For decades it has been assumed within mainstream psychiatry that psychosis has a genetic basis and that the social environment has little influence.
But this conventional wisdom is now being challenged.
On Friday I attended the Soteria Network Conference 2011—Alternatives Within and Beyond Psychiatry.
One of the keynote speakers was Professor Richard Bentall, the author of Madness Explained and Doctoring the Mind, who gave us a preview of current research he and his colleagues and students are working on and which looks set to change how we think about psychosis. They have examined hundreds of published academic papers using meta-analysis—a statistical technique for aggregating the results over many studies—and what they have concluded is that ‘social inequality and racial discrimination drives people crazy'.
Other early traumas in life, such as child sexual abuse, physical abuse and bullying, increase the risk of psychosis, Professor Bentall explained. Their results show that, those who are traumatized in early life are three times at greater risk of becoming psychotic in adult life.
And in another study it was found that those who had experienced childhood sexual abuse were ten times at greater risk of having hallucinations.
This new work builds on research over the past decade by Professor Bentall and others such as Professors John Read and Mark Shevlin which has also begun to illuminate the links between early abuse, trauma and psychosis.
Professor Bentall cautioned that while early trauma increased the risk of psychosis, not everyone who has had early trauma will develop psychosis, and importantly, not everyone who has psychotic experiences has experienced childhood abuse.
It seems likely that as research continues to develop in this important area we will increasingly discover that the problems people face in their life often have their roots in traumatic events, regardless of their psychiatric diagnosis.
The diagnosis of Posttraumatic stress disorder (PTSD) has been helpful in acknowledging that psychological problems can result from traumatic events, but perhaps there has been too much emphasis on PTSD at the expense of recognising that trauma may be at the core of many other psychological difficulties that people experience.
If early trauma is one cause of later psychosis, which it now seems to be, there are profound implications. Psychologists and psychiatrists can't assume a purely biological cause; they need to talk to people diagnosed as psychotic about what has happened to them and to explore non-medical ways of helping as alternatives to drug-based therapies.
To find out more about my work: http://www.profstephenjoseph.com
Bentall, R. (2011). The Social Origins of Psychosis. Paper presented at the Soteria Network Conference 2011. The Riverside Centre, Derby. November 11th, 2011.
To find out more about the Soteria Network, see: http://www.soterianetwork.org.uk/index.php