Trauma, Loneliness & Psychosis: Thoughts from ISPS-US President


Adapted from Dr. Brian Koehler’s upcoming article for the American Psychoanalytic Association on the relationship between Trauma, Loneliness and Psychosis.

Trauma, Loneliness & Psychosis
Early life trauma such as physical/emotional/sexual abuse as well as
neglect, bullying and social isolation, are correlated with pervasive
neural alterations in both gray and white matter in the CNS, e.g., atrophy
and dysmyelination, respectively (Lanius, Vermetten & Pain, 2010). In 1997
at our ISPS internal conference in London, I proposed that the
neuroscience of the severe mental disorders overlaps with the neuroscience
of chronic and profound stress, trauma, social isolation, extreme
loneliness and social defeat. Fourteen years later, I am even more
convinced that this might be so for many persons diagnosed with a severe
mental disorder. The role of various kinds of traumas in psychotic disorders
is being increasingly recognized (Larkin & Morrison, 2006), e.g., the
catastrophic interaction hypothesis involving stress, trauma, emotion and
information processing abnormalities (Fowler et al. 2006) and theories
linking cognition, emotion and the social world (Bebbington et al., 2008).
Social isolation and loneliness can, among other things, undermine our
capacity to think clearly, and regulate our emotions as well as paranoid
experience of others (Cacioppo & Patrick, 2008). In humans, loneliness,
which is associated with higher rates of mortality/morbidity for every cause
of death, has been demonstrated to predict the progression of
neurodegenerative disease as well as to alter DNA transcription in the cells
of our immune system (Cacioppo & Patrick, 2008). In addition to the
consequences of cardiometabolic disease secondary to the use of second
generation antipsychotic agents (e.g., Zyprexa), perhaps trauma and
loneliness (i.e., social disconnection) are partly responsible for the
reduced longevity in persons diagnosed with severe mental disorders (Insel,
2009).

Pervasive stress-induced neuroplastic changes may be observed in persons
with schizophrenia. Hoffman (2007) suggested that social
deafferentation-induced neuroplasticity plays a role in schizophrenia. He
noted: “…it is at least plausible that severe social withdrawal in humans
during critical developmental periods induces deafferentation-like
reorganization in regions of association cortex underlying social cognition
that consequently produce spurious experiences with social meaning [e.g.,
hallucinations, delusions]” (p. 1067 ).

References:

Bebbington, P. Fowler, D., Garety, P. Freeman, D. & Kuipers, E. (2008).
Theories of cognition, emotion and the social world: missing links in
psychosis. In C. Morgan, K. McKenzie & P. Fearon (Eds.), Society and
Psychosis, pp. 219-237. Cambridge, UK: Cambridge University Press.

Cacioppo, J. T. & Patrick, W. (2008). Loneliness: Human Nature and the Need
for Social Connection. New York: W. W. Norton & Company.

Fowler, D., Freeman, D., Steel, C., Hardy, A. et al. (2006). The
catastrophic interaction hypothesis: how do stress, trauma, emotion and
information processing abnormalities lead to psychosis? In W. Larkin & A. P.
Morrison (Eds.), Trauma and Psychosis: New Directions for Theory and
Therapy, pp. 101-124. London: Routledge.

Hoffman, R. E. (2007). A social deafferentation hypothesis for induction of
active schizophrenia. Schizophrenia Bulletin, 33 (5): 1066-1070.

Insel, T. R. (2009). Translating scientific opportunity into public health
impact: a strategic plan for research on mental illness. Archives of General
Psychiatry, 66 (2): 128-133.

Lanius, R. A., Vermetten, E. & Pain, C. (2010). The Impact of Early Life
Trauma on Health and Disease: The Hidden Epidemic. Cambridge, UK: Cambridge
University Press.

Larkin, W. & Morrison, A. P. (2006). Trauma and Psychosis: New Directions
for Theory and Therapy. London: Routledge.

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1 Response to Trauma, Loneliness & Psychosis: Thoughts from ISPS-US President

  1. zeemaharaj@mweb.co.za says:

    Good Day
    I am the mother of a 30-year old, Milu, who was diagnosed with schizophrenia when he was about 19, having at 10 been described by educational psychologists as ‘highly gifted, in the top 0.01% of the world’s intelligentsia’ (intelligence can be a curse, it seems!)
    The depth of his loneliness and sense of isolation that came a) from his intensely missing his beloved, absent father (who was a South African freedom fighter), b) from my own absenteeism as a single mum trying to put bread on the table and c) from his not ‘fitting in’ with other children – for reasons that had to do with more things than his giftedness – was a source of great pain for him, for his younger sister and for me (his dad was not aware of it).
    Milu lives with his father now, who tries hard to make his life better . But Milu’s social withdrawal (he is ashamed of his condition and keeps apologising for it partly because the rest of us are successful and high achievers, I guess) is at odds with the intense loneliness he still seems to feel. As a result, his mental condition seems to be deteriorating even though his warmth and often ‘togetherness’ contradicts the so-called blunted emotions and presence of mind schizophrenics are supposed to suffer.
    Reading your notes (‘Trauma, Loneliness and Psychosis’) I remain convinced that Milu’s problems started at age 7 when his loneliness was exacerbated by arriving in a strange, hostile-seeming country (the school accepted him, then reneged on its decision but accepted his sister!!) at a time when his nightmares about his father’s being tortured to death in prison were most vivid – and when he had no one, only his little sister, he felt he could talk to about any of this (I for one, preoccupied as I was, totally oblivious that mental illness could be lurking within the family!).
    I am prepared even today to do whatever it takes to try and help Milu break out of his vicious cycle of loneliness and ever-lowering self-esteem, to try and help him attain a better quality of life – even if it means taking him for interviews where he might talk about the pain of his past (and present) especially if there is a chance that this will benefit others too by throwing light on the impact of trauma on mental illness. By the way, he can be extremely articulate when he wants to be.
    Please let me know if we could help Milu by helping him open up to professionals like you.
    I continue to hope for him.
    Regards
    Zee Maharaj

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