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Psychology essays | Trauma of Psychosis

• Understanding the Nature of Experience - Part:1
• Understanding the Nature of Experience - Part:2
• Understanding the Nature of Experience - Part:3

Trauma of Psychosis: Understanding the Nature of Experience

The aim of this dissertation is to enable the reader to understand the trauma of psychosis. This cannot be done without understanding the nature of the psychoses to be discussed. Therefore, this dissertation opens by defining the terms trauma and psychosis to ensure that the reader understands exactly what is meant when these terms are being used. The dissertation continues by providing examples of what may be classified as a ‘traumatic’ experience and then discuses, in general, the implications of such experiences on an individual’s life. For example, witnessing a traumatic event has been found to lead to psychotic episodes. Such episodes following exposure to a traumatic event have been classed as symptomatic in the onset of Post Traumatic Stress Disorder. Therefore, the dissertation will explain for the reader what types of trauma may lead to Post Traumatic Stress Disorder while also portraying Post Traumatic Stress Disorder is in terms of its history and the symptoms often experienced by the sufferers. Furthermore, the ‘trauma’[1] of experiencing Post Traumatic Stress Disorder will discussed in terms of the effect that such a disorder has on, for example, an individuals relationships and work-life. The dissertation will also review the common coping mechanisms adopted by the sufferers while suggesting the coping mechanisms adopted by the individuals can either relieve or exacerbate the symptoms of PTSD by indirectly influencing the extent of the ‘trauma’ of experiencing such an event for the individual. This section of the dissertation concludes by introducing some of the treatments available for the individual with PTSD.
Psychosis is not only found amoung individuals with PTSD. Psychosis is also the defining symptom of Schizophrenia. For this reason, the dissertation will also investigate the trauma of experiencing the psychosis of Schizophrenia. Once again, it is important to understand schizophrenia before the full impact of such a disorder on an individuals life can be appreciated or understood. Therefore, a description of the symptoms of Schizophrenia will be provided for the reader followed by an overview of the historical development of this disorder. The dissertation will ensue by presenting the possible impact the disorder may have on the individual’s life course followed by a section highlighting the common coping styles adopted by individuals on receipt of such a diagnosis. The efficacy of the current interventions used and the prognosis of the sufferer will also be addressed. The dissertation concludes its discussion pertaining to schizophrenia by offering some interesting reflections on the ‘trauma’ experienced by individuals during the onset and diagnosis of their symptoms and the implications that this experience may have, or has had on their life thereafter.
The dissertation will now begin by offering operational definitions of the terms to be used in this dissertation.
Trauma is originally a Greek term and is used to depict “psychological injury caused by some severe emotional assault” (Reber, 1999:764). A traumatic event is defined by Michenbaum as an event “so extreme or severe, so powerful, harmful and/or threatening that they demand extraordinary coping efforts” (Michenbaum, 1997:17). Traumatic events take various forms. One such form is as a single

event such as a natural disaster like a flood; or an accidental disaster like a car, boat, or airplane crash. More alarmingly they can also be deliberately caused or ‘of Intentional Human Design’ (IHD) like a bombing, shooting, rape or terrorist attack (Michenbaum, 1997:19). Traumatic events can also extend over long periods of time. Such events include being held hostage, having a chronic illness or being sexually harassed for example (Michenbaum 1997:18).
Research suggests that the implications of experiencing a traumatic event can instigate the onset of a disorder called Post Traumatic Stress Disorder (PTSD). PTSD is form of psychosis and before examining the nature of PTSD a definition of Psychosis must first be introduced. Psychosis is a “fundamental mental derangement (as in Schizophrenia) characterized by a defective or a loss of contact with reality”…“radical changes in personality, impaired functioning, and a distorted or non-existent sense of objective reality…” (Martin, 2003 and Merriam-Webster, 2003). Therefore, in the case of PTSD, if psychotic symptoms begin within four weeks of exposure to the traumatic event and last from 2-28 days, the individual is diagnosed with acute stress disorder. Problems only arise once the symptoms last longer than 28 days. In this situation the diagnosis of PTSD is more appropriate according to the DSM-IV guidelines (Comer, 1993).
PTSD, according the Diagnostic and Statistical Manual (DSM-IV), includes symptoms such as recurrent and intrusive distressing recollections of the event, this can include intrusive images, thoughts or perceptions. The individual may also be plagued by recurrent distressing dreams relating to the event and may also act or feel as if they are re-living the trauma. This experience in particular includes, illusions, hallucinations, and dissociative flashbacks episodes, which is almost parallel to the ‘loss of reality’ symptom included in the definition of ‘psychosis’, mentioned above. The individual may also experience symptoms such as; feelings of detachment or estrangement from others, a restricted range of affect, irritability and outbursts of anger while also finding it very difficulty to concentrate on any one thing for any length of time. More importantly, before any diagnosis can be made, the symptoms of PTSD must cause clinically significant distress or impairment in the individuals social, occupational, or other important areas of functioning (Perris & McGorry, 1998).
Before the dissertation introduces the hindrances of such a disorder, a brief overview of how PTSD came to the fore as we know it today will be presented. The symptoms of PTSD have been recorded as early as 1666 by Samuel Peppys. Peppy’s recorded PTSD symptomology in his depiction of people’s reactions to the great fire of London (Michenbaum, 1997:41). Such symptoms were later brought to public attention following the war. Post traumatic Stress Disorder (PTSD) was known first of all as ‘shell shock’ during the First World War (WW1). At this time, symptoms such as; shaking limbs, manic behaviour, paralysis, depression and sleep disturbances, were thought to have been caused by exposure to the explosions on the battlefield (Parkinson, 1997:18). During WW2, this group of symptoms became labeled as ‘battle stress’ and was recognized as a condition to be treated. The treatment then was to offer ‘breaks away from the strains and stresses of battle’ (Parkinson, 1997:19). The popular treatments today will be discussed later.
The extremity of the symptoms displayed by individuals with PTSD are not static and are thought to be influenced by personal variables such as age, gender, personality traits and psychosocial resources. Any of these factors can exacerbate the severity of PSTD (Keane,1989 and Thomas, 1995; as cited in; Strauser, 2001).
So what kind of a trauma must an individual experience to induce such a dramatic response?
In PTSD it can be “any incident we experience which is sudden and unexpected …[causing]…stress reactions which can be identified as Post Traumatic Stress” (Parkinson, 1997:15). As mentioned earlier, such traumatic events can include, sexual assault, and exposure to war experiences and participation in battle. To investigate the proposition that exposure to such events can lead to psychosis, or PTSD, a number of articles have been consulted and will be presented in the following order. First of all, the implications of rape in the onset of PTSD will be examined followed by the role that exposure to war experiences may play before finally introducing an article examining the health of UK service men that served in the Persian Gulf War.
An article recently published in the European Journal of Obstetrics and Gynecology and Reproductive Biology explored the “longitudinal course of Post Traumatic Stress Disorder (PTSD)…over the 6 month period following the rape…[and the]… predicative factors for chronic PTSD” (Michel & Bornoz, 1997). The author’s claim that rape has been identified as a frequently occurring psychological trauma where in France 7% of women under the age of 35 have reported that they have had sexual intercourse under pressure. This figure is taken from a report published by the National Health and Medical Research Institute (INSERM) in 1993 (Michel & Bornoz, 1997). As already mentioned the aim of this study was to establish the longitudinal course of PTSD. The participants (n=83) in this study were recruited from a center for victims of sexual abuse in France. 98% of the participants were French and had a mean age of 21. Clinical assessments were made once the participants arrived at the center to report the rape then again after 10 days, 1 month, 3 months and finally 6 months (Michel & Bornoz, 1997). The authors found that fifty-nine of the eighty-three participants had PTSD after 6 months. They also showed that the type of rape experienced, or the ‘type of trauma’ could predict the type of PTSD at 6 months e.g. incestuous rape was found to be predicative of chronic PTSD. The results reported showed that a significant number of the cohort who experienced a trauma displayed the symptoms of PTSD at 6 months thus providing strong evidence that experiencing the trauma of rape can lead to PTSD.
What effect then does exposure to war have on the individual? It is inevitable that those exposed to the trauma of war like experiences will develop the symptoms synonymous with PTSD?
Goldstein et al., (1997) found that amoung a sample of 364 children who were living in a refugee camp during the Bosnian war, 94% met the criteria for PTSD. Following the five month occupation of Kuwait, Nader at al., (1993) reported more than 70% of the children in their sample to be exhibiting the symptoms of PTSD (as cited in; Allwood, 2002). More recently, Maureen Allwood attempted to find out more precisely the types and frequency of war experiences children in Sarajevo are exposed to. And, if this exposure leads to PTSD amoung the children living in the midst of the Bosnian war (Allwood, 2002:2). The participants in Allwoods study had a mean age of 10 (n=791) and came from ten different schools within the same school district (Allwood, 2002). The most frequent types of trauma that the sample was exposed to were; the death of a family member (79.4%), a family member being wounded during the war (73.4%), followed by being exposed to close shootings (72.8%) (Allwood, 2002:5). The researcher found that girls were more likely to experience PTSD reactions than boys and that all the “children exhibited substantial post-trauma reactions with 41% falling within the clinically significant range for PTSD” (Allwood, 2002:5). The two traumatic experiences showing the greatest correlation with post-trauma reactions were; witnessing people being wounded and knowing of the rape of a family member (Allwood, 2002). This correlation was supported both by self-report accounts and the ratings attributed by the interviewers during clinical interviews. In conclusion to ‘the possible effects of exposure to the traumas of war’ it would seem that there is strong evidence to suggest that such an experience is highly likely to lead to PTSD.
Finally, this section of the dissertation will examine the effects of war on a different cohort i.e. participation in war and the onset of PTSD symptoms. A 1999 study conducted by Unwin, Blatchley, Coker, Ferry Hotopf, Hull, Ismall, Paler, David & Wesley attempted to investigate this particular area. The authors investigated the mental health of UK service men on return from the Persian Gulf War, an investigation sparked by international speculation and concern over the various symptoms being displayed by military personnel on return to their home countries (Unwin et al, 1999). Unwin et al (1999) conducted a postal survey with a 65% valid response rate giving them a sample size of 8195. The questionnaire each of the participants received requested information pertaining to PTSD symptoms, alcohol and cigarette intake and various demographic variables. The results of the servicemen sent to the Gulf were then compared to those from the cohort sent to Bosnia. The results of this study found that the UK veterans from the gulf were two times more likely to develop PTSD than those who were sent to Bosnia (61.9% vs. 36.8% respectively compared to only 1-14% for the general population; Unwin, 1999 and Strauser, 2001). The authors have put one possible reason for this discrepancy forward. Unwin et al (1999) purport that the type of exposure in the Gulf differed significantly in comparison to that faced by their Bosnian counterparts. The difference lay in the potential exposure to biological warfare. This hypothesis is supported by their findings in that “service men who received vaccinations against biological warfare agents were more likely to report long term [PTSD] symptoms” (Urwin et al., 1999:177). Therefore, the threat of exposure to chemical weapons during this war could be argued to have precipitated the higher incidence of PTSD amoung the ‘Persian Gulf war’ cohort.
To conclude, the evidence supporting the hypothesis that exposure to traumatic events precipitates the onset of PTSD appear to be extremely robust. Each of the articles included for review revealed a scientifically significant result between exposure to a traumatic event and PTSD symptoms.
The implications of a Post Trauma Stress reaction are extremely debilitating and are exacerbated by ignorance surrounding the disorder. This ignorance adds to the individuals ‘trauma’ when attempting to cope with the symptoms of PTSD. In 2002, Kim, Strauser and Malinsky noted that 50% of such individuals go untreated and “continue to have symptoms that impact on their overall functioning” (as cited in Strauser, 2001:2). In essence these individuals are constantly experiencing their trauma through their symptoms of PTSD i.e. the flash-backs or sense of ‘re-living’ the trauma as mentioned earlier. Such levels of ignorance do not lie in the hands of the sufferer, families and general public alone because “many doctors, hospital staff, clergy, social workers and other helpers do not understand Post Traumatic Stress Disorders…[and assume that people will be]…back to normal within a relatively short time” (Parkinson, 1997:17). This however is not the case. Such experiences are often so traumatic that the individual does not want to re-experience any of the thoughts, images or emotions related to the experience and so instead attempt to suppress the reminders of the event by using defense mechanisms such as denial or repression (Parkinson, 1997). However, the traumatic experience does not disappear and does not even lay dormant but festers inside “waiting for the opportunity to emerge and influence other areas of our lives” (Parkinson, 1997: 18).
The impact of PTSD on an individuals life can be evidenced all areas of functioning including their relationships, careers, and ability to cope (Zinbar, 1992:258). The way the individual copes with the impact of this disorder on other areas of their lives can itself, be viewed as traumatic i.e. the trauma of psychosis involves the fact that the individual must face the effects their disorder has on almost everything and everyone around them. One such sufferer notes the realization of the impact that the symptoms can have on other people:

“It was like Dr. Jeykll & Mr Hyde. I’d go on self-destruct cycles you wouldn’t believe, especially when I started drinking. My poor wife, she went through hell”
([The War Within, 1985; as cited in Comer, 1993:221)

Therefore, this section of the dissertation turns to examine the possible ‘trauma’ caused by PTSD on the sufferer’s relationships, career, and general behaviour patterns. Researchers have discovered that the divorce rates amoung individuals with PTSD are likely to be higher than that of the general population. More specifically, Comer cites that the divorce rate amoung Vietnam veterans is nearly double that of the general population (Comer, 1993:223). The effects of PTSD are also enduring and can stretch across decades. Kuck & Kox (1992) found that 50 years after the Holocaust, 46% of their sample met the criteria for PTSD (as cited in; Michenbaum, 1997) and that the effects of the trauma were being ‘passed on’ through the survivors to their relatives via ‘Vicarious traumatisation’ (Felsen & Erlich,1990; as cited in Michenbaum, 1997). An effect which has also been identified amoung the wives and children of veterans” (Michenbaum, 1997:236). The trauma of psychosis for these individuals is likely to include extreme feelings of guilt because of the influence their experiences are having on their family. Therefore the individual is likely to experience ‘emotional injury’ (on some level) as a result of this emotional assault, which is mentioned earlier in the definition of trauma.
Regarding employment, the effects of PTSD are evidenced both directly and indirectly on the survivors vocational functioning (Strauser, 2001). The most common areas presenting difficulties for the individual experiencing PTSD are those involving understanding & memory, concentration & persistence, social interaction and adaptation (Fischer & Booth, 1999; as cited in Strauser, 2001). Experiencing problems in any of the above areas is likely to diminish an individual’s effectiveness in the workplace. Particularly when asked to complete tasks requiring attention and concentration for extended periods of time. Moreover, if the event occurred at work, involved their colleagues or even someone that looks like a colleague, the workplace may remind the individual of the traumatic event, thus depleting their ability to work quickly, meet deadlines, and effectively handle every day work stresses (Fischer & Booth, 1999; as cited in Strauser, 2001:5). If on returning to work an individual is unable to complete the tasks they were capable of prior to exposure to the trauma this may threaten their self-confidence and self-esteem. The individual may also feel that their sense of self is being threatened as the job that an individual does often holds a central component to their self-concept (Lord, 1996). Therefore the individual experiencing PTSD does not only have to experience the traumatic re-exposure to the event but also to accept the realization that they may not be who they thought they were any more.
The impact that PTSD has on an individual’s social life, as has already been evidenced, can be dramatic. But perhaps the most challenging aspect of the disorder to deal with (from the perspective of family and friends) may be that the individual often displays a complete change in their personality (Joseph, Williams & Yule, 1997). Perhaps the most noticeable aspect of the change in their personality is their significantly reduced ability to experience a range of emotions. This aspect of the disorder can induce a number of symptoms in the individual. These symptoms will now be discussed.
First of all, the individuals may feel as though life has lost it’s meaning. In the midst of such apathy the individual is likely to experience extreme difficulty at work or struggle to maintain their relationships with others. Parkinson (1997) claims this reduced range in affect is instrumental in the increased incidence of divorce amoung individuals with PTSD. The survivor is also at an increased risk of developing anxiety disorders and depression (Muser, et al, 1998). This vulnerability is likely to be fuelled by feelings of shame, anger, regret and bitterness towards themselves or other people…“especially those who have been killed, even if we don’t know them…bitterness is also common and there can be a deep cynicism and resentment about work, family, friends, self, or life in general” (Parkinson, 1993:58). Guilt in particular is particularly difficult to understand given that the reason for this is often because they have survived while others have perished e.g. decades later survivors of a Nazi concentration camp feel guilty that they had survived while other family members and their friends had not (80%) and 92% still blamed themselves for not saving their friends and relatives (as cited in Parkinson, 1997). As already mentioned, the survivor is at an increased risk of developing depression. This presents one aspect of the ‘trauma’ of survival. The traumatic experience of surviving plus dealing with the after effects of witnessing a traumatic event is further exacerbated by the sense if isolation and loneliness often felt by survivors. In particular it is often perceived that ‘no one understands’, even if others have been involved in a similar or even the same event (Parkinson, 1997). The ‘trauma’ of psychosis (or PTSD) can lead to comorbidity resulting in a further diagnosis of agoraphobia, which is a fear of open spaces. The development of this phobia is facilitated by the desire of some individuals who have experienced a traumatic event to stay at home and avoid any aversive stimuli that may trigger reminders of the trauma. Agoraphobia is an extremely debilitating disorder with some individuals refusing to go their office, place of work or even step into a car. Moreover, groups of people may be perceived as threatening which further disables the individual to the point that they refuse to leave their house.
Perhaps the element which relatives perceive to be the most challenging is when an individual who was previously renound for being calm and collected becomes aggressive and unreasonable for no apparent reason. As is not difficult to imagine, this aggression can have a severe impact on the individual’s current circumstances and future depending on where the aggression is directed. The aggression may for example, be directed at ones partner, children, pets, work colleagues or sometimes towards anything that reminds the individual of the trauma. Each of these targets are likely to negatively impede the individual’s recovery. However if the aggression is channeled and understood in a therapeutic manner the outcome will be more constructive for the sufferer. The final ‘change in personality’ to be reviewed is physical and refers to any change in the individuals sex drive or preferences. Such a change in a relationship can be perceived as detrimental as may raise suspicion if their partner does not understand the implications of PTSD on an individuals libido as has been found in dome studies (Comer, 1993:224 and Parkinson. 1993:56)
The possible implications of PTSD on ones life are in no way set in stone and, to a great extent, depend upon the coping mechanisms adopted by the individual. Research suggests that the way in which individuals appraise and cope with stress and the social support networks they have available plays a significant role in determining their ability to re-adjust (Michenbaum, 1997:224). According to Michenbaum (1997) positive coping techniques include; re-appraisal, reanalysis and active coping verses. Negative coping styles include externalization, self-pity, personal neglect, passivity and withdrawal (Michenbaum, 1997:244). The central feature of those individuals who cope effectively with their PTSD are those who are able to find a sense of meaning and purpose in the suffering of others (Michebaum, 1997:244). Furthermore, Wolfe et al (1993) claim that the individual who is more likely to remain free of PTSD symptoms is the individual who is able to re-experience their trauma with a great degree of personal control (as cited in; Michenbaum, 1997). Parkinson has found that there is a “high incidence of substance abuse in PTSD clients…several studies …[have found]…23%-76% of PTSD patients have concurrent diagnosis of alcohol abuse and PTSD” (Michenbaum, 1997:229). Alcohol Abuse occurs in 30% of individuals with PTSD, which initially, may have been a very effective coping mechanism in the form of self-medication. In a study of Vietnam veterans the number reporting incidents of heavy, and often abusive drinking constituted 63% of the sample (n=40; Joseph et al, 1997). In an even larger study with more than four times as many participants (n=268) almost half of the veterans thought to be suffering from stress disorders like PTSD were heavy drinkers. Furthermore, over half of this sample also reported using other drugs (Joseph et al., 1997). Similar findings have also been reported in more recent studies. For example, Foa, Keane & Freedman (2000) clearly show the lifetime prevalence for alcoholism to be higher for individuals with PTSD than for the general population:
Table 1: Alcohol Abuse and PTSD

These figures are particularly alarming. Joseph, (1997) suggests, “with Vietnam veterans there is evidence that alcohol abuse…may lead to later homelessness” (Joseph, 1997:23).

1. When the term trauma appears in inverted commas, it is referring to the negative experience of the individual following their diagnosis with a mental illness.[Return]