Understanding Psychosis: A Continuum of Trauma, Dissociation

Source: Photo by Taylor Deas-Melesh on Unsplash

Co-authored by Ann Bayly-Bruneel

Psychosis means experiencing a break with everyday reality, where we may struggle to determine if our perceptions are real or unreal. When in a state of psychosis, we experience profound emotional dysregulation and become so completely overwhelmed that we engage in behaviours that are not typical of our regular state of being.

The World Health Organization outlines how individuals who experience psychosis are at greater risk of experiencing human rights violations.¹ Psychosis is a frequently misunderstood experience that is disenfranchised by others, partly due to the lack of awareness and appreciation for how dissociation is a biological imperative for survival.

People with a history of developmental trauma and adverse childhood experiences have a higher risk of developing psychosis later in life.² Early-life adversity impacts our biology, which subsequently influences our developmental trajectory, perceptions, behavioural responses, and our nervous system’s capacity to cope with future stressors.

Traumatic risk factors for psychosis include interpersonal violence, sexual abuse, chronic neglect, systemic racism, and other overwhelming traumatic experiences in early childhood or adolescence.³ Psychosis can also be related to substance use or physical diseases as well.

Surprisingly, systematic research has consistently found that most people who utilize mental health services are not asked about childhood abuse or neglect. Previous traumatic experiences and social determinants of health are not considered when understanding how dissociation presents within the contexts of our lives.⁴ Furthermore, research has uncovered how people who are diagnosed with psychotic disorders are asked even less about their previous trauma history than other populations.

The Continuum of Trauma, Psychosis, and Dissociation

In our shared experience as psychotherapists who specialize in complex trauma, we have consistently discovered an extensive trauma history for those who have a history of psychosis or are actively experiencing psychosis. Individuals describe having prolonged chronic exposure to highly distressing experiences that overwhelms their capacity to cope.

Psychosis can be conceptualized as part of the dissociation continuum. While there are many theories and ways to understand the process of psychosis or dissociating, one theory that has gained traction within psychosomatic (body-oriented) communities is to see this as embodied wisdom.

As humans, we have been gifted with the innate survival mechanism to dissociate and to fragment when life is so untenable.⁵ Imagine being subjected to continuous experiences of trauma and oppression if we did not have this innate capacity. We believe in an approach of gratitude towards this experience, as experiencing profound disconnection can actually save our lives.

Dissociation is a physiological process reflected in nervous system states of shut-down, collapse, or what is commonly called freeze.⁶ This is a conservation strategy that results in having fractured developmental egoic states. Thus, we learn to hide or leave parts of ourselves emotionally isolated—similarly to how we may have been made to feel. In addition, and contrary to the theory of humans existing as a mono-mind, we are multidimensional and made up of an inner habitat of many parts.

Dissociation is also intersectional and complex; the more marginalized a person’s experience is, the more vital dissociation becomes for their well-being and self-protection.

Approaching Dissociation More Holistically

Everything in our being clings to survival, and this does not need to be pathologized. Instead, we can approach psychosis and dissociation as different parts of ourselves that have different nervous system states. When we can foster safety in our lives, we can show up for these protective aspects of ourselves with a deep level of compassionate care, love, and kindness.⁷

Somatic and relational psychotherapies can help foster a felt level of embodied safety. This experience of safety allows us to stay present with our individual and collective pain.

Developing a relationship with our body and capacity for survival is a courageously vulnerable process that often involves breaking our hearts wide open. Healing invites us to lift the veil, the fog, and our experiences of disembodiment to truly feel what it is to be human. It is radical to meet ourselves and each other in this way because it is actually counter to the physiological ways in which we adapt and survive.

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In our experience, this often requires people to unlearn oppressive sociocultural norms that perpetuate disembodiment and the avoidance of feelings. As therapists, we often gently challenge preconceived notions around productivity, stoicism, and the belief in the need to always be in control. This helps people actually develop deeper relationships with their sensations or feelings and embrace both light and shadow.

We actively invite readers to consider new ways of relating to themselves and others through a lens of radical curiosity, connectedness, compassion, and awe, which is often in striking contrast to institutionalized mental health models.

Conclusion

The truth is that our mind (psyche) and body (soma) are frequently more interested in survival than always experiencing a sense of wholeness. Dissociation is a natural response to horrifying, mind-boggling, and overwhelming traumatic experiences. We do not consider psychosis as a symptom that needs to be intrinsically eliminated or destroyed, and we do not find the pathological language of “disorder” to be fruitful in our shared healing journeys.

Rather, when we honour dissociation as a truly amazing, organic, and life-saving process that often reduces shame-based responses to the physiological ways in which people adapt and survive. Unfortunately, many institutionalized mental health services often fail to understand how psychosis is an unconscious yet purposeful attempt to come to terms with overwhelming threats, stress, and trauma. Understanding this often requires us to explore our own inner terrain and unearth a new level of somatic and revolutionary inner-standing.

When meeting dissociation in ourselves or with another, we invite you to reflect appreciation and gratitude for the body's ability to survive. It’s time we collectively embrace compassionate solidarity and humility in the treatment of trauma, and we hope you will engage in a deeper process of befriending your own survival responses.

Ann Bayly-Bruneel / Used with permission.

This article was co-authored with Ann Bayly-Bruneel, a registered psychotherapist, art therapist, and somatic experiencing practitioner. Ann has worked in the field of mental health, addiction, and trauma for over twenty years. Ann and Mark both actively facilitate trauma-responsive psychotherapy in London, Ontario, Canada.