Trauma model of mental disorders

Trauma models of mental disorder (alternatively called trauma models of psychopathology) emphasise the effects of psychological trauma, particularly in early development, as the key causal factor in the development of some or many psychiatric disorders (in addition to post-traumatic stress disorder). Trauma models are typically founded on the view that traumatic experiences (including but not limited to actual physical or sexual abuse) are more common or more serious than thought in the histories of those diagnosed with mental disorders. Such models have traditionally been associated with psychoanalytic approaches, notably Sigmund Freud's early ideas on childhood sexual abuse and hysteria. John Bowlby, who developed Attachment theory, also describes many forms of mental illness as based on early childhood trauma. [Cassidy, J., & Shaver, P., (Eds). (1999) "Handbook of Attachment: Theory, Research, and Clinical Applications". Guilford Press, NY] In addition there is significant research supporting the linkage between early experiences of chronic maltreatment and later problems. [Main, M. & Hesse, E. (1990). "Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism?" In Greenberg, M., Cicchetti, D., and Cummings, M. (Eds.), "Attachment In The Preschool Years: Theory, Research, and Intervention". Chicago: University of Chicago Press.]

In the 1960s trauma models also became associated with humanist and anti-psychiatry approaches, particularly in regard to understanding schizophrenia and the role of the family. [cite journal
last = Lilienfeld
first = Scott
title = Will the real pseudoscientists please stand up?
journal = Skeptical Inquirer
volume = November/December
pages = 45
date = 1995] Personality Disorders have also been a focus, particularly Borderline Personality Disorder. Extreme versions of trauma models have implicated the foetal environment and the trauma of being born, or have been associated with recovered memory controversies. More generally, trauma models highlight particularly stressful and traumatic factors in early attachment relations and in the development of mature interpersonal relationships. They are often presented as a counterpoint to a psychiatry claimed to be too focused on genetics, neurochemistry and medication.

History

In the 1940s, 50s, 60s and 70s some mental health professionals proposed trauma models to understand schizophrenia: Harry Stack Sullivan, Frieda Fromm-Reichmann, Theodore Lidz, Gregory Bateson, Silvano Arieti, Ronald Laing and others. They held that schizophrenia is induced by experiences in profoundly disturbed families, or by attempts to cope with a damaging society. In the 1950s Sullivan's theory that schizophrenia is related to interpersonal relationships was widely accepted in the United States. The "Diagnostic and Statistical Manual of Mental Disorders" or "DSM" does not claim that the specific etiology of schizophrenia and other serious psychoses has been established. However, the psychogenic models proposed by these early researchers are no longer in vogue in the psychiatric profession. Since the 1960s pharmacological treatments became the increasing focus of psychiatry, and by the 1980s the theory that the family dynamics could be implicated in schizophrenia became a taboo in many quarters. [ cite book
last = Hahlweg
first = K.
coauthors = et al
title = "Familienbetreuung als verhaltenstherapeutischer Ansatz zur Ruckfallprophylaxe bei schizophrenen Patienten", in M. Krausz, D. Naber (eds.) "Integrative Schizophrenietherapie"
publisher = Freiburg: Karger
date = 2000 ] Before his death in 2001, aged ninety, Lidz, one of the main proponents of the "schizophrenogenic" parents theory, expressed regret that current research in biological psychiatry is "barking up the wrong tree." [ [http://www.yale.edu/opa/v29.n21/story14.html] - article on Theodore Lidz] Like Lidz, Laing maintained until his death that the cause of both schizoid personalities and schizophrenia was influenced by family relationships.

In 1975 Silvano Arieti won the American National Book Award in the field of science for his book, "Interpretation of Schizophrenia", which advances a psychological model for understanding all the regressive types of the disorder. [ [http://www.associazionesilvanoarieti.org/english/sa_curriculum.html associazionesilvanoarieti.org] - page on Arieti (mostly in Italian)] According to more recent research child abuse at home plays a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders. [ cite journal
last = Kendler
first = K.
coauthors = et al
journal = Archives of General Psychiatry
title = Childhood sexual abuse and adult psychiatric and substance use disorders in women
volume = 57
pages = 953–959
date = 2000
doi = 10.1001/archpsyc.57.10.953 ] The more severe the abuse the more probability symptoms will develop in adult life. [ cite journal
last = Mullen
coauthors = et al
journal = British Journal of Psychiatry
title = Childhood sexual abuse and mental health in adult life
volume = 163
pages = 721–32
date = 1993 ] In the psychiatric field it is hypothesized that child abuse is less related to the most serious psychoses, such as schizophrenia. However, some mental health professionals maintain that the relationship is stronger in psychoses than neuroses. [ cite book
last = Davies
first = Emma
coauthors = Jim Burdett
title = "Preventing 'schizophrenia': creating the conditions for saner societies" in Read et al, Models of Madness
publisher = Routledge
date = 2004 ]

A common critical argument

Critics of the model, such as August Piper Jr., argue that the logic of the claim that childhood trauma causes insanity demonstrates a serious flaw. If the claim were true, critics contend, the abuse of millions of children over the years should have caused many cases of insanity; but no evidence exists. [cite journal
last = Piper
first = August
title = Multiple personality disorder: witchcraft survives in the twentieth century
journal = Skeptical Inquirer
volume = May/June
date = 1998] Arieti had addressed this line of argumentation, stating that the only persons before whom young human beings are vulnerable are the ones to whom they are emotionally bonded in childhood. A passage of "Interpretation of Schizophrenia", originally published in 1955, sheds light on the heart of the trauma model:

Cquote|First of all we have to repeat here what we already mentioned [...] , that conditions of obvious external danger, as in the case of wars, disasters, or other adversities that affect the collectivity, do not produce the type of anxiety that hurts the inner self and do not themselves favor schizophrenia. Even extreme poverty, physical illness, or personal tragedies do not necessarily lead to schizophrenia unless they have psychological ramifications that hurt the sense of self. Even homes broken by death, divorce or desertion may be less destructive than homes where both parents are alive, live together, and always undermine the child's conception of himself. [ cite book
last = Arieti
first = Silvano
title = Interpretation of Schizophrenia, p. 197
publisher = Aronson
date = 1994 ]

Psychohistory Table

Psychohistorians endorse trauma models of schizoid, narcissist, masochist, borderline, depressive and neurotic personalities. [ [http://primal-page.com/ps2.htm] - article by Lloyd deMause]

The chart below shows the dates at which gradual forms of child abuse are believed by psychohistorians to have evolved in the most advanced nations, based on accounts from historical records. The timeline doesn't apply to hunter-gatherer societies. It doesn't apply either to the Greek and Roman world, where there was a wide variation in childrearing practices. The major childrearing types described by Lloyd deMause are:
With the exception of the "helping mode of childrearing" (marked in yellow above), for psychohistorians the major childrearing types are related to main psychiatric disorders, as can be seen in the following "Table of Historical Personalities":

Childrearing	Personality	Historical Manifestations
Infanticidal	Schizoid	Child sacrifice and infanticide among tribal societies, Mesoamerica, the Incas; in Assyrian and Canaanite religions. Phoenicians, Carthaginians and other early states also sacrificed infants to their gods. On the other hand, the relatively less abusive Greeks and Romans exposed some of their babies to death.
	Narcissist
Abandoning	Masochist	Longer swaddling in the early Middle Ages, fosterage, outside wetnursing, oblation of children to monasteries & nunneries, and apprenticeship.
Ambivalent	Borderline	Although the later Middle Ages ended the abandonment of children to monasteries, "ambivalent" parents tolerated extreme love and hate for the child without the two feelings affecting each other. Enemas, early beating, shorter swaddling, mourning for deceased children, a precursor to empathy.
Intrusive	Depressive	The intrusive parent began to unswaddle the infant. Since infants were now allowed to crawl rather than being swaddled, they had to be formally "disciplined", threatened with hell; use of guilt. Early toilet training, repression of child's sexuality, end of swaddling and wet-nursing, empathy now possible, rise of pediatrics.
Socializing	Neurotic	Use of "mental discipline"; teaching children to conform to the parents goals, socializing them. Hellfire and physical discipline disappeared. Rise of compulsory schooling. The socializing mode is still the main mode of upbringing in the West.
Helping	Individuated	Absolute end of humiliation to control the child. The helping parent tries to assist the child in reaching its own goals rather than socializing him or her into adult goals. Children's rights movement, deschooling.

According to psychohistory theory, each of the above psychoclasses co-exist in the modern world today.

Recent approaches

In more recent years psychologist Alice Miller, author of twelve books on mental distress and disorders, including non-psychiatric conditions like falling prey to cults, has informed future parents and former victims about the disastrous consequences of child abuse. Former schizophrenic patients, such as John Modrow, have also endorsed the views of the pioneers of the trauma models. [ [http://www.schizosavant.com] - John Modrow’s book]

The "trauma model of mental disorders" is the name given by psychiatrist Colin A. Ross to his specific model, which is presented as a solution to the problem of comorbidity in the mental health field. [ [http://www.rossinst.com/trauma.htm] - Colin Ross’ web site ] An information packet given to inpatients at the Ross Institute for Psychological Trauma describes the theoretical basis of his trauma model in commonsensical terms:

In "Schizophrenia: an Innovative Approach to Diagnosis and Treatment", [ cite book
last = Colin
first = Ross
title = Schizophrenia: An Innovative Approach to Diagnosis and Treatment
publisher = Haworth Press
date = 2004 ] Ross determines that some patients diagnosed with schizophrenia have symptoms related to Dissociative identity disorder. [ [http://www.rossinst.com/schizophrenia_book.pdf] Ross’ book on schizophrenia]

The family conditions during infancy are at present considered virtually irrelevant in the psychiatric profession. [ cite journal
last = Johnstone
first = Lucy
title = Family management in "schizophrenia": its assumptions and contradictions
journal = Journal of Mental Health
volume = 2
pages = 255–69
date = 1993
doi = 10.3109/09638239309003771 ] According to some critics, the goal of modern psychiatric treatment is not to understand how parents could have contributed to the problem or how it can be resolved by improving the relationship. The objective is how to reduce the burden of a psychotic crisis for the family through medication of the disturbed individual. As two trauma researchers have put it, "the ideology of biological reductionism" in psychiatry is "to exonerate the family." [ cite book
last = Aderhold
first = Volkmar
coauthors = Evelyn Gottwalz
title = Family therapy and schizophrenia: replacing ideology with openness” in Read et al, Models of Madness
publisher = Routledge
date = 2004 ]

In 2006 a UK researcher and a New Zealand clinical psychologist presented a meta-analysis of schizophrenia studies to psychiatric conferences which they claimed demonstrated that the prevalence of physical and sexual abuse in the histories of those with schizophrenia is very high and is being under-studied. The researchers admit that not all schizophrenics suffered trauma, but they believe "the level of actual abuse may be an important difference". While conceding that genetics may still be a causative risk factor they maintain "other evidence shows that genes alone do not cause the illness." [ [http://www.scienceagogo.com/news/20060514024158data_trunc_sys.shtml] - New Zealand study]

In the field of criminology, Lonnie Athens developed a theory of how a process of brutalization by parents or peers that usually occurs in childhood results in violent crimes in adulthood. Richard Rhodes' "Why They Kill" describes Athens' observations about domestic and societal violence in the criminals' backgrounds. Both Athens and Rhodes reject the genetic inheritance theories. [cite book
last = Rhodes
first = Richard
title = Why They Kill: The Discoveries of a Maverick Criminologist
publisher = Vintage
date = 2000
isbn = 0375402497] Other criminologists such as Jonathan Pincus and Dorothy Lewis believe that, although it is the interaction of childhood abuse and neurological disturbances that explains murder, virtually all of the 150 murderers they studied over a 25-year period had suffered severe abuse as children. Pincus believes that the only feasible remedy for crime would be the prevention of child abuse. [cite book
last = Pincus
first = Jonathan
title = Base Instincts: What Makes Killers Kill
publisher = W.W. Norton & Company
date = 2002
isbn = 039305022X]

ee also

* Attachment in children
* Biomedical model
* Biopsychiatry controversy
* Complex post-traumatic stress disorder
* Depersonalization Disorder (DSM-IV Dissociative Disorders 300.6)
* Dissociation "(psychology)"
* Dissociative disorders (DSM-IV Dissociative Disorders); Structured Clinical Interview for DSM-IV
* Dissociative Identity Disorder ("formerly" Multiple Personality Disorder) (DSM-IV Dissociative Disorders 300.14)
* Fugue state; Dissociative Fugue ("formerly" Psychogenic Fugue) (DSM-IV Dissociative Disorders 300.13)
* Hearing Voices Movement
* John Bowlby provides the theoretical platform on which the trauma model is built
* Psychogenic amnesia; Dissociative Amnesia ("formerly" Psychogenic Amnesia) (DSM-IV Dissociative Disorders 300.12)
* Psychohistorical views on infanticide
* Refrigerator mother - Psychogenic theory of autism

References

External links

* [http://www.alice-miller.com/ Alice-Miller.com] - According to Miller, the "forbidden issue" is the parental role in mental disorders
* [http://laingsociety.org LaingSociety.org] - The Society for Laingian Studies, R.D. Laing (1927-1989)
* [http://www.moshersoteria.com/ MosherSoteria.com] - Loren Mosher, MD, (1933-2004)
* [http://www.psychohistory.com Psychohistory.com] - The Institute for Psychohistory
* [http://www.rossinst.com/ Rossinst.com] - Home page of the Ross Institute for Psychological Trauma