Is Psychosis Meaningful? Trauma, Dissociation and Schizophrenia - Part I

so today these talks have all been posed in terms of questions today we're going to talk about what is trauma and what is dissociation next week what is psychosis and what is schizophrenia and then the last week what are delusions and what are hallucinations you want it higher but my can I just ask before we start how many of you have some experience in working with traumatized people okay great and how many of you have some experience with dissociation that's a few of you as well great good and since we're added what about psychosis couple and specifically schizophrenia there's a great deal of overlap as you know great okay all right so my position is a fairly radical one the if you've if you're in the psychiatric field you know that the dominant paradigm the dominant view is that schizophrenia is a genetic biologically driven brain disease but when you start to look at the actual studies and the actual data there are lots of flaws with this one of the things we know about any field is that fields are driven by paradigms and paradigms our overarching worldviews really that tell you what you should be looking for and what you shouldn't be paying attention to in fact what you're not trained to even notice what kind of questions you should ask and what kind of answers are acceptable and in the fields of psychiatry particularly with schizophrenia the dominant paradigm is biological genetic the older family studies for example were really really flawed so you may hear in the press for example schizophrenia is 70% heritable you know this expression heritability heritability itself is a very problematic concept because it comes from breeding it comes from grains and growing different types of plants and flowers and being applied to people it's very very tricky so the concept itself is problematic but in these older studies which a lot of the estimates are still based on they did things like so the basic design is that if there's a family member who has schizophrenia what is the risk of the other family members to also have that diagnosis to get that disorder but in many of the studies they didn't only look for schizophrenia they looked for schizophrenia schizophrenia spectrum disorders and these often included things like personality disorders they even included in some studies manic depressive insanity bipolar disorder as a genetic risk factor for schizophrenia there's one absurd study that still quoted quite often in which they want to kill interview all of the family members even those who were dead so they made up interviews they literally made up interviews based on what they thought these dead family members would say right it's quite astonishing then there's also something in the more recent studies called the equal environments assumption as anyone heard this term equal environments assumption the argument is this has to do with twin studies that if identical twins have a greater risk of both having schizophrenia let's say compared to fraternal twins who don't will only share 50% not a hundred percent of their genetic background this means that schizophrenia is more genetically caused and the equal environments assumption argues that in general the amount of shared environmental influences between identical twins should be about the same as it is between siblings but that's not true and there's clear evidence that's not true if you know any twins have any twins in your family first of all there they're treated much more similarly than fraternal twins are and they get treated by others much more similarly so for example there's a lot more comorbidity for childhood abuse in identical twins than fraternal twins if one identical twin has a risk for as a history of abuse much greater likelihood the other identical twin will as well as opposed to fraternal twins but what the genetic folks argue is that it's their genes that's driving these environmental problems there really was a study that looked at bullying for example and argued that there was some aspects of being an identical twin that caused other people to believe the older adoption studies were also equally flawed adoption studies take children of course after they're born sometimes 6 months 8 months after they're born we now know so much can happen in those first few months that has a powerful impact on their development also in most of these countries where these adoption studies were done they weren't blind adoptions the family members knew about the history of the family of the kid that they were getting so if there was mental illness in the family the adoptive parents would know that and there's very good reason to believe that there was a lot of self selection going on and finally there's at least one study that found kids with a biological risk for schizophrenia would develop schizophrenia or psychosis only when they were placed with a disturbed adoptive family they were placed with the healthy adoptive family they tended not to develop these problems Molecular Genetics studies there's a lot of talk about this now this is a particular genetic problem when the genes duplicate themselves often they distort or they get deleted there are many many difficulties so this has been touted as the most powerful genetic risk factor for schizophrenia two things to notice first of all these kind of three things to notice I feel like Monty Python 3 things to notice some of you might know that reference what causes these kind of problems stress so fetuses that are exposed to significant stress or a great much greater risk of even having these kind of a greater number of copying variations secondly these sort of things are not specific for schizophrenia they cause problems with all organs including facial abnormalities so children who have these kind of problems also look different all right and thirdly do you know how significant this thing is do you know how powerful it is and this is bragged about this is found in point three percent of people with the diagnosis of schizophrenia and almost no control what does that mean 997 people with the schizophrenia diagnosis don't have this don't have this but this is considered a huge important genetic finding and finally brain abnormalities enlarged ventricles hippocampal reduction all sorts of problems with the brain that has been argued to be evidence for the biological nature of schizophrenia these things are a caused by childhood trauma often or at least children who have been traumatized have very similar looking brain problems structural and functional problems and and be chronic antipsychotic medication years and years of antipsychotic use cause your brain to shrink and literally there have been people from the bio medical paradigm who have argued well maybe part of the problem is is their brains are too big so if the medication is strength their brains maybe it's a good thing all of our brains are doing anyway I don't want to spend any more time on this but if you're interested there is literature on this there's an fella by the name of Jay Joseph who has a website Jay Joseph who criticizes the genetic studies and a Norwegian fellow by the name of roar Foss say that I've worked with as well so I'm gonna start by giving you the opposite point of view that my position is that of course there can be some soda genetic predisposition of some sort but a we have a lot of evidence that the environment impacts the development of these problems schizophrenia and psychosis and B intervening with families when their children are very young is by far the best way of trying to prevent any of these problems and there are some countries that are doing this fairly successfully what I'm going to talk to you about today comes from the first chapter of the second edition of our book which will be out later this year we haven't previously talked about it but I'm happy to make my slides available all right what is trauma some of you may have seen this before I'm right there in the room and no one even acknowledges me it's an elephant sitting on the couch which is part of the problem with trauma it has not dealt with in our technology so what does trauma mean trauma is an old word that comes from the Greek and it literally means a stabbing wound something that actually a knife or a sword that that cuts the body that penetrates and with the Greeks it's not only the body that was damaged but their souls they didn't distinguish between body and mind as neatly as we do now and also the community so the feeling was that an injured person is an injury to the community we need to remember some of these ideas the current medical definition is an injury or wound violently produced and there's many shows medical shows you may have seen where they talk about trauma wards there's a number of popular American shows that have been around for a long time that's medical trauma car accidents and so forth the problem the main problem with trauma is where is it located are we talking about events in the world are we talking about people's reactions to those events or are we talking about some combination of that so trauma is a metaphor so it first was used in a medical sense and then in the late 19th century this fellow named oilin Berg decided that it made sense to use it psychologically and he called psychological trauma he referred to the the powerful impact of emotions on the Bryant brain a psychological trauma and he actually thought that being traumatized by powerful emotions would cause you brain damage as though you were struck on the head and in some ways he probably was right who are these partly right those of you who know about history the term traumatic neurosis was used in the late 19th century Freud was one of the first to use it in the 1893 paper with with Breuer and he said in traumatic neuroses the operative cause of the illness is not the trifling injury but the effect of fright the psychical trauma so he's also saying it's the emotion that's the problem doesn't really matter too much what causes it and what causes it could be trifling it could appear to be minor William James the great American psychologists reviewed their paper and this is what he said hysteria which is really the old way of thinking about dissociative disorders or maybe borderline personality disorder to some extent hysteria for Breuer and Freud starts always with a shock and is a disease of the memory Freud and Breuer came up with this famous saying that hysterics suffer primarily from reminiscences certain reminiscences of the shock fall into the subliminal consciousness we might say unconscious where they can only be discovered in hypno estates if left there they act as permanent psychic trauma to thorns in the spirit so to speak so they can't be accessed in your normal state of mind your normal state of functioning and they're they're acting like psychic traumatic forms in the spirit there's a very beautiful evocative phrase something that's constantly bothering you and you can't pull out you can't get to so originally the original idea for trauma is that it was about the person's reaction it was the subjective reaction to an event and in fact that event could appear to observers to be relatively minor two of the important trauma figures in the field that Judith Herman who wrote the classic book trauma and recovery and vessel Vander Kolk and Judith Herman in her book says this traumatic reactions occur when action is of no avail when action does us no good when neither resistance nor escape as possible the human system of self defense becomes overwhelmed and disorganized each component of the ordinary response to danger having lost its utility tends to persist in an altered and exaggerated state long after the actual danger is over this is a very insightful and wise statement as mammals we only have certain evolutionarily based responses to danger fight-or-flight is the most famous one of course but there's also freeze responses and immobility responses and what Herman is saying is that when we're in a situation in which none of these things are solving the problem that's when we get traumatized but trauma is the result of an inability to successfully deploy our fear responses our responses to danger and in a complimentary way Bessel van der Kolk says the post-traumatic syndrome is the result of the failure of time to heal all wounds the failure of time to heal all wounds the core issue is the inability to integrate the reality a particular experiences and the resulting repetitive replaying of the trauma and images behaviors feelings physiological states and interpersonal relationships so once people become traumatized and for example develop PTSD it tends not to go away unless unless there's some intervention if something happens the person is not able to heal themselves and what happens in a futile attempt to heal themselves they replay the trauma my Freud talked about repetition compulsion other people talk about this in different ways but we see the trauma becomes replayed in images certainly in memories and flashbacks but it can also play out in interpersonal relationships which people often misinterpret trauma is a wound that doesn't heal itself but may fester and grow larger and it comes because we can't use the only responses that we have to danger a little bit about the official definitions of trauma trauma is defined in the part in the diagnosis of post-traumatic stress disorder because to get a diagnosis of PTSD you have to have been exposed to a trauma or a traumatizing event and for most of the time what these diagnostic systems did is they emphasized both some sort of an event and generally this was something that threatened death or serious injury so it's it's it's almost always interpreted as physical danger and strong negative reactions that at the time the person experienced fear horror or so forth but this has changed the DSM is the American diagnostic system and the icd-10 is the the World Health Organization for the rest of the world so trauma is defined in the dsm-5 which came out a few years ago as actual or threatened death serious injury or sexual violation so one good thing that they've done is they've expanded this now to include sexual assaults and ICD 11 which is due out this year or next year maximally they don't they no longer include emotional reaction in the definition so they are defining trauma as an event in the world an event that could be described by anyone really and this is a dramatic change from the beginning in the beginning trauma was persons react and then it was defined as an event and the person's reaction and now it's only the events itself is this a problem I think so I hope you agree let's start by talking about stress these are some of the definitions of what stress is one thing that's nice about the concept of stress is that there's a distinction between stress and stress or and stress is usually what we experience or sometimes just the body's response the physiological response increased heart rate blood pressure and so forth and the stressor is the event that precedes it but more generally stress is not something that is incomprehensible may trauma is fundamentally incomprehensible at least for a period of time stressors are things like probably for most of you standing in front of a group of people and talking maybe let's say there were ten times as many of you or moving house or moving apartment right these are considered to be very stressful events certainly the breakup of a relationship but we kind of know what these things are like right we've gone through these things before we don't like them but we've gone through them or we know people who've gone through them and we have an idea of what it's like to go through stressful events but that's not true for trauma that's not true for trauma trauma is something that you cannot comprehend until you go through it somebody talking to you about the events is not really gonna prepare you for what you've gone through right and also in general stress tends to be quantitative so when people talk about stress the type of event itself is usually not all that important but it's the amount of stress that you want to go so why is this problematic when we think about trauma for trauma the meaning of the event the personal meaning of the event is crucially important what does it mean to you individually there's a famous case a woman was raped she obviously was severely distressed and affected but she didn't develop pts and then about a half a year later her perpetrator was caught and it was discovered that not only had he raped other women but that he had killed one of them and this woman developed PTSD because she reinterpreted what had happened to her and had triggered other parts of her that produced post-traumatic stress disorder the meaning of the events to the individual is crucially important some people are wounded in war other people aren't I also like the metaphor of being overwhelmed now the original use of the term overwhelmed and I don't think that there's a word called whelmed it's one of these curious English words you don't have the absence of the prefix it meant to be capsized so you're in a boat in a body of water and you're capsized now what happens to people when they're capsized it depends can you swim how strong is the current how powerful is the storm are you physically well are you physically sick all of these factors affect who survives and who drowns so who becomes overwhelmed depends on a number of factors and that's what we have found certainly to be true and we also have research to argue that doesn't make sense to talk about trauma as an event only as an event there's good solid research out there that shows people can develop the full symptom profile the post traumatic stress disorder that is symptoms of reacts perience in the trauma avoidance and numbing symptoms hyper arousal physiological hyper arousal in response to something that would not meet the definition of a trauma like breakup of a relationship like the loss of your home for financial reasons not because there's a natural disaster people can develop the full gamut of PTSD symptoms and response to this at bullying as well internet bullying I mean this is a whole nother area how does the definition of trauma hold up when we're talking about people who develop PTSD because of what happens to them over the in you know there's no physical danger that there may be threats or so forth but they don't even have to be so I tend to think that trauma is really about a threat to the psychological integrity of the self yes physical integrity is important protecting ourselves are important but the psychological integrity and that's not always the same thing so being shamed powerfully shamed by by some event or some people as is quite traumatizing so we argue in our chapter that really you can't say that trauma exists in the world because it's too problematic a lot of people exposed to an event don't develop PTSD some do what does that tell us and even but saying it's in the individual is also problematic we should probably locate trauma in between an individual and and their world or in their world so on ovando Hart a colleague of mine talks about events things that happen as more or less potentially traumatizing right betrayal attachment figures who who severely let you down or turn return on you are quite traumatizing and in our chapter week we described trauma as an inability to integrate the implications of an event into the existing conceptions of oneself in the world in other words a failure to integrate that trauma involves not being able to come to terms with something that happened and importantly as we as well see not being able to come to terms over an extended period of time and this actually is very much what I mean to describe to you as dissociation inability to integrate a particular event but before we go to dissociation a few more words about trauma always trauma involves a vision in time that is to say when people are genuinely traumatized they're a different person there's the person who existed before they were traumatized and the person that they are now after the trauma it's not the same person so there is a fundamental split in time and people like Judith Herman have argued because of this treatment of trauma should always involve mourning should always involve grief part of what you have to do is let go of the person you were before because you're not gonna be the same person just like when you're stabbed with a knife or a spear you have a wound you have a scar that scar is visible you're not the same as you were before but what what I will argue is that it also involves a fragmentation of the self not only in terms of time but also within a person there's a traumatized self that coexists with the post-traumatic self really in a way the development of two selves okay so we'll have time to have questions about trauma but I want to turn to dissociation now and I sure hope that this one's gets gets more of a rise from you you're a tough audience humpty-dumpty well eventually I'd like to see you be able to put yourself back together again fragmented humpty-dumpty it doesn't look terribly happy about Freud's interpretation so what is dissociation dissociation is also a metaphor dissociation has been used for hundreds of years in a social way to mean really to drop out of a group you're a member of a group they start doing something you don't agree with you dis associate yourself or disassociate yourself you cut yourself off from fellowship it was also used by chemists to describe the breakdown of an element often through heating that breakdown of a compound into elements and different elements have different dissociation points at which point what temperature for example does it take for this compound to fall apart so like those concepts dissociation meaning dropping out of a group or a compound breaking down into its parts when dissociation was first to psychologically also in the 19th century it was a division of the personality a division of the personality there was a lot of fascination with these ideas in the 19th century dr. Jekyll and mr. Hyde the notion that they were hidden selves an individual or that they were to blame all as well Piaget used the term dissociation also disaggregation to refer to a division of the personality but slowly things began to change in the 20th century there was a term called depersonalization we'll talk about that more in a few minutes the personalisation the sense of not being entirely alive feeling disconnected from yourself robot-like perhaps and that has been used for quite a long time associated with schizophrenia now it's considered part of dissociation that wasn't always the case and often it's considered the dominant part of dissociation so I feel like I'm a stranger to myself so in a way we can say this original psychological conception of dissociation from Pierre's Rene and also the theory of structural dissociation of the personality is a narrow and pathological division of the personality so from this perspective there's no normal dissociation dissociation is abnormal alright but this has changed so over the past several decades people have particularly focused on alterations and consciousness as meaning to Association you're sitting in a room with somebody you're talking with them and all of a sudden they seem not to be there that they're vacant they're disconnected from you people will often say they're dissociating right they are depersonalized in a way but are they dissociating D realization is in a way the opposite is it's the world that seems not quite real for other people that seem not quite real but this concept also now often includes normal experiences like absorption absorption is the normal capacity the adaptive capacity to focus intensely on one aspect of your environment for example reading a book so perhaps you are like this or you know people like this they're reading a book they're so intensely absorbed in this as they don't hear things going on around them maybe not even their name being called you know people like this right who are really intensely focused this is an interesting trait it does vary across people some people have told me they think if you're from a family with lots of siblings kind of healthy and normal to develop this and it may also include this capacity to get lost in your imagination or your fantasies that there are probably are very normal variations in how intensely people can experience really their inner world there are a fantasy life their imagination I won't spend much time with this these are the official definitions of dissociation they're very very broad right a disruption or discontinuity and the normal integration of all of these things so part of the problem we're facing is that the official definitions of dissociation are so broad that it seems like almost anything can fit into there so some years ago some people try to make sense of this field and say well maybe we're talking about two different kinds of dissociation that have fundamentally different mechanisms one we'll call it detachment disconnecting yourself from the environment from something that's going on and the other will call compartmentalization right psychological compartmentalization and and this is appealing in some ways but these people disagree that basically they argue that dissociation is a special form of compartmentalization which which as you could see is close to division division of the personality not detachment so I want to try to explore with you now some of these different ways of understanding dissociation and I'm gonna do this by using the simple phrase I'm not here I'm not here obviously something that doesn't make literal sense in any way that we can understand it but it's very useful when we talk about different forms of different ways of understanding dissociation so if we think about depersonalization and derealization in a sense depersonalization is a withdrawal of the eye from the situation and and often it's transient as well so depersonalization often comes in very stressful occurs in very stressful events not necessarily traumatic anxiety disorders particularly panic attacks have a lot of depersonalization I feel I feel wooden I don't feel quite real in a sense whereas the realization is I'm not here it's the word I'm not here it's the world that becomes unreal the problems not me the problem is the world it's like I'm in a dream it's like I'm watching a movie and these are often transient reactions to feeling stressed and they're quite common so depersonalization and derealization are common in a range of psychiatric disorders and also for all of us we have brief periods where we go through these kind of experiences even being quite physically sick can lead you to experience derealization in deeper zatia so it's problematic to to use these ideas to think of as dissociation because they're so common outside of dissociative disorders and part of what we're looking for is what predicts dissociative disorders fantasy prose honest or imaginative involvement now this is actually quite interesting to me there are some people there's a group of people that a colleague of mine has have called has described as having maladaptive daydreaming and these are people who are essentially addicted to their daydreams and we're not talking about computer internet gaming or anything like this in their own minds they experience these fantasies that get a lot of pleasure from these fantasies sometimes they get some pain from them as well and they spend hours every day immersed in their fantasy world instead of doing other things it's very much an addiction who are these people do they have a stronger capacity to get lost in their mind than other people do does it have to do with their experiences we're not sure but there is some I think there's some evidence that there are differences in how much people can use their inner worlds as a defense or as a coping mechanism absorption now this again is a normal experience that I don't think tells us very much about dissociation but what we do know is that very dissociative individuals particularly those with dissociative identity disorder are quite skilled that divided attention so when you do experiments with them and these experiments are designed for them to respond to stimuli at the same time that's not something we normally are able to do but highly dissociative individuals can do this quite successfully it's it's Lois they have two streams of consciousness I'll give you one example when I first started teaching about twenty years ago in New Zealand I was beginning to talk about these things and I had a student come up to me afterward and thanked me for talking about dissociative identity disorder the new term for multiple personality disorder because that had rarely occurred in her studies and she said and I have this I have dissociative identity disorder she was very bright which often is the case with people with this and she told me that one of the things that she could do is that she could drive her car and read a book at the same time so she she'd be driving her car down the road and she have a book on the on the steering wheel and part of her was able to watch the road and respond to cars and another part of her was able to read a book can you imagine driving driving next to someone like that I'd get off of the next exit certainly would freak me out but there is evidence that this can happen that there are some individuals who are very skilled at this it's not the same thing as absorption absorption is this intense focus just on one aspect of your environment now dissociation is now often used in this upper way here which is a compartmentalization of mental functions for example a separation of narrative memory from emotional memory you describe the events that occurred to you in a fairly neutral abstract way the emotions are stored elsewhere it's also used in in biology and neurology basically just to mean a separation there if there's independent pathways that they are dissociated but what this does not require is that these parts have their own first-person perspective what do I mean by first-person perspective that these compartments were parts of the personality have their own individual way of looking at themselves in the world so they view themselves they view other people they view the world in different ways it's what lr9 Huson otto van der Hart call the first-person perspective so classically the classic conception of dissociative identity disorder are these as a person who has different parts of their personality some parts are in control at one point and other parts are in control at another point and the person has amnesia for what happens during periods time right so I say here I'm not here who is I've had some experiences with this I worked in the prison as I told you and will I was working with a co therapist with somebody who was highly dissociative and we had been meeting with him for several sessions in a room with a number of chairs and he always sat in the same chair and right and then there was another part of him that I had not met before who liked to smoke and he didn't like to smoke and you often see this that they also have different tastes and different desires in a way so one time we went to meet with him and he came to the door of the room and he said where should I sit and we said anywhere but that's a really interesting subtle idea because if you were trying to fake something like this you wouldn't necessarily think of something as as subtle as that if this person has not been there before they wouldn't know what they're supposed to do in the room even more intriguing as I said this part of the person liked to smoke and I guess had been out if you will and had been smoking and there was a switch while we were working with him and the guy we were most used to came back came back into the room and as he came back he did this and of course what was happening is he was reacting to the taste of cigarette smoke in his mouth which he didn't like but he was just experiencing it because he wasn't conscious before he wasn't aware before the other part of the person was there in addition to this what you also see is what times sometimes called Co consciousness and the best the easiest way to think about this is some people who hear voices when these voices represent parts of their personality that means that there is more than one aspect of them or part of them or if I prefer a personality subsystem that's active at the same time you can talk to them and you can also talk to their voice so this is sometimes called Co presence or Co consciousness for some people only this really is dissociation these other things are not dissociation I think that this at least might be a predisposition to dissociation as well ok I know that there is skepticism about the existence of some of these diagnoses maybe we'll have time after the presentation to talk about this I don't have time to present data to encourage you to think that this is possible but there is certainly data out there which we can talk about in general when you think about how useful a term is or isn't there's a number of things to talk about how was it used originally what was the original use of the word how useful is it clinically what's the empirical evidence how elegant is it conceptually one of the problems with dissociation now is it's used so broadly and trauma is the same in a way that it doesn't tell us very much so if we use the term dissociation to describe everybody who appears vacant all of a sudden it's not really giving us very much information whereas if you use like some of my colleagues dissociation to argue for the presence of a division of the personality that tells you a lot more so this is what they call ongoing structural dissociation of the personality that there's fears and phobias the reason people are dissociated is because they can't integrate something that happened to them otherwise they wouldn't for example be hearing voices in some cases so what these people argue structural dissociation the personality is no normal dissociation we should not use the term dissociation to describe what occurs normally only pathological these other things we've been talking about derealization depersonalization so forth these are alterations in consciousness a lowering of the level of consciousness a narrowing of the field of consciousness that's actually common in dissociative disorders but it's not a definition for dissociative disorders and dissociation is tightly tied to trauma its Association as a result of trauma and there is no trauma without dissociation so trauma causes dissociation in the way I'm talking about it now at a very fundamental level what does trauma do with traumatizing events it splits the personality and if you work with PTSD I hope you'll see this makes sense there's a part of the person that's stuck in the past when you have been traumatized you cannot get over what has happened to you and there's a part of you that gets pulled back over and over again into that event and into that experience there's another part of you that is desperately trying to function in daily life trying not to be reminded of the trauma and they have called this rather quaint terms the emotional part of the personality and the apparently normal part of the personality apparently normal part of the personality Ellard nine Huson band heart says each dissociated part of the personality minimally includes its own at least rudimentary first-person perspective does it have a different view of itself of other people of the world as each dissociative part the individual can interact with other dissociative parts and other individuals at least in principle by definition if this really is dissociative parts of the personality they can communicate with one another and they can theoretically communicate with you as well that is the fundamental idea of dissociation of structural dissociation of the personality there is the potential capacity for communication I actually said this already that trauma splits the personality into a part that's stuck in the past and a part that's trying to function the part that stuck in the past has a lot to do with these mammalian defense reactions freeze flight immobility and if you know about PTSD there is already this division built in there we experiencing symptoms are being pulled back into the past being stuck in the past flashbacks nightmares but and avoiding symptoms are trying to avoid all reminders of the trauma so we have these symptom clusters but most people don't consider these to be identity systems or parts of the personality but I think there's a good argument to say that they are and that they should be treated as such ok just a couple more things on this and then I'll go to the final part I wanted to talk to you about the most fundamental the most basic the most simple form of structural dissociation is post-traumatic stress disorder but it's not the only form it can get more complicated so you have this trauma part of the personality and this neutral or functioning daily functioning part when there's more trauma you can have several of these emotional parts and many borderline personality disorder cases are like this so if you have if this person acts in different ways depending on what kind of danger they perceive to be out there they might have rage responses fight responses they might have cutting they might have fleeing responses these are different forms of dangerous Ponce's and they would argue they're actually different parts of the personality and there is fairly good evidence that probably most persons with borderline personality disorder a highly dissociative it's not classified that way but probably it should be the most severe form the classic dissociative identity disorder different parts of the personality functioning and daily life a part of the person who's a very capable mother another part that's very capable at driving but then there's also these many fear driven parts as well and the treatment for these approaches always begins by addressing the fears there's a huge fear of the trauma one of the reasons people remain to traumatize as they they're terrified of remembering the thoughts and the feelings they basically feel that it would kill them psychologically kill them so you have to deal with the fears and also the the distrust between the different parts of the individual and then importantly symptoms dissociative symptoms can be both psychological and somatic so there are physical dissociative symptoms and they can be negative or positive intrusions or withdrawals so psychologically you have flashbacks classically hallucinations these are experiences coming into the mind dissociative experiences amnesia is a classic negative psychological symptom but also physical symptoms and this these were very well recognized a hundred years ago that numbness anesthesia feeling like you can't feel anything that you're blind these are somatic symptoms driven by trauma they're dissociative those would be more negative somatic symptoms but also unexplained pain there's a lot of trauma based dissociative genital pain for example for which there's no medical explanation other types of pain that appeared to be trauma related these can be understood as dissociative because they're an intrusion from one part of the mind into your awareness oral withdrawal as well alright so I only have a few more slides yeah I want to talk to you a little bit about PTSD because there's some enigmas or mysteries in PTSD that I think we can understand when we start thinking this way so what do we know about PTSD not everyone exposed to a life-threatening event develops PTSD but almost everyone exposed to a life-threatening event has flashbacks for a period of time a week two weeks three weeks PTSD requires four weeks of symptoms and this is the reason for it so in one study 95% of rape survivors had flashbacks in the first week only 50% had them after a month these are actually attempts to integrate what flashbacks are about are opportunities for you to make sense and in a way your mind is showing you over and over again this experience so that you can start to decompose it and you can say well it happened once it's not always gonna happen or what can I learn from this that's another way of thinking about it if this is a dangerous situation that we couldn't cope with flashbacks can be very adaptive we can learn from this what can we do differently in the future so these symptoms are normal these symptoms are normal the problems occur when people start to avoid the reminders when they can't deal with it or they find it too overwhelming as we already talked about some people develop PTSD to events that are not that severe and now this is really interesting if you've worked with people with PTSD what happens when people develop PTSD a lot of old stuff comes back and starts to bother them things they hadn't thought about for many many years things from childhood are now giving them nightmares why is that why is that didn't bother them before I think what we have to realize when we talk about PTSD is that an event occurs and this offense I think I'll talk about this a little in a minute but I'll talk about it now this event affects people differently why does it affect people differently people have different histories so for some people they may have experienced some events have some similarity to what occurred and they may have mastered those events they're more likely to do well what about those people who had some events some experiences that they successfully suppressed or oppressed for a long time and now this trauma occurs it triggers those memories it triggers those experiences they get lit up they get energized and then all of a sudden the person can deal with them because that they have all this power behind them now this trauma is feeding these earlier experiences that they could not deal with and when you treat people who are traumatized you have to go back in their past I don't know if any of you know EMDR eye movement but this is what EMDR does it goes back over the channel down the network from the current trauma to the previous ones and works in them all because you now have to deal with all of it the person can no longer ignore what had happened and this varies a lot from person to person those personality differences as well there's also this different capacity in terms of holding things together all right so two sets of conclusions here it's a mistake to use the term trauma to have refer to events in the world and certainly only events that are physically threatening this really is illogical it's not based on research and it makes us go off in a number of wrong directions we overlook people who are legitimately traumatized to something that just doesn't look bad enough and that's really not legitimate legitimate and it's not only the individual but the family and the community that are wounded trauma implies dissociation and inability to integrate an experience or a fissure in the self and a part of the personality is trapped in the past for all people who are traumatized in every level of dissociation part of them is stuck in the past transient failures of integration are common hypnosis daydreaming we all have these experiences the first few weeks after an a problem I had a car accident a few years ago wasn't a serious one and for a couple of weeks sure enough I was sure that there was a car coming at me from from the side when there wasn't but I continued to get into the car even though I was nervous and originally and drove and that experience and these are the things that are related to individual differences clearly a person's history is very important personality structure the support we haven't talked about that much but this is so important family supports social support community support people a lot of people will not develop PTSD I I went to a talk a few weeks ago in Chicago fascinating guy in the PTSD field he claims that when you go to Vietnam the soldiers who fought for the Viet Cong aren't traumatized but there's very little PTSD in Vietnam because of the way the culture in the community has dealt with these individuals whereas in America these soldiers are isolated and stigmatized and they develop PTSD also this psychological tension the capacity to hold things together executive functioning alright so next week I'm gonna be moving on to psychosis instability basically what part of what today was about was giving you a foundation and the concepts of trauma and dissociation to try to understand psychosis and schizophrenia Carl Jung is part of who we will talk about next week he worked very closely with Hogan boiler when the concept of schizophrenia was being developed in the early 20th century if you want to hear the answer to this question stay tuned next week as they said when I was growing up same time same place finally Carl Jung gave a talk in Zurich in January 1908 and this was a couple of months before we think the first use of the term schizophrenia was was made publicly so he gave a talk to the public in the zurich city hall and this talk was called there in health they are psycho so the contents of the psychosis and Jung who is one of my heroes ended this talk with these three sentences for those of you who speak German this is the original German but I will read the English though we are far from being able to explain the relationships in that obscure world we can maintain with complete assurance that in dementia praecox the old name for schizophrenia there's no symptom which could be described as psychologically meaningless or groundless even the most absurd things are nothing other than symbols for thoughts which are not only understandable in human terms but dwell in every human breast in insanity we do not discover anything new and unknown we are looking at the foundations of our own being the matrix of those vital problems on which we are all engaged thank you [Applause] right so we have sure well I would say there's some truth to that certainly that if you have successfully dealt with a particular type of trauma but really successfully and you are traumatized again in a similar way you may be able to handle it differently now I'm being cautious because people may feel that they've done what they need to do and in fact the new trauma would then trigger things again and maybe maybe there's some earlier things that weren't fully dealt with so it doesn't necessarily have to to be that way but theoretically it could be yeah but let me give you one one I think that in many ways the best example of a trauma is loss because if you have ever lost someone or in my case a very a dog who I loved a great deal who was very close to you you can't make sense of that right there so there is at least a transient association there's a there's a failure to integrate the experience for a period of time successful mourning involves bringing that experience into yourself you find some way to come to terms with it unsuccessful mourning is essentially being traumatized that you you can't integrate this as experience you can't make sense of it you can't bring it into the person that you have then become right so I I think I think loss is it an easy way to think about trauma yes I think you were personal well I well I mean I thinks I think my thought is and the short answer to your question is no as far as I know we don't really have very much to do about that and I have to give you a little aside now part of the problem is that certainly the psychosis field has really ignored this area for a long time partly because they're biologically driven but there's other reasons as well there are hardly any studies in which they will screen for dissociative disorders absolutely not even PTSD so they will rarely look for people like this who may be part of their group but it's also true in the other way that people in the trauma and psychosis field or are frightened or concerned about this and now I forgotten your question right yes it's very normal but there may be some kids who are particularly skilled at it and here's the thing is that I mean some people describe dissociation as basically wishing powerfully wishing that I wasn't here or that somebody else was that this was happening to someone else and there are children who can make that happen basically that they can [Music] create a division so that the part of them that gets traumatized stays sort of separate from the part of them that goes to school and that place with their friends and therefore they do well I mean I don't think it's a complete coincidence that people with the ID are often very intelligent and very creative they have been able to protect their functioning through this my idea and I don't have any basis for this but my idea is that the people who become psychotic and schizophrenic can't do this as well so if you are you know if you are in a situation and you can't escape through your mind in this way then what happens first of all you don't do well in school your social skills deteriorate and probably your brain is also stressed a lot more so these are great questions and I hope we have some answers yeah I believe that you first I mean here's the thing one of the problems that we get into in the field is we have we have too much black-and-white thinking I mean there's there's too much thinking either this happened or the person's making it up right and it's never like that I mean even when things really happen to people that the secondary gains there's secondary issues there they can then use this some more to to get some of the things they want in their life I mean the only thing I can say is just we should try to be as non-judgmental as possible to people of course there's going to be people who end up making up things very often they will have had experiences that are probably not what they're talking about but that provide the fuel you know the the emotional fuel for what's driving them I don't know if that answered your question people who use especially the PTSD you've seen in the debate of well soldiers are the only people who are traumatized you have to have a trauma test a bitter event so we're able to restructure the way that we and here's the here's the other problem with that is that it's a lot harder to work this way I mean it's much easier to say well either this thing happened to you where this didn't happen to you right when we have to really delve in there and try to understand why the person we how they reacted and then importantly why did they react the way they did what was it that lit up their hidden parts you know their wounded parts so powerfully that's hard to do there I mean there's always a reason for people's symptoms it might not be the reason they think it is but there's always some reason for it I think you're next yeah well I mean the bottom line is I mean everything we're talking about is how well do you function really I mean none of these things are inherently bad necessarily if I know a lot of people who hear voices and who don't want to get rid of their voices and who function fairly well doing that my position on this has varied somewhat over the years with with my changing views but basically if person can control it if he can turn it on and turn it off it's when it pulls them away it affects their their work functioning their social functioning their sleeping and their eating as well but just quickly you know characters and writing and all that that's another fascinating area because and there's been very little work in this area but authors have there characters talk to them right authors sometimes hear the voices of their characters actually Robert Louis Stevenson who wrote Jekyll and Hyde he he said that his stories were written by his little brownies in his head and Jekyll and Hyde came to him in a dream he wrote in like three days feverish dream and there's other authors who say you know famously Harry Potter JK Rowling when she first started writing their stories she said to herself you know why do I have a boy protagonist you know I it should be it should be a girl I mean I'm a woman and she tried to change it and she says he wouldn't let her but that he was too he was too evolved so yeah yes yes yes yes yes I mean I think if we if we think of trauma and traumatising events as things that we're not able to master then in a sense all of this kind of makes sense these are opportunities to try to make sense of them and learn from them and perhaps the earlier experiences weren't as severe but if they do all connect in a way maybe we are meant to try to tease out what the connection is and to to make something for it but let me just say one other thing about what you're talking about another way to understand this old things coming up is that trauma weakens the mind that trauma and this is what PR Gen a would say that when you'e traumatized the synthetic capacity of the mind basically our ability to hold things together is weakened hardly because we're exerting so much energy trying not to think about the trauma right that we don't have in a way the mental strength we don't have the same psychological tension or psychological efficiency or psychological strength to keep everything in its place so this is one way of thinking about I I kind of like the idea that there's there's a connection that gets triggered by the trauma there's a hidden network in a sense that gets lit up but you can also think about it as this weakening of executive capacity holding things together what-have-you yeah yes I think that there's been there are many reasons why they try to define trauma in this way I think one very simple reason is that in America there's a lot of lawyers and there's a lot of lawsuits and PTSD is a very popular diagnosis for lawsuits and I think they try to really make it as narrow as possible so that if somebody trips going down some stairs they they can't sue and say they've got PTSD right so this so this is one thing but yeah I mean you know there are some experiences that are more likely to cause PTSD and others that are less likely but there's a lot of individual difference I would just like to argue against the idea that it's something that happens in the world that's all we have to worry about yes that some Viet Viet Cong soldiers well both of those things I think are true I mean in general if people have the an opportunity to simply talk for many people if it's just if there's someone they can simply talk to that they feel comfortable with that can be enough there's a story I use sometimes when i teaching about a soldier sorry a police officer we develop PTSD and it took six months for it to happen it was literally because nobody wanted to listen to him or pay attention to what had happened and if they had I'm sure that would have that would have gone so a having someone to listen to and a few more things ideally around that but then certainly also the cultural ideas the this fellow I was told you about before in Chicago who talked the guy named Edie tick really interesting person who worked with has worked with them Vietnam soldiers for decades and and he uses a lot of Mythology and he says part of the problem with trauma is that we're focusing too much on what happened to these people and he said you know think about all the old Greek myths in which people went down into the underworld right for some reason they're punished they're cursed - thrown down into the underworld they have these tasks they have to do and they come out and they're transformed and he thinks that in some of these societies there is the recognition that these people are on a journey a very difficult journey but they're on a journey and that we have to it's not like everything stopped in the trauma and they have to just get over it they they have to go through it and then figure out who are they now who have they become and he thinks some of these cultures are much much better at doing that and that America has been abysmal at doing that I think he's right [Music] yeah yeah look I mean I figured you might be going in that direction I mean this is use hugely difficult I mean one of the things we know about childhood sexual abuse is that children's bodies sometimes who often responds right even though they didn't want it to happen and even though was horrible and there's so much confusion and shame about that but it may also relate then of course to later Oh sexual addictions as well as combination of pleasure and pain and you know all these all these difficult things what what should we do about that it depends I mean it depends I mean you know basically if a person is suffering and if they come to us or their family comes to us we should try to help them they're not causing any harm okay I think maybe this would be the last question [Music] [Music] well you vested questions I'm gonna answer one and it might not even be any of the ones you passed but that is you know in a weird way certainly very dissociative people some of these other folks as well they they have an advantage because they're their wounds are visible right they have you know if you're very dissociative and you develop these parts of you you can engage with them right for a lot of people who don't reach that point or develop problems in other ways it's not as easy for them to see what it is that's going on with them what has happened to them people who are very dissociative you know for a therapist who was very skilled he can identify and work with and help to help to integrate all the parts of the person and in a way they can be then very hell because they wouldn't have as many Darkseid's perhaps they were they will have been illuminated more I don't know but it's in a weird kind of way one might think somebody who leads a quote-unquote perfect life and has no challenges is ideal but you know what do they turn into okay great thank you I hope to see some of you next week and I'm able to stay for a little while if there's other comments or questions [Applause]

Channel: Stillpoint Spaces Berlin

Views: 11,149

Rating: 4.9298244 out of 5

Keywords: Psychology, Trauma, Dissociation, Schizophrenia, Psychosis

Id: slta180wZ1o

Length: 75min 11sec (4511 seconds)

Published: Mon Jan 14 2019