The Effects of Trauma on Psychosis

CNN: Little boy in Aleppo a vivid reminder of war’s horror

By now, most of you have probably either seen or come across this child’s photo on the web. And for some brave few, you have also probably seen the video that details his rescue and accompanying story behind the image above.

His name is Omran Daqneesh, and he is a Syrian refugee survivor of the ongoing civil warfare in Syria. His family survived the bombings in Aleppo and he is shown in the image above–sullen, despondent, and suspended in shock. The video shows him being quiet, still, and calmly trying to make sense of what has happened to him. It appears that he is trying to orient himself to the situation at hand. Why is there blood coming from the top of my head? Who are all these people–looking at me, taking my photos, shouting and shining bright lights at me? Unfortunately, images like these tend to lose their value and become old news in a matter of days, no matter how gut-wrenching and horrific. We humans tend to forget quite often and too soon. His experiences become sensationalized for the moment, and we move on to the next interesting headline.

From a research standpoint in clinical psychology, I often linger on these silent but powerful images. I become interested in what happens to people after their experiences with trauma, and how their lives might play out hereafter. For this specific child, I grow heavily worried about what it means to be a survivor of a traumatic event such as warfare. I also grow increasingly concerned about how this pivotal experience in his early childhood will contribute to future maladaptive development in his cognitive, psychological, social, and emotional functioning. There is ample research to date that suggests how adverse childhood experiences (ACEs) are detrimental to one’s physical and psychological health, often showing its negative effects well into adulthood. ACEs become high-risk factors for more serious mental illness, such as Posttraumatic Stress Disorder, Major Depressive Disorder, and Schizophrenia. Examples of ACEs can vary from bullying by peers in the school setting, witnessing domestic violence, physical abuse, sexual abuse, to hearing about something bad that has happened to another person causing marked and intense fear in the individual. In addition, there is a dose-response relationship that has been noted; that is, the greater the amount or increased total duration of lifetime ACEs, the more likely one is at risk for developing serious mental illness.

We all worry about mental health concerns, but the most pressing of all is the experience of psychosis symptoms. Too often, there have been cases that present both trauma and psychosis symptoms. Yet, surprisingly, there is no current evidence-based treatment that comprehensively addresses the symptoms of trauma-related psychosis. In fact, a recent article focused on this very topic where refugees are found to be at increased risk for developing psychosis symptoms. As part of an NIMH initiative, more and more early psychosis treatment and intervention programs are emerging in the U.S. However, the current clinics are sparse and are primarily able to provide services to health care consumers in their nearby area, leaving most of the U.S. with limited access to top-quality research-supported early clinical intervention. In addition, the National Child Traumatic Stress Network boasts a list of evidence-based treatment and an outpouring number of online resources to help individuals provide care and address childhood trauma.

In an ideal world, this would be enough to get children like Omran the help he needs. But children like Omran are probably far from likely ever receiving such top-quality care. Many get stuck in the cracks of healthcare disparities and never get the treatment they need and deserve. As research shows, early risk factors such as abuse, trauma, and neglect create a negative impact on a child’s emerging view of the world around him/her. To find that, again and again, the negative life events they experience serve as constant reminders that they are bound to are caused by internal, stable, and global factors can push anyone to the point of hopelessness and helplessness. And yet we still wonder why such extreme ideologies, behaviors and cruelty exist in our world? When we do not stand up for others’ suffering, we risk standing for nothing and losing everything.

Why do we care? Because what we do know from the growing amount of research in trauma literature is that there is a dynamic interplay that occurs between trauma and psychosis: early adverse child events such as trauma can increase one’s vulnerability for later development of psychosis; in addition, those who go on to develop symptoms of psychosis are more apt to show greater vulnerability for future traumatic experiences. And it goes on and on.

How do we effectively intervene? This is where I dare you, the reader, to become an active member of your community and find a way to contribute to the improvement of mental health treatment. Donating money is not enough. Often we do not even hear about or know exactly how our donations are used to help others. Here are other ways to help:

  1. Support your local NAMI chapter
  2. Support NCTSN
  3. Volunteer at a shelter
  4. Become a mental health ambassador
  5. Offer your time and listen to others who are in need of your help
  6. Promote open discussion of mental health and help reduce the stigma of mental illness
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