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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.[1] In addition there is significant research supporting the linkage between early experiences of chronic maltreatment and later problems.[2]

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.[3] 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.[4]

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".[5] 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.[6] According to more recent research, child abuse at home plays a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders.[7]

The more severe the abuse the more probability symptoms will develop in adult life.[8] In the psychiatric field it is hypothesized that child abuse is less related to the most serious psychoses, such as schizophrenia.[verification needed] However, some mental health professionals maintain that the relationship is stronger in psychoses than neuroses.[9]

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.[10]

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.[11]

Psychohistory table

Psychohistorians endorse trauma models of schizoid, narcissistic, masochistic, borderline, depressive and neurotic personalities.[12]

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:

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 less abusive Greeks and Romans exposed some of their babies to death.
Narcissistic
Abandoning Masochistic Longer swaddling in the early Middle Ages, fosterage, outside wetnursing, oblation of children to monasteries and 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.[13]

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.[14] 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,[15] Ross determines that some patients diagnosed with schizophrenia have symptoms related to dissociative identity disorder.[16]

The family conditions during infancy are at present considered virtually irrelevant in the psychiatric profession.[17] 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."[18]

In 2006 a UK researcher and a New Zealand clinical psychologist presented a meta-analysis of schizophrenia studies[19] 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[20][21]

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.[22]

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.[23]

See also

References

  1. Cassidy, J., & Shaver, P., (Eds). (1999) Handbook of Attachment: Theory, Research, and Clinical Applications. Guilford Press, NY
  2. 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.
  3. Lilienfeld, Scott (1995). "Will the real pseudoscientists please stand up?". Skeptical Inquirer November/December: 45.
  4. Hahlweg, K; et al. (2000). "Familienbetreuung als verhaltenstherapeutischer Ansatz zur Ruckfallprophylaxe bei schizophrenen Patienten", in M. Krausz, D. Naber (eds.) Integrative Schizophrenietherapie. Freiburg: Karger.
  5. [1] - article on Theodore Lidz
  6. associazionesilvanoarieti.org - page on Arieti (mostly in Italian)
  7. Kendler, K; et al. (2000). "Childhood sexual abuse and adult psychiatric and substance use disorders in women". Archives of General Psychiatry 57 (10): 953–959. doi:10.1001/archpsyc.57.10.953. PMID 11015813.
  8. Mullen, P. E.; et al. (1993). "Childhood sexual abuse and mental health in adult life". British Journal of Psychiatry 163: 721–32. doi:10.1192/bjp.163.6.721.
  9. Davies, Emma; Jim Burdett (2004). "Preventing 'schizophrenia': creating the conditions for saner societies" in Read et al., Models of Madness. Routledge.
  10. Piper, August (1998). "Multiple personality disorder: witchcraft survives in the twentieth century". Skeptical Inquirer May/June.
  11. Arieti, Silvano (1994). Interpretation of Schizophrenia. Aronson. p. 197.
  12. [2] - article by Lloyd deMause
  13. [3] - John Modrow’s book
  14. [4] - Colin Ross' web site
  15. Colin, Ross (2004). Schizophrenia: An Innovative Approach to Diagnosis and Treatment. Haworth Press.
  16. [5] Ross’ book on schizophrenia
  17. Johnstone, Lucy (1993). "Family management in "schizophrenia": its assumptions and contradictions". Journal of Mental Health 2: 255–69. doi:10.3109/09638239309003771.
  18. Aderhold, Volkmar; Evelyn Gottwalz (2004). Family therapy and schizophrenia: replacing ideology with openness” in Read et al., Models of Madness. Routledge.
  19. Read J, van Os J, Morrison AP, Ross CA (November 2005). "Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications". Acta Psychiatr Scand 112 (5): 330–50. doi:10.1111/j.1600-0447.2005.00634.x. PMID 16223421.
  20. "Media report of sexual abuse as cause of schizophrenia". http://www.scienceagogo.com/news/20060514024158data_trunc_sys.shtml. Retrieved 2009-04-15.
  21. "Maudsley debate on sexual abuse as a cause of schizophrenia". http://www.iop.kcl.ac.uk/podcast/?id=208&type=item. Retrieved 2009-04-15.
  22. Rhodes, Richard (2000). Why They Kill: The Discoveries of a Maverick Criminologist. Vintage. ISBN 0375402497.
  23. Pincus, Jonathan (2002). Base Instincts: What Makes Killers Kill. W.W. Norton & Company. ISBN 039305022X.

External links

es:El modelo del trauma de los trastornos mentales

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