Transcript Survivors disclosing to deaf ears

Survivors experience of the mental health system
Blind Eyes and Deaf Ears
Simon Mullins
Prevalence within mainstream services
History of childhood abuse (either sexual or physical) for
Inpatient and Outpatient populations with at least half
diagnosed with ‘psychosis’
Men (15 studies, 518/877)
59.1%
Women (23 studies, 960/1395)
68.8%
Acta Psychiatr Scand 2005: 112: 330–350
Understanding the association of childhood abuse with
suicide, depression, PTSD, Borderline PD and other
conditions is more established
The link between
childhood trauma and
‘psychosis’ is a younger
debate and more
controversial
Childhood trauma, psychosis
and schizophrenia: a literature
review with theoretical and
clinical implications
J. Read, J. van Os, A. P. Morrison, C. A. Ross
Acta Psychiatr Scand 2005: 112: 330–350
Controversy
Child abuse is a causal factor for psychosis and
schizophrenia and, more specifically, for
hallucinations, particularly voices commenting
and command hallucinations.
Acta Psychiatr Scand 2005: 112: 330–350
Reality
Many people receiving care in psychiatric
services who are diagnosed with psychosis
and schizophrenia have been abused in
childhood.
Service users subjected to CSA or CPA have;
Earlier first admissions
Longer and more frequent hospital admissions
Spend longer in seclusion
Receive more medication
More likely to self-harm and to try to kill themselves
Have higher global symptom severity
Acta Psychiatr Scand 2005: 112: 330–350
What does it mean for survivors to have
their distress medically labeled as
symptoms of a disease?
WHAT’S ON A PSYCHIATRIST’S MIND?
DIAGNOSIS
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1917:
1952 (DSM I):
1968 (DSM II):
1980 (DSM III):
1987 (DSM III-R):
2000 (DSM IV):
59
128
159
227
259
357
DSM-II; 1968
Depression
This disorder is manifested by an excessive
reaction of depression due to an internal
conflict or identifiable event such as the loss of
a love object or cherished possession.
DSM-III 1980
Depression
A:
At least five of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood, or (2) loss of interest or pleasure. (Do not include symptoms that are clearly due to a physical condition, mood-incongruent delusions or
hallucinations, incoherence, or marked loosening of associations.)
(1) depressed mood (or can be irritable mood in children and adolescents) most of the day, nearly every day, as indicated either by subjective account or observation by others
(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation by others
of apathy most of the time)
(3) significant weight loss or weight gain when not dieting (e.g., more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (in children,
consider failure to make expected weight gains)
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
B:
(1) It cannot be established that an organic factor initiated and maintained the disturbance
(2) The disturbance is not a normal reaction to the death of a loved one (Uncomplicated Bereavement)
Note: Morbid preoccupation with worthlessness, suicidal ideation, marked functional impairment or psychomotor retardation, or prolonged duration suggest bereavement
complicated by Major Depression.
C:
At no time during the disturbance have there been delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms (i.e., before the mood
symptoms developed or after they have remitted).
D:
Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS.
Aetiology of depression and schizophrenia:
current views of British psychiatrists
The Psychiatrist (2009) 33: 374-377
Most psychiatrists thought that genetic and
biochemical factors are significant in the aetiology
of schizophrenia (85%) and depression (70%).
Psychiatrists thought that ‘childhood factors’
(including history of abuse) are more important if
someone is assessed to have depression (65%)
but not if schizophrenia is diagnosed (20%).
Professional blinkers, the blind eye
Psychiatrists tend to view ‘psychosis’ as an organic
disease and subsequently this poses a barrier to
understanding the roots of distress which frequently
relate to childhood traumatic events.
Survivors disclosing to deaf ears
Survivors disclosing to professionals need support to
make transformative links between their distress
(‘symptoms’) and their life experience. Psychiatric
labeling of voices becomes another barrier for survivors
to report abuse to professionals as their human reaction
to life events is seen as a disease.
Barriers 3 (Delancey Street), 1998
Courtesy Spencer Tunick and the I-20 Gallery, New York