By Sophie Olson
A survivor’s view on the debate between trauma and mental illness
Some people with underlying trauma will be misdiagnosed. I believe it happened to me and I’ve seen it happen to others. I’ve also seen for myself the devastation of untreated mental illness, the way it impacts on family and the miracle that happens when that person emerges from the depths of despair to claim back the life they lost.
I’ve witnessed someone experience the agony of delusion, paranoia and extreme mania that seemed to be, in his opinion, successfully managed with medication. As far as I know, he didn’t have a background of trauma. I have also met people who were abused as children, survivors like me who never got ‘better’ with this treatment because they weren’t ill in the first place. They, like me, should have been offered specialist support for trauma. All of us lost a significant number of years in the mental health system, chasing the elusive ‘cure’.
It’s devastating to be on the receiving end of the wrong treatment, absolutely devastating. I’m horrified by the labels presumably still on my medical notes and it frightens me to think these might remain there for the rest of my life, not because of stigma, but because my trauma responses that I’ve learnt to live with can still get the better of me when I’m triggered. If this were to happen when I was in a medical environment, for example, my ‘history’ could mean I’m quickly judged as mentally ill. When triggered I get distressed, or I lose the ability to speak. If misunderstood by someone not fully trauma-informed, this distress may be seen as irrational. Hysterical. Psychotic. I’m more likely to be offered medication. If I decline, it may be seen as non-compliance. I am more likely to be detained, to be forcibly medicated. I know how it works because I’m no stranger to the system.
I’m in full support of those who challenge the mental health system to do better; those who can draw much needed attention to those like me where trauma is the crux of the issue, because trauma must be recognised and the treatment offered must be appropriate. However, like most things in life, when it comes to trauma versus mental illness, despite my experience, I don’t believe the argument is clear-cut.
Survivors can be misdiagnosed but that doesn’t mean that no survivor will benefit from medication. Many survivors will need specialist trauma support and some might need more support for their mental health, including medication. For those who say it’s a placebo, if this was the case then would it even matter? If the person is released from the anguish and horror of the symptoms of mental torment, then thank God for placebos.
There are many different pathways to healing, to recovery, to living a happier life – however you want to describe it. What works for one person, might not work for the next. What must change is the understanding of trauma. The mental health system is not trauma informed. It can be too quick to label the survivor of sexual violence as ‘disordered’ or ‘unwell’ before exploring other treatment such as long-term specialist therapy, and this doesn’t necessarily help recovery, it can hinder it. This is what happened to me and by the time I found my voice and spoke up about the child sexual abuse it was too late. They didn’t seem very interested and were solely focused on the ‘illness’.
I gave up when I was told by a psychiatrist I would never recover from mental illness. I waited to die young of suicide, the thoughts of which consumed me. The pivotal point of change for me was a therapist telling me I was reacting totally normally to an abnormal experience. When I heard this, I began to see there may be a way through.
I am encouraged to see this issue being talked about but I am dismayed at how divisive it is.
It made me sad to see a tweet from a clinical psychologist stating that the trauma ‘industry’ scared her. I was sad because I can see why. A few (not all) supporters promote it aggressively, or they cherry-pick the latest research and make it fit a trauma narrative. This is counterproductive, but absolutely understandable as people are rightly angry. When you’re misdiagnosed, it’s a serious matter. Many of us are treated with medication that is increased, added to, or frequently changed. We suffer a roller coaster of side effects and withdrawals. Our hopes as we chase this always out of reach ‘cure’ are dashed time and time again. The side effects are terrible for some. Anyone who knew me ‘before’ and ‘after’ would agree my short-term memory has been affected. Benzodiazepines have left me with empty blanks. There are missing chunks in my memory around the time I was most heavily medicated. Precious memories of my children, of motherhood that I’ll never recover. If I’d stayed in the system, I know ECT would have been given as the next cure all – it was discussed many times. I feel fortunate to have avoided that, as I know others who didn’t, and yet, I can acknowledge that some survivors’ experiences will differ from mine.
Some will feel medication is of benefit. Some may take great comfort in official diagnosis as it can help them to make sense of the way they feel. It comforted me in the early days. Initially, diagnosis validated my distress. It was certainly far easier to explain to others that my struggle with life was the result of severe mental illness, than it was to say I wanted to die because I was a survivor of intrafamilial CSA – a secret that enshrouded me in shame. It is not my place to tell anyone else my opinion is right and theirs is wrong because how could I possibly know that? It wouldn’t be very trauma-informed of me to disregard someone’s experience of healing just because it was different to mine.
It’s very hard to have these conversations on social media. I was in two minds whether to publish this article. When I’ve previously shared my experiences and expressed my own anger at the sheer amount of medication I was given, of the labels and of being told I’d never recover from mental illness, I have been accused of gaslighting those with disorders, pill-shaming or stigmatising mental illness – which is certainly not my intention. I can see how trauma survivors who are helped by the mental health system must feel a bit under attack at the moment. On the flip side, a lot of people contact me to say the same thing happened to them, or that my experiences have helped them to challenge their own diagnosis they feel is hindering, not helping, and to approach the third sector for a different type of support. I want to feel able to recount my time in the system and for my experiences to be respected just as I try to respect the lived experience of others.
I have an image in my mind of Team Psychiatry versus Team Trauma, standing facing one another with their arms crossed. Neither want to listen and both believe they are right and the other is wrong. I wish they would work together. Psychiatry needs help to understand the role of trauma and responses to trauma, and to respond appropriately to the person in need. Trauma needs help to explore different pathways when the survivor needs added support or intervention.
To be clear: no one is denying the reality of distress, or benefits of drugs for some. We’re correcting a decades-long public disinformation campaign, with damaging impacts on prescribing rates, informed consent, & willingness to address known psychosocial causes.Lucy Johnstone
Now is the time for both Psychiatry and Trauma to join forces; to support one another, not to vilify and fear each other. Nothing in life is ever black or white; there are a multitude of shades in between. Surely those working in both fields want the same outcome? – a well person, free from the grip of distress, depression, or suicidal ideation; able to manage trauma responses; able to live a happy life.