| A
combat veteran exposed to a loud noise 10, 20,
or 30 years after combat reacts in a predictable
way. Any event, sufficiently intense and similar
to earlier combat experience, can precipitate
a flashback or even a delayed Posttraumatic
Stress Disorder. The reaction is understood because
the initial combat experience was life-threatening.
Few realize that
separation from the mother to the baby can be
more frightening than war trauma to the soldier.
For 150 million years of patterning of the mammalian
brain, separation from the mother has meant death,
and thus the human infant is very sensitive and
easily overwhelmed by events that would seem non-traumatic
to the adult.
To the soldier,
a loud noise in the present precipitates a flashback
to a loud noise in the distant past. To the schizophrenic,
separation from a "most important person"
(husband, wife, girlfriend, boyfriend) - or group
- in the present, precipitates a flashback to
separation from the "most important person"
(mother) in the distant past. The author has found
that each initial psychotic episode -
if the history is known - is precipitated by a
separation from a most important person (or group)
in the present.
To the soldier,
the flashback is to combat experience, behavior
and reality. To the schizophrenic, the flashback
is to infant experience, behavior and reality.
Each piece of bizarre reality and behavior of
the schizophrenic matches in some way that of
the infant at the time/age of the original trauma.
Further evidence
of this shift to infancy is found in the counter-transference
relationship between the mental health worker
and the schizophrenic, which becomes a parent-infant
relationship. When the patient shifts to the infant
mind brain/reality, everyone treats the patient
as though he or she were an infant.
Infant reality
and behavior is so age-specific that the author,
after more than 30 years of matching symptoms/reality/behavior
with age of origin, clinically, is able to identify
the age that the original trauma occurred. The
primary measuring stick for this was the birth-of-a-sibling
trauma in patients born prior to the
advent of the working mother and prior to managed
health care. Separation trauma is worse after
good bonding, and earlier generation infants in
the United States had good bonding in the first
four to six months because mothers stayed home
and did not work. This caused the later separation
to be more traumatic. Mothers also stayed five
days in the hospital after delivery, which produced
more trauma in the infant/toddler at home. Sometimes,
when the mother returned from the hospital, holding
and feeding a new baby, the older child was sent
to the grandmother's house. Few realized the devastating
impact this could have on the older child.
Because of the
severity of this trauma in the earlier generations
studied in the United States, and because of the
high incidence of schizophrenia this may have
caused, whenever a schizophrenic had a sibling
less than two years younger, the age of origin
of the disorder could be ascribed to the date
of birth of that next sibling.
This served as
a guideline for the identification of other infant
traumas. If one observed ten schizophrenics who
experienced the world in the same bizarre way,
and if all ten had a sibling 17 months younger,
then the next time a person was observed experiencing
the world in the same particular way, it could
be inferred that something happened to that person
at 17 months as well.
Approximately
three chances in ten, it was the birth of a sibling,
and the other seven out of ten chances it was
one of the many other separation traumas at that
age. This allowed for the discovery of the other
infant traumas, because it narrowed the search
to a particular age in months.
Research surveys
confirmed many years of cumulative observations.
In the first survey, 60 schizophrenics and 60
control individuals were polled to find how many
had siblings 18 or fewer months younger. Twenty
of the 120 persons had the younger sibling in
the specified age range. Of the 20, three were
from the control sample and 17 were from the schizophrenic
group. Using the binomial equation this reached
the .001 level of significance.
In the next study,
schizophrenic along with psychotic and non-psychotic
major depressive patients with siblings less than
three years younger were polled to find how many
had siblings less than or more than 24 months
younger. The hypothesis (based on 30 years of
cumulative observations) was that schizophrenia
and psychotic major depression had their origins
prior to 24 months, whereas non-psychotic major
depression had its origin between 24 and 34 months.
Based on the expected natality findings of equal
distribution in the two age groups, the survey
reached the .001 level of significance with a
mixture of the first 35 schizophrenic and depressed
individuals who had one sibling less than three
years younger. When the number of schizophrenics
in the survey reached 35, that too reached the
.001 level of significance, and when the number
of non-psychotic major depressive patients reached
35, that also reached the .001 level of significance.
Sarnoff Mednick
of the University of Southern California tested
the birth-of-a-sibling trauma on 6,000 patients
in the Finnish data base on schizophrenia, and
found it highly significant. He stated that there
was a substantial increase in sibling births in
the first two years of life among those who later
developed schizophrenia. The traumas in the
first two years of life, which correlate with
the later development of schizophrenia, are the
same traumas that correlate with the later development
of non-psychotic major depression when they occur
in the next year of life. Thus, major depression
and schizophrenia share the same mechanism, with
schizophrenia activating slightly earlier developmental
regions of the brain and exhibiting slightly earlier,
and therefore more bizarre, behavior and reality.
All traumas have one common denominator - a relative
degree of physical or emotional separation from
the mother as experienced by the infant or toddler.
Biological
Psychiatry
Equally as convincing
as the delayed Posttraumatic Stress Disorder mechanism,
and the research survey data, are the biological
and neuropsychological research findings, which
confirm the delayed PTSD model. The combat veteran
flashes back to the adult brain structures he
was using during his combat experience, but the
schizophrenic shifts to phylogenetically earlier
developmental brain structures that were active
and developing at the time/age of trauma during
infancy.
The earlier developmental
brain structures produce proportionately more
of the neurotransmitters involved in the schizophrenic
process, and when reactivated, that is what they
do. Likewise, along with the activation of the
earlier developmental structures, there is a relative
deactivation of higher cortical structures, and,
as with any other part of the body not used, there
develops a disuseatrophy.
All biological
changes and neuropsychological changes can be
seen in terms of a partial shift in activity to
the earlier brain structures and functions. The
initial flashback, or the initial awakening of
the earlier mind, is a partial flashback to the
entire earlier gestalt (i.e., a partial flashback
to the mind/brain/reality/feelings/behavior/chemistry/physiology
and neuroanatomic sites that were active at the
time/age of the original trauma), and it is the
author's opinion that all or nearly all biological
change is a result of this process.
Biological psychiatry
has provided valuable information in terms of
proving the Unification Theory of Mental Illness,
particularly since all biological change reflects
physical representation of the shift of brain
activity to phylogenetically earlier developmental
brain structures. If indeed, the biological change
is the result of the disease process,
then biological research alone cannot identify
cause and prevention. For this reason, it is necessary
to explore the unrecognized separation traumas.
The Unification
Theory of Mental Illness, according to O. Spurgeon
English, who first suggested the name, is a marriage
of psychological and biological approaches, spanning
the neuroses and the psychoses, from infancy to
old age. It is presented in the textbook Delayed
Posttraumatic Stress Disorders From Infancy: The
Two Trauma Mechanism, by McKenzie and Wright,
which describes the above mechanisms in far greater
detail. It expands Posttraumatic Stress Disorder
to include possibly all serious mental/emotional
disorders. The textbook is available through the
author or through the University of Toronto Press.
©1998
by The American Academy of Experts in Traumatic
Stress, Inc. |
