Delayed Posttraumatic Stress Disorder Model for Schizophrenia and Depression
(The Unification Theory of Mental Illness)
Clancy D. McKenzie, M.D., B.C.E.T.S
Philadelphia Psychiatric Consultation Service

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.