy a chat?”
I’m not saying things are getting harder as time progresses. There was a time and a place somewhere back in the stone ages when and where people died around the age on average of 35 years. Okay. Someone might think that pretty “traumatic”.
Calling living through what people take for life “traumatic” is to stretch a point that perhaps doesn’t need stretching. While there’s no question about physical trauma being trauma, “psychological trauma” is another thing. The problem is not people “healing”, the problem is people not “healing” from “wounds” they never received in actuality, unless slights and insults (words as opposed to sticks and stones) be accounted “wounds”.
Well, words are a lot easier to shrug off than bullets. I often wonder why some people have a much harder time than other people at doing so. Sometimes I think “treatment” is their problem, together with the presumptions that go along with it, and that neither represent any sort of an answer.
Of course, poverty, patriarchy, and foreigners don’t particularly make life easier for people either. This social “wound” so-to-speak though, isn’t way past “healing”.
Thank you so much for this elegant explanation.
Oops. That^ was intended for John H.
But while I’m here, what do you mean by “foreigners,” Frank?
Thanks, John, for this; yes-exactly…
uprisng, John Hogget spoke of “the poor, women and ethnic minorities”, and so I returned with “poverty, patriarchy and foreigners”. To ethic minorities the majority ethnic group are foreigners, and to the majority ethnic group the ethnic minorities are foreigners. I guess they just have to get to know one another a little better.
Okay, I get what you are saying. Thanks for the clarification.
“Well, words are a lot easier to shrug off than bullets. I often wonder why some people have a much harder time than other people at doing so.”
One of the reasons may be the social isolation. Whatever the hardships of the life in Stone Age might have been I guess the people back then had close social groups and also a bit of a different lifestyle, including more physical exercise and being close to nature. All these things have unsurprisingly been shown time and again to promote what one would call mental health and resilience.
Well, trauma and chronic stress are quite different though of course chronic stress can make you more susceptible to develop trauma-related problems. But there is a difference between someone developing mental health problems because of living in constant stress of poverty or racism and someone developing a PTSD because of rape or assault. On top of that you can have both things being combined e.g. in the war situation or domestic violence where you have chronic stress punctuated by acutely traumatic events.
But you’re of course right that there are many factors determining how people respond to such challenges ranging from genetic and developmental resilience, through social support and individual coping mechanisms
Yes, very many thanks, John. Resiliency is like for dispositions to return to happy intimacies, productive encounters? Plus the tendency to form attitudes to open to the opportunities? And for not taking one person’s affecting you negatively to govern your attitude and ideas? So like a freedom thing? Then fairness matters to causing its appearance and its not this chemico-genetic asset to be resilent or have resiliency…? If that’s legimately within the range of how you see it, as it seems to follow from your descriptions and explanation, then the idea finally squares up for me. Recalls the Dorothy Rowe remarks you put me on to, critical of how people in clinics wrongly make resiliency stand for what about you does not or does need fixed something serious or not about you. Of course, so only the healer did the work that made you get better. Sorry, but that’s how it goes–I’m sure not with you.
Well said john ~ when the people who should be caring for you are the ones hurting you, when the people who should be explaining get defensive, when professionals add insult to injury by distancing themselves from your disorientation and life experiences, you’re very likely to develop a low distress tolerance. Add (perhaps related) learning needs and a ‘social’ prejudice or two to the victims life and you’ve possibly got a person incapable of explaining why they’re in such a state…at least to a professional who cant / wont relate to any / all of that…and bingo, instead of someone suffering ptsd and the consequences of social exclusion you’ve got someone labelled as schizophrenic. No wonder the most vulnerable are (and too often remain) at risk of incarceration, ‘medication’, and suicide!
“what is it that separates the resilient folk from the non-resilient folk”
Many factors here:
– I’ve recently seen a talk discussing showing some evidence of genetic differences in genes involved in stress signalling pathways. The effects were non-significant over the whole population but people with “sensitivity” alleles were more likely to develop problems under stress.
– There may also be a developmental components – it’s been shown that maternal stress can affect up to 4 generations in rodents and also that chronic stress in pregnant mothers or young animals can cause depressive or aggressive behaviours in offspring in adulthood
– the type of stressor/trauma – I believe that there is an amount, duration or severity of adverse life circumstances or tragic events that can break almost anyone. Of course you’re going to respond differently to a job loss when you’re in a supportive relationship, when you can count on social services and are in good health than when you’re sick, lonely and facing homelessness and starvation.
“how can we change the situation for people who are less than resilient.”
“Resiliency training maybe?” – well, I’d consider “psychiatric treatment” resiliency training – if you survive it you’re surely going to see all other problems in your life as minor ;). But honestly I think that people in distress should be helped by a) support in changing/overcoming the objective life circumstances that create stress (on a system level like social security, housing, healthcare, childcare, help with dealing with abuse etc. and personal level by counselling and individual help in daily life) and can be improved b) by support in dealing with trauma and stress which cannot be changed – to recover from loss, dramatic experiences, to deal with loneliness or chronic illness. And of course every person should be treated individually because everyone has different problems and different needs and people require various forms of support.
ECT brain damage or drugging is not an answer even if some people may find drugs helpful in just hanging in there for a short time.
I wouldn’t put much credence in the genetic research into the subject being conducted these days, especially if you are one after whom such research is being directed. True, eugenic theory does evolve, after exposure, naturally enough into nugenics, but having someone suggest you are incapable because you have incapable genes presents an additional challenge nobody needs, provided, of course, he or she would prefer capability.
Study rodents for 4 or 100 generations and you will still not arrive at human beings. I rest my case. You can study rodents forever. If it ever gets you close to any significant insight into the motivations of human beings, somebody is fooling themselves, although that somebody is probably not the rodent.
I certainly don’t, under any circumstances, consider psychiatric treatment resiliency training. Given that standard psychiatric practice is a matter of injuring patients, it is not healthy reactions psychiatrists are looking for. Psychiatry kills. Resiliency is better maintained outside of the psychiatric institution rather than inside. Witness what has been termed the”learned helplessness” that comes of long term institutionalization. Randal Patrick McMurphy dies at the end of One Flew Over the Cuckoos Nest, well, there are hundreds of thousands of Randle McMurphys’ in the mental health system at this very moment. Resiliency is what takes you out of that system, and keeps you out of that system. If wisdom is learning from one’s mistakes, so too is resilience.
“I certainly don’t, under any circumstances, consider psychiatric treatment resiliency training.”
I was being sarcastic…
Thank you for this excellent article about trauma and its relation to emotional and ‘psychiatric’ suffering. Trauma Informed Peer Support (TIPS) is one model that works (as Darby referred to above) and my hope is that we will offer this to anyone in distress. I especially like the way you mentioned that trauma can mean many things beyond the obvious life threatening trauma such as being verbally bullied, growing up in a difficult family or many other difficult and painful emotional experiences. I am so glad you put the time and effort into this article -thank you
Thank you for this enlightening post. Since the medical community has no interest in “what happened to you,” and only concentrates on “what’s wrong with you,” I’ve had to research “what happened to” me, myself. And I definitely feel your perspective is infinitely more accurate than bio-psychiatry’s belief that all real life problems are “fictional,” and all distress results from “chemical imbalances” and “genetic” defects, especially since I had no family or personal “mental health” issues, until after I was unwittingly drugged up on psychoactive drugs by doctors wanting to cover up easily recognized iatrogenesis, and based upon a list of lies and gossip from the people who abused my children, according to my medical records. Obviously, my issue stemmed from trauma, bullying, and dealings with unethical “professionals,” especially since I was tranquilized for being disgusted by 9.11.2001, in 12.2001.
But I appreciate your discussion of “disassociation,” because I did end up suffering from what I thought was a drug induced “psychosis” (it occurred two weeks after I was put on the first neuroleptic), then I got “voices,” when this “Foul up” with Risperdal was covered up with massive major drug interaction laden psychoactive cocktails. Once I was finally weaned off the drugs, I suffered from what I’ve learned might have been a drug withdrawal induced super sensitivity manic “psychosis.” But, my personal experience was much more closely related to “disassociation,” than “psychosis,” according to your definitions. (The drug withdrawal induced super sensitivity “psychosis” / awakening to the story of my dreams was similar to what others describe when they talk about a “spiritual emergency,” and actually there are many who are now talking about similar [but not necessarily drug induced] “awakenings” on the internet.)
Based upon my experience and research it seems quite clear to me that the psychiatric community has spent 60 years writing a DSM “bible,” which quite accurately describes the ADRs and withdrawal symptoms of their psychotropic drugs, although they claim these ADRs and withdrawal symptoms to be “life long, incurable, genetic mental illnesses.” The bottom line is, psychoactive substances (which is what the psychiatric industries’ drugs are) do cause “psychotic symptoms,” but to claim these drug induced altered states are “life long, incurable, genetic mental illnesses” is highly inappropriate, and borders upon evil – but that’s just my personal theory and opinion, based on my experience of the psychiatric drugs, and my last nine years of research. And I do understand, this would be a hard pill for the mainstream psychiatric industry to swallow.
“Treat others as you’d like to be treated.” Currently, it strikes me that mainstream psychiatry would like to be judged by someone who disregards all their real life concerns, then defames and tortures them for the rest of their existence; since this is how they’re treating their patients. But on the off chance there really is a God who is good and brings about justice in His own time, perhaps the psychiatric community should rethink their unrepentant harm and murder of so many? Again, that’s just my own personal theory.
I think everyone has part or parts of themselves they feel separate from. Part or parts of themselves they don’t understand, and also can’t relate to, can’t control. And then comes the part about taking another look at how things work. Everyone in our “culture” has a child survivor, a child that had to do what it was told or would be punished, a child that depended on it’s legal guardians and had to obey. A child that took on behaviors, not because it believed in them itself but because it had to in order not to be punished. And then beyond that, when someone is abused physically or emotionally, they disassociate. They can’t function while remembering the abuse.
Why do they disassociate? Disassociation, to me, is something that occurs in order to transcend trauma, rather than harness it as a means to control or exploit. A child can’t control the situation and can’t express anger (or sorrow, or sadness, or outrage), but the disassociation also functions so that one isn’t investing in the very same concepts of trauma which are the root cause of whatever or whoever is causing the trauma.
I don’t believe that multiple personalities exist in order to “re-integrate” a person back into the society with it’s trauma based discipline which caused or didn’t attend to the trauma, which caused the behavior, which caused the abuse; which then caused the “disassociation,” which then “needs” to be re-integrated back into the matrix, which is in collusion with causing the cycle. The same with other forms of disassociation.
I believe multiple personalities exist in order to give a person the space to let go of their potential of responding with more trauma. When a “fragmented” personality is surrounded by love, and is allowed to have loving thoughts, then it can integrate; or find that there always was a connection, but that comes from allowing love, rather than wielding trauma based controls. But this would point out that it’s not the personality that was fragmented at all, it was the society itself; and it’s “consensual reality.” It’s the society which needs healing…
“I think everyone has part or parts of themselves they feel separate from.”
Good point. I personally do have “bunch of people living inside of my body” whom I actually consider parts of me – of course not literally, these are simply my internal representations of myself. Most of the time I do not notice this split but sometimes, especially when in dire emotional states I have internal conversations with them. I actually consider this a good thing and it’s be quite insulting for anyone to say that there is something wrong with me because of that.
Also “feeling unreal” or “feeling one’s surroundings are not real” is something that happens to me quite often and it’s usually not an entirely pleasant experience but I don’t see how that should be pathological. I’ve spoken to many “normal” people and quite a few told me they have had similar experiences of things not being real (often) and having multiple personalities (more rare but still I have a few friends who told me they had experienced it too).
Also other unusual states such as sleep paralysis can be potentially linked to stress – at least for me personally they often happen when I am under some sort of pressure or I have recently moved to a new place.
“Recent years have seen an influx of numerous studies providing an undeniable link between childhood/ chronic trauma and psychotic states.”
True. I’ve recently went to FENS (the biggest neuroscience conference in Europe) and my main impression was “wow, all the studies seem to show what most people at MIA have been discussing from the get go”. The studies for genetic markers of mental illness have returned very little except a few marginally significant genes which are associated with stress pathways. And the biggest determinants for the development of pretty much any “mental illness” were things like living in a city, being a child of migrant parents, experiencing poverty or racism and so on. All encompassed by one major theme: stress and trauma.
Yet the mental health “professionals” seem to be ignoring all of the above just as much as they ignore the fact that psych drugs are mostly sugar pills with dangerous side effects.
B: I had significant childhood trauma, but my involuntary commitment was four years after I left home. It seems to me the key to my “manic episode” rested in my most recent life experience, something that was not explored in any depth when I was committed. I also wonder how my “diagnosis” followed me through five or six providers. When I requested my psych records two years ago, I only received the records from the last psychiatrist, although in talking to the psychiatrist, it is obvious that she had access to some of my prior records. Shouldn’t your psych records follow you along the way, so as to inform about past medications.
Any way on another note, I believe that the written copy of my mock counseling session when another student, clearly demonstrates that I have a better ability to get to know someone than is reflected in the notes from the psychiatrists in my psych record
“I had significant childhood trauma, but my involuntary commitment was four years after I left home.”
…and there is also some evidence that experiencing problems as a kid or adolescent can “prime” people to have less resilience towards stress later in life even if the childhood issues are not immediately responsible.
In any case it only shows that there is plenty scientific evidence that the major cause of “mental illness” is environmental, especially related to social stress, trauma etc. and it begs the question – why is there such a mismatch in what is known about causes of mental suffering vs what is being done about it.
I believe R.D. Laing had it right decades ago. People say, “Christianity has not been tried and found wanting, it has been found difficult and never tried.” I’m an atheist, but I think that saying applies well to Laing’s ideas. They’ve been found difficult, labor-intensive, and requiring of the highest degree of dedication and goodwill on the part of professionals–therefore, they’ve been rejected, mocked and swept under the carpet.
The mind tries to heal. The mind must be given safety, time and space to do so. Each trauma is individual, so every attempt of the mind to heal trauma will be unique in some features, but the same in a general sense. Psychiatry at the moment just piles trauma and chemicals on top of the original wound. They can’t be excused for that. Don’t minimize the evil–yes, evil–they are doing now.
What a brilliant analogy. Thank you, Ann, for this comment. I also agree that there is no excuse for the evil being done to suffering people by some practitioners of psychiatry – unless one considers willful ignorance a valid excuse.
Yes Ann , the mind tries to heal ,that last paragraph of yours up above is right on. Noel also says the mind is trying to heal itself. I would say it is trying to reach equilibrium. Why wouldn’t it just as the body try and heal itself. And it does need safety time and space to do so.We must just try and also remove interfering obstacles that we are aware of like various poisons like mercury in dental fillings for example. Check out Paracelsus Klinic (yes with a K) in Switzerland (google it) . See their advanced modalities and success rate. Also check out www. yuenmethod .com Energy healing would be a great help for all types of trauma /mixtures.
Thank you all for your supportive and thought-provoking comments. I wanted to respond to a couple of statements regarding what constitutes “trauma” and the idea that certain things are clearly “traumatic” while others are a “stretch”. The overall point to what I was trying to discuss in my post was that psychiatry, specifically, but really all of society needs to stop defining another person’s experience based upon their own values and experiences. “Trauma” is something different to everybody. What is traumatizing to one person may or may not be to another, but to insinuate that there are certain things that somehow cannot be considered traumatic is horribly invalidating to the person who is suffering already. One may very well have a much more severe traumatic reaction to words and non-verbal threatening dynamics (particularly if they are a child) than a person who has a great deal of familial, societal, and financial support might have to a brutal attack like rape. These terms are problematic for the very reason that this discussion has started to take. People suffer, and they do so in different ways. I implore those reading this to step back for a moment and try to stop putting your ideas onto someone else’s experience, but instead to try to validate the suffering another might have had. Dismissing someone’s suffering because in your mind it is not “traumatic” is to do the very thing that so many of us on this website complain about the psychiatric system doing. Sometimes when change is what we are seeking, we must first look inside ourselves to find that change.
So well said. Personally, I feel the when we seek change, we ALWAYS must first look inside ourselves. To shift reality, we shift perspective, so long-held beliefs are bound to be challenged and evolved. That evolves everything around us.
At one time explanations of human nature in the West had to be filtered through religion. Even going back to the Greeks and Romans. However, in the art and literature of the various times the artist or writer could transcend these constraints and restrictions. Something like that still holds. A very fine novel by Max Sebold, Austerlizt, portrays a man without a childhood–or one he can not remember. When he begins to find that childhood through a childhood woman friend in Prague he also begins to have all sorts of symptoms from insomnia to panic attacks. He walks all night through the streets of London. Later after a fall during the time of paralyzing panic attacks he spends a year in a hospital. But the novel is beautifully written without relying on psychological jargon. And reader may see the subtle interconnections of times and places.
So I do not see any real advance in the study of human psychology. New jargon, a new paradigm (science?) but many entangling theories. What was once common sense now translated into almost unintelligible gibberish. Certainly very bad experiences will lodge in the memory bank and begin to function like magnets drawing similar experience whether the memories are accessible or not. It makes very good sense that bad experiences will hinder future behavior. A terrible childhood will be like fetters. War experiences can feel like a noose around the neck. Rape. Assault, a car accident, divorce . . . these change a person. Our pasts count for much in our lives. Part of a causal chain. In a very extroverted society like America people are not encouraged to know themselves much. Science sneers at anything that can not be quantified. It equates mind with brain. That is an unprovable assumption. Many scientists state hypotheses as matters of fact. There is a certain arrogance in that area. Intuition once represented by women is still treated much like women are treated as not quite equal and inclined to superstition.
The best novelists and poets are still the best sources of wisdom about people. As music can be and paintings. The real truth is everywhere spread for the observing and patient eye and ear. Without the philosopher Schopenhauer (who knew many languages and loved and valued the classics) there would have been no Freud. That might actually have been better? In any case Schopenhauer writes beautifully and was appreciated by Tolstoy, Conrad, Proust, Beckett, Hardy . . . and of course Wagner and Nietzsche.
Artists tend to be introverts and solitary. Not very American. Imagine spending a day with Shakespeare talking about people. A day with Thomas Mann. A day with Rilke. Or would you rather spend it with Freud? Or Jung? What about Dante? Or Rumi. My own preference would be the great writers. Poetry conveys a deeper level of life. Those moments of glimpse into a deeper truth. Eternities of the moment.
Thich Nhat Hanh spent a week with Vietnam vets. They sat silently with the last one for three hours before he could tell his story. And then over time with a bit of advise from Thich Nhat Hanh he completely recovered. Oh, and then there is the doctor who wrote Achilles In Vietnam and Odysseus In America. He was something of a Greek scholar as well and found a great deal of help in Homer. Best of luck!
This article is timely for me, as I’ve been giving a lot of thought lately to exactly these issues. You have provided me with an excellent resource. Thank you. I hope to see more like this at MIA.
I agree completely and will also testify that altered identity states and associated memory problems are very real indeed.
This article also inspired the following thoughts:
As a reader who identifies as a trauma survivor and who holds an anti-psychiatry stance, I am very sensitive to the phrase, “problems of living,” which Thomas Szasz used as an answer to the question, “Well, if mental illness doesn’t exist, as you say, then what is it that obviously troubled people are experiencing?” While I think Szasz’s answer is correct, it also feels to me like a minimization.
“Problems of living” is inadequate to describe what I have been through and what I am going through now. I suspect that this part of the otherwise bulletproof Szaszian critique of psychiatry might put off many others for this same reason – others who might otherwise appreciate it.
As much as people in distress might loathe psychiatry – and many active psych patients do, make no mistake – they are not going to get behind an agenda that invalidates them, minimizes their suffering, and offers them no support. Szasz was absolutely correct that “mental illness” is a myth. What many of the people so labeled are suffering from are the effects of trauma, broadly defined. That is what the evidence shows. I would urge other anti-psychiatry leaning readers to take this into consideration as an alternative explanation.
Thank you for this post; I appreciate the work that’s gone into it.
I wasn’t clear on a couple of points, and look forward to hearing your thoughts on them.
For example, in the first couple of paragraphs you refer to the “trauma field,” but then switch to the “trauma and dissociation field.” I wouldn’t expect them to be synonymous, so I was puzzled by you making them so. Are there no distinctions?
Second, you wrote, “Yet, the trauma and dissociation field often goes to great lengths in an apparent effort to draw a decisive line in the sand between “real” trauma “disorders” and “schizophrenia.” This largely is done by insinuating that “dissociation” is trauma-based and explains the bizarre behaviors of so many distressed individuals labeled with “borderline” or “dissociative identity disorder”, while some cognitive or brain-diseased factor contributes to “real” psychosis.”
I’ve not seen examples of this insinuation in the trauma field (that is, not the “trauma and dissociation field”), and would benefit from doing so. Will you be providing any in later versions of this piece? Are there trauma-related groups or organizations you know of that maintain that line of demarcation in written or other materials? (And please note that I don’t doubt that it exists, I simply haven’t seen it.)
I also wasn’t clear on exactly how you saw the relationship between dissociation and distress labeled as schizophrenia, versus dissociation and other psychiatric labels, e.g., nonschizophrenic psychosis, bipolar disorder, etc. And are you saying (and I ask only to better my understanding) that the old biomedical/broken-brain model is correct for the experience labeled psychosis (whether or not with that of schizophrenia), but not for the distress labeled mood or personality disorders?
Finally, you open the article with a reference to the “many political, ideological, and financial reasons” the links between childhood trauma and psychosis are so often ignored, yet you don’t state them. Will you tease these out in a later version of this piece?
Thanks again for your work. I look forward to reading more of it.
Thank you angelaursery for your comment.
You ask some great questions that I hope I can provide some clarity to. So…
First, you asked about the trauma vs. trauma and dissociation field. The trauma field does consist of specialty areas related to war trauma, sexual trauma, developmental trauma, etc. There are also researchers and clinicians dedicated to the dissociative disorders. So, you’re right, although I used the terms synonymously, there is a distinction that should be made. Particularly because not all trauma scholars believe that dissociative disorders exist (this is from personal knowledge, I have no citation to provide you).
Second, you asked about written materials that provide examples of how trauma specialists (including, but not limited to dissociation specialists) insinuate a demarcation between real trauma disorders and schizophrenia. Because I want to avoid challenging any particular person, researcher, clinician, etc., I am hesitant to provide specific resources. But, if you read books about dissociative disorders, guidelines, or specific articles discussing “psychosis” vs. “DID”, for instance, this insinuation will be there. Many are likely to discuss the problems associated with the schizophrenia label, but few question the validity of the diagnostic system itself, the biomedical understanding of psychosis (or bipolar or any other category), or the brain disease rhetoric. You will be hard pressed to find a dissociative specialist who does not believe that there is a brain disorder called schizophrenia, and who will say that DID is trauma-based, while schizophrenia is biologically based. Of course, without any evidence to actually back this up. An interesting example of an exception to this, and an article that discusses this very problem at length is “Schizophrenia, Trauma, Dissociation, and Scientific Revolutions” by Andrew Moskowitz
The biggest example of the line in the sand can be found looking at the DSM- Dissociative disorders are not in the trauma disorder section, but they come right after with the caveat that they are “closely related” and there is an explicit message in the first couple of paragraphs stating that it is understood that trauma is at the root of these disorders. The psychotic disorders are nowhere near this section. Also, any dissociation organization will tell you first and foremost the importance of getting psychological testing in order to obtain an official diagnosis, and part of this process is ruling out “real psychosis”. Yet, there really are no objective differences between dissociative psychosis, other psychosis, schizophrenia spectrum…it’s definitely a topic that could warrant another piece.
Your next question is one that I don’t think I can adequately answer. The focus on discussing dissociation and schizophrenia was because this is the biggest area of confusion and contention between different schools of thought. While there are many other psychiatric labels often given to a person who might meet criteria for DID (such as depression, which is almost universal in this population), none overlap in the same way or have the same level of disagreement as with these 2 categories. Depending on how you define it, dissociation is an aspect in almost any major category. But, there are no weird efforts to say that someone who has mood swings that might meet criteria for bipolar disorder has “mood-like swings” in DID. This is the baffling logic, though, when discussion psychosis and DID. They might argue that such mood swings exist due to “alters” rather than “real bipolar”, but it just isn’t the same level of effort or disagreement. There is an entire page or so in the DID section of the DSM dedicated to describing the difference between “real psychosis” and “DID”, which is based on the rhetoric I have mentioned in the blog piece. There is no effort such as this to demarcate DID and, say, bipolar (although there is for DID and borderline, but that’s another discussion). Perhaps I will take your suggestion and write another piece about dissociation’s relationship with other various categories (just none have the controversy that these 2 do and the near impossibility of clearly saying how they are different).
You also asked if I believe the broken-brain model is correct for psychosis. I’m not clear where I have given this impression, and I hope you can let me know so I can fix it! I do not believe this is true for any DSM category, except for dementia and Alzheimer’s…because there’s actual clear evidence that this is true. And, so these disorders are really under the realm of real medicine not psychiatry.
Lastly, regarding “many political, ideological, and financial reasons” the links between childhood trauma and psychosis are so often ignored”- I left this alone largely because it is an entirely different subject, and also because most who visit this website already hear enough of these reasons in other posts. Perhaps, though, I will write more on this eventually. I appreciate your thought-provoking questions.
Thank you so much for writing this. I’ve long been a recipient of mental-health services, and, some time ago, stopped believing that I could rely solely on others to guide me towards what I call simply “healing”, and have been trying to learn enough to help myself – a practice, that, of course, the profession frowns on, but then, they have a vested financial interest in the matter…
What you’ve written here is the first piece I’ve seen anywhere about trauma and dissociation that is in-touch with reality. It’s also incredibly valuable, because it’s written from the perspective of an insider to medicine. I expect to wind up referring to it often as a translation dictionary between my experience and the official explanations. 🙂
This is also my first visit to this site, where I hope to become a regular. I did read the posting policy, and I recognize that simply praising an article for its merits may not be sufficiently constructive by its standards. If so, let me know.
Welcome to MIA- I’m sure you will find many helpful things at this site. Personally, I do not believe that anybody can be “helped” until said person is willing to help himself. So, I applaud your efforts to help yourself!
Your concerns about the posting policy are understandable….but I am pretty sure that not a single author pretty much anywhere will complain about a comment that is “simply praising an article”. I know I sure don’t mind 🙂
I’m pretty sure that the policy is in regards to the occasional times when heated discussions or comments made in the heat of emotion turn into personal attacks against somebody instead of constructive debate.
Anyways, good luck on finding some resources around here…
I work as a peer worker in a state hospital. I give an hour long presentation on trauma informed care every month to new employees. It’s interesting that psychiatrists and psychologists don’t go through new employee orientation. So, I was given the chance to talk at the weekly psychopharmocology conference which anyone can attend but which is usually populated by psychiatrists, psychologists and social workers. The room is always packed. When I presented this week there were two psychiatrists, one psychologist, and no social workers. At least all of the Administration attended.
I suspect people chose not to attend number one because it was about trauma and number two, the presentation was given by a former patient. Go figure.
I find this to be incredibly sad and disheartening…yet…not surprising. Your ability to forge through in spite of the less than desired support is truly amazing. Don’t stop. I’ve come to reason that if you can reach just one person, then the entire struggle is worth it.
Hi Noel… just wondering if you are DID? You seem to know so much and so well shown through your writings about the depth understanding of this condition… ?
Glad to see that recognize this as a true condition… also think about the possiblity that also, all so-called “mentally ill” people are actually very gifted intuitively… there is NO doubt in my mind about this.
Do you have a private email? OR is this the only format… you offer guidance?
“I am working to try to get first-person perspectives on how to work with altered identity states and memory loss; so many individuals” — your words from your article here…Noel.
I can help with this.
Noel – In following up now on this article, since just a couple of days ago when you answered me on another, significant points of recovery have taken shape for me. First, probably because of going bananas about everything I could recall about dual representation theory (on Jay Watts page) and how it fits much of my so-called symptomatology, I recovered the sense of engaged ownership of the memory of my first panic attack. I was seven, swimming in summer classes during a test, anticipated and perhaps caused the precipitation of the event (by focusing on the possibility ahead of time– vaguely conceived of.) I got freed up in terms of feeling good just imagining less fixation on the memory, then immediately had a mild panic attack triggered by a passing car. (This always happens to trigger some reaction for me at this time.) I like to get descriptions right, though, and can only talk along the lines of healing until some new fragmented memory comes together for me. I mean descriptions that go into how you are using or can or cannot use your mind as seems natural in terms of the sense of before, during, and after each marker event–trauma and “dissociation” on the one hand recovery or re-instantiation of comfortable affective connections on the other. Natural takes seem available, if only in the abstract no matter that the abnormal state has persisted for fifty or more years, go figure. And not just picturing yourself, but knowing about what you are looking for from your hoped-for change. The slate of fragmented memories is meanwhile covered with opportunities for better functioning for me, so I hope to learn the pattern.
Secondly, persevering in the threads and getting involved in people’s stories and ideas, working at self-acceptance, venting, and articulating a lot subsequent to that first small recovery step, seems then to have enabled me to recover memory proper. Since getting involuntaried based on lies in court after getting arrested based on lies, not being allowed to opt for going to the hospital voluntarily and keep my full citizenship and gun purchasing rights intact, I had become unable to recall anything but the worst of all I knew was bad about it from experience. Nothing of significant benefit ever really came to me except once or twice temporarily from counselling, but not every meeting with clinicians had been dreadful, banal, and un- or mis-informative. Just most of them had. Now this recovery presented me with subdued levels of rational feeling compatible with the general context of consultations in which respect and interest were shown for me. No gush of emotions, no reaction per se, and yet not just emotional tone like when deliberately recalling yesterday’s emotion. This second step differed from the first in that the pleasant return of feeling lingered while I contemplated the fact of not having had such recollections for so long. But I doubt repression explains this. My sense of such a “forgetting is that it was wilful in some sense every step of the way, and that meant I had to keep my eye on not remembering anything but what I wanted never to forget about as wrongdings done to me. I wanted to describe this for you Noel because what you have facing you as required for classes and graduation is probably mostly just something you surpassed by the time you fixed on the reasons for pursuing this career. Like you, I think that for helping with problems in living the logic and the method needed are both already first and foremost in the language for how we choose to act or how can’t help but notice ourselves to be.
Ok, so you can trust that I know it isn’t casework online with you, Noel, hopefully…. A little while ago, my phone conversation with a longtime acquaintance heart gave me the chance to call forth the emotions particular to the healing experiences themselves noted above. I’m glad life is how it is so that something as dry sounding as adjustment has real empirical consequences on your senses and beliefs about yourself all at once. That when it happens in stages and steps full of emotional continuities and tensions, you can have clear intuitions of the significance of narrative solutions as elements for tuning to what you got right for yourself in the felt shifts sensed in the first dispersion of mechanical feeling patterns of stress, now physical, now a heartache or passing thought. So just the facts: more cohesiv approach to getting past the inclination (you’d say, subpersonal inclination, or the automatic response) to tense up for a swimming session. The phobia wasn’t the problem, susceptibility to panic in potential drowning situations was, and I get the feeling you will already know what I say. That in fact the support for this proneness to anticipate the onset of a panic attack, although no other one ever happened in terms of any kind of aquatic settings, was itself supported by anticipatory feelings. I could examine now the underlying apprehension of the vertigo that sets in when you feel horror, and tempts you to cast yourself into the open jaws of whatever threat. I had an underlying fear that panicking meant loss of good judgment, so-called losing your mind. I thought my responsible attitude could easily fail or my rational competence vanish and make saving myself from drowning seem like a kind of creatural act that would make me feel very strangely transmogrified. Kids, they get the funniest ideas stuck in their heads. The other thing about repression not suiting what explains keeping your conscious awareness off of like getting respected so as to only adjust to how you were or are not, that was right, true enough, and I feel like a new person compared to a couple of weeks ago. The very activity of thinking of someting unpleasant constantly in order not to think of it effectively at all, had represented my most notable problem in living. Changing anything going on, and in particular changing rooms, clothes, leaving the house made me feel so much grief for how many new things I would have to keep straight about and used to. So functioning in that sense of getting freed has some understandable shape and recognizable good sense of drama or engagement to it now. I really aporeciated your work and ideas, seen here. And so far my sense of self and Other, feelings and significance of things past or actions possible, all seem most compatible with your critical presentation of issues concerning efforts directed at restoring wellbeing and naming the things you are helping with in the right way for the person getting the fixed troubles clearly before themselves and out of the way, finally. It might have depended on “Focusing” training, but that wasn’t that wasn’t an adequately directive approach for explaining how many things fell in to place. Which as always makes me wonder why Gene Gendlin didn’t want to go all out helping people with worse problems. But after being two peas in apod with Carl Rogers who never had a stern word for psychiatry in all its hideous incarnations, …at least that’s popularly heard of. From that era, there’s just Karl Menninger’s mea culpa to Thomas Szasz that’s legend. So Gendlin just gives his businessy trainings and seminars, and all the while proudly drops hints that he knows all of what is true and would prove more right in all of psychiatry. But he leaves the potential customers hanging, and leads his crops of therapists to employ explanations relative to labels and not their humanity alike with others in need. Why so coy? I give up.
Noel, Thanks very much for your time and thoughtful resignation on my behalf in your earlier reply. You believe right that there’s nothing doing but what’s entrenched beyond a few inroads in theory and methods too little applied. Nothings stopping just getting it all on track except greed and sloth and resistance either.
“I am working to try to get first-person perspectives on how to work with altered identity states and memory loss”
I’ve spent the last 7 years navigating my wife thru the healing process of d.i.d. I spend the majority of my days and nights with the ‘altered identity states’, though they WANT to be referred to as just girls. Largely I’ve found attachment theory to be the bedrock of what I do, but I have learned some other things along the way too. No medications, no hospital stays. No major depression or suicidal ideation. And if by memory loss you mean past memories, we pretty much do the opposite suggested by ISSTD which seems to minimize the retraumatization of the host.
I didn’t realize this was such an old blog already, but I’ve never forgotten it and the unsatisfying way that the experts have defined dissociation. I finally got around to writing a 3-part discussion of dissociation after my wife and I have lived and breathed it for the last 11 years. This is what our experience has taught us about dissociation if anyone cares.
Hi, I have had the lot, at its worst I was hospitalised, I think I have full DID, but in its most simple form, so maybe my case, may help with understanding. From my research I now believe that the trauma happened when I was too young to comprehend and my personality, not fully intergrated (this coming from the model, that our personalities, are not fully intergrated, when we are very young, but, different parts of the brain associated with characteristics related to personality, that bond together). The parts of the forming personality associated with morality, love and goodness, blew a fuse and went into shock. The parts of my personality associated with cunning, anger and protection, carried on, in a heightened state. From then on the two parts couldn’t fully weld together, because the moral good side, could not deal with its memories related to the trauma or the memories carried by the other side. This was ok, most of the time, until something happened that served as a reminder and the part that originally went into shock, fused out again, with ensuing puzzling and terrifying complications. If I had been older and therefore intergrated as a personality, at the time of trauma, the protective angry part, would have helped the moral, loving part deal with it.