Trauma, Psychosis and Transcendence (4/5): Karen’s Story

So, as I asked at the end of the previous post, what chance do Christina and Stefan Grof stand in their efforts to prove the mystical component of psychosis?

I need to repeat the caveats I voiced at the start of this sequence about their book, The Stormy Search for the Self: understanding and living with spiritual emergency, so that I do not come across as easily taken in. It is not easy to tread the razor’s edge between the default positions of intransigent incredulity and irremediable gullibility, but here goes.

Their book has echoes for me of Hillman’s The Soul’s Code in that it combines deep insights with what read like wild flights of fancy and carefully substantiated accounts of concrete experience with vague waves at unspecified bodies of invisible evidence. Even so, so much of it is clearly derived from careful observation and direct experience, and goes a long way towards defining what look convincingly like spiritual manifestations which are currently dismissed as mere madness. It seemed important to flag the book up at this point.

I am going to focus on what I feel are their strongest points: concrete experiences that illustrate their perspective and their brave and, in my opinion, largely successful attempts to make a clear distinction between mystic and merely disturbed experiences, not that the latter are to be dismissed as meaningless. It’s just that their meaning is to be found in life events not in the transcendent.

First I’ll deal with their account of one person’s spiritual crisis. In the last post I’ll be looking at their scheme of diagnostic distinction.

Georgiana Houghton‘s ‘Glory Be to God’ (image scanned from ‘Spirit Drawings’ – the Courtauld Gallery)

A Concrete Example

What follows is a highly condensed summary of one person’s story. A key point to hold in mind is one the Grofs made earlier in the book (page 71):

Often, individuals benefit from their encounter with the divine but have problems with the environment. In some instances, people talk to those close to them about a powerful mystical state. If their family, friends, or therapists do not understand the healing potential of these dimensions, they may not treat them as valid or may automatically become concerned about the sanity of the loved one or client. If the person who has had the experience is at all hesitant about its validity or concerned about his or her state of mind, the concern of others may exaggerate these doubts, compromising, clouding, or obscuring the richness of the original feelings and sensations.

Karen’s Story

They begin by providing some background (pages 191-92):

[S]he had a difficult childhood; her mother committed suicide when she was three, and she grew up with an alcoholic father and his second wife. Leaving home in her late teens, she lived through periods of depression and struggled periodically with compulsive eating.

Assuming that her subsequent experiences were what they seem to be, and I do, then it is clear that just because there is trauma in someone’s background does mean that the unusual experiences they report are entirely reducible to some form of post-traumatic stress response any more than they can be explained satisfactorily simply in terms of brain malfunction. Whatever is going on in the brain is just a correlate but not a cause, and previous trauma may have rendered any filter susceptible to leaks from a transcendent reality. I am restraining myself from leaping too soon to that last and much desired conclusion.

Interestingly, it’s possible that there was an organic trigger to her spiritual crisis (page 192):

. . . [F]ive days before her episode, Karen had begun taking medication for an intestinal parasite, stopping as the daily experience started. . . . . It is difficult to accurately assess its role in the onset of this event. . . . Whatever the source, her crisis contained all the elements of a true spiritual emergency. It lasted three-and-a-half weeks and completely interrupted her ordinary functioning, necessitating twenty-four-hour attention.

Her friends asked the Grofs to become involved in her care so they were able to observe the whole situation as it unfolded.

That Karen was able to avoid being admitted to psychiatric hospital was down to the support of a wide circle of friends. That this meant that she did not have to take any medication is important, according to the Grofs and other sources. Anti-pychotic medication has the effect of blocking the very processes that a successful integration of the challenging experiences requires. They describe the lay nature of her support (pages 192-93):

[B]ecause of Karen’s obvious need and the reluctance of those around her to involve her in traditional psychiatric approaches, her care was largely improvised. Most of the people who became involved were not primarily dedicated to working with spiritual emergencies.

What were her experiences like during this period of what they call ‘spiritual emergency’?

Their description covers several pages (page 194-196). This is a very brief selection of some of the main aspects. To Karen her vision seemed clearer. She also ‘heard women’s voices telling her that she was entering a benign and important experience. . . .’ Observers noted that ‘heat radiated throughout Karen’s body and it was noted that ‘she saw visions of fire and fields of red, at times feeling herself consumed by flames. . . .’

What is also particularly interesting is her re-experience of previous life crises: ‘[S]he struggled through the physical and emotional pain of her own biological birth and repeatedly relived the delivery of her daughter,’ as well as confronting ‘death many times and in many forms, and her preoccupation with dying caused her sitters to become concerned about the possibility of a suicide attempt.’ She was too well protected for that to be a serious risk.

In the last post I will be linking a therapeutic technique the Grofs advocate, Holotropic Breathwork, with some of my own experiences. This makes their description of how this technique can uncover repressed memories of traumatic experiences all the more credible to me. More of that later. That Karen should have been triggered into such regressions is not therefore surprising to me.

By way of supporting her through this, ‘telling her that it was possible to experience death symbolically without actually dying physically, her sitters asked her to keep her eyes closed and encouraged her to fully experience the sequences of dying inwardly and to express the difficult emotions involved.’ It is significant for their model that encouragement and support in facing what we might otherwise be tempted to flee from helps. ‘She complied, and in a short time she moved past the intense confrontation with death to other experiences. . . .’

Given my interest in the relationship between apparently disturbed mental states and creativity, it was noteworthy that ‘[f]or several days, Karen tapped directly into a powerful stream of creativity, expressing many of her experiences in the form of songs. It was amazing to witness: after an inner theme would surface into awareness, she would either make up a song about it or recall one from memory, lustily singing herself through that phase of her process.’

They describe her during this period as ‘extremely psychic, highly sensitive, and acutely attuned to the world around her.’ For example she was ‘able to “see through” everyone around her, often anticipating their comments and actions.’

Georgiana Houghton‘s ‘The Glory of the Lord’ (image scanned from ‘Spirit Drawings’ – the Courtauld Gallery)

 

Things began to take a more positive turn (page 196):

After about two weeks, some of the difficult, painful states started to subside and Karen receive increasingly benevolent, light-filled experiences and felt more and more connected with a divine source.

Perhaps I need to clarify that I am not attempting to adduce this as evidence of the reality of the spiritual world. People like David Fontana and Leslie Kean have collated such evidence far better than I ever could, and sorted out the wheat from the chaff with honesty and discernment.

What I am hoping to do is use this as a demonstration that sometimes at least what could be written off as meaningless and irrational brain noise might not only be significantly related to early experiences in life, as the trauma work suggests, but also to a spiritual dimension whose reality our culture usually denies with the result that the experiences are pathologised. The outcome in this case strongly suggests that pathologising them needlessly prolongs them and blocks life-enhancing changes that would otherwise have resulted.

They go onto describe the end of the episode and its aftermath (ibid.):

. . . . As Karen began to come through her experience, she became less and less absorbed by her in the world and more interested in her daughter and the other people around her. She began to eat and sleep more regularly and was increasingly able to care for some of her daily needs. . . .

Rather as was the case with Fontana and his poltergeist investigation, as the vividness of the experiences receded, doubts beganset in (ibid.:)

As she became increasingly in touch with ordinary reality, Karen’s mind started to analyse her experiences, and she began to feel for the first time that she had been involved in a negative process. The only logical way of explaining these events to herself was that something had gone wrong, that perhaps she had truly lost her mind. Self-doubt is a common stage in spiritual emergencies, appearing when people begin to surface from the dramatic manifestations . . .

She was not blind to the positives in the end (page 197):

Two years later, when we discussed her experience with her, Karen said that she has mixed feelings about the episode. She is able to appreciate many aspects of what happened to her. She says that she has learnt a great deal of value about herself and her capacities, feeling that through her crisis she gained wisdom that she can tap any time. Karen has visited realms within herself that she previously had no idea were there, has felt enormous creativity flow through her, and has survived the previously frightening experiences of birth, death, and madness. Her depressions have disappeared, as well as her tendency toward compulsive overeating.

But her doubts persisted, and may have been to some extent fuelled by her family and friends’ reactions and the lack of informed support (page 198):

On the other hand, Karen also has some criticisms. Even though she could not have resisted the powerful states during her episode, she feels that she was unprepared for the hard, painful work involved. In spite of the fact that she received a great deal of assistance during the three weeks, she feels that she was not yet ready to venture forth into the daily world when she was required to do so by the exhaustion of the resources of those around her. Since that time, she has lacked contact with people with whom to further process her experiences. She considers herself somewhat “different” for having had the episode (an opinion also indirectly expressed by her family and some of her friends) and has tended to downgrade it by concentrating on its negative effects.

The support had to be reduced after the three-week peak period because the support network was burning out. The Grofs felt (ibid.:)

Many of these problems could have been avoided if Karen had had consistent and knowledgeable support immediately following her crisis, perhaps in a halfway house, and follow-up help – in the form of ongoing therapy, support groups, and spiritual practice – for a more extended period of time.

It is dangerous to extrapolate too wildly but I feel that in Karen’s story there are real grounds for hope. She recovered from an apparently devastating episode of mental disturbance without drugs. She demonstrated modest but lasting mental health gains in terms of no subsequent depression or compulsive eating. There is every reason to suppose given this experience and the evidence of Dr Sami Timimi’s study, adduced by James Davies in Cracked and described in the previous post, that an outcome like this could apply far more widely across the so-called psychotic spectrum. Yes, the intervention was time intensive, but it was brief and successful. This compares with long-term interventions involving medication resulting in symptoms that continue to simmer for years or even decades, blighting the whole life of the sufferer and the lives of close family.

The Grofs then explore models of help and aftercare, which I won’t go into now as the main focus I want to take is on their ideas of how to distinguish a spiritual emergency such as Karen’s from other forms of disturbance. This is clearly an important distinction to be able to make as the approaches taken when dealing with trauma-related disturbances and spiritual crises will be somewhat different, though Karen’s case implies there might well be an overlap.

However, all the evidence that has accumulated since they wrote suggests that all such so-called psychotic episodes are better dealt with in a non-diagnostic way, which is an issue that the Grofs do not fully address, probably because at the time of their writing placing spiritual emergency on the agenda seemed a more urgent issue, given that it was and still is doubly disparaged.

Now for the difficult distinction in the next post, along with a brief description of their recommended intervention.

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Trauma, Psychosis and Transcendence (3/5): The Everest of Instinctive Incredulity

In the last post I ended up exploring James Davies’ perspective in his recent book Cracked. I was focusing upon his emphasis on relationships rather then medication as the more effective way to help those with psychotic experiences.

Pseudo-Science

It’s where he goes next that I found most unexpected but most welcome to my heart. He leads into it with an interview with Thomas Sasz just before his death at the age of 92 (page 276). He asks Szasz, ‘why do we believe as a culture that suffering must be removed chemically rather than understood in many cases as a natural human phenomenon, and possibly something from which we can learn and grow if worked through productively?’

Szasz’s response is fascinating:

Our age has replaced a religious point of view with a pseudo-scientific point of view. . .   Now everything is explained in terms of molecules and atoms and brain scans. It is a reduction of the human being to a biological machine. We don’t have existential or religious or mental suffering any more. Instead we have brain disorders.

This resonates strongly with the Bahá’í position as expressed, for instance, in Century of Light (page 136):

What [Bahá’ís]  find themselves struggling against daily is the pressure of a dogmatic materialism, claiming to be the voice of “science“, that seeks systematically to exclude from intellectual life all impulses arising from the spiritual level of human consciousness.

Davies summarises Szasz’s position on psychiatry (page 277): ‘It had become deluded in its belief that its physical technologies, its ECT machines and laboratory-manufactured molecules, could solve the deeper dilemmas of the soul, society and self.’

He quotes Bracken’s view on how this brings in capitalism (page 278):

What complicates things more is that we also live in a capitalist society, where there is always going to be someone trying to sell you something… In fact, some people would argue that capitalism can only continue by constantly making us dissatisfied with our lives.… You know, if everybody said I am very happy with my television, my car and everything else I’ve got, and I’m perfectly content with my lifestyle, the whole economy would come shattering down around our ears.

He continues (page 279):

What we customarily call mental illness is not always illness in the medical sense. It’s often a natural outcome of struggling to make our way in a world where the traditional guides, props and understandings are rapidly disappearing… Not all mental strife is therefore due to an internal malfunction but often to the outcome of living in a malfunctioning world. The solution is not yet more medicalisation, but an overhaul of our cultural beliefs, a reinfusing of life with spiritual, religious or humanistic meaning with emphasis on the essential involvement of community, and with whatever helps bring us greater direction, understanding, courage and purpose.

Instinctive Incredulity

However, we are even further away from generally accepting that some experiences labelled psychotic may have spiritual dimensions.

Christina and Stefan Grof’s indictment of our civilisation in their book The Stormy Search for the Self: understanding and living with spiritual emergency sings from essentially the same hymn sheet as Davies (page 235):

Though the problems in the world have many different forms, they are nothing but symptoms of one underlying condition: the emotional, moral, and spiritual state of modern humanity. In the last analysis, they are the collective result of the present level of consciousness of individual human beings. The only effective and lasting solution to these problems would, therefore, be a radical inner transformation of humanity on a large scale and its consequent rise to a higher level of awareness and maturity.

David Fontana also writes from direct experience of this painful level of materialism and its default stance of resolute incredulity when faced with any evidence, no matter how compelling, in favour of a spiritual dimension to reality. He had to combat it at almost every turn of his investigations. He even bravely admits to being contaminated by it himself. In the in-depth survey of his book Is there an afterlife? he writes (page 335):

My difficulty in writing about Scole [a long and detailed exploration of psychic phenomena including material effects] is not because the experiences we had with a group have faded. They are as clear as if they happened only weeks ago. The difficulty is to make them sound believable. It is a strange fact of life that whereas most psychical researchers interested in fieldwork are able to accept – or at least greet with open minds – the events of many years ago connected with the mediumship of physical mediums such as Home, Palladino, and Florence Cook, a strain of scepticism fostered by scientific training makes it much harder for them to accept that similar events may happen today, and may even be witnessed by those of us fortunate enough to be there when they occur. I mentioned in my discussion of the Cardiff poltergeist case… the struggle I had with my own belief system after seeing the phenomena concerned. When in the room while they were taking place I had no doubt they were genuine, but as soon as I began to drive home I started to doubt. . . . . The whole thing seemed simply unbelievable.

He adds:

It took a lengthy investigation, including one occasion when I witnessed phenomena while I was on my own in one of the rooms where the disturbances took place and the owners were two hundred miles away on holiday, before I could fully accept that poltergeist phenomena can indeed be genuine, and provide evidence not only of paranormality but, at least in some cases, of survival.

The Grofs articulate the challenge exactly (page 236)

The task of creating an entirely different set of values and tendencies for humanity might appear to be too unrealistic and utopian to offer any hope. What would it take to transform contemporary mankind into a species of individuals capable of peaceful coexistence with their fellow men and women regardless of colour, language, or political conviction – much less with other species?

They list our current characteristics in detail including violence, greed, habitual dissatisfaction and a severe lack of awareness that we are connected with nature. They conclude, ‘In the last analysis, all these characteristics seem to be symptomatic of severe alienation from inner life and loss of spiritual values.’

To describe it as an uphill struggle would be an understatement. Climbing Everest alone and unequipped seems closer to the mark.

They see at least one window through which the light of hope shines (page 237)

[M]any researchers in the field of transpersonal psychology believe that the growing interest in spirituality and the increasing incidence of spontaneous mystical experiences represent an evolutionary trend toward an entirely new level of human consciousness.

As we will see in the final two posts, our medicalisation of schizophrenia and psychosis might well be slowing this process down. If so there is all the more reason to give the Grofs’ case a fair and careful hearing. This will not be easy for the reasons that Fontana has explained.

Incidentally, after acknowledging that absolutely convincing proof of the paranormal seems permanently elusive, after all his years of meticulous investigation Fontana reaches a conclusion very close to that put forward by John Hick (op. cit.: page 327):

Professor William James may have been right when he lamented that it rather looks as if the Almighty has decreed that this area should forever retain its mystery. If this is indeed the case, then I assume it is because the Almighty has decreed that the personal search for meaning and purpose in life and in death are of more value than having meaning and purpose handed down as certainties from others.

In his book The Fifth Dimension, John Hick contends that experiencing the spiritual world in this material one would compel belief whereas God wants us to be free to choose whether to believe or not (pages 37-38):

In terms of the monotheistic traditions first, why should not the personal divine presence be unmistakably evident to us? The answer is that in order for us to exist as autonomous finite persons in God’s presence, God must not be compulsorily evident to us. To make space for human freedom, God must be deus absconditus, the hidden God – hidden and yet so readily found by those who are willing to exist in the divine presence, . . . . . This is why religious awareness does not share the compulsory character of sense awareness. Our physical environment must force itself upon our attention if we are to survive within it. But our supra-natural environment, the fifth dimension of the universe, must not be forced upon our attention if we are to exist within it as free spiritual beings. . . . To be a person is, amongst many other things, to be a (relatively) free agent in relation to those aspects of reality that place us under a moral or spiritual claim.

So what chance do Christina and Stefan Grof stand in their efforts to prove the mystical component of psychosis?

More of that next time.

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Trauma, Psychosis and Transcendence (1/5): Swimming against the tide

Readers of this blog will remember that I was struggling recently to find more detailed discussion of the possibility that some severe mental disturbances have spiritual aspects. Isabel Clarke’s Spirituality & Psychosis left me frustrated by its lack of such detail.

Recently I came across a second hand copy of Christina and Stanislav Grof’s The Stormy Search for the Self: understanding and living with spiritual emergency. It was published in 1991 at a less than universally receptive time so it is hard to determine from the book itself how far things might have moved on since. This is something I will have to investigate further.

It has echoes for me of Hillman’s The Soul’s Code in that it combines deep insights with what read like wild flights of fancy and carefully substantiated accounts of concrete experience with vague waves at unspecified bodies of invisible evidence. Even so, much of it is clearly derived from careful observation and direct experience, and goes a long way towards defining what look convincingly like spiritual manifestations within mental disturbances which are currently dismissed as mere madness. So, it seemed important to flag the book up at this point.

Before I go into more detail I think I need to place its thesis in perspective. We need to understand how much of an uphill battle it is going to be to get the spiritual dimensions of the experiences currently labelled psychosis accepted in mainstream psychiatry and psychology. To do so we need to look back at the history of the way the effects of trauma have been treated.

Attitudes to Trauma in the Past

It has taken a century or more for the work on trauma and its basic consequences to be properly understood.

This struggle involved swimming against the strong tide of dismissive opinion.

There are many places to look for evidence of the slow progress towards an acceptance and understanding of the role of trauma in mental disturbance. There are few better than Judith Herman’s book Trauma & Recovery. I have covered her account in more detail elsewhere on this blog so I’ll just summarise it here.

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 psychoanalysis in spite of the intervening decades.

There was a massive backlash which caused a backtrack. Experiences were dismissed as fantasies or interpreted as subliminally desired. As Herman puts it (page 14): ‘The dominant psychological theory (psychoanalysis) of the next century was founded in the denial of women’s reality.’

Herman recognises how impossible it would have been for Freud to fight successfully 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.

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 – it seemed the best was to get a traumatised soul quickly back to the trenches that had traumatised him in the first place.

The Second World War resurrected the issue with some progress. Even so (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.

Later in the book they explore in detail how accepting relationships are usually critical to the fully effective treatment of trauma. I may come back to that in more detail in later posts but for now it is important to signpost that point for future reference when we come to look at trauma and psychosis in the next post. Herman writes:

. . . . group treatment complements the intensive, individual exploration of the trauma story, but does not necessarily replace it. The social, relational dimensions of the traumatic syndrome are more fully addressed in a group than in an individual setting, while the physioneurosis of the former requires a highly specific, individualised focus on desensitising the traumatic memory.

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Recommended link: Anne Brontë – the sister who got there first

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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Transliminality and Psychosis (5/6): a very delicate balance (a)

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

From 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.

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.

A 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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Trauma and Psychosis (3/3): Trauma in Relation to Psychosis (b)

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 (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)

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.

Layard 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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Trauma & Psychosis (2/3): Trauma in Relation to Psychosis (a)

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.’

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

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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