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Posts Tagged ‘trauma’

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Emily, Anne and Charlotte in To Walk Invisible. Ann is seated in the middle. Photograph: BBC/Michael Prince

I am slowly picking myself up after a busy festive season. At the end of it I found myself wondering what themes were calling me, as I’d rather dropped the ball over the last few weeks. 

I find I am being drawn to the Brontës by a number of hints including Sally Wainwright’s recent excellent documentary drama, To Walk Invisible (it’s available for another 19 days), and this excellent Guardian article of last Friday  by Samantha Ellis, which redresses the balance in terms of Anne.

The Brontës’s combination of trauma and creativity suggests that trauma can elevate a person to a higher level of understanding which is a form of transcendence, even in the absence of transliminality, unlike my rather glib conclusion in an earlier post’s diagram. 

So, I’ve added another substantial clutch of books to my list. Heaven knows when I will be able to read them all, let alone pull what I have learned into a coherent perspective. I guess I’ll not be keeping up my previous pace of posts for a few days or even weeks yet. I hope your patience with me will prove worth it in the end. 

Anyhow, here is a short extract from the Ellis post – how intriguing to have as a surname Emily’s pseudonym! Click the link for the full post.

Seen as less passionate than Emily, less accomplished than Charlotte, Anne is often overlooked. But her governess Agnes Grey is a clear model for Jane Eyre.

Anne Brontë started writing her first novel some time between 1840 and 1845 while she was working as a governess for the Robinson family, at Thorp Green near York. I imagine she must have made her excuses in the evenings, and escaped the drawing room, where she had to do the boring bits of her pupils’ sewing, and often felt awkward and humiliated – excluded from the conversation because she was not considered a lady, yet not allowed to sit with the servants either, because governesses had to be something of a lady, or how could they teach their pupils to be ladies?

Anne must have stolen away to her room and pulled out her small, portable writing desk. Leaning on the desk’s writing slope (which was decadently lined in pink velvet), Anne could go on with her novel. She had to write in secret because she was skewering her haughty employers and her peremptory pupils on the page. Although her job was difficult and thankless, she had realised that it was providing her with excellent material, that she was telling a story no one else was telling. As she laboured away in her neat, elegant handwriting, Anne must have felt that she was writing a novel that would go off like a bomb.

Agnes Grey sticks close to the facts of Anne’s life. The eponymous heroine is a clergyman’s daughter, just as Anne’s father, Patrick Brontë, was the perpetual curate of Haworth in Yorkshire. Anne doesn’t specify where Agnes grows up, but she does say she was “born and nurtured among … rugged hills”, so when I read the novel, I imagine the Yorkshire moors. Both Anne and Agnes were originally one of six children. Anne lost her two eldest sisters when she was five. Agnes has lost even more siblings; she and her older sister Mary are the only two who have “survived the perils of infancy”. Both Agnes and Anne are the youngest. When Agnes says she is frustrated because she is “always regarded as the child, and the pet of the family”, considered “too helpless and dependent – too unfit for buffeting with the cares and turmoils of life”, it feels like Anne talking. She always chafed at being patronised.

. . . . Agnes turns to one of the only other jobs open to middle-class women: she decides to become a governess. . . .  instead of an adventure, Agnes gets a crash course in how cruel the world can be, and how it got that way.

One of Agnes’s pupils, Tom Bloomfield, enjoys torturing birds. One day his vile uncle, who encourages Tom’s cruelty, gives him a nest of baby birds. When Agnes sees him “laying the nest on the ground, and standing over it with his legs wide apart, his hands thrust into his breeches-pockets, his body bent forward, and his face twisted into all manner of contortions in the ecstasy of his delight” and he won’t be reasoned with, something rises within her. She grabs a large flat stone and crushes the birds flat.

This brutal mercy killing is almost too violent to read. Agnes Grey’s first critics thought it went too far, but Anne insisted that “Agnes Grey was accused of extravagant overcolouring in those very parts that were carefully copied from life, with a most scrupulous avoidance of all exaggeration”.

 A new Vintage Classics edition of Agnes Grey is published on 12 January. Take Courage: Anne Brontë and the Art of Life by Samantha Ellis is published by Chatto & Windus on the same date.

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In the last post, I reached a point where I felt that a different angle on the issue of transliminality was required.

Irreducible MindFrom Irreducible Mind 

This is where revisiting Irreducible Mind might pay off, even though it does not deal with psychosis as such.

So, here I go back to the Kellys, Myers and James. The core relevant material is between pages 606-39 in Irreducible Mind.

They distance themselves from the idea of a brain that faithfully transmits information from the subliminal to the supraliminal:

The related term ‘filter,’ which is like Aldous Huxley’s ‘reducing valve,’ suggests selection, narrowing, and loss, is much more appropriate to that relationship, and for that reason we greatly prefer it as a shorthand description of Myers’s theory.

So far so good.

They note this metaphor has since been updated to that of the brain as ‘a TV receiver.’ (Incidentally, Pim van Lommel’s analogy of the transceiver is more appropriate, and the computer analogy more appropriate still, in that the latter allows for the brain generating as well as transmitting and receiving a great deal of data both consciously and unconsciously: not that I accept in any other respect the idea that either the mind or the brain is a computer in the way it functions.)

The Kellys rightly warn us to be cautious before attributing too many high level functions to this capacity. I am also treading warily from now on as I am really not convinced that we can risk conflating creative subliminal uprush from within the brain with extrasensory stimuli from a transpersonal or transcendent dimension, though I am not ruling out the possibility that such experiences might first be registered subconsciously for later transfer to consciousness.

Anyhow let’s see where Edward Kelly, the author of this chapter, is going to take us.

It is at this point in his explanation that it becomes clear that Kelly is arguing from a perspective of mind-brain independence:

More generally, we wish now to argue that by thinking of the brain as an organ which somehow constrains, regulates, restricts, limits, and enables or permits expression of the mind in its full generality, we can obtain an account of mind-brain relations which potentially reconciles Myers’s theory of the Subliminal Self with the observed correlations between mind and brain, while circumventing the conceptual difficulties identified above in transmission models.

He then moves on to considering both dualist and monist theories of mind. Although evidence was marshalled early on that might seem to support the simple dualist position that the mind is separate from and to some degree independent of the body, he feels it was ‘insufficient to establish it, since alternative explanations based on the conventional viewpoint were nowhere decisively excluded.’

Sperry, he explains, opted for an ‘emergent property’ explanation, arguing that ‘mind and consciousness “emerge” from brain processes when these processes reach a certain threshold of complexity.’ The problem was that Perry stated this without accounting for how it might come about.

He then points out that thinking has shifted to increased acceptance of the possibility, entertained by Myers, that there may not be ‘any sharply defined distinction of mind and matter.’ This weakens the argument, used by critics against simple dualism, that if mind were so different from matter it could not affect it. It becomes easier and more plausible to entertain that possibility that if a brain can affect a mind the opposite could also be true.

This leads him to shift his argument to a consideration of the impact of quantum physics on our ideas about the relationship between consciousness and matter. This is a controversial area about which I am not competent to adjudicate. He ends by quoting Stapp as saying, ‘Contemporary physical theory allows, and in its orthodox von Neumann form entails, an interactive dualism.’ Though he accepts that much more work needs to be done to articulate and support this model he still contends:

The model also potentially explains in a natural way certain of the characteristic features of conscious experience, such as the attentional ‘bottleneck’ of Pashler… and the properties of the ‘global workspace’ as conceived by many contemporary brain theorists – broadly, the fact that a serial, integrated, and very limited stream of consciousness somehow emerges in association with a nervous system that is distributed, massively parallel, and of huge capacity.

He is keen to find ways of undermining the assumption that the brain produces experience rather than transmits or permits it. He is encouraged by findings from neuroimaging that suggest that far from the brain operating exclusively in a modular way, it seems rather to function as a ‘global workspace.’ He sees this as supporting the idea of the brain as ‘an instrument adapted by evolution to enable the mind to gain information about, and to act upon, the everyday physical environment.’ He argues we are moving towards a picture of the mind as residing ‘in the associated psychic entity, which is at least in part outside the brain as conventionally conceived.’

We will be returning to this in more detail in the next post. It is perhaps worth flagging up that Mario Beauregard, in a chapter in Exploring the Frontiers of the Mind-Brain Relationship, offers a mind-brain interaction model of his own design (page 133):

In line with [William] James’s view, I recently proposed the Psychoneural Translation Hypothesis (or PTH) . . . . This hypothesis posits that the mind (the psychological world, the first-person perspective) and the brain (which is part of the ‘physical’ world, the third-person perspective) represent two epistemologically and ontologically distinct domains that can interact because they are complementary aspects of the same underlying reality. . . . [M]entalese (the language of the mind) is translated into neuronese (the language of the brain). This . . . . allows mental processes to causally influence brain activity in a very precise manner.

This all is hopefully indicating that we might have a mind which is not completely reducible to the brain.

We still have a very long way to go though:

The traditional dualist problems regarding mental causation and energy conservation seem to be overcome, but there remain further deep problems with no good solutions in sight. We still have no real understanding of the ultimate nature of the relationship between brain processes and mental activity, and certainly no solution of Chalmers’s ‘hard problem’ – why conscious experiences with their specific qualitative characteristics should arise at all in connection with the associated patterns of brain activity. It is not clear which aspects of the ‘cognitive unconscious’ go with the brain, which with the associated psyche, and how their respective contributions get co-ordinated.

filter-spectrum-v2

This last question exactly matches the problem highlighted in the earlier diagram.

He turns to monist possibilities for further possible enlightenment. Hard questions are raised about the nature of matter:

In our attempt to develop the non-Cartesian dualist-interactionist model we relied heavily on a first major consequence of quantum theory, that it brings consciousness back into physics at the foundational level and in a causally effective manner. There is a second major consequence, however, no less profound but even less widely appreciated. It is this: there is no such thing as matter as classically conceived.

He quotes Stapp again:

The new conception essentially fulfils the age-old philosophical idea that nature should be made out of a kind of stuff that combines in an integrated and natural way certain mind-like and matter-like qualities, without being reduced to either classically conceived mind or classically conceived matter.

He goes back to Whitehead’s thinking (1938):

Whitehead’s fundamental move is… to re-situate mind in matter as the fundamental factor by which determinate events emerge out of the background of possibilities.

He also argues for ‘a global interconnectedness that is fundamental to nature’ and adds in a footnote: ‘How far down nature can plausibly be viewed as manifesting such “mentalistic” properties remains an open question, but the threshold, if one exists, is undoubtedly much further down than most of us commonly assume.’

Kelly suggests that Whitehead’s ‘original philosophical system is being progressively “modernised” in light of continuing developments in physics,’ while acknowledging it is anything but problem-free.

From a spiritual point of view I know where I want the evidence to point.

The Conscious Universe IRMA very delicate balance

I am heartened but not completely satisfied that there are bodies of carefully gathered evidence that confirm the idea that there is a transcendent dimension which is not reducible to matter. I am aware that the strongest evidence there is points to the reality of psi, at least. Dean Radin’s book, The Conscious Universe, marshalls it compellingly, as I have already explored on this blog.

His response to ill-informed scepticism is worth quoting once more. He quotes Paul Churchland as a not untypical example (page 207):

‘… There is not a single parapsychological effect that can be repeatedly or reliably produced in any laboratory suitably equipped to perform and control the experiment. Not one.’

Radin’s reposte, which his book proves is completely warranted is (ibid.):

Wrong. As we’ve seen, there are a half dozen psi effects that have been replicated dozens to hundreds of times in laboratories around the world.

Radin goes onto explain that such sceptics as Churchland have not even bothered to find out what the tiny handful of well-informed sceptics had come to accept (page 209):

Today, informed sceptics no longer claim that the outcomes of psi experiments are due to mere chance because we know that some parapsychological effects are, to use sceptical psychologist Ray Hyman’s words, “astronomically significant.” This is a key concession because it shifts the focus of the debate away from the mere existence of interesting effects to their proper interpretation.

Mario Beauregard endorses this view in his book The Spiritual Brain.

He ends up on Alvin Plantinga’s ground at one point (Kindle Reference: 2520):

We regard promissory materialism as superstition without a rational foundation. The more we discover about the brain, the more clearly do we distinguish between the brain events and the mental phenomena, and the more wonderful do both the brain events and the mental phenomena become. Promissory materialism is simply a religious belief held by dogmatic materialists…who often confuse their religion with their science.

He refers in summary to the areas of exploration he has adduced which he feels a nonmaterialist view can explain more adequately, and includes the research on psi (2528):

For example, a nonmaterialist view can account for the neuroimaging studies that show human subjects in the very act of self-regulating their emotions by concentrating on them. It can account for the placebo effect (the sugar pill that cures, provided the patient is convinced that it is a potent remedy). A nonmaterialist view can also offer science-based explanations of puzzling phenomena that are currently shelved by materialist views. One of these is psi, the apparent ability of some humans to consistently score above chance in controlled studies of mental influences on events. Another is the claim, encountered surprisingly often among patients who have undergone trauma or major surgery, that they experienced a life-changing mystical awareness while unconscious.

And these near-death experiences are more controversial than psi, if that is possible, as we will see next time.

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For many years it was believed that psychotic symptoms were discontinuous from `normal’ psychological functioning. This position is becoming increasingly untenable in the light of research evidence that positive psychotic symptoms can be understood with reference to normal psychological processes. This paper will outline the evidence from current psychological conceptualizations that psychotic symptoms are closely related to a person’s psychological functioning and that they are therefore amenable to psychological intervention (Yusupoff et al., 1996). Current psychological conceptualizations of hallucinations and delusions hold that the content of these symptoms contain material which is personally relevant to the individual. Indeed, this personal relevance is critical to the understanding of, and cognitive interventions with psychotic symptoms.

(From An Interacting Cognitive Subsystems Model of Relapse and the Course of Psychosis by Andrew Gumley, Craig A. White and Kevin Power – page 262)

In the previous post I began to outline a picture of the kind of traumatic life experiences which can give rise to psychosis.

There’s more to add to the list of factors.

Additional Factors

Many who experience psychosis also, for example, according to Murphy at al (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse), have experienced heightened levels of social deprivation, discrimination and isolation even beyond the age of 16. Additionally, members of the group with no history of Childhood Sexual Abuse were more likely to have experienced Childhood Physical Abuse, PTSD, social isolation and neurotic disorder. Interestingly, members of this class were also more likely to be male.

This profile seemed to indicate that, in the absence of Childhood Sexual Abuse, individuals who experienced psychosis were likely to endure a wide range of other traumatic experiences. It seemed that the composition of this class, particularly in terms of sex, suggested that, while psychosis may be a phenomenon highly associated with traumatic experience and adversity, the precise nature of this trauma and adversity may be dependent upon the sex of the individual. The Child Sexual Abuse-only class was more likely to be female and was characterised by elevated probabilities of childhood physical abuse and adult sexual trauma, neurotic disorder and cannabis consumption.

It may be worth spending sometime teasing out the exact level of risk of psychosis represented by trauma.

Longden and Read (The Role of Social Adversity in the Etiology of Psychosis – page 7) focus on two substantial meta-analyses (ie collated data from a number of well validated studies). The first screened 736 articles, retaining 41 of the best designed. When results were pooled, individuals with a history of childhood trauma (child sexual abuse, physical abuse, emotional abuse, neglect, bullying, parental death) were shown to be 2.8 times more likely to develop psychotic symptoms than those who had not. The second meta-analysis retained 25 studies from a search result of 1104, and found that rates of childhood adversity (including child sexual abuse, physical abuse, emotional abuse, neglect, witnessing domestic violence, and loss events) were 3.6 times greater in people diagnosed with schizophrenia relative to “healthy controls.”

It is important that we make sure we are not being misled into attributing cause when we have only correlation. By this I mean that just because, when I am holding my key to either open or lock my front door, the light goes on, I should not jump to the conclusion that my door key is switching the light on. I need to understand that my mere presence with no key is enough to trigger the motion sensor. The key is a confounding variable that needs to be eliminated, for example by leaving the house without locking the door one night. I’d be wise not to go further than strictly necessary to prove the point though.

Longden and Read (pages 7-8) deal extensively with this problem:

Large-scale population studies have shown that associations between adversity and psychotic experience remain significant when controlling for possible confounders, including: family history of psychosis and other mental health problems (which negates the notion that psychosis only occurs in those genetically predisposed), age, sex, ethnicity, marital status, exposure to discrimination, other psychiatric diagnoses, education level, neuroticism, and substance use. Furthermore, the association has repeatedly demonstrated a dose-response relationship; that is, the likelihood of psychosis increases relative to the extent of adversity exposure.

 

Lucretia by Rembrandt

Lucretia by Rembrandt (For source of image, see link)

Even this does not end the list of factors (ibid.):

Despite much emphasis on childhood abuse, this is by no means the only environmental adversity associated with psychosis. Other cited factors (Larkin & Morrison, 2006; Read, 2013a; Scott, Chant, Andrews, Martin, & McGrath, 2007) include discrimination, witnessing domestic violence, prenatal stress, war trauma, torture, adulthood rape and physical assault, excessive marijuana use in adolescence (in some instances this may represent attempts to self-medicate posttraumatic symptoms . . . ), and disturbed attachment relationships with one’s caregivers, including abandonment, being the result of an unwanted pregnancy, being raised in institutional care, dysfunctional parenting (often intergenerational), and parental death or separation. Another factor receiving significant attention is poverty and inequality . . .

Longden and Read feel (page 9): ‘that erroneous reports of sexual victimization are no different between patients diagnosed with schizophrenia and the general population,’ so we have as much reason to believe a patient diagnosed with schizophrenia as anyone else, and we have already established in the first post of this sequence that this level of credibility is basically compelling.

The Brain

Now is the time to return to a closer examination of the role of the brain in all this.

Longden and Read describe what they intimidatingly label (page 12) ‘the traumagenic neurodevelopmental (TN) model of psychosis’ by which they mean how, during our formative years, trauma can affect the brain in ways that make psychosis more likely. They argue that there are similarities between abnormalities in the brains of abused children and those of adult patients with psychosis.

A key point is this: ‘A major premise of the TN model is that the heightened stress sensitivity consistently found in patients with psychosis is not necessarily inherited, but caused by formative exposure to abuse and neglect.’ This is key because it moves the debate away from genes to life experience.

They give various examples of the research including (pages 20-21):

A . . . study with 45 individuals considered at clinical high risk for psychosis found significant positive associations between trauma exposure (psychological and/or physical bullying, emotional neglect, emotional abuse, physical abuse, Childhood Sexual Abuse) and feelings of being watched or followed, as well as false beliefs about power or status. . .

An equally important finding is the relationship between psychotic content and precipitating trauma (ibid.):

Comparable work with 41 patients experiencing a first episode of psychosis found that attributes of stressful events in the year preceding psychosis onset were significantly associated with core themes of both delusions and hallucinations.

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

Implications for Therapy

How might this realisation help?

Murphy et al (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse) feel that:

. . . . identifying and evaluating trauma specificity in the onset and maintenance of psychological distress may aid clinicians and service users alike, in

(1) clarifying sources of distress and

(2) understanding symptom content and expression, while enhancing treatment design and efficacy also.

They emphasise that point that ‘symptoms of psychosis are often characterised by content that can be meaningfully attributed to past personally significant experiences.’

Longden and Read (page 22) feel that their evidence points in this same direction and  ‘reinforces a standpoint formed in the earliest days of psychiatry and that has gathered a striking momentum in the past two decades; that it is no longer a scientifically or morally tenable position to view psychosis as a purely biogenetic disease.’

This has clear implications for the approach we should adopt. They remind us that the British Psychological Society ([BPS] Division of Clinical Psychology) recently published a report emphasizing the utility of psychotherapeutic approaches to psychosis. The executive summary opens with the observation that “Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of . . . psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages” (BPS, 2014, p. 6)

Unfortunately the evidence I find in what I read now suggests that the situation that confronted someone I worked with in the 1990s may not have changed much. She wrote me as follows, after she moved to another city:

Today I saw my new CPN. He’s called D, and I’m feeling very upset as a result of our meeting. I’d be able to give you a ten foot long list of insensitive things he said, if I wanted to! His main objection was that I’m not out there working, earning money and contributing to the country. He said he’s going to phone the DRO tomorrow and get her to come out and see me to assess me for a job. . . . D was also very heavy-handed in his approach to “disability”. He said there’s people much worse off than I am and they’re using their abilities to the benefit of other people. I think one of the worst things that anyone can say to someone who’s got my kind of disability is that there are people worse off than they are. It has to come from the individuals themselves to say that sort of thing. I’ve applied to do a BA at the Open University — D wasn’t even satisfied with that, because it won’t lead to a “practical skill.” He questioned the intensity of my voices, the fact that I’m not sleeping . . . and he also physically tried to stop me rocking. I’m feeling really upset by it all.

[Later] My new CPN is . . . . refreshingly gentle and unassertive, but he’s only here for another couple of weeks. It’s very unsettling all this changing around, because I can’t work consistently with them, and by the time I feel ready to talk in confidence it’s time for them to move on to another post. I think it will be like this for the next six months until the permanent CPN comes back from maternity leave.

ThriveLayard and others certainly do not think things have changed for the better. It is an indictment of our society’s approach to mental health that effective treatment for many forms of mental problem is not sufficiently available to meet the need. Writing in 2014, Layard and Clark’s in their book – Thrive – draw this forcefully to our attention. The data the authors use to prove their case include the fact that (page 381):

. . . while over 90% of diabetes sufferers receive treatment for their condition, under a third of adults with diagnosable mental illness do so. This is largely because good evidence-based psychological therapy is not readily available

If anything things have got worse in the intervening period. The value of talking therapy for psychosis is clearly not sufficiently well recognised to guarantee that it will be funded and, if funded, that it will be safeguarded and prioritised. In the few areas seeking to provide some form of psychological support, Health Care Commissioners, even while knowing that CBT for psychosis should be available in 12 session packages, in itself a minimum requirement, frequently fund only six sessions or less. If this policy were followed for the prescription of antibiotics or the provision of cancer treatment there would be a national outcry.

Part of the reason for this blindness is the still prevailing implicit conviction that psychosis is basically a biological problem and is best treated with drugs not psychotherapy. Hopefully this sequence of posts will go some way to adding momentum to the increasingly powerful wave of dissent from this conveniently short-term cost-saving point of view.

In fact, it doesn’t save any costs at all in the long-term. With even the minimum basic intervention of CBT mounted early enough, sufficient benefits would accrue for enough patients to save the costs of relapse and readmission further down the road.

Beyond this though, in my view, we need more widely effective forms of ‘talking cures’ before we will see really major benefits long-term. But better half a loaf than none at this point.

So, having dealt at some length with the relatively straightforward issue of trauma and psychosis I plan to embark in the next sequence of posts on the trickier issue of thresholds of consciousness and psychosis. Wish me luck!

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I dealt last time with the long and difficult journey both women and soldiers have had to travel to get their way of behaving after combat or abuse properly recognised as the effect of the trauma they have undergone rather than as evidence of some despicable personal weakness.

Trauma in Relation to Psychosis

I’ll try to keep this section intelligible with as little neuro-scientific psychobabble as possible.

As we move through this evidence, we need to keep aware of how hard it must be for people who have been invalidated by the diagnosis of schizophrenia, to gain the necessary credibility to shift public and professional opinion from insisting they are the victims of an irrational disease of the mind, limited to those whose genes are against them, to seeing them as human beings like the rest of us, experiencing a comprehensible response to intolerable stress and emotional pain – much harder, I suspect, than anything that veterans labelled with combat fatigue had to face.

A good place to begin is with Richard Bentall’s examination of the issue in his 2003 edition of Madness Explained. This book, as will become clear, significantly predates most of the references I draw on in this section. He writes (page 277):

In this discussion of environmental influences on psychosis, I have left the contribution of trauma and until last because, for many psychologists and psychiatrists at least, even to raise this issue is to court to controversy.

Clearly Freud was not the last in the line of writers to find that pursuit of this line of reasoning could be inviting professional disaster.

Even so his conclusions on the basis of the best evidence at the time is (pages 478-79):

Despite difficulties, there is consistent evidence that a history of physical or sexual abuse is unusually common in psychotic women.

Comparable evidence of an association between trauma and psychosis has emerged from studies of men.

Even as late as 2010 there seemed to be persisting resistance to widespread acceptance of what should have by then have become obvious and widely accepted (The Impact of Early Life Trauma –  page 9):

While biological factors undoubtedly play a significant role in many cases of psychosis, there is an abundance of evidence supporting the impact of early trauma on the development of psychosis . . . , yet biological accounts in isolation still dominate treatment and teaching on the aetiology of psychosis. . . . Just as the research findings do not support childhood abuse and neglect as the only pathway to psychosis, there is no compelling evidence to suggest that biological models satisfactorily account for all psychosis . . . . Acceptance and acknowledgement of explanations more consistent with empirical findings need to overcome what societal attention to child abuse and neglect has always had to overcome: society’s desire for minimisation and denial.

  • The existence and effect of child maltreatment is perpetually fighting for acceptance against powerful psychological and social processes set to deny, ignore or undermine it.

When we leap almost to the present day there is thankfully far less hesitation in many quarters. I’m not sure though that we have yet come to the end of the need to change the prevailing consensus.

Longden and Read’s treatment of the issue (The Role of Social Adversity in the Etiology of Psychosis  – page 15) is where we can pick up the thread.

Childhood sexual abuse can definitely damage the brain in ways that may lead to psychosis. They quote a study comparing abuse exposure and brain volume in 60 patients and 26 matched controls which had found that ‘a significant amount of variance in grey-matter volume in psychotic disorders can be accounted for by a history of sexual trauma. The association was not significant for other types of childhood maltreatment, although rates of [childhood sexual abuse], physical abuse, emotional abuse and physical neglect were all higher in the patients with psychosis than the healthy controls.’ We will return to brain issues, or do I mean ‘tissues’, again in a later post.

Jamie Murphy, Mark Shevlin, James Edward Houston, and Gary Adamson dig somewhat deeper and uncover the true complexity of the problem (Modelling the co-occurrence of psychosis-like experiences and childhood sexual abuse –pages 1037-1043).

Evidence, in their view, has repeatedly shown that Childhood Sexual Abuse (CSA) is ‘significantly associated with psychosis at both clinical and sub-clinical levels (Psychotic-like Experiences – PLEs): the worse the CSA, the greater the risk, severity and duration of psychosis.’

Voices

My own clinical experience powerfully validates the link between sexual abuse and psychotic experiences. I have blogged about this in detail previously so a very brief summary as well as the poem above will have to suffice at this point.

In 1988 a young woman persuaded her GP to refer her to me. She had carried a diagnosis of schizophrenia since she was 16. Before that she had had a twelve year history of sexual abuse at the hands of her father which went undisclosed and unnoticed at the time.

It took more than a year for her to begin to describe the abuse, so painful was it for her. She could focus on it for no more than ten minutes in each hour at first. After that she became overwhelmed with terrifying hallucinations of her father, hallucinations which impinged upon all her senses – smell, touch, hearing, taste and vision. The only way she learned to determine afterwards that he had not really been there was to observe that she had no marks upon her body. Generally it would take the rest of the session to help her regain control of her own mind.

Sexual abuse is not the only trauma implicated in psychosis and does not always lead to psychosis as Murphy et al go on to explain:

Many individuals who experience CSA [Childhood Sexual Abuse] do not develop psychosis or PLEs [Psychotic-like Experiences]. Many individuals who also experience PLEs or who are diagnosed with a psychotic disorder have never experienced CSA.

What explanation might there be for that?

Clearly, and I feel not unexpectedly, Childhood Sexual Abuse, they found, does not lead to psychosis/ Psychotic-like Experiences, in all cases. Many who experience Childhood Sexual Abuse, for example, go on to develop Post-Traumatic Stress Disorder, depression, anxiety, substance abuse/dependence or other forms of psychological debilitation and distress. Many others, on the other hand, seem to demonstrate resilience or seem to be less affected by their abuse experiences. In the same way, people with Psychotic-like Experiences and psychotic disorder are not always the victims of previous Childhood Sexual Abuse. Many psychosis sufferers experience a wide range of non-sexual traumas and many experience traumas, stressors and adversities that occur throughout their lifetime, not just in childhood.

Talking to Ian

Talking to Ian

Ian is an example of this form of troubled trajectory.

His mother died of tuberculosis before he was 12 months old. His childhood was disrupted and then made even more stressful by a custody issue in which his estranged father sought to wrest the care away from his grandparents to whom he was firmly attached. He was five before the case was settled in favour of his grandparents. Two years later his much loved grandfather died. When he was nine he was walking to school through a farmyard and saw the farmer hanging in his barn. Benign voices, which comforted him, began soon afterwards.

To avoid going down the mines, as his grandfather had done, and to avoid the consequent damage to the lungs which killed his grandad, he joined the army. He was posted eventually to Hong Kong where being bullied by a sergeant major precipitated his first episode of psychosis.

In the military hospital, to escape its oppressive atmosphere and enforced treatment, he faked recovery and was trained as a sniper, something which the army felt he could cope with better as ‘schizophrenics work better alone.’ The trauma undergone during his army experiences left him wracked with guilt for the deaths he had caused[1], and led to his playing a kind of Russian roulette, in which he deliberately courted death as a way of determining whether or not he deserved to live. The last occasion he did this while still in the Army was when he deliberately walked towards a suspect bomb in Northern Ireland. The bomb exploded while he was close enough to incur lung damage from the blast but not close enough for it to kill him. He was invalided out.

A traumatic break with his alcoholic partner later precipitated the intense psychosis which led to my work with him. There are more details of that work on my blog so I won’t discuss it here.

He died sometime after our work ceased. The cause of death was emphysema, brought on by his heavy smoking, which exacerbated the lung damage from the bomb. A sad echo of his early life. The failure of his lungs, like that of his mother’s all those years before, was what killed him.

Next time I will be exploring other factors.

Footnote:

[1] The experience of the Falklands conflict has led to many well-documented examples of where what leads to PTSD is not seeing your comrades killed, but seeing what happens to the soldiers you shoot. Psychologists shamefully found it easy to train men to shoot to kill, but were not prepared for how the trauma of that would affect large numbers of combatants.

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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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focus-of-exploration

In a previous post, lamenting the death of my cafetière, I spoke of my strange elation as pennies dropped in my head when I realised more fully the significance of death in my life and appreciated better its relationship with mental health issues, especially psychosis.

I ended by saying that I felt as though all the pennies still had not dropped. Even so, I had no idea of the cascade of currency that was to follow.

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I was on my usual walk. At this time of year the hill through the wooded park near our home is every shade of brown, crimson and gold. As I was striding to the top at a pace brisk enough to get my heart beating faster, three words leapt to mind: trauma (including terror of death), transliminality (thresholds of consciousness and such) and transcendence (including spirituality in general). My subliminal mind had done it again. Not only had it grasped firm hold of the three things preoccupying me most strongly right now, but it had given me a mnemonic with which to hold onto them more easily. It’s so smart at doing this my left-brain gets quite envious.

churchill-gardens

As I walked, the trees, even with all their gold, faded into the background. I felt the three words jockeying for a position that made some kind of sense.

It was then I sensed there were dancing partners. When trauma paired up with transliminality the offspring could be psychosis. I’d need to explore how that might happen. Transliminality was not a faithful partner though and, as soon as the music changed beat, it eloped with transcendence and they gave birth to mysticism. Something else I needed to explore.

As soon as I got home, I dashed upstairs to my desk and notebook to catch these ideas on the wing before they migrated to Neverland.

I knew there were some gaps in my thinking. I wrote, at the same time as I drafted the diagram in Word: ‘Trauma is clearly an external event. The permeability of our threshold is probably a composite of experience, including the impact of trauma, and genetics. The transcendent will be hard to distinguish from illusion. Also I am not claiming that any of these factors explain all there is to know about the others, nor that psychosis is the only destructive consequence of trauma, or creativity the only positive consequence of transliminality, or transliminality its only precondition. All I am saying is that theirs is the interrelationship that fascinates me.’

Even so, I thought I’d nailed the essence of what I wanted to research more deeply.

img_3275No such luck. Thee days later, as I was getting the lawn mower out of the garage to give the front lawn its last trim of the year, I found myself wondering where my other obsessions – creativity, interconnectedness and compassion – fitted in. (Actually, it was more like a meadow – I don’t believe in cutting the grass, the wild flowers and the mushrooms more than is absolutely necessary: I was only mowing it now because the neighbour’s gardener had been wrily wondering whether all the sycamore leaves on our patch would blow over to the driveway he’d just cleared.)

I could see that reflection, my idée fixe, was necessary as a means of keeping me on the alert during every experience for any hint that would shed light on any aspect of these preoccupations, but I remembered my more muddled diagram of more than a year ago now, outlining what I wanted to investigate.

Interconnectedness

Clearly that wasn’t exactly on target anymore, but I didn’t want to lose anything of real importance that it contained.

As I walked the mower up and down the leaf-strewn grass, I could not escape the implications of the season; not so much ‘mists and mellow fruitfulness’ in my case – more leaf-death and cut greenery as potential compost and food for next year’s growth.

The beauty of the colours spread across the lawn drew me into the rhythms of the earth. I felt rather than thought that I am as much a part of nature as nature is a part of me. That’s why, as I have explored elsewhere, I prefer to be called Pete, with its echo of peat, rather than Peter, with its connections with rocks and popes. I loved dancing to the rhythms of rock music when I was younger, but geo-theological rhythms of that kind never have appealed to me in the same way.

I abandoned my mowing for the moment and went back in-doors for my iPhone. I needed to take some pictures even though most of the greenery and leaves were gone from our meadow by now. There was enough left though to capture what was stirring me into other perspectives on death.

Leaves die for a purpose as Shelley understood and as I have explored elsewhere.

According to Holmes in his biography (page 546):

Shelley went for walks along the banks of the Arno thinking of . . . . his own exile, his ‘passion for reforming the world,’ his apparent impotence to help the downtrodden people of England, the disasters of his private life and inevitably, at 27, the beginning of the end of his youth.

His hair was already becoming streaked with grey, according to Anne Wroe a possible symptom of syphilis. It is perhaps not surprising then to see the appeal of autumn as a symbol of his declining condition and his deep need for a powerful force to lift him out of his despondency. The climax of the The Ode to West Wind fuses these two aspects:

Make me thy lyre, even as the forest is:
What if my leaves are falling like its own!
The tumult of thy mighty harmonies

Will take from both a deep, autumnal tone,
Sweet though in sadness. Be thou, Spirit fierce,
My spirit! Be thou me, impetuous one!

Drive my dead thoughts over the universe
Like wither’d leaves to quicken a new birth!
And, by the incantation of this verse,

Scatter, as from an unextinguish’d hearth
Ashes and sparks, my words among mankind!

img_3279Once I had finished the lawn and transferred all I had gathered to the compost bin with my wife’s help, I rushed again indoors to capture what my subliminal mind had garnered as I mowed.

The only way I can describe the feeling of these moments is to say it was as though connecting with the earth had lifted my mind up to the sky. Possible ways of making the abstract elements of my quest grounded in reality had floated across my mind’s sky as I focused on guiding the mower over the leaf-strewn surface, sucking up the gold and green together.

microsoft-word-focus-of-exploration-v2

Suddenly I could see how creativity, connectedness and compassion might fit into the pattern, and how the terror of existence for some might narrow rather than widen their horizons, so that defending themselves against the darkness could made them dark instead. I also could consider the possibility that, without transliminality, transcendence and trauma would never dance together to create a child. From my recent reading of Waking, Dreaming, Being, Evan Thompson’s richly rewarding, though for me somewhat flawed, analysis of the interface between Buddhism and neuroscience, I remembered that the pollen and nectar for the hive of my current enterprise can be gathered from almost anywhere. He weaves academic, monastic, literary and his own personal experience into a tapestry rich in implications for the nature of the relationship between the mind and the brain.

Incidentally, how I found his book was a beautiful example of serendipity – something else I need to be on the alert for at all times.

Sorry to digress again – well, not really.

thompsonI went to Waterstones in Birmingham because I knew they had a copy of Boarding School Syndrome. As I followed the shop assistant with the skull-head rings (would I never escape reminders of death?) across the shop to look for Schaverian’s book my eyes were caught by the cover of Thompson’s book. Even that glance was enough to convince me I needed to give it a more careful look.

Once we’d located Boarding School Syndrome and I’d got it firmly in my grasp after a bit of a search, I made a beeline (and I’m using that expression in full knowledge of what it means in terms of pollen and nectar, as my earlier post indicates at length) for Waking, Dreaming, Being, grabbed it off the display shelf and headed for the nearest chair. Reading a few pages made me feel it might be too good to be true so I Googled some reviews. No, it was the real Macoy. You will hear more about it later.  

I don’t think I will be able to produce, twice a week, posts with anything like that degree of disparate experience integrated into them. I may have to make myself slow down even further than I have done so far to get anywhere close.

Let’s see how it goes!

Winter v2

sky-lawn-fusion

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bssAt the end of the last post I quote Joy Schaverian’s description, in her powerful book Boarding School Syndrome, of her patient,Theo’s shock at being reminded of the traumatic event he’d described in the previous session. He seemed not to have realised that he had revisited it.

I can testify to the truth of this process from my own experience.

My Hospital Experience

Those who have read this before on my blog can skip this bit.

In 1985 I had a powerful experience using Rebirthing therapy. The key was breathing:

I found a therapist and I went for eight sessions and it was the last one that brought about the dramatic shift in consciousness. It was on 11 July 1985. The session lasted over three hours.

So, there I was in the back room of a small cottage, lying on a mattress along the wall, a stone fireplace nearby, with the therapist on a cushion by my side. I can’t remember her name, which is rather sad. It’s fortunate that she ignored the clock for this session – a generous piece of good judgement for which I am extremely grateful.

The breathing had gone well as usual but this time, after less than half and hour, I began to tremble, then shiver, then shake uncontrollably. This was not a result of hyperventilation: I’d got past that trap long ago. She quietly reminded me that I simply needed to watch the experience and let go. Watching was no problem. Letting go was quite another matter. I couldn’t do it. I knew that it must be fear by now, but the fear remained nameless, purely physical. And this was the case for more than two hours of breathing. Eventually, we agreed that, in terms that made sense for me, Bahá’u’lláh was with me at this moment and no harm could befall me. There could be no damage to my soul and almost certainly no damage to my body.

And at that moment I let go.

Several things happened then that would be barely credible if I had not experienced it myself.

First, the quaking literally dissolved in an instant – the instant I let go – into a dazzling warmth that pervaded my whole body. My experience of the energy had been completely transformed.

Secondly, I knew that I was in the hospital as a child of four, my parents nowhere to be seen, being held down by several adults and chloroformed for the second time in my short life, unable to prevent it – terrified and furious at the same time.

Pam reynold's surgeryThis was not new material. I had always known that something like it happened. I had vague memories of the ward I was on and the gurney that took me to the operating theatre.  What was new was that I had vividly re-experienced the critical moment itself, the few seconds before I went unconscious. I remembered also what I had never got close to before, my feelings at the time, and even more than that I knew exactly what I had thought at the time as well.

This all came as a tightly wrapped bundle falling into my mind, as though someone had thrown it down from some window in my heart. It didn’t come in sequence, as I’m telling it, but all at once. It was a complete integrated realisation – the warm energy, the situation, the feelings and the thoughts. And yet I had no difficulty retaining it and explaining it to the therapist. And I remember it still without having taken any notes at all at the time that I can now find. The journal entry recording the event is a single line – no more.

And what were the thoughts?

I knew instantly that I had lost my faith in Christ, and therefore God – where was He right then? Nowhere. And they’d told me He would always look after me. I lost my faith in my family, especially my parents. Where were they? Nowhere to be seen. I obviously couldn’t rely on them. Then like a blaze of light from behind a cloud came the idea: ‘You’ve only yourself to rely on.’ It was rather uncanny when I read almost the same words in Schaverian’s book, speaking of Theo’s experience (page 126): ‘He remembered thinking to himself that he was now alone. He had no one to depend on but himself…’ It’s harder to imagine a stronger resonance to someone else’s experience than that.

This was more like a preverbal injunction to myself for which my adult mind found words instantly. For the child I was at the time, it had been a white-hot blend of intolerable pain and unshakable determination. It shaped a creed that had been branded on my heart at that traumatic moment, and its continuing but invisible hold on me till the explosion of insight was why it had taken me so long to let go.

At that young age I began to grow the carapace that would lead me eventually to feel safe only in trusting no one but myself. The shell continued to hide its origins even from me as its creator until that moment. It was the root of my atheism, the root that I had concealed from myself and everyone else for so many years.

What is even more bizarre, and relates to the point that Schaverian is making, is that in my 1976 diary, which I re-read only recently, I found that in my Transactional Analysis group at the time, I’d re-enacted the moment of my second surgery, when it took half-a-dozen ward staff to hold me down.

I wrote that it left me sobbing in the absolute clarity of the insight. Even the words of the life-script I wrote in my diary the day before the re-enactment – ‘I’ve only myself to rely on’ – are the very same ones that came like a bolt of light into my head in 1985 during the breathing meditation in Much Wenlock. I could understand why I might not remember something that had happened 40 years previously, even if it was important at the time. But to forget about something so significant in less than nine! Still, forget all about it was what I had done: I had no memory at all, not the faintest trace, that I’d used those words before. It came as a complete surprise.

cricket-bat

Theo had not fully understood when he drew it that he was kneeling at the desk before being hit in the face with the cricket bat.

Theo again

Schaverian explains why when she discusses Theo’s difficulties dealing with the time a teacher hit him in the face with a cricket bat (page 57):

Theo first told of this incident early in analysis. Then, a few months later, he retold it, this time with more depth of feeling. It was as though he was at first incredulous but then, as I took it seriously, he began to believe himself and to take seriously how abusive this had been. As Theo recounted it for the second time the feelings associated with the event became live in the session. Theo went white; he felt sick; he had trouble breathing and physically regressed.… The emotional impact of this was fully present in the room. Theo was overwhelmed and speechless.

There is even more to it than this need to revisit traumatic events, possibly having forgotten the previous attempts (page 118):

. . . if [traumatic events] can be told they are gradually detoxified, thus eventually accepted as part of the person’s personal history. It is then an accessible narrative and no longer unconsciously dominates their life. When there is no such witness the trauma may become embodied, leading to conversion symptoms such as digestive problems, migraines, chronic pain, poor energy and a large number of other physiological indicators. This may be because the event that caused it is remembered in an embodied sense, but not recalled cognitively and so it cannot be consigned to the past.

I suspect the long-time focus on my lungs and breathing may have been such an indication of embodied memory. Certainly the efficacy of a breathing therapy seems unlikely to have been a coincidence and my need to re-experience the events strongly suggests that the original Transactional Analysis attempt had only been partially successful, and therefore the memory of it was suppressed until the whole event resurfaced nine years later. Even then I never recalled the original work.

Ian and not believing yourself

There are just two other less lengthy correspondences to note before this very personal record is complete.

I recently revisited my work with Ian. I quoted from a recording we had made of his feedback about the process.

P.: I know this sounds a very stupid question, but in terms of when you then came and talked about them, what was valuable about just talking about them?

I.: Because it made it real. When I was ill, it didn’t seem real. You know what I mean? My memory didn’t seem real. It was like a dream. And it was as if I’d never done anything. But talking to you reminded me that I’d actually done these things, you know? And that it was memory. And that I’d actually done the things. It was reality.

P.: And how did knowing that it was reality prove so helpful? What did it do?

I.: Well, it proved the voices wrong for a start.

P.: Ah. Why? Were they saying that they were real and your memories weren’t?

I.: Yeh. It proved the voices were wrong. And that my memory was right. And talking to you fetched it out into the open. . . .

Theo’s experiences echoed this as well. Schaverian had encouraged him to draw when he initially could not describe in words what had happened (page 64):

There was a notable change in Theo’s demeanour as he sat back and viewed the drawings; they gave credence to his story. He began to believe himself and he was overwhelmed. The atmosphere of the school was live in the room and with it the long-buried emotions.

Until you see it in front of you, it’s hard to realise that anyone could doubt their own experiences in this way, particularly when they are so powerful. But it really is as I quoted earlier (page 81):

It is common for those who have suffered trauma to disbelieve the extent of their own suffering and so it may be difficult for the analyst to believe it.

This is another aspect that Schaverian only touches on relatively lightly, which my own experience suggests is immensely important. It is not enough to have a sense that the traumatised person does not necessarily believe their own story. The problem is confounded by the fact that in many cases too many other people don’t either. Judith Herman confronts this head on in her excellent groundbreaking 1992 treatment of the problem, Trauma and Recovery (page 8):

Soldiers in every war, even those who have been regarded as heroes, complain bitterly that no one wants to know the real truth about war. When the victim is already devalued (a woman, a child), she may find that the most traumatic events of her life take place outside the realm of socially validated reality. Her experience becomes unspeakable.

The study of psychological trauma must constantly contend with this tendency to discredit the victim or to render her invisible.

I can speak here for the soldier, Ian, whose story was consistently met with incredulity by some of the ward staff who had to look after him during his acute admissions. One even denied at one point that Ian had ever been in the army, even though we had seen the evidence that confirmed he was receiving an army pension.

Returning to Safety

There is another important issue I recognise from my own work with people who had been traumatised. The work they do on their past reactivates the trauma and at the end of each session it crucial to ensure that they have come back safely to their more ordinary consciousness. Schaverian describes the situation (page 69):

Theo was still regressed and after a while I realised that I needed to intervene in a practical way. It was vital with such regression to attempt to bring him back to safety before the end of the session. When trauma is so live in the room the therapist needs to speak. Ten minutes before the end of the session I suggested that he wrap himself up in the blanket from the couch and then sit in the chair to recover.

The most powerful example of this phenomenon from my own work was with a young woman who had experienced years of sexual abuse at the hands of her father. She had a diagnosis of schizophrenia and came at her own request for help coming to terms with her traumatic history.

It took more than a year for her to begin to describe the abuse, so painful was it for her. She could focus on it for no more than ten minutes in each hour at first. After that she became overwhelmed with terrifying hallucinations of her father, hallucinations which impinged upon all her senses – smell, touch, hearing, taste and vision. The only way she learned to determine afterwards that he had not really been there was to observe that she had no marks upon her body.

Generally it would take the rest of the session to help her regain control of her own mind. This we managed to do partly by using her strong visual and sensory imagination for her benefit. We asked her to imagine that her dog was with her on her lap. She loved and trusted her dog and would use it at home to calm herself down. Even imagining that her dog was close to her at the end of a distressing session would gradually calm her down, the hallucinated presence of her father would fade and she would be able to leave safely.

My final comment

So, in short, I find the book powerful and credible, at least in part because of its strong resonance with many of my own experiences. I’m not sure whether that means I am biased or just very well placed to make an authentic judgement. Either way, I wholeheartedly recommend this moving and important book and leave it to you to decide, if you read it, which description applies to this review. Even for those who might not share her Jungian perspective and feel somewhat frustrated by the relative lack of quantitative data, will find it an illuminating read because of the authentic qualitative data it draws on, which make the issues she discusses come alive.

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