Category Archives: Trauma and schizophrenia

More on Trauma in Youth and Schizophrenia

By David Laing Dawson

This blog is in response to a comment made on an earlier blog called As For Trauma Causing Schizophrenia: No! No! No! 

The comment was how do you account for this study? And how can you claim that trauma cannot be causative of schizophrenia? https://www.sciencedaily.com/releases/2012/04/120419102440.htm

This is the answer:

There is no doubt severe trauma in childhood can have long lasting effects. But can trauma be a specifically causative element in the development of the full illness schizophrenia? And is it either a necessary causative element or a contributing factor?

Data mining and surveys come up with many associations, some weak, some strong. Fair enough. But we have to examine the definitions of each and every term and understand that association is not necessarily causative. And in this situation we must be very careful what we publicize because any association between trauma and schizophrenia provides support for parent blaming.

I am back to eating butter after something like 20 years of favouring margarine. This because for many years data mining found associations with butter and other animal fats and cardiovascular disease, and only recently further data mining and studies have shown that, au contraire, we need fat, and margarine may be worse than butter. Now I slather butter on my corn and biscuits without guilt. As someone else has pointed out, there is a very strong association between major road accidents and the presence of ambulances.

The word paranoia is used in many of those studies. I don’t know how they define it or determine it. Adolescents suffering from anxiety often experience what they call ‘paranoia’ but we refer to as ‘ideas of reference’. They feel their peers are always talking about them, judging them. Some avoid school because of this. Sometimes this feeling becomes a conviction and then it may be prodromal of a psychotic illness.

Bullying is interesting. I have 30 years of experience dealing with families in which a child is reported as being bullied by his peers. There are some distinct subcategories in this: In one subset, when the details are elicited, it turns out the boy in question is as much a perpetrator as a recipient. They taunt one another. But this particular boy tells his mother that Jason called him a “…..” in order to get a reaction from his mother, or to avoid something, or simply to get in front of the call that is going to come from Jason’s mother or the school.

A second subset is the Asperger/ASD child. They are common targets for bullying, precisely because of the way they react to unfairness, teasing, slights, and taunts. It is not kind and it is not good but they have become targets for bullying precisely because of the social deficits they already exhibit. My own survey reported on this site indicates that at least a third to a half of people diagnosed with schizophrenia have had autistic symptoms since infancy. So I would definitely expect a higher proportion of bullied children to develop a psychotic illness. The bullying is not causative, but the prodromal symptoms of the illness “invite” bullying.

Auditory hallucinations are not, in and of themselves, schizophrenia. People, girls, who have suffered prolonged sexual abuse report a higher incidence of auditory hallucinations. This certainly could be understood as persistent trauma of a particularly disorienting kind causing impairment in the brain’s otherwise quite miraculous ability to (usually) locate the locus of a thought or feeling, as well as causing all the other symptoms of PTSD as well.

On the other hand preteen and teen girls with ASD or prodromal symptoms of schizophrenia are vulnerable to predators within a family and neighborhood.

In sum, there are weak associations, though all suffer from our poor definitions and lack of clarity of diagnosis. None are strong enough to be considered causative. And if this were an association between salt intake and hypertension, to publish early causes little harm. (although even here we now have the problem of some people having too little salt in their diet, and other studies showing high salt intake may have nothing to do with hypertension).

But because this overall weak association with all its definition and cause/effect problems could support the existing serious prejudice of parent blaming for schizophrenia, I have to stick with my simple, “No. Neither psychological trauma nor poor parenting cause the serious illness we call schizophrenia.”

Though, of course, either could make it worse.

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Psychiatry, Eugenics and Mad In America Scare Tactics – Part I

By Marvin Ross

Much of what I read on the Robert Whitaker website, Mad in America, stretches logic but this newest blog has to be one of the biggest stretches I’ve seen. Dr Robert Berezin, a US psychiatrist, warns that psychiatry is moving closer and closer to eugenics.

As defined by dictionary.com “eugenics is a word that made everyone at the event uncomfortable. … The very subject evokes dark visions of forced sterilization and the eugenics horrors of the early 20th century. … The study of hereditary improvement of the human race by controlled selective breeding.”

The most famous proponent of eugenics was Adolph Hitler who wanted a pure Aryan race but the subject has been advocated by many in recent history in an attempt to eradicate debilitating diseases. In fact, one could say that the reason for amniocentesis is to do just that. Sampling of the amniotic fluid of pregnant women can predict such things as Down’s Syndrome. And some parents will opt for abortion if Down’s is found but many do not.

Amniocentesis can also predict such genetic conditions as Tay Sachs Disease where the infant usually only lasts to about age 4. But, nowhere in the article by Dr Berezin does he actually show that modern psychiatry is planning to eliminate anyone who suffers from schizophrenia or any other psychiatric disorder.

What he talks about is the fact that genetics is being employed to try to understand these conditions better. He states that:

The accepted (and dangerous) belief is that psychiatry deals with brain diseases – inherited brain diseases. We are back to absolute genetic determinism. Today’s extremely bad science is employed to validate not only the idea that schizophrenia and manic-depression are genetic brain diseases, but that depression, anxiety, phobias, psychopathy, and alcoholism are caused by bad genes

I have no idea why he considers the genetic research to be bad science other than he does not agree with it. So what if he doesn’t. He does state that “The temperamental digestion of trauma into our personalities is the source of psychiatric conditions.” But, as Dr David Laing Dawson has written on this blog:

Childhood deprivation and childhood trauma, severe and real trauma, can lead to a lifetime of struggle, failure, depression, dysthymia, emotional pain, addictions, alcoholism, fear, emotional dysregulation, failed relationships, an increase in suicide risk, and sometimes a purpose, a mission in life to help others. But not a persistent psychotic illness. On the other hand teenagers developing schizophrenia apart from a protective family are vulnerable, vulnerable to predators and bullies. So we often find a small association between schizophrenia and trauma, but not a causative relationship.

Dr Berezin’s concern does not come from anything that anyone has said about aborting fetuses that genetic testing proves will be born with schizophrenia or bipolar disorder or any serious psychiatric condition. And the reason for that is that genetics and the understanding of the causes of these diseases is nowhere near a point that this can be demonstrated with 100% accuracy. Science is a long way from getting to that point if it ever is able to.

Suggesting that these research avenues will lead to abortion, eugenics or something similar is absurd and nothing but scare tactics perpetrated by someone who does not agree with the causation theories being investigated. If these avenues lead nowhere and it is discovered that science has been on the wrong path, then science will self correct. Attempting to generate unfounded fear is counterproductive.

Next Part II by Dr David Laing Dawson

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.”