Everyone is quite familiar with the ideology these days that mental illness is a biochemical malfunction due to shitty brains and genes. Of course, the only ‘real’ answer is to take medication to re-balance what went off-centered (despite the fact that anti-depressants only work on the severely depressed, see the UK). I’m not interested in blaming Big Pharma and the biologzation of psychopathology because it is undeniable that genes and neurotransmitters can certainly leads to bizarre behavior, thinking, and emotions. For instance, one of my scholarly interests is schizophrenia and the psychotherapy of psychotic disorder (dissertation focuses on the treatment and model for schizotypal personality disorder). I am well aware of the genetic component and the finding that monozygotic twins have a 40% chance of developing the disorder if the other twin likewise suffers from schizophrenia (general population has a 1% chance). That’s all well and good, and I have no problem with the findings. However, what is getting lost in this conversation is the prominent role that trauma and childhood sexual abuse have on the development of schizophrenia. For example, Colin Ross has proposed adding a dissociative subtype (akin to paranoia) to DSM definition of schizophrenia to account for the large percentage (~25%) of people of schizophrenia who suffered from chronic abuse. The folks tend to have more positive symptoms (hallucinations/delusions) and less negative symptoms (withdrawal, avolition, etc). They tend not to respond to anti-psychotics and benefit more from psychotherapy. Another recent study conducted by Heins et al. (2011) in the American Journal of Psychiatry confirmed that different levels of positive psychotic symptoms are correlated to the exposure/severity of trauma the person endured in childhood. The study was designed to avoid reporting error/bias by interviewing non-psychotic siblings of the psychotic individuals. This really should not come as a surprise, although many in the establishment continue to pretend that environment plays little to no role. We might recall the derision that academic psychologists regularly heap on Fromm-Reichmann’s notion of the schizophrogenic mother, which despite its manifest flaws, does implicitly recognize that shitty childhoods can actually drive people crazy.
In my graduate work over the last couple of years what never ceases to amaze me is the prominence of abuse (and childhood sexual abuse, in particular) in my work with patients. Freud likewise discovered this in his early clinical work although he abandoned the seduction theory (i.e. sexual abuse) as the underlying cause of hysterical symptoms. Given the overwhelming influence that childhood sexual abuse has on psychopathology (and not merely schizophrenia, e.g. depression, dissociative disorders, personality disorders, eating disorders, etc.), one might wonder why we never hear about this in public discourse. Mental health coverage in this country is notoriously awful, and since the passage of the Community Mental Health Act of 1963 the severely mentally ill have become more invisible, homeless, and incarcerated. Here’s a terrifying fact: more folks with schizophrenia tonight will spend the night in jails than in hospitals. One wonders how these people who not only have experienced more traumas, but are also rendered more vulnerable to abuse given their difficulties, are ever going to get help. It seems the first place to start is to tell the truth about childhood sexual abuse and how it is responsible for so many of our problems. Perhaps nobody has been bolder than Louis Farrakhan in calling out men to stop abusing children at the Million Man March in 1995 in Washington, D.C. Farrakhan, “I, say your name, pledge from this day forward I will never abuse my wife by striking here, disrespecting her for she is the mother of my children and the producer of my future. I, say your name, pledge that from this day forward I will never engage in the abuse of children, little boys, or little girls for sexual gratification. But I will let them grow in peace to be strong men and women for the future of our people.” Twenty bucks says neither Romney nor Obama will once address the problem of childhood sexual abuse on the campaign trail this election year.
We need more public figures to call out this major problem because no progress will be made as long as silence continues. Despite the fact that childhood sexual abuse is revolting, it is surprisingly common (statistics are difficult to estimate, but I don’t think it’s a stretch to think it’s around 30% for men & women, if not higher). As a psychologist in training, nothing is more painful and liberating than hearing someone talk about such issues and attempting to come to terms with what happened to him/her. People spend decades running away from the trauma, and parents, siblings, and friends often collude in the silence because of the terror/guilt it stirs up in them. This takes me back to my beginning discussion of schizophrenia. So many folks are intent on biologizing the disorder and ignoring the social factors. “We, parents, aren’t to blame for this psychotic disorder. We’re victims too”. Sure, maybe you are. But I want to also be vigilant to the fact that psychotic disorders often have historical and traumatic origins (see Davoine and Gaudilliere’s History Beyond Trauma, 2004 for a Lacanian take). We have to hold individuals accountable as well as call into question certain social structures that do nothing but encourage abuse (i.e. the nuclear family).