Our Mental Illness Crisis & The Doctors’ Blind-Spot.
Until ‘traumagenic dysphasia’ trips off the tongue as smoothly as ‘antibiotic’ we’re sunk.
PLEASE CIRCULATE BOTH THIS, AND THE LINKED PAPER AS WIDELY AS YOU CAN – newspapers, radio, TV, podcasts whatever – only by building up enough steam can we shift this juggernaut.
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Our Mental Illness Crisis & The Doctors’ Blind-Spot.
Until ‘traumagenic dysphasia’ trips off the tongue as smoothly as ‘antibiotic’ we’re sunk.
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COVID WAS TRAUMATIC. But whereas doctors did treat the virus, they continue to mistreat the trauma. Such medical neglect wastes lives. The overlap with the 1890s is uncanny – except in those days it was “germs”, not “trauma”, that was medically taboo. Tragically, medical intransigence then, led to many needless cholera deaths. Today, huge numbers of lives are wasted, because the medical profession again actively resists massively overdue innovation. “Long Covid”, for example will remain needlessly excruciating, and wilfully inexplicable, medically – until doctors can be persuaded to relent.
One potent disbeliever in “germs”, Max von Pettenkofer, was only undone when one side of a particular street escaped cholera, while the other side succumbed. What made the irrefutable difference was that one side, though otherwise identical, had intact sewage. This proved beyond any unreasonable medical doubt that cholera cannot occur, if uncontaminated drinking water is in adequate supply.
Precisely the same pivotal proof for trauma is readily available, lacking only the UK government’s approval. Instead of comparing the two sides of a given street, the one with intact sewage, the other without – all that needs to be compared are two phases in the lives of some 50 dangerous, violent prisoners – both before and after their trauma had been given the priority it fully deserves, on strictly medical grounds.
A Special Unit in Parkhurst Prison UK, 1991-1996, handled a number of long-term prisoners, especially selected for their ill-discipline, instability and violence. Running them through the prison computer system would be as easy as counting the number of cholera cases on one side of a street, compared with the other. In this case, known as the ‘waiting-list-control’, the number of antisocial infractions would be as strikingly absent, post Parkhurst, as were the cholera cases in the street which undid von Pettenkofer.
Of course, neither “germs” nor “trauma”, are quite as visible as doctors have come to hope for. With the first, all microorganisms are invisible to the naked eye – they require both microscope and Petri dish. Whereas the second calls for brainscan equipment, as mentioned in the attached paper. Unless and until the investigator admits these unaccustomed procedures into the argument, no amount of non-subjective scientific proof can possibly prevail. There is an additional hurdle in the present case, in that trauma actively distorts thinking out of all recognition, both the patient’s and potentially the observer’s. This additional mental barrier brings heavier obstacles, all of its own.
No sentient clinician would expect a coherent clinical history from a patient suffering from a Cerebro-Vascular-Accident – it wouldn’t make any raw clinical sense to do so. People suffering from such a stroke, cannot talk coherently. Some 30 years ago, Professor Van der Kolk found that the same applied to those recalling trauma. Trauma, he proved, renders its victims speechless with terror.
Van der Kolk points out that once Broca’s Area, the brain’s speech centre, is paralysed, because of inadequate blood supply – then no patient whatsoever can, in his phrase, put thoughts and feelings into words. In 2014 he wrote “Without a functioning Broca’s area, you cannot put your thoughts and feelings into words. Our scans showed that Broca’s area went offline whenever a flashback was triggered.”
Even so, from a strictly medical practice viewpoint, this does not call for anything exceptional in the way of practitioner activity – certainly no belief is required into any intangible entity or other ungrounded postulate. But what it does demand is an enhancement of what should be standard clinical practice in every case. But with two additions. The standard medical requirement is that the doctor take as coherent a history as available circumstances will allow, and further, that the patient’s fully informed consent be obtained at every juncture, without exception. The latter is especially wanting in too many psychiatric consultations today – how psychiatry can presume to progress, safely, without it, begs a whole panoply of questions.
The two additions to the standard clinical approach are described in the paper. Without them, any beneficial impact from medical practice is jeopardised. And the longer doctors ignore this “trauma” challenge, as it did for decades with “germs”– then the more iatrogenic damage must inexorably follow.
Just pause to consider how catastrophic this disability is. As the attached paper spells out, this difficulty in thinking through and describing symptoms can play havoc with all branches of medical practice. The phrase traumagenic dysphasia, which covers this point, will inject penetrating dismay into the heart of every clinician, until it is fully accepted as an integral part of clinical practice. Until it is taken into account in every clinical setting, including surgery, but especially psychiatry, then doctors will be practising with occluded vision, as already happens within the cacophony of DSM diagnoses.
Do we have to wait for customers to pressure this troubled profession into allowing them to benefit from immediate relief like ‘Pat’ received in the attached paper? And like the further 50 or so such cases, to be included in a later paper, which responded to my trainees’ input, within one or two interventions and no drugs. Surely doctors can admit their blindspot and remove it without the need for patients to press them to do so?
Freud was a colossus in psychiatry, so I’m delighted to report in this paper how, during the limited time he was working with Josef Breuer, he explicitly endorsed precisely the approach advocated here, and to do so in his characteristically uncompromising way. Unhappily for us all, he then succumbed to his own version of traumagenic dysphasia, even to the age of 81, as noted therein.
Today the “Max von Pettenkofers of Trauma” currently hold sway. They urgently need silencing by a major effort of the existing general medical establishment, perhaps guided there by the wider public. Obviously, it’s only a matter of time, before doctors do catch up, just as they did with “germs” – but how long will it take?
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Professor Bob Johnson, Consultant psychiatrist (retd), visiting professor School of Psychology, University of Bolton, BL3 5AB, UK. DSc (hon), Member of Royal College of Psychiatrists, Member of Royal College of General Practitioners, PhD (med computing), MA (Psychol), MBCS, DPM, MRCS, GMC num. 0400150. Https://unisciencepub.com/abstract/where-re-aligning-her-coping-strategies-eliminated-17-years-of-panic-attacks/