Posts tagged trauma
Posts tagged trauma
Two years after my father killed himself, everything suddenly fell apart. I had failed to grieve and was plagued by nightmares. Now I understand why I was suffering
In 2005, my father killed himself. A high-profile figure, his suicide adorned the front page of newspapers, a private moment retrofitted for public consumption.
He had always been my hero, larger than life, and I adored him. But when I heard the news, I was struck by my detachment, my inability to cry. We had been exceptionally close, so my seemingly indifferent response to his death both perplexed and perturbed me. Was it stoicism? Courage? Neither made sense. If anything, I had always erred on the side of sentimentality and cowardice.
At his funeral, media scrum in tow, I comforted others. I took only a day or two off work, more as a mark of respect than an opportunity to mourn. And all the while, I marveled at my strength in the face of adversity.
I continued with my life as if nothing had happened. I set about keeping the family business going, and making sure my mum and sister were okay. I even aced my university exams a month or so after his death. I felt invincible, and so it was for just over two years.
Then in late 2007, something irrevocable shifted in me. I couldn’t put my finger on it, but something wasn’t quite right. I was consumed by acute hypochondria, and saw several doctors in an effort to identify my ailment. I was sure some neurological disorder was the culprit, and even insisted upon a brain MRI, which revealed nothing untoward.
Not long after, everything fell apart. I had no idea why, but my best guess was that either I was going crazy or dying. I quit work. I withdrew from university. And I retreated to bed, gripped by fear. You know that harrowing heroin withdrawal scene from the movie Trainspotting? That was me, writhing around the bed that had become my prison in paroxysms of anxious agony.
This incarceration lasted the better part of six months. Simple tasks like grocery shopping were only made possible thanks to my good friends Valium and Xanax. Socialising was out of the question without liberal amounts of alcohol.
All the while, the world looked different. It didn’t seem as real as it once had, and my head felt lost in a fog, like I wasn’t part of my surroundings. I felt like I was slipping away, and thought of death often during that time. I welcomed danger, and recall riding my bike and wishing a truck would hit me and put an end to my misery.
Sleep was a brief respite, but even then I managed only a few hours before waking with a start and falling down a hole of unrelenting fear and despair. I soon took to falling asleep wishing I wouldn’t wake. I wasn’t actively suicidal, though a lengthy coma would have suited me just fine.
How had I become this spectre of my former self? This question plagued me, and not knowing compounded my anxiety immeasurably.
One day I happened upon a book some concerned friends had given me in the months following my father’s death. It was about complicated grief and living in the wake of suicide. At the time I scoffed at their concern, and abandoned the book to some inconspicuous corner of my bookshelf.
But as I read it, I at once recognised my pain in those pages. Those living in the shadow of suicide are suffering not only from grief, but they are also reacting to a traumatic event. The pain, the fear, the disorientation – these are some of the hallmarks of PTSD.
It seems ludicrous now as I write this, but back then, I hadn’t even an inkling that my suffering might be related to my father’s suicide. I had been fine, and anyway, that was years ago. But post-traumatic stress symptoms can show up months, years or even decades later.
My feelings about my father’s death were complicated. I was relieved he was no longer suffering. I was angry with him for choosing to leave. I was saddened by his absence. But mostly I felt nothing, like an automaton who still tells the story as though it weren’t his own.
I had failed to grieve, or even fully acknowledge the reality that he was gone. It took me over a year to delete his number from my phone. I kept the leftovers of our last dinner together, only a few nights before his death, in the freezer for over five years. I just couldn’t bring myself to part with little reminders of him.
And the dreams. Some would call them nightmares, of course. Even now, several nights a week, he visits me in my sleep, often replaying various macabre scenes. His wanting to die. His asking my permission to die. His death. His lifeless body. But in some way, these dreams bring me comfort. In my dreams, he is still with me.
Along with therapy and antidepressants, understanding my trauma related symptoms was my path out of the darkness. I still struggle, but not like back then. All too often, PTSD is thought of as the product of war or natural disaster, but that is far too narrow a view. Trauma comes in many forms, and many who have lost someone to suicide need to know that they too have suffered a trauma. This is the first, and most important, step towards healing.
Violence perpetrated on the mentally ill shows that victim-blaming is nothing more than a cover-up for subhuman behaviour
Some years ago, the Mufti of Australia got into hot water when he likened women who failed to wear the hijab to “uncovered meat”, at risk of being devoured by cats. In other words, if a woman who dressed “immodestly” were to be raped then she should share, if not take all, the blame.
Sadly, despite the outcry that followed, this attitude – that of blaming the victim – is still deeply prevalent. It should be obvious, but it apparently needs stating over and over: the criminal is the offender. That is, in a rape, the rapist is at fault. No argument.
Women, for example, do not just “get raped”. Somebody has to actively perform an unwelcome act. There is no place for blaming a victim for wearing the “wrong” clothes: if you do, you justify the action. Not to mention that there is no evidence that wearing so-called provocative clothing has anything to do with whether or not someone is likely to rape someone else. Neither is being intoxicated an invitation to rape (because cultures where alcohol is banned and women must be covered up don’t have a problem with rape, right?).
It is worth repeating here that the major motive for most rapes is not sexual attraction, but power. And rapes tend not to be spur-of-the-moment: most rapes are pre-meditated, and only about 8% of rapes are perpetrated by strangers.
More than this, if you blame the victim – by saying she is like a plate of uncovered meat, say – you also remove agency from the offender. Saying “She was asking for it” is simply an abdication of responsibility: it makes you into a simpleton with no control over your actions. An animal perhaps – a feral animal who should maybe be treated like one. It’s also pretty bloody insulting to most men to imply that they are helpless animals with no self-control, but that’s by the by.
To follow victim-blaming logic, you would argue that if someone (and it doesn’t have to be necessarily a woman) does anything that is slightly outside a cultural norm then it is their own fault if someone rapes or otherwise abuses them. If that logic doesn’t immediately sound perverse to you, perhaps it would help to think of an example. Shall we consider mental illness?
There is still a stigma against mental illness. It’s a broad term covering many conditions, and it is still majorly misunderstood. You just have to look at other recent events to realise this. People suffering from severe mental illness are often stigmatised, feared even, because of the public misperception of (for example) schizophrenics as violent. But you can’t help suffering from mental illness, and you can’t always be cured of it.
Would we blame a woman who suffered from schizophrenia if someone raped her? Would we attribute the rape to her illness, and say she should have taken steps to prevent it?
A study by researchers at University College and Kings College London, published today in Psychological Medicine, reports that of women with severe mental illness surveyed for the study, 40% had been the victims of rape or attempted rape.* This compares with 7% of the general population (the figures for men are no less remarkable, although lower overall: 12% of men with severe mental illness had been seriously sexually assaulted, versus 0.5% in the general population).
“the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”
– Professor Louise Howard, Kings College London
Somebody seriously sexually abuses nearly one in every two women with severe mental illness. Although this is an association rather than a proof of causation, the study makes it clear that the illnesses being treated could not all be caused by the abuse: all participating patients had been treated for at least a year and 10% had experienced sexual assault within the past year at the time of the survey. So it looks that for at least some (and I’d wager most) of the victims, the assault would not have happened if they had not been suffering from mental illness.
Nearly half of the sexual abuse of women was classified as “domestic”, that is carried out by a partner or other family member. So again, this isn’t opportunistic rape, not a case of seeing someone “asking for it” and acting upon that notion; this is abuse by a (probably trusted) family member who is more than likely aware of the victim’s vulnerability, and who deliberately takes advantage of it.
Would you say that it is the victim’s fault for having schizophrenia that somebody abused them? Would you say that the 12% of men in the survey who were sexually abused should have done something to prevent it? Were they “asking for it”?
No? Why then say women should cover up, or not drink, or stay inside, or not take raunchy photographs of themselves with their partner? Is it simply that people with mental illness don’t have a choice, but that women do have control over their dress and their alcohol intake. If that’s what you think, then take a moment to consider what that says about you. (Hint: it’s nothing complimentary).
So why blame a woman when someone rapes or otherwise treats them like an item of property?
Shall we take the victim-blaming argument to its logical conclusion and simply say, if you don’t want to be raped, don’t be a woman?
The civil thing to do is to say no; the perpetrator of the hack; the viewer of the photographs; or the apologist for the rapist: they are the ones who poison society like a cancer, and who deserve to be publicly shamed.
I can remember the early days of having schizophrenia. I was so afraid of the implications of subtle body language, like a lingering millisecond of eye contact, the way my feet hit the ground when I walked or the way I held my hands to my side. It was a struggle to go into a store or, really, anywhere I was bound to see another living member of the human species.
With a simple scratch of the head, someone could be telling me to go forward, or that what I was doing was right or wrong, or that they were acknowledging the symbolic crown on my head that made me a king or a prophet. It’s not hard to imagine that I was having a tough time in the midst of all the anxiety and delusions.
Several months after my diagnosis, I took a job at a small town newspaper as a reporter. I sat in on City Council meetings, covering issues related to the lowering water table and interviewing local business owners for small blurbs in the local section, all the while wondering if I was uncovering some vague connections to an international conspiracy.
The nights were altogether different. Every day, I would come home to my apartment and smoke pot, then lay on my couch watching television or head out to the bar and get so hammered that I couldn’t walk. It’s hard to admit, but the only time I felt relaxed was when I was drunk.
I eventually lost my newspaper job, but that wasn’t the catalyst for change.
It all came to a head one night in July. I had been out drinking all night and, in a haze, I decided it would be a good idea to drive the two miles back to my apartment. This is something I had done several times before, but it had never dawned on me that it was a serious deal. I thought I was doing well, not swerving and being only several blocks from my house, when I saw flashing lights behind me.
What started as a trip to the bar to unwind ended with me calling my parents to bail me out of jail at 3 a.m.
The next year of my life would mean change. I’m not entirely clear on the exact point at which my routine drinking and drug use turned into healthier pursuits. Maybe it was the shock of meeting with a D.U.I. lawyer, or the point after sentencing when I realized I’d be forced to make a daily call, first thing in the morning, to find out if I would have to pee in a cup that day. Maybe it was the fact that I’d need someone else, mainly my mom, to drive me anywhere for the next year. Or perhaps it was the consistent Saturday morning drug and alcohol therapy group or Wednesday and Thursday afternoons of community service that kicked me into a groove.
The groove of it eventually turned into a routine, one that wasn’t marked by indulgence but instead by forced commitment that eventually I would grow to respect.
During that time, I quit smoking pot, I quit drinking and I got some of the best sleep I’d gotten since my diagnosis. Trips to the bar on Monday afternoons turned into extended hours at coffee shops where I finished my first novel.
For some reason, it gave me joy to recite my routine to whoever asked. I would wake up at 7, get coffee and a bagel with plain cream cheese, check Facebook, write until I had 1,000 words, get lunch, do errands in the afternoon, return home, get dinner, take my pills (with food), watch TV and get to bed around 9.
It might all sound tremendously boring. But this regimented series of events was always there; they’d always carry over. And with time, it gave me great comfort to not have to deal with the unexpected. I had a set plan for most days, and there was already too much chaos in my head.
I found that I never forgot to take my medicine. I always had at least eight hours of sleep. And I felt much more relaxed and was able to finally wrap my head around my diagnosis. I began to see the world as a mostly random series of events, rather than an overarching conspiracy plot. The healthy routine was integral.
My story, as with so many stories of recovery, isn’t over. The biggest things in my life are now my friends and family, my work and my daily routine. I take my meds faithfully, and although I no longer attend regular therapy sessions, I find eight years of living with schizophrenia has made me well equipped to deal with future problems. I still get up early, do my work for the day, hang out with my mom or my friends in the afternoon and then ease into the evening. Most important, I still get to bed by 9 every night. I’m more stable, much healthier, and I’m happy.
The routine of things set a stable foundation for recovery by providing me with familiarity. That familiarity was more than welcome when my mind was unrecognizable.
Recent years have seen an influx of numerous studies providing an undeniable link between childhood/ chronic trauma and psychotic states. Although many researchers (i.e., Richard Bentall, Anthony Morrison, John Read) have been publishing and speaking at events around the world discussing the implications of this link, they are still largely ignored by mainstream practitioners, researchers, and even those with lived experience. While this may be partially due to an understandable (but not necessarily defensible) tendency to deny the existence of trauma, in general, there are also certainly many political, ideological, and financial reasons for this as well.
Many have called for the trauma and psychosis fields to join forces. So many valuable findings have come out of the trauma field that could inform practitioners and lay people alike in understanding how one might come to be so overwhelmingly distressed and behave in such seemingly strange ways (see Read, Fosse, Moskowitz, & Perry, 2014, for an informative overview of how trauma affects our bodies). Studies looking at how the non-disordered brain adapts to chronic stress, how cumulative adverse events affect how people perceive and react to the world around them, and how many creative ways people come up with to defend against their own awareness of their distress all can help others to understand the un-understandable. More importantly, the trauma field has shown time and again how trauma-informed care can help a person slowly heal from horrid life experiences.
Yet, the trauma and dissociation field often goes to great lengths in an apparent effort to draw a decisive line in the sand between “real” trauma “disorders” and “schizophrenia.” This largely is done by insinuating that “dissociation” is trauma-based and explains the bizarre behaviors of so many distressed individuals labeled with “borderline” or “dissociative identity disorder”, while some cognitive or brain-diseased factor contributes to “real” psychosis. Somebody with “schizophrenia” may have experienced trauma, but it is largely irrelevant to the present distress. Is this true? Is there any actual evidence for this beyond ideology? It may be helpful to look at the overlap and separation between “dissociation” and “psychosis” to get a better understanding.
Brief History of Trauma Research
Over 100 years ago, Pierre Janet became the first major figure to identify and treat the vast array of the effects of trauma. In fact, he considered almost all “psychopathology” to be the result of childhood trauma and dissociation (Janet, 1919/25). Under the large umbrella term of “hysteria”, Janet identified the following symptoms: hallucinations in all senses, fugue states, amnesia, extreme suggestibility, an odd disposition, nightmares, psychosomatic and conversion symptoms, reenactments, flashbacks, paranoia, subjective experiences of possession, motor agitation, mutism, catatonia, thought disorder (or disorganized speech), and/or double personalities (Janet, 1907/1965). He believed that treatment consisted of a phase-based approach involving stabilization, trauma processing, and recovery. Fatefully, Janet’s use of hypnosis provided the main basis for his eventual expulsion from the psychiatric community. He responded to his exile by pointing out that the medical establishment denied the existence of trauma and its effects, to the point of focusing too much on the physiological and biological domain.
For the next 8 decades or so, the mental health field became more and more narrow in its focus on and recognition of trauma to the point of neglecting it completely in the more biological domains. It was not until the late1970′s, when a massive influx of veterans gained political clout and women began to speak out and be heard, that trauma was once again recognized as a major factor in extreme emotional distress. This also was the time when the DSM became psychiatry’s new bible; and so, while trauma was once again recognized, it was also separated into narrowly defined disorders that included PTSD, adjustment disorders, and dissociative disorders (including multiple personality disorder, as it was then known). It was then that the modern-day lines were drawn.
So what are people talking about when they speak of “dissociation”? Well, not too many people agree on this. It also appears as though the more professionals attempt to come to a consensus on what this term means, the more they do so in an effort to delineate it from any possible association with “psychosis”; their attempts to define dissociation are done by disassociating.
Wikipedia defines dissociation (in the broad sense) as: “an act of disuniting or separating a complex object into parts.” I do not believe that many mental health professionals, particularly dissociation researchers, would entirely disagree with this definition. Rather, it is the interpretation of this meaning that is a hotly debated topic within psychiatry (a general term I use to describe the entirety of the mental health field). In general, it may be used to describe a process, a multitude of symptoms, specific disorders, a division of the personality (or lack of integration), and/or a psychic defense. Many believe that it refers to disconnection from one’s thoughts, feelings, environment, self, others, etc. The term is also used to refer to a process of entering a trance-like state or extreme detachment. Most agree that dissociation lies on a continuum from “everyday dissociation” (i.e., losing track of time while driving, becoming absorbed in a book) to severe dysfunctional dissociation (i.e., “multiple personalities”). Lately, it appears as though trauma researchers and practitioners are interpreting dissociation as solely meaning a separation of identity states or ego functioning that is based in trauma and is clearly understandable (i.e., not psychosis).
If nobody agrees on what it means, then why do we really care? Because the political implications and resulting effects on treatment options are directly related to how one interprets this meaning. We can see by looking at the DSM how this might work…
DSM and all its Fancy Terms
Akin to many religions throughout time, psychiatry makes up many technical terms and then create circular and eccentric definitions to confuse lay people into believing that mental health issues can only be dealt with by an educated professional. Putting this political maneuvering aside, I would like to focus for a moment on key terms related to the topic at hand: trauma, dissociation, dissociative symptoms, psychosis, psychotic symptoms, dissociative disorders, and schizophrenia.
Trauma: Trauma is technically defined as an event that provokes death-related fears in an individual. It is also agreed upon that trauma is defined by the person’s response to such an event, rather than the event itself. But, what of the child whose parents are cold and over-protective? Or the child who is “only” bullied verbally? Or the child who is chronically invalidated? Or poverty? Or the person in existential crisis? Are these not a form of “trauma”? Certainly, they are shown to be chronically stressful which, physiologically, is not any different than “trauma” defined in the DSM-sense. Although it is understood that trauma is subjective, the DSM insists on narrowly defining it anyways.
Dissociation: As stated previously, very few professionals in psychiatry agree on what this term means. Instead of just saying “absorption”, “feeling unreal”, “feeling one’s surroundings are not real”, “lack of integrated sense of self”, or “detachment” (all considered in different circles as varied forms of dissociation), scholars instead argue over its meaning until it has no meaning at all. Often, it is an ideological term that is used to say “trauma” vs. “not trauma”, whether this is explicitly acknowledged or not. Therefore, when one’s “symptoms” are considered non-dissociative, the assumption generally tends to be that they also are not trauma-based.
Dissociative symptoms: Although dissociative symptoms are acknowledged as existing in a multitude of different DSM categories, they mostly are usurped by the dissociative disorder classifications. In this case, as I will discuss in a moment, dissociative symptoms often seem to take on the meaning of “not psychotic” rather than having any distinct meaning in and of themselves.
Psychosis: Psychosis is another technical term with no precise meaning. It tends to refer to a state in which a person appears to not be aware of or in touch with consensual reality. This can be for 5 minutes or 5 years, but the term itself is non-time specific. In practice, it tends to be used when the professional comes to a point where they say “I don’t understand you or agree with your interpretation of reality.”
Psychotic symptoms: Most people tend to think that psychotic symptoms clearly refer to things such as hearing voices, seeing visions, having strange beliefs, or disorganized thinking/speech. However, “psychotic symptoms” specifically refers to symptoms of psychosis. What is psychosis? Having psychotic symptoms. If you don’t have psychosis, then you may have “psychotic-like” symptoms or “quasi-” insert what you like here. What makes these symptoms psychotic-like instead of truly psychotic? Whether or not your therapist understands you.
Dissociative disorders: While there are 5 dissociative disorders, the one that is most intertwined with the idea of psychosis is dissociative identity disorder (DID). People who might meet the criteria for DID often experience what is inarguably the core of the term “dissociation”; namely, having a fragmented sense of self. In addition, they also experience periods where they cannot remember large gaps of time. This amnesia is certainly not an experience that is universal to many or even most individuals suffering extreme states; however, the other experiences common in DID are definitely non-specific to this classification. These include: hallucinations in all senses, incoherence, bizarre beliefs, impaired reality testing, lack of awareness of the present moment, paranoia, and paranormal experiences. However, these are reframed as: hearing voices of an “alter”, body memories, flashbacks, intrusions of trauma and/or “alters”, beliefs attributed to “alters”, not being grounded, and hypervigilence. These words do not necessarily indicate any difference in the lived-experience, but rather a difference in how psychiatry interprets the experience. And who wouldn’t rather say “I have body memories and intrusions” then “I have hallucinations and delusions”?
Schizophrenia: The category of schizophrenia, and all its sister disorders, is one that is assumed to be a largely biological, genetic brain disease. What differentiates it from DID? No one seems to be able to define where this distinction lies, but those in the dissociative disorder field will state that the difference is based on the existence of “delusions” and/or “thought disorder”. A delusion, of course, is a belief that society deems unacceptable. Yet, nobody seems to be able to explain where the line is separating a delusion from an acceptable belief. More specifically, nobody will explain what the difference is between believing “I have a bunch of people living inside of my body who are not me” (DID) and “I am God” (psychotic). But questionnaires that measure dissociation use this very distinction to say whether one has dissociation or not. And then they say “delusions are not related to dissociation” because they just ruled out dissociation by the fact that a person did not endorse an interpretation of their experience that the questionnaire makers deemed dissociative.
“Thought disorder” has been convincingly described by Richard Bentall as a problem in communication, rather than an indication of any true cognitive impairment (Bentall, 2003). Yet, the theory adopted by mainstream psychiatry remains that “thought disorder” is a neurological disease. And so, if one is considered to have DID, any indication of thought disorder is instead interpreted as “intrusions” or “rapid-switching” of altered identity states. Only those with “real” psychosis have a “real” thought disorder.
On the other hand, psychosis researchers solve the problem by simply saying DID just does not exist. People who present with altered identity states and memory problems (not attributed to an actual neurological problem) are considered as just “borderline” or “attention-seeking”. I honestly cannot think of much that is worse than experiencing such emotional turmoil and distress to the point of a break-down and then being told I am making it up for attention. But, then, of course, that is just my perspective.
In spite of these ideological battles, studies still have shown that individuals meeting criteria for schizophrenia endorse a greater level of dissociative symptoms than any other clinical group, discounting PTSD and dissociative disorders (Ross, Heber, Norton, & Anderson, 1989). Approximately two-thirds of individuals diagnosed with DID who are hospitalized also meet structured interview criteria for schizophrenia or schizoaffective disorder (Ross, 2007), 25-50% of anybody diagnosed with DID has received a previous diagnosis of schizophrenia (Ross & Keyes, 2004), and approximately 60% of those diagnosed with schizophrenia meet criteria for a dissociative disorder (Ross & Keyes, 2004). Up to 20% of individuals diagnosed with DID have been found to exhibit communication styles indicative of thought disorder (Putnam, Guroff, Silberman, Barban, & Post, 1986), and levels of dissociation are highly correlated with thought disorder (Allen, Coyne, & Console, 1997). Bizarre explanations for anomalous experiences are not rare in those diagnosed with DID; indeed, one study discovered that 41% of individuals diagnosed with DID have been found to believe they were possessed by demons, and 36% experienced possession by some other outer power or force not attributed to part of the self (Ross, 2011). In addition, the original concept of ‘schizophrenia’ (as it was discussed by Kurt Schneider, Eugen Bleuler, Harry Stack Sullivan, and Harold Searles) appears to emphasize presentations indicative of a dissociative disorder.
On the other hand, it has been found that dissociatively detached individuals are not necessarily chronically psychotic and can function at a high level (Allen et al., 1997). Individuals diagnosed with DID are often able to maintain reality testing despite experiencing “psychotic” phenomena (Howell, 2008). Another difference is that persons diagnosed with DID also report higher levels of dissociation, and more child, angry, persecutory, and commenting voices (Dorahy et al., 2009; Laddis & Dell, 2012). They also generally report a higher rate of more severe childhood trauma than any other clinical group (Putnam et al., 1986).
What Does This all Mean???
It is often purported that “delusions” and “schizophrenia” are not dissociative, when using the narrow definition of dissociation; when dissociation means dis-integration of identity. I would argue that when one is so distressed so as to be labeled as having delusions or schizophrenia, the person has experienced such a high level of dissociation so as to have a completely shattered identity; dis-integration to the point of disintegrated oblivion. But, this is not acknowledged as dissociative, and so then is considered somehow something completely different and separate.
I do not believe it is possible to separate psychosis and dissociation; to me this is like attempting to separate a headache and a fever when I have the flu. Where does the headache begin and the fever end? And should I focus on “treating” my headache, fever, or maybe the virus that infected me and is creating an interconnected process of events in my body? While psychosis and dissociation are not the same thing, I believe that one does not have psychosis without dissociation or dissociation without psychosis. Often the difference simply boils down to: who can frame things the way that the professional wants to hear or agrees with.
Certainly not all those who experience altered identity states experience strange beliefs, voices, or incoherence, but most do. Not all those who experience extreme states also experience altered identity or memory loss, but some do. These experiences are not separate, even if they are different. Although one may appear more reality-based and “dissociative” while another may appear more out of touch with reality and incomprehensible, I believe both stem from the same underlying process of attempting to deal with overwhelming life experiences. And this is where “treatment” should be focused.
Of course, this belief comes with the caveat that some presentations of emotional distress (whether it is psychosis, depression, dissociation, or any other term or category one might like to think of) are dietary, biological, and/or neurologically based. These are not psychological or psychiatric problems, then, and should be dealt with in the medical realm. All individuals suffering from extreme states should evaluate their diet, exercise, and overall physical health; when these are shown to be a non-issue, however, it should be assumed that some difficulty with life has led to whatever the person is suffering through in the present rather than blaming a faulty brain or neurochemicals without any evidence to back up such assertions.
I do not have all the answers. But, I do ask why it is that mental health professionals do not start with just saying what they mean? We can talk about altered identity states, memory loss, feeling unreal, not knowing what is real or not, being terrified of others, etc. Mental health professionals can own the fact that “I do not understand this person” instead of taking this as equivocal evidence of some brain-diseased process of “psychosis.” Each of these experiences do not make a distinct disease. People are complex. People do not fit in nice, neat boxes. People suffer, and when they do this is not necessarily a disease. People adapt to unbearable life circumstances in a number of complex ways that cannot be categorized, no matter how much psychiatry insists that it can. And none of these labels can tell anybody much of anything about a person beyond the stereotypes and confirmation biases they elicit.
At the end of the day, extreme states and anomalous experiences are terrifying; they are terrifying to the people experiencing them and to all those around those people. Doctors are human beings (much as many might like to state otherwise) and they too often act out of that fear. Certainly, nobody wants to get labeled with being psychotic, and there is benevolence in the efforts of those who try to save many from being so doomed. Being recently labeled with “schizophrenia” appears to be enough to increase the likelihood somebody will commit suicide (Fleischhacker et. al, 2014).
Instead of trying to understand people through labeling and insisting on enforcement of an authoritarian dictation of what the experience “really” is, perhaps psychiatry can listen to those who have actually been there. The Hearing Voices Network has given us tools to work with voices and other anomalous experiences; the National Empowerment Center has given us tools on how to work with crises and extreme states; I am working to try to get first-person perspectives on how to work with altered identity states and memory loss; so many individuals (most famously Marsha Linehan) have given us tools on how to work with self-harm and suicidality.
Why does psychiatry then continue to insist on abiding by a broken and invalid system of disease mongering? Why do we not allow the experiencer to make sense of their experience through their own framework? Why must we be so evangelical and insist that they see things our way? There is NOTHING that truly, scientifically can say that one diagnosis is more “accurate” than another. All of these diagnoses are just checklists of behaviors- there is nothing that anybody “has” and until some biological test shows otherwise than nobody can claim that there is. What matters is being with a person in their world where they are at and understanding the MEANING behind the experience, not attempting to define the experience itself in a way that makes sense to us. This is nothing more than social control and perpetuation of the status quo, not science.
Even the most biologically-based medical doctor knows that treatment can only be effective when the underlying disease is recognized and addressed. In my opinion (and it is only that), the underlying “disease” is trauma, overwhelming emotions in reaction to an un-understandable and terrifying world, and/or fear of death/annihilation. If this is the issue, and logically then the issue that needs to be “treated”, then why do we spend so much time splitting hairs over differentiating what behaviors or beliefs belong in what technical categories? In the heart of the Hearing Voices Network, why are we not focusing all of our time on understanding what happened to the person, not what’s wrong with the person?
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Disclaimer: The views presented here are constructed from my biased interpretation of the vast literature associated with the various topics discussed. This is based on my on-going dissertation work as well as personal and clinical experiences that influence my views. In no way is any of this meant as a criticism towards any individual organization or researcher. I have a great appreciation for the work done in both the trauma and psychosis fields, and recognize that we all cling to views that help us make sense of the world. I just hope that one day we might be able to move past some of these partialities and work towards improving options for people who are in extreme distress without further traumatizing them in the process.
This article’s references can be found HERE.
Author of the book Animal Madness, TED Fellow Laurel Braitman shares 5 ways in which animals and humans suffer from similar mental illnesses. Anthropomorphism run amok? You decide.
A golden retriever chases his tail every morning for hours on end. In the evening he compulsively licks his paws till they’re bare and oozy. When he’s given Prozac, he calms down and stops injuring himself … After the death of her mate, a scarlet macaw plucks out every last one of her feathers and doesn’t stop until she’s befriended by a cockatoo … A tabby cat who grew listless and stopped eating after his favorite human went off to college is cheered by the arrival of the family’s new pet rabbit, whom he likes to follow around the house.
Is the dog obsessive-compulsive? The parrot struggling with trichotillomania? The cat, once depressed, now recovered?
Making sense of animal emotional states and behavior, especially when they are doing things that seem abnormal, has always involved a certain amount of projection. The diagnoses that many of these animals receive reflect shifting ideas about human mental health, since people use the concepts, language and diagnostic tools they are comfortable with to puzzle out what may be wrong with the animals around them.
This isn’t to say that the creatures aren’t suffering, but the labels we give to their suffering reflect not only our beliefs about animals’ capacity for emotional expression, but also our own, most popular, ideas about mental illness and recovery. Where, for example, earlier generations saw madness, homesickness and heartbreak in themselves and other animals, veterinarians and physicians now diagnose anxiety, impulse control and obsessive-compulsive disorders in humans, dogs, gorillas, whales and many animals in between.
Looking at instances of purported animal madness is like holding up a mirror to the history of mental illness in people. It’s not always flattering — but it’s always interesting. Here are five classic examples of animal insanity, as diagnosed by arguably the craziest creatures of all, humans:
Well into the 20th century, brokenheartedness was considered a potentially lethal medical problem that affected both humans and other animals alike, from jilted lovers who were thought to have died of shock after being left at the altar to loyal dogs that died immediately after their masters. In 1937, a German shepherd named Teddy stopped eating when his horse companion died; he stayed in the horse’s stall for three days until he died himself. These cases still pop up from time to time. In 2010, two elderly male otters that had been inseparable for 15 years died within an hour of each other at a New Zealand zoo. Only one had been ill; their keepers believed that the second otter died of a broken heart. In March 2011 another heartbreak story pinged around the web. A British soldier, Lance Corporal Tasker, was killed in a firefight in Helmand, Afghanistan. His dog, Theo, a Springer spaniel mix trained to sniff out explosives, watched the whole thing. Theo wasn’t injured in the firefight, but hours after Tasker died, she suffered a fatal seizure, brought on, according to witnesses, by stress and grief over the loss of her companion.
It wasn’t until Louis Pasteur successfully inoculated the first person against rabies in 1885 that people began to understand the disease as a matter of contagion. Before Pasteur, rabies symptoms were often seen as a form of insanity that could be passed between people and other animals. How and why animals could catch madness was a confusing business. Creatures could go mad from a lifetime of abuse, such as Smiles, the Central Park rhinoceros, who reportedly did so in 1903. Maddened horses, as they were known, could simply take off running, still attached to their carriages or dragging their riders behind, often with fatal consequences. Mad monkeys bit small children at the circus, and dogs could sometimes go mad with loneliness. Looking back, it’s likely that more than a few of these animals were not actually rabid. Instead, madness was a catch-all term for lots of different kinds of emotional suffering and other forms of insanity.
Obsessive-compulsive disorders are now relatively common diagnoses in humans and other animals. Many of these behaviors are actually healthy animal activities gone awry. People, mice and dogs, for example, can develop hand- or paw-washing habits that are so extreme as to keep them from playing, eating their meals, going on walks or sleeping. Parrots can develop feather-plucking compulsions that leave them bald as roasting chickens; rodents, cats, humans and other primates can compulsively pluck their hair to the point of baldness, a disorder known as trichotillomania. Other OCD spectrum behaviors, like rituals, can also be seen in nonhumans, as for instance this dog that spins every time he sees a car.
Some animals, like some people, develop extremely specific fears of particular things in their environment, such as escalators, the beeps of an electronic alarm clock, shadows, even toaster ovens. One of the most common phobias, at least in dogs, iscrippling fear of thunderstorms, but cats can develop fears too, like this one whose owners believe is scared of measuring spoons. Horses can develop fears of plastic bags or umbrellas, among many other things. Thankfully, both people and other animals can learn to overcome their phobias, often with a mixture of behavior therapy and training, time, and psychopharmaceutical drugs such as Valium or Xanax.
Traumatic stress disorders have been documented in a variety of animal species — from great ape veterans of pharmaceutical testing and elephants rescued from brutal circus training to canine veterans of armed conflict. How similar is PTSD in different animal species? It’s hard to know, but there are many shared symptoms, from changes in temperament and mood, difficulty sleeping and more sensitive startle responses to possible flashbacks of traumatizing events. In his book Second Nature,the ethologist Jonathan Balcombe shares an account of PTSD at the Fauna Sanctuary in Quebec, Canada, a refuge for chimps who’d been used in research. One afternoon, keepers loaded a shipment of materials onto a metal trolley they pushed past the enclosure of two chimps, Tom and Pablo. As soon as the chimps caught sight of it they let out frightened shrieks and became inconsolable. The staff later realized that the same brand of trolley, or one that looked like it, had been used to transport unconscious chimps to the surgery room at a research facility where Tom and Pablo had lived, and been experimented upon, two years earlier.
Laurel Braitman’s book, Animal Madness: How Anxious Dogs, Compulsive Parrots and Elephants in Recovery Help Us Understand Ourselves, is out now.