There has been some discussion in recent weeks concerning the role of childhood abuse in the etiology of the condition known as schizophrenia.
It is particularly difficult to address this problem because the condition known as schizophrenia is not a unified phenomenon. Rather, it is an assortment of loosely clustered behaviors which has been falsely and illogically labeled by the APA as an illness, existing in an individual.
So the question “Is schizophrenia caused by childhood abuse?” is a meaningless question. In other words, it cannot be answered either as “true” or “false.” In fact, it can’t even be answered “maybe.”
So let’s instead focus on one key aspect of this assortment of loosely clustered behaviors, i.e. delusions. And let’s rephrase the question: are delusions in adulthood caused by childhood abuse?
The APA defines delusions as follows:
“A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary.” (DSM-IV-TR, p 821)
There are problems with this definition, of course, because one man’s proof is another man’s conspiracy theory. In other words, the definition presumes that there exists a body of knowledge that is the Truth, which I suggest is a little naïve.
But instead of struggling with these abstruse issues, let’s instead take an example. Let’s consider the case of a person who believes firmly that the government is spying on him and has tapped his phone, and let’s, for the sake of argument, assume that this contention is false and patently unwarranted.
So the question becomes: is this belief caused by childhood abuse? But here again, even in asking this question, we’ve made another unwarranted assumption. We’ve assumed that believing (without reason) that the government is spying on one is a unified phenomenon which can be attributed to a single cause in all or even most cases. It’s easy to fall into this trap because science routinely does identify unified phenomena that do indeed admit of a single explanation. Rainbows, for instance, are caused by droplets of water suspended in the air, together with a certain geometric arrangement of the sun and the observer. But believing that the government is spying on one (or more correctly expressing the belief that the government is spying on one) is not the same kind of thing. There are likely to be many reasons why a person would express this belief, and the only way to establish the actual cause in a given individual is to get to know that person and his history, to listen very carefully and empathically to what he has to say, and to try to see the world from his perspective.
Based on my experience, here are some of the factors that might have a bearing on the development of this belief:
1. One’s parent(s) expressed beliefs of this sort and passed them on through normal parent-child interactions.
2. One has experienced a profound and persistent sense of failure in childhood and early adulthood.
3. One belongs to a group where the expression of these kinds of beliefs is encouraged and reinforced.
4. One is copying the views of another person.
5. One is using, or withdrawing from, certain drugs (including pharmaceutical products).
6. One has something wrong with one’s brain. Definite information in this area is hard to find. But just as hearts, livers, kidneys, etc., can develop problems, brains can also malfunction, and it’s possible that certain malfunctions could precipitate paranoid beliefs. In my view this factor is extremely rare.
In my clinical experience, the second item above – a profound and persistent sense of failure – is the factor most often encountered in practice; a notion, incidentally, which was propounded by the eminent psychiatrist Eugen Bleuler in 1912. (Affectivity, Suggestibility, Paranoia, p 97-98)
But here again, the level of individual variation is enormous. If we pose the question: why do some people experience so much failure? Numerous scenarios come to mind. For instance:
1. Parental expectations were too high given the individual’s general ability.
2. Basic social skills were not coached (for a variety of reasons).
3. Parents (or other caregivers) were preoccupied with other matters (e.g. economic survival).
4. Basic problem-solving and competency skills were not coached.
5. Child was bullied at school and failed to learn.
6. Deaths or other tragedies at an early age interfered with skill acquisition.
7. Parents were poor problem-solvers and failed to pass on the notion that problems are something to be tackled and resolved.
8. A history of abuse (physical, sexual, or emotional). To state the obvious, a child who is being abused tends to be preoccupied with matters of survival. In such a context, skill acquisition often takes a backseat.
9. Etc., etc., etc…
In other words, there are lots of reasons why a person might experience profound and persistent failure, and some of these individuals will develop paranoid beliefs. Some of these individuals also have a history of abuse.
There is a strong statistical correlation between acquiring a “diagnosis of schizophrenia” and having a history of abuse (at least 50% in women), and in my view, the possibility of a history of abuse always warrants exploration when working with individuals who express paranoid or otherwise delusional beliefs.
If (when?) the medical model domination of the research agenda wanes, and more psychosocial research is pursued, I believe we will see increasing evidence for this position.
What I have tried to do in this post is put the abuse question into perspective. Similar analyses could be done on the other “symptoms” of “schizophrenia.”
The central point I’m making is that people are complicated. We are each a bewildering tapestry of threads drawn from different sources, dyed in different vats, and interwoven in an endless and ever-shifting array of circumstances and conditions. There are no simple, pat explanations of any human activity, including expressing paranoid beliefs. The only way to gain any significant insights into these kinds of matters is to take the time to get to know the individual, to establish trust, and to form a constructive alliance. There are no shortcuts.