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Archive for November 21st, 2016

focus-of-exploration

Many of our most intractable public health problems are the result of compensatory behaviours such as smoking, overeating, promiscuity, and alcohol and drug use, which provide immediate partial relief from emotional problems caused by traumatic childhood experiences. That relationship is straightforward: early trauma to depression or anxiety, to obesity, to diabetes, to heart disease; trauma to smoking, to emphysema or lung cancer.

(Vincent J. Felliti in The Impact of Early Life Trauma on Health and Disease: the hidden epidemic edited by Lanius, Vermetten and Pain – page xiv).

I am aware that the full focus of my current enquiries spreads across this whole diagram. However, I need to start somewhere manageable and progress from there, or else my next blog post will have to wait several years until I have had time to explore the whole diagram.

It should be no surprise to regular readers of this blog that I have decided to start with the left side. I’m not sure what the brain laterality implications of that are exactly, but I’m very clear that I’m trying to play to my strengths here. The most enriching part of my career was spent working with the experiencers of psychosis. That’s the work I loved most and where I learned most.

Even so this is not going to be plain sailing.

As we will see it’s easy to demonstrate that trauma plays some kind of causative role in psychosis, as well as in other distressing problems. That will be the focus of this first sequence.

It is also relatively easy to show that transliminality, a permeable threshold of consciousness, appears to correlate with some experiences of psychosis. My first problem there will be trying to clarify exactly what transliminality is.

After that, what may not be so easily supported by evidence is the idea that transliminality is also playing a causative role. It may simply be another consequence of trauma: in fact, there is some evidence to that effect. To close in on resolving this I will need to search for evidence that transliminality, at least with some people, is present prior to both trauma and psychotic experiences: I am still in the process of trying to pull that evidence together, but it is not proving easy so that will be addressed, along with the issue of transliminality per se, in a later sequence.

trauma-recoveryAttitudes to Trauma in the Past

Before looking specifically at the relationship between trauma and psychosis, I feel it would be sobering and ground us more firmly in social reality if I very briefly highlighted how we have dealt with explanations about the effects of trauma in the past.

There are many places to look for evidences of this picture but few better than Judith Herman’s book Trauma & Recovery.

Herman rightly emphasises that only if the social context facilitates, can trauma and its impacts be studied (page 9):

The study war trauma becomes legitimate only in a context that challenges the sacrifice of young men in war. The study of trauma in sexual and domestic life becomes legitimate only in a context that challenges the subordination of women and children.

She lists, in her historical review, three forms of trauma (ibid.): hysteria, shell shock/combat neurosis and sexual and domestic violence. She looks at the work of Charcot, Janet, Freud and Breuer. The fruit of their extensive collaborative interactions with female patients was Freud’s The Aetiology of Hysteria, in which he wrote (page 13):

I therefore put forward the thesis that at the bottom of every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood, but which can be reproduced through the work of psycho-analysis in spite of the intervening decades.

The backlash caused a backtrack. Experiences were dismissed as fantasies or interpreted as subliminally desired. As Herman puts it (page 14):

Out of the ruins of the traumatic theory of hysteria, Freud created psychoanalysis. The dominant psychological theory of the next century was founded in the denial of women’s reality.

WebsterIn case some of us should think that Herman’s feminism disqualifies her from comment on this issue, we can turn to what a man has to say on the matter. Richard Webster was no fan of Freud, and he feels he has good reasons. This is one of them (page 513):

In the theory of the Oedipus complex Freud had, in effect, invented a perfect theoretical instrument for explaining away allegations of sexual abuse and undermining their credibility. Since Freud’s theory held that all children might fantasise about sexual relations with their parents, it followed that recollections of sexual abuse by parents could be construed as fantasies. [Despite Freud’s insistence that such memories were sometimes valid] the overwhelming tendency in the psychoanalytic profession throughout most of the twentieth century has been to construe recollections of incest as fantasies. In this respect, at least, psychoanalysis in general and the theory of the Oedipus complex in particular have caused untold harm.

Webster makes it completely clear that, in his view, the battle the feminists have fought on this front has been founded in fact (ibid.):

Only in the last twenty years has it become possible to oppose this climate effectively. This is almost entirely due to the influence of feminism.

I will return to that in a moment, but we’re not quite finished with hysteria yet. Herman recognises how impossible it would have been for Freud to successfully fight to get his authentic theory recognised (page 18):

No matter how cogent his arguments or how valid his observations, Freud’s discovery could not gain acceptance in the absence of a political and social context that would support the investigation of hysteria, wherever it might lead. Such a context had never existed in Vienna and was fast disappearing in France. Freud’s rival Janet, who never abandoned his traumatic theory of hysteria and who never retreated from his hysterical patients, lived to see his works and his ideas neglected.

Soldiers in the First World War triggered a similarly divisive debate. Lewis Yelland used shaming, threat and punishment as a ‘remedy’, for example treating the mutism that sometimes resulted from combat neurosis with electric shocks, in one case to the throat. The film of Pat Barker’s novel Regeneration horrifically re-enacts that method on screen. W H R Rivers’ approach was more humane, and also featured as the central theme of that novel/film. He used psychoanalytic principles. Freud was not all bad. In the end what was learned was soon forgotten, because the social context did not value it.

The Second World War resurrected it. Even so, though progress was made (page 26), ‘systematic, large-scale investigation of the long-term psychological effects of combat was not undertaken until after the Vietnam War.’

This took an altogether different form from the expert-dominated approaches of the past (ibid.):

The antiwar veterans organised what they called “rap groups.” In these intimate meetings of their peers, Vietnam veterans retold and relived the traumatic experiences of war. They invited sympathetic psychiatrists to offer them professional assistance.

Their activism ultimately led to (op.cit. page 27):

. . . comprehensive studies tracing the impact of wartime experiences on the lives of returning veterans. A five-volume study on the legacies of Vietnam delineated the syndrome of post-traumatic stress disorder and demonstrated beyond any reasonable doubt its direct relationship to combat exposure.

Activism remained a vital element in the further development of a proper understanding of trauma and its true prevalence (page 28):

For most of the twentieth century it was the study of combat veterans that led to the development of a body of knowledge about traumatic disorder. Not until the women’s liberation movement of the 1970s was it recognised that the most common post traumatic disorders are not those of men in war but of women into civilian life.

The incidence figures were as staggering then as they had been when Freud decided they could not be credible and backed off. A rigorous study of 900 randomly selected women in the 1980s revealed that one in four women had been raped, and one in three had been sexually abused in childhood.

Herman describes the way that research into rape led investigators from the street more deeply into the family (page 31):

The initial focus on street rape, committed by strangers, led step by step to the exploration of acquaintance rape, date rape, and rape in marriage. The initial focus on rape as a form of violence against women lead to the exploration of domestic battery and other forms of private coercion. And the initial focus on the rape of adults led inevitably to a rediscovery of the sexual abuse of children.

We will see in the next post why the long and arduous journey of soldiers, women and eventually children, from being labelled as fantasising or malingering wimps to being compassionately regarded victims in need of support and redress, is not over yet in a different form for another marginalised group of people.

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