Custom Essays and Free Coursework

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

The prognosis however, depends on the coping mechanisms used. In 1988, JT Mitchell & Atle Dyregrov produced a report following a bus crash in Norway looking at the psychological effects of this tragedy and the various coping strategies used both during and after the event. The sample consisted of all the professionals who worked at the accident. When faced with the traumatic experience of treating children with multiple injuries and being helpless to those already dead 94% of the professionals on site tried to keep themselves active and 90% found strength from the mutual support being offered by the helpers. Importantly 76% of the helpers suppressed their emotions enabling them to deal effectively with the job at hand.

In contrast, on leaving the scene, 67% felt helpless and found the situation to be a stark reminder to them that they were often powerless and could do nothing and 75% experienced fear and anxiety. This response was found to be exaggerated amoung those individuals who had their own children. The symptoms amoung these professionals after dealing with the trauma included them becoming more anxious and overprotective of their own children, experiencing sleep disturbances, venting rage & anger, experiencing sorrow & grief and also re-experiencing the event via vivid images of particular elements of the trauma. These elements are clearly indicative of the symptoms often found amoung individuals with PTSD. This study shows that even professionals trained to witness and cope during such events often experience the symptoms of PTSD showing that most individuals are vulnerable to this disorder. The reactions displayed by individuals are not abnormal but are in fact “the normal reactions of people to events, which for them are unusual or abnormal” (Parkinson, 1997:24) as events involving the death of children, even for professionals, often are. The authors found that one year later, 45% of those involved felt that their lives had more meaning and that they had an increased level of appreciation for their loved ones. The article concludes by highlighting that the negative coping styles adopted by participants in this study included the individuals distancing themselves instead of actively confronting their own impressions and reactions to the event (Parkinson, 1993). Therefore the trauma of psychosis amoung this cohort was to avoid confronting the original trauma and the risk of re-living the event by instead suppressing this experience until it emerges at a later, unexpected date.
Once these symptoms do emerge, there are treatments available for PTSD. These include; behavioural therapies, cognitive behavioural therapy, psychodynamic therapy group therapy, residential care and medication. Medicaiton is often used in conjunction with other therapies (Parkinson, 1997).
Michenbaum cites a few of these interventions advocated as appropriate after treatments for those individuals who have experienced a traumatic event such those listed above and Eye Movement Desensitization and Reprocessing therapy EMD/R. Due to the restraints of this dissertation, three of the suggested interventions have been selected for inclusion. These are; pharmacological treatments, exposure based treatments and EMD/R.
“The literature on pharmacological interventions for clients with PTSD is quite extensive…[and it]…recognizes that different medication appears to affect specific symptom clusters in PTSD”

(Michenbaum, 1997:295). However, medication rarely relieves all of the symptoms of PTSD and is therefore not recommended as a long term treatment although it can help in the short run where the individual has difficulty sleeping (Michenbaum, 1997). Therefore medication does not provide the answer for those suffering from PTSD although when used conjunctively the efficacy of pharmacological interventions may be magnified.
Exposure based treatments for individuals with PTSD are based on the theory that individuals not only fear the original trauma but also the memory that they hold of it (Rothbaum & Foa, 1992; as cited in Michenbaum, 1997). Exposure therapy has been found to be effective amoung individuals with PTSD as a result of some traumatic experiences such as rape, combat or living in a war zone for example. This method is more effective on the arousal levels; startle response, and intrusive thoughts that the individuals have rather than the psychic numbing, alienation and restricted affect that they often experience (Michenbaum, 1997).
A study of 24 Vietnam veterans aimed at investigating the efficacy of various interventions and PTSD symptoms was conducted by Zinbar, Barlow, Brown, & Hertz in 1992). The participants were randomly assigned to either Direct Therapeutic Exposure (DTE) or stress management techniques, anger management, problem solving and basic rest and relaxation techniques. The results revealed that prolonged exposure led to the most significant decrease in symptoms at a three and a half month follow up. The authors have explained these findings as being underpinned by the permanent change in the cognitive processes surrounding the trauma. This change is apparently instigated by the prolonged exposure the subject’s experience versus SIT which requires long term practice before its efficacy is evidenced (Zinbar, 1992). Therefore it would appear that DTE is the most effective intervention for individuals with PTSD. Despite the relative efficacy of this method when compared to medication, exposure therapy should be approached with caution. In a study by Pitman et al., (1991), six of twenty individuals experiencing combat related PTSD reported experiencing increased levels of anxiety, panic symptoms, obsess ional thinking, an increase in alcohol abuse accompanied by an increased incidence of re-traumatisation (Adapted from Pinman et al., 1991). These symptoms were reported as a result of exposure-based therapy in more than 25% of participants in this study. The greatest risk with this method is that the client is being pushed. This may be what is being displayed by the above 25% of subjects.
Finally, EMD/R is a rather controversial intervention introduced by Francine Shapiro in 1987. It is basically a variant of the exposure based intervention and combines the clients envisioning their traumatic experience and experiencing all the sensations and emotions that go along with it while visually tracking the therapists finger “from extreme left to extreme right” (Michenbaum, 1997:304). The therapy requires the individual to track this movement 12-14 times and on stopping, the individual should blank the image out and take a deep breath while thinking of a contradictory statement such as “I am in control” (Michenbaum, 1997). The rationale behind EMD/R as a treatment for PTSD is that the traumatic event has become locked in ones system and that visually tracking the therapist’s finger allows the trauma to become unlocked via expression in a less traumatic way (Michenbaum, 1997).
Several researchers have called for the evaluation of multi-componential treatments for PTSD. Zinbar (1992) argues that future researchers should evaluate the efficacy of using exposure based techniques parallel to stress management and pharmacological interventions (Zinbar, 1992). The technique or ‘applied to’ the individual may be less important when compared to the attitude of the individual with PTSD.

“There are no ready made answers. We go the road alone. We may be helped by we cannot be pushed or misdirected. We each have the powers to re humanize ourselves. We are our own self-healers”

(Brian Keenan, 1991; as cited in Parkinson, 1993:101)

Therefore the prognosis and impact of this disorder on the individual and their life may not only be mediated by the symptoms they experience but also by their own attitudes and whether or not they feel prepared to recover.
With regards to the trauma of psychosis, the symptoms of PTSD have been found to impact on all aspects of the individual’s daily life leading to alcohol abuse, divorce and in some cases homelessness. How does an individual deal with the trauma of such losses? The only hope is that ignorance surrounding the long implications of exposure to trauma decreases and that individual receives the help that they need at an early enough stage to enable them to cope with, understand and educate others regarding the nature of their disorder.
PTSD is not the only disorder characterized by symptoms of psychosis or ‘a loss of touch with reality’. Psychosis is often cited as the defining factor in schizophrenia (PsychNet-UK, 2003). Schizophrenia is a psychotic disorder characterized by “severe symptoms in the realm of judgment, emotions, perceptions and behaviour…the schizophrenic person suffers from a psychosis, a mental state in which there is extreme impairment in reality testing and sometimes the creation of a new reality” (Perretto & Culkin, 1993).
The symptoms of schizophrenia are often divided into positive and negative. The positive symptoms include delusions and hallucinations for example and are generally regarded as additional to the individual’s usual array of experiences. The negative symptoms include depression and flattened affect and signify a deficit in the normal range of experiences. The dissertation will now provide an overview of the positive and negative symptoms of schizophrenia. This will be done before moving on to describing the history, the impact and the most common coping mechanisms used by individual sufferers of the schizophrenia. This will be followed by a brief look at the efficacy of some of the treatments and the prognosis of the individual while also introducing some very stimulating reflections on how it feels to cope with the trauma of psychosis as noted by previous sufferers.
This section begins by introducing the reader to three of the positive symptoms of schizophrenia. These are delusions, disorganized thinking & speech, and finally heightened perception & hallucinations. The person with SZ may experience one of four types of delusions; persecution, reference, grandeur and control. Delusions of persecution include the belief that one is being plotted / discriminate against, threatened or victimized. Delusions of reference lead the individual to believe that everything is a sign aimed at oneself e.g. the words use in a movie or displayed on a billboard will be perceived to be directed at the person suffering from schizophrenia. Delusions of grandeur occur when the individual believes himself or herself to be a historical figure; and delusions of control are where the individual believes that other people are controlling their impulses, feelings, thoughts and actions (Comer, 1993). Disorganized thinking and speech causes the individuals extreme confusion and makes communication with others extremely difficult for the sufferer. The disorganized thinking and speech patterns have been grouped into; loose association, neologisms, preservation, and clang. Loose association is where the individual rapidly shifts from one topic to another; neologisms is where the sufferer constructs their own words and attributes meaning to them; preservation is where words are repeated continuously, and clang involves speaking in rhymes (Comer, 1993). The final category included in the grouping of positive symptoms and schizophrenia is a heightened level of perception & hallucinations and inappropriate affect. Heightened sensitivity includes the sensation that ones senses are being flooded, particularly sight and sound. Hallucinations incorporate both auditory and tactile hallucinations. The final element is that of inappropriate affect. This incorporates the unusual behaviour of smiling when informed of ones husbands’ death for example (Comer, 1993).
The negative symptoms of schizophrenia, poverty of speech, blunt & flat affect and disturbances in volition, will now be introduced. Poverty of speech is where the individual’s ability to speak decreases and speech is characterized by short and/or delayed replies. This impairment is exacerbated by what is known as ‘blocking’, which is when the individual’s thoughts disappear from their mind. Blunt affect is characterized by the expression of emotions to a lesser degree than was done prior to the onset of SZ. And, as the term would imply, flat affect is characterized by the expression of no emotion at all. Disturbances in volition include both avolition and ambivalence. Avolition is the experiencing of feelings such as apathy, being drained of energy and having no desire to achieve ‘normal goals’. Ambivalence describes the situation where activities such as “eating, dressing and undressing…eventually become impossible ordeals” (Comer, 1993:528). Even though these are the common symptoms found amoung individuals with the diagnosis schizophrenia, the range of symptoms experienced differ for every individual. Despite the idiosyncrasy of the disorder, many people appear to progress through three clear stages, prodromal, active and residual.

Table 2: The stages of Schizophrenia

During the main stages of the disorder, the individual with schizophrenia “usually functions very poorly…unable to take care of self, maintain relationships or to hold down a job” (Comer, 1993:531) and the individual often ends up withdrawing emotionally and socially from their environment…[becoming]…totally preoccupied with their own ideas and fantasies” (Comer, 1993:528). Individuals with schizophrenia are also likely to distance themselves from others which only serves to facilitate their further distancing from reality. The finding that when comparing individuals with schizophrenia to individuals with other psychosocial disorders 75% of the individuals with schizophrenia are significantly less aware of everyday social issues which demonstrates the extent to which they are distanced from ‘reality’ (Comer, 1993:528)
Schizophrenia is a disorder which was described as far back as Hippocrates (Martin, 2003) and was introduced under the guise of ‘schizophrenia’ by Eugene Bleuler who used two Greek terms which, when placed together, literally mean ‘split-mind’. However, the psychiatrist Torrey Fuller argues that schizophrenia may not have existed prior to the 18th century, an assertion supported by Richard Napier, a medieval physician who specialized in the care of the mentally ill. But there are records of individuals suffering from schizophrenia like symptoms in ancient India and Rome. Nevertheless Dr Habelensky argues that the greatest increase of schizophrenia occurred during the present century in an article entitled “the epidemiology of schizophrenia: A European Perspective”. The doctors argument is based upon the findings that schizophrenia increased dramatically alongside the industrial revolution in Great Britain and that an increase in the occurrence of schizophrenia around this time can be explained by a change in nutrition, obstetric complications and neonatal care which also became ‘revolutionized’ during this period of the United Kingdoms industrial history (Warner, 1994).

Please note: The above essays and dissertations were written by students and then submitted to us to display and help others. Thanks to all the students who have submitted their work to us.