Are general MDs and psychiatrists not trained in medical school and/or during psychiatry residency to know the difference between somatized trauma and psychosis? I just heard a chilling history from a new client. Her urinary and bodily symptoms including chronic irritation could not be diagnosed with tests, so she was put on psych drugs by her primary, and then, probably due to having good insurance, misdiagnosed as psychotic and sent to a locked ward for almost two weeks. Apparently, she was never asked, "what happened to you?" Her somatized physical symptoms MATCH the physical, digital abuse she suffered almost daily for years. Maybe "The Body Bears the Burden" by Bessel van der Kolk, MD, needs to be required reading. If this critical diagnostic information is missing in medical schools and psych/therapist schools, the trauma-informed community needs to do something to get it into the curriculums.
Doctors need to learn about this. Can someone tell doctors everything that is known about dissociation because medical school doesn’t teach anything. I was taught the DSM lists and that’s it.
Hi Tina, Thanks for your reply. I taught LCSWs and MFTs for CE in California for 4 years and all of them were taught "parts work" which is just a continuation of CBT and which results in, (according to dozens of clients who have had it) a dialogue between the adult and one or more of their child selves, but which doesn't release the traumatic imprints from the limbic brain or body. It's more insights and coping skills, not to be confused with becoming symptom-free.
During part of the tenure of the 1974 National Health Planning Act [Public Law 93-641], I worked on the only 'Patient-Governed Ward' at our State [psychiatric] Hospital. We did not have a psychiatrist assigned there, rather a 'National Health Service Corps' Family Physician, who went to 'great lengths' to assist a Patient who previously worked as a Public School Teacher, who was also an 'Incest survivor'-but when given a sex-educ 'task' at her teaching job, started 'having problems'.
At about that time, the 'Health Law Project Library Bulletin' published an article by a Family Physician who described three 'patients' who taught him things that weren't included in his medical school curriculum: 1) was a 'couple' wanting a 'home birth'-who taught him how he said he would have liked to have been born; 2) was an elderly man, near death, who wished to die at home, surrounded by family and friends... who taught him how dying with dignity might occur; and 3) a 'Heroin Addict' he passed outdoors on his walk to his office every morning, who he usually acknowledged/later greeted...turned out to also be a VietNam Veteran who had been at a Landing Zone machine gun post, at night, when the 'VC had attacked, and unbeknownst to the 'gunner', the VC had marched all the women and children of a nearby village in front of the Viet-Cong's advance on the landing zone. When the sun came out, the machine gunner had 'discovered' all the dead unarmed women and children...During a conversation with the Physician, on the street one day the man had shared this. The Physician explained that it was not entirely the 'gunners' fault, as combat-under those conditions is challenging, Less than a week or so later, the Veteran asked him for help quitting heroin, and was able to successfully do so a short time later.
The medical model drives me crazy! During an otherwise fine report on NPR this past week, aimed at reducing the stigma around mental illness, not one mention was made of trauma as the cause. Apparently it’s much easier to categorize people according to DSM laundry lists, but recognizing folks as resilient survivors of trauma would be far less stigmatizing than the claim that psychosis is just another illness like flu or cancer. That’s all well and good, but healing has to go much deeper— and much wider.
This is a systemic problem. It’s great that in the 19th century, the slaves were emancipated but the reality of racism that made slavery acceptable remains a huge problem on all levels of society. It’s the same thing with trauma. Unless we deal with the underlying causes of mental illness, the changes remain surface only.
To what extent does big Pharma have a hand in keeping things this way?
Helen, you're right in that it is a pervasive systemic problem. There are billion$ of reasons why Big Pharma is in the addiction and symptom-suppression business, especially where psych meds are concerned. There are a number of doctors who have written books on the same topic, one being "Medication Madness" by psychiatrist Peter Breggin. Healing/curing is misunderstood as losing money. The truth is that when someone is healed/cured, they tend to tell everyone who will listen about their great results and who treated them.
I'm chiming in from Toronto Canada. We are seeing something like this with the female Yadizi refugees who have come to Canada and are survivors of the ISIS camps. There were bartered/traded/sold into serial 'marriages' with ISIS fighters as a reward for joining ISIS. Some are/were children.
Hi Emma-Lee, thank you for this. In Bessel van der Kolk's work, he shows an old black and white film of WWI combat veterans with uncontrollable shaking and tremors similar to what you're describing.
Obviously, this intense level of PTSD/trauma embedded in the brain and body is not going to yield to any kind of conventional CBT or other talk therapy and with the dissociation, anything involving exposure like EMDR will only cause more dissociative abreactions and probably drive the trauma deeper. Symptom-suppressing drugs can make survivors worse and cause suicidal ideation.
From the article: "Doctors have scanned Mejo's brain and found no signs of epilepsy. She has been prescribed medication and is going to therapy, but nothing has helped."
The root problem here is that the torture/overwhelm caused dissociation and now the complete body/mind trauma imprint-- sights, sounds, smells, touch, taste, as well as the emotional overwhelm-- are encapsulated in a dissociative state.
Conventional cognitive approaches to treat dissociation, ("parts work") will not work on these people. What will work is a very slow and gentle unraveling of the traumatic aspects with EFT, Emotional Freedom Techniques or TFT, Thought-Field Therapy. There are various EFT techniques that minimize or prevent retraumatization, then the dissociation has to be treated.
Dissociation is, (having literally seen evidence of this clairvoyantly in my practice,) when ages of us, detached segments of our consciousness, are trapped, still suffering, one dimension away. Those ages/parts need to be rescued and recovered back into present time, which can be done quickly using a specific guided imagery script. There have to be some outcome-based adaptations to the conventional model paradigm in order for severely traumatized people to heal.
The closest thing to TFT research on torture survivors is a study and accompanying video that a team of my colleagues did in Rwanda. They worked with genocide survivors, most of whom became symptom-free or measurably better with a one-hour session of evidence-based TFT, Thought-Field therapy, (another version of EFT tapping) guided by an interpreter. The study is attached. Here is a short video done a month ago as a 4-year follow-up on the original RCT study featuring Dr. Suzanne Connolly, one of the researchers. https://www.youtube.com/watch?v=358ubhtPvC0
How about Neurofeedback? Just curious. It seems first we have to tame a Fear Driven Brain.