How Psychiatrists Talk About the Relationship Between Trauma and Psychosis

In recent years there has been increasing interest in the debate regarding the role of trauma and abuse in the development of distressing experiences labelled as 'psychosis'. However, despite literature reporting a high prevalence of physical and sexual abuse in those diagnosed with psychosis, the aetiology of psychosis has been predominantly constructed as best understood through biomedical or disease models. Research suggests such models are most strongly endorsed by psychiatrists in relation to the categories of psychoses, in particular schizophrenia. These models tend to position life events as triggers of an underlying biogenetic vulnerability, and therefore have implications for psychiatric practices, the identity of those labelled as ‘psychotic’, and the meaning that is attributed to a person's experience of distress.
This study adopted a critical realist social constructionist epistemology to explore psychiatrists' discursive constructions of the relationship between trauma and psychosis using qualitative methodology. Seven psychiatrists with experience working in NHS services were interviewed. Interviewees appeared to draw on psychiatric classification systems to define both 'psychosis' and 'trauma', therefore privileging individual and internal pathology, and limiting acknowledgement of contextual influences on a person's distress. A biomedical aetiological repertoire was consistently drawn upon which constructed psychosis as a brain disorder with psychosocial factors positioned as consequences, or symptoms, of an illness. This reliance upon medical pathological frameworks to define 'psychotic' experiences led to an incompatibility with a view of a person's distress as meaningful and understandable in the context of their lives. Psychiatry's professional alignment with medicine favoured impersonal, neutral and objective accounts of treatment decisions, with the construction of decontextualised individuals warranting interventions targeting the modification of internal biological pathology. Furthermore, constructions that positioned a person as a passive victim of internal pathology, diverted professional attention from how and why people were subjected to abuse and/or neglect. Implications of the study are considered in relations to research and theory, professionals practice and training, and service users.