Trauma model of mental disorders

Trauma models of mental disorders (alternatively called trauma models of psychopathology) emphasize 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. In addition there is significant research supporting the linkage between early experiences of chronic maltreatment and later problems.

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. Personality disorders have also been a focus, particularly borderline personality disorder. Extreme versions of trauma models have implicated the fetal 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, R.D. 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.

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". 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. According to more recent research, child abuse at home plays a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders.

The more severe the abuse the more probability symptoms will develop in adult life. 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.

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.

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: 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.

Psychohistory table
Psychohistorians endorse trauma models of schizoid, narcissistic, masochistic, borderline, depressive and neurotic personalities.

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, or the ancient Chinese 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:

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.

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. An information packet given to inpatients at the Ross Institute for Psychological Trauma describes the theoretical basis of his trauma model in commonsensical terms: The problem faced by many patients is that they did not grow up in a reasonably healthy, normal family. They grew up in an inconsistent, abusive and traumatic family. The very people to whom the child had to attach for survival, were also abuse perpetrators and hurt him or her badly [...] The basic conflict, the deepest pain, and the deepest source of symptoms, is the fact that mom and dad's behavior hurts, did not fit together, and did not make sense.

In Schizophrenia: an Innovative Approach to Diagnosis and Treatment, Ross determines that some patients diagnosed with schizophrenia have symptoms related to dissociative identity disorder.

The family conditions during infancy are at present considered virtually irrelevant in the psychiatric profession. 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."

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." The review caused considerable debate

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.

Other criminologists such as Jonathan Pincus and Dorothy Otnow 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.