By Luuk L. Westerhof, MSc
Psychosis and schizophrenia are often regarded as enigmatic, deeply misunderstood phenomena in the field of mental health. Mainstream psychiatry has long framed these experiences as chronic, primarily biological brain disorders that require lifelong pharmacological intervention. This perspective, however, has been increasingly challenged by trauma experts, neuroscientists, and critical psychiatry researchers, who argue that medicalization is a fundamentally flawed and unscientific approach that primarily benefits pharmaceutical companies rather than the individuals it claims to help (Whitaker, 2010; Gøtzsche, 2015; Foucault, 1965; Szasz, 1974). This chronicle argues that psychosis and schizophrenia are not simply the result of a “chemical imbalance” or genetic defect, but are instead profoundly human responses to overwhelming adversity, best understood as neuroceptive coping mechanisms aimed at survival in the face of extreme stress and trauma (Porges, 2011; Mate, 2019; Levine, 2010).
The Medicalization of Distress: A Flawed Framework
For decades, the dominant narrative within psychiatry has been that mental disorders like schizophrenia and psychosis are primarily brain-based diseases, treatable only through biochemical interventions. This perspective, largely driven by the pharmaceutical industry, has led to the widespread use of antidepressants and antipsychotic drugs as first-line treatments (Gøtzsche, 2015). However, this biomedical model is increasingly criticized for lacking robust scientific support, relying heavily on industry-sponsored studies that often overstate benefits and underreport harms (Whitaker, 2010). For instance, a comprehensive meta-analysis by Gøtzsche (2015) revealed that psychiatric drugs, including antidepressants and antipsychotics, are associated with a wide range of adverse effects, including cognitive impairment, emotional blunting, and increased mortality.
Moreover, the very foundation of this model – the chemical imbalance theory – has been widely discredited. A recent systematic review by Moncrieff et al. (2022) concluded that there is no convincing evidence to support the theory that depression, let alone psychosis, is caused by a serotonin deficiency or any other specific neurotransmitter imbalance. Despite this, the psychiatric profession continues to promote this narrative, perpetuating the myth that brain chemistry can be 'corrected' through medication. This approach, critics argue, reduces complex human experiences to simplistic biochemical equations, ignoring mental distress's profound social, psychological, and existential dimensions (Moncrieff, 2022; Whitaker, 2010; Szasz, 1974).
Psychosis and Schizophrenia as Survival Mechanisms
Rather than viewing psychosis and schizophrenia as symptoms of an internal biological defect, many trauma researchers argue that these experiences are better understood as neurobiological responses to overwhelming stress and danger. For example, Stephen Porges’ Polyvagal Theory provides a compelling framework for understanding how the nervous system adapts to perceived threats (Porges, 2011). According to Porges, when a person is exposed to severe, unrelenting stress, their autonomic nervous system shifts into defensive modes, including shutdown, dissociation, or extreme hypervigilance – responses that can manifest as psychotic symptoms in extreme cases.
Similarly, Gabor Maté (2019) argues that psychosis and schizophrenia are not discrete brain diseases, but rather deeply ingrained coping mechanisms that arise when the brain is overwhelmed by trauma. This view aligns with the work of Ruth Lanius and Janina Fisher, who emphasize that fragmented self-states and dissociation are not pathologies in themselves, but adaptive responses to trauma that enable individuals to endure the unendurable (Lanius, 2015; Fisher, 2017).
Moreover, Judith Herman (2015) has long emphasized that many of the symptoms associated with severe mental illness, such as hallucinations, delusions, and disorganized thinking, can be understood as complex adaptations to chronic relational trauma. These symptoms, rather than evidence of a defective brain, often reflect the profound isolation and terror experienced by survivors of abuse and neglect.
The Need for Compassion, Not Coercion
If we reject the medical model, the question then becomes: what do people experiencing psychosis and schizophrenia truly need? If these phenomena are, in fact, neuroceptive survival mechanisms, then the last thing these individuals require is a coercive, drug-centered approach that disregards their humanity. Instead, they must be met with kindness, compassion, love, and patience – qualities that foster safety and trust, and enable true healing (Levine, 2010; Porges, 2011; Mate, 2019).
A.H. Almaas (2004) has written extensively about the transformative potential of unconditional presence and empathic attunement in the therapeutic relationship. He argues that genuine healing can only occur when the therapist sees beyond the diagnostic labels and connects with the person’s core, undamaged self – the part of them that remains whole, despite the trauma they have endured.
Towards a Trauma-Informed Understanding
To shift from a medicalized model to a trauma-informed understanding of psychosis and schizophrenia is not merely a matter of changing terminology, but of fundamentally rethinking what it means to be human. It requires a shift from asking “What is wrong with you?” to “What has happened to you?” – a question that opens the door to proper understanding and compassion. As Peter Levine (2010) argues, trauma is not merely a psychological phenomenon, but a deeply embodied experience that requires an equally embodied approach to healing.
Conclusion: Reclaiming the Human Story
Ultimately, we must move away from the narrow, reductionist frameworks that dominate psychiatric practice and towards approaches that honor the full complexity of human suffering. This means rejecting the dehumanizing language of pathology and embracing a more holistic, compassionate view of mental distress – one that acknowledges the profound impact of trauma and prioritizes human connection over biochemical control (Whitaker, 2010; Mate, 2019; Lanius, 2015; Foucault, 1965; Szasz, 1974).
References
Almaas, A. H. (2004). The Pearl Beyond Price: Integration of Personality into Being: An Object Relations Approach. Shambhala.
Fisher, J. (2017). Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. Routledge.
Foucault, M. (1965). Madness and Civilization: A History of Insanity in the Age of Reason. Vintage.
Gøtzsche, P. C. (2015). Deadly Psychiatry and Organised Denial. People's Press.
Herman, J. L. (2015). Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror. Basic Books.
Lanius, R. A. (2015). The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic. Cambridge University Press.
Levine, P. A. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. North Atlantic Books.
Mate, G. (2019). In the Realm of Hungry Ghosts: Close Encounters with Addiction. North Atlantic Books.
Moncrieff, J., et al. (2022). The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence. Molecular Psychiatry.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W.W. Norton & Company.
Szasz, T. S. (1974). The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. Harper Perennial Modern Classics.
Whitaker, R. (2010). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Crown Publishing Group.
Legg til kommentar
Kommentarer