On the Sad State of Mental Illness Knowledge in Britain

by Marvin Ross

What is it with the Brits, or maybe just some of them, that they promote strange theories of mental illness and, in particular, schizophrenia? First we had the very controversial British Psychological Society report Called Understanding Psychosis and Schizophrenia that generated a great deal of controversy. See the summary of it by James Coyne. Now we have a course being offered by King’s College London for caregivers of people with schizophrenia.

This sounds like a very worthwhile course given by a university that claims to be “one of the world’s leading research and teaching universities based in the heart of London”. I was encouraged to sign up for it and did so much to my chagrin. After the introductory explanations of what schizophrenia is, they tell us that trauma is an important cause of this ailment and that this concept is gaining greater interest. The traumatic event they mention first is the loss of a parent either through death or separation. They then suggest that trauma may be associated with the hearing of voices and that the symptoms of schizophrenia may actually be Post Traumatic Stress Disorder (PTSD).

I looked for references but could find none. As a medical writer I’ve been involved in producing learning materials for doctors and other health care providers and the first rule is that whatever you write has to be evidence based and the evidence must be cited. I recall once being told to find references to prove a statement in a document I was writing on blood pressure that exercise is beneficial.

I left a comment in the King’s College course asking for references but received no reply.

So, lets look at some of the evidence. According to Dr Cheryl Corcoran, a psychiatrist at Columbia University Medical School, chronic stress may lead to psychotic symptoms (hallucinations, delusions) in the context of PTSD or depression. However, she points out that schizophrenia is more than just those symptoms. Schizophrenia, she says “also includes problems in thinking (concentration, planning, memory, etc.) as well as what are called “negative” symptoms (low motivation, difficulty enjoying things, lack of strong feelings, little emotional expression). Schizophrenia can also include odd and disorganized thinking and behavior.” She concludes that there doesn’t seem to be any evidence that stress leads to these other symptoms of schizophrenia.

The National Health Service in the UK also disagrees. They say “some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it’s not known why some people develop symptoms while others don’t.” They point to a variety of possible causes including genetics, brain development, neurotransmitters, pregnancy and birth complications.

According to the Australians “Any evidence that childhood trauma directly causes psychosis or schizophrenia is controversial. Psychotic disorders may be secondary to co-morbid affective ilness, substance use, personality, or post-traumatic stress disorders, all of which have been linked to early trauma and all of which are common in those with a psychotic mental illness. Another difficulty for reporting childhood trauma in adulthood is accurately recalling events, and for some people memory is affected by the psychotic disorder. In other areas of research, such as depression, instruments have been developed which employ strategies to overcome recall problems such as the use of multiple sources of information. To date, these strategies have not been employed in most studies of schizophrenia.”

The number one cause of trauma that the King’s College Course cites is coming from a one parent family. Well, as I’m sure that most people know, this is a growing phenomenon. According to the Child Trend’s Database in the US, the proportion of children living with both parents has been in decline since 1970 and reached 64% in 2014. That means that in the US, 36% of children are in one parent families. This is a trend that is universal in the developed world and yet there is no increase in the number of people who develop schizophrenia. One study conducted in England over the period of 1960 to 2009 concluded that “We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.”

This course also suggests treatment modalities such as Cognitive Behavioural Training for Trauma and Eye Movement Desensitization and Reprocessing (EMDR). Both are tried as treatments for PTSD and may or may not be effective but they are not a first line for schizophrenia. The other risk factor that is talked about is marijuana use but I suggest taking the course and deciding for yourself how relevant it is.

One psychiatrist to whom I mentioned the emphasis on trauma as a cause of schizophrenia commented that this is both insulting to the families and potentially dangerous. But, let me end by quoting my blogging colleague, Dr David Laing Dawson from his blog called As For Trauma Causing Schizophrenia: No! No! No!

“People with psychotic illness do not need someone probing the wells of their psychic discomfort; they do not need (no matter how well-intended) a therapist scouring their childhood memories in search of an unhealed wound. They need support, safety, security, grounding,  and satisfying routine before they can get better. And good medical treatment.”