How Trauma Simplifies The Science Of Sanity

As mentioned earlier, I join 350 psychiatrists around the world, critiquing psychiatry. Herewith my response to a regular contributor there. Here I call her “L”. She wrote –

Bob as we “discussed” in our interchanges from a long time ago, am I correct that you think that trauma is a permanent wound?  

That’s right L, it’s the permanent-wound type trauma which stirs me, and it does so, ever so much more, the more I think through my multitude of cases. And the reason it does, has such an obvious simplicity, all to itself. It’s the fact that all this muddle gets steadily simpler that keeps me going – unlike Freud who had to enlist ever more disparate bodily functions.

It is precisely 37 years since September 1986, when my pivotal case with the ‘axe-lady’, opened my eyes to the clinical fact that there are traumas which the patient cannot tell themselves (nor therefore you) about. From this it is clear that there are two, radically distinct categories of childhood trauma – the everyday ones, and the non-survivable ones.

Every toddler falls over, sometimes mum dies – infancy is trauma-prone for all. BUT it’s what happens next that makes all the difference, all the difference in the psychiatric world.

You fall over – but someone is there to pick you up. Your parent dies, but other adults are immediately to hand to reassure, to ‘save’ you – to put an otherwise devastating event into a life-long perspective – your life is never seriously at risk, you are secure, your mental world has stability, has longevity – no worries.

HOWEVER, if your dad throws your mum down stairs, when you are 4 (as he did for the serial killer I call ‘Alec’, in my book), then your mental world implodes – because there’s no one there to put it back together for you.

Two types of trauma therefore – the one survivable, the other life-threatening. It happens. And the ‘remedy’, the only ‘solution’ that the second category can come up with in infancy, is ‘frontal blockage’ – don’t think any further, DO NOT RECALL – or you're dead.

So this is a ‘life-saving’ mechanism – a type of self-defeating auto-immune emotional response, akin to some sort of obstructive mental anaphylactic shock – reasoning, instead of saving your life, exposes you to worse. So ‘you’ and your ‘mind’ shuts off all cognition, in a desperate attempt to deflect an otherwise lethal scenario. Homo sapiens then becomes homo non-sapiens, ensuring that life is ephemeral, is cheap (including your own), as with Hitler, Putin and too many others – with all and every variety of psychiatric morbidity in between. Who wouldn't get depressed, when you can’t see/think any way out of an on-going quasi-lethal scenario? ADHD, addiction and even psychotic symptoms – all arise through blocked frontals – blocked to ‘preserve’ your very own life from the lethal figments which still insist on assailing you. DSM-psychiatry, since 1980, could not be more wrong-headed, nor psychodrugs less appropriate.

Don’t think it, don’t say it, and you might just possibly live a bit longer. Think it, say it, and the axe will fall, or dad will throw you downstairs next – when your life will assuredly be over. Given a choice between non-thought and death – too many choose to not-think. So they can never ‘think through’, can never see that they are now adult, and that childhoods of whatever hue, are over. And the axe continues to be about to fall in perpetuity, as it did on that first fateful occasion.

My axe-lady was 6 when her father, in a drunken rage, waved a hatchet at his family, cut holes in the door they were hiding behind, and threatened to ‘kill you all’. It took her 9 months of not-talking about this, of not disclosing this event to me, during our weekly hour long sessions – until she must have concluded I wasn’t going to go away, so she might as well risk telling me. Which she did. And then, contrary to her earlier firm (and unspoken) belief – she survived. And she survived because the axe-event had ended all of 34 years before, and her father had actually been dead 4 years , so could no longer wield axes of any kind. (I already knew this, having also been his family doctor too). He couldn’t in reality  – though every micro-second, he continued to do so in her head.

Thus memory of non-survivable trauma self-perpetuates.  And it will persist, until you meet someone strong enough, but also safe (trustworthy) enough, to unpack your deepest fear, without them killing you off, in the very telling. She said – “The axe is still there, you fool”. I said —“Oh no, it’s not”. And – eventually – she believed me, as have countless others, including most of the 50 murderers I tackled in Parkhurst Prison, and so many different people since.

That, essentially, is why they don’t know why they killed. Just as Putin doesn’t really know why he invaded Ukraine – he gives you a lot of guff – but the real reason for doing it, he keeps well buried – in case it kills him. Letby, the baby-serial-killer, provides us with a horrendous instance of non-sapiens – if you’ve a more cogent explanation for her exceptional inhumanity, then I hope you have better luck at disseminating it than I have had. On the other hand, ‘Alec’ demonstrates that it is certainly possible to regain sapiens status – so in that sense, his life-threatened trauma has ceased to be permanent. . . . . .

This radically different approach to quotidian psychiatry is a tall order for any profession to accept, especially one which deals with patients who are generally all too eager to inundate you with interminable, and otherwise utterly irrelevant, symptoms. Here is the crucial item you need to winkle out from under the deluge – with their consent, and very much against their better judgement – else you, being powerful and quasi-parental, will kill them off, just as easily as nearly happened long decades ago.

Let’s suppose, for the sake of argument, that what ails the psychiatric patent is invisible to (and unspeakable by) the psychiatric patient – how long will it take the medical profession to wake up? Freud half saw this – most don’t even begin. And the DSM-III (1980) vetoed it from the off.

For me, personally, it elevates psychiatry to be queen of the medical sciences – but it's not obvious how many of my medical colleagues I can take with me to that elevated position. Until then, I content myself with muttering on about it, as much as I am able.

Rock on L, and let me know what you think

Thanx

Bob

Professor Bob Johnson, DSc(hon), MRCPsych, MRCGP, PhD(med computing), MA (Psychol), MBCS, DPM, MRCS, School of Psychology, University of Bolton, BL3 5AB, UK.      GMC num. 0400150

 Thursday, 24 August 2023