According to fact sheets published by the US National Institute of Mental Health (NIMH) psychosis is caused either by a “mental illness” or by the current impacts of drug use, sleep deprivation, or a medical condition. If other factors are ruled out, then a mental illness like schizophrenia or bipolar disorder can be identified as the cause.
But there is something quite important hidden by the language used by the NIMH. When people are told that their disturbance is caused by their “illness” they naturally think of the problem as something inside of themselves, some brain defect or chemical problem. But what if the real cause was something that happened to them, and what if their current problems are an understandable reaction to that? Something, for example, like child abuse?
While the NIMH often declines to mention trauma as a possible cause of psychosis, and even funds programs that explicitly deny that people can play a role in causing psychosis in others, research increasingly shows that trauma, such as various forms of child abuse, can be a major factor in making psychosis more likely. In fact, the connection between experiencing multiple forms of trauma and then psychosis appears comparable to the link between smoking and lung cancer.
And while people are told that the brain differences that are commonly (but not always) found in people diagnosed with schizophrenia is proof that schizophrenia is a “brain disease,” a nasty but lesser known fact is that the brains of those traumatized as children show the same brain differences.
Here’s a video summary of the evidence that trauma can be a cause for psychosis:
It is true that not everyone who experiences psychosis has been a victim of major traumas or abuse. But we might best think of psychosis as something like taking a “fall” from stability. Not everyone who falls was pushed, some fall for other reasons. But telling people they fell because they have a “falling illness,” and distracting attention away from the impact of the push, is not a helpful way to help people understand themselves or figure out how to do better in the future.
That is, when people are told that an “illness” is causing the psychosis, attention is turned away from what might have happened to the person, and from how the person’s current behavior might be an understandable reaction to those events, even if a severely troubled one. This makes it harder for people to understand themselves, which in turn gets in the way of recovery.
It’s also true that when kids are abused, they tend to blame themselves for what happened. When the long-term consequences of the abuse are defined by mental health professionals as being caused by a “mental illness” within the person, the result is that people once again are likely to blame their troubles exclusively on something being wrong inside themselves. This tends to deepen a sense of personal inadequacy and self-blame; there is a kind of piling on to the damage and distortions created by the original abuse.
What would work better? That’s a subject I explore in an online course, “Working with Trauma, Dissociation, and Psychosis, CBT and Other Approaches to Understanding and Recovery.” This course offers 6 CE to most US mental health professionals. You can find out more about it, check out some free preview videos, and register, at this link.
The experiences we call “psychosis” can be incredibly confusing, not just to the experiencer but to those who may be trying to help. And trauma is only one possible cause of psychosis, so many other factors may also need to be addressed. But at the very least, let’s quit telling people that their experiences are caused by some “mental illness” which is really just a label invented by a committee. People who are suffering deserve at least our honest efforts to understand them, and that includes addressing the possible role of trauma in creating their current confusion.