Outlines some of the relationships between trauma and psychosis and schizophrenia, which are usually ignored by the mental health establishment. This is a presentation that will be given at the Oregon State Hospital on April 22, 2009. I also provide a 6 hour online course on this topic, with 6 CE credits, go to https://www.udemy.com/working-with-trauma-dissociation-and-psychosis/ for more information, to watch some free previews, and to register.

1. When Trauma and Psychosis Mix Presenter: Ron Unger LCSW 541-513-1811 [email_address]

7. Trauma (involves perceived need to reorganize in a radical way.) Psychosis (disorganization or mistaken way of being organized.) Trauma (involves perceived need to reorganize in a radical way.) Psychosis (disorganization or mistaken way of being organized.)

8. Peter Bulimore’s story illustrates all three levels of trauma, as well as why it is so important for the mental health system to begin to understand these issues.

21. Let the experience intrude so vividly it seems to be happening right now: The experience is so vivid I get retraumatized just by having it, and I still don’t put it in context. Refuse to let the experience intrude: I stop the experience from retraumatizing me right now, but I also fail to integrate it so I will run into problems with it later. I let the experience occur, but I have ways of reducing its intensity by changing my reaction to it: I can note that reduced intensity and remind myself it is not a current threat. I gradually put it into a context. Spectrum of ways de-contextualized experiences/memories can be dealt with

22. Focus on defending against external threat, guard against feeling too safe internally: to maintain vigilance. Focus on maintaining internal sense of safety, guard against perceiving too much external threat: to maintain stability. Guard against either ignoring threats or seeing exaggerated threat: I seek to be vigilant but not hypervigilant, to maintain a feeling of safety without being oblivious. Two Extremes in Seeking Safety, Not Very Compatible……

24. Trauma reminder seen as current threat Over-react to trauma reminder Experience bad consequences from one’s over-reaction Prepare to react even more strongly to such “threats” in the future Attribute bad consequences to the perceived threat itself, not to the over-reaction

26. Possible origin of some voices in effort to block trauma related intrusions Trauma Interpret trauma memories as a threat, attempt to block Voices form to overcome blocks & raise issues related to trauma Interpret voices as a threat, become emotionally distressed, attempt to block or distract from voices Voices increase in volume & frequency as emotional distress and blocking increases

28. Trauma Seeking control & toughness to deal with trauma Voices appear as an internal representation of what cannot be controlled Voices are interpreted as a threat to sense of control, so attempts are made to control them Voices “feed” off the tension involved in efforts to control them: they increase Life goes increasingly out of control as preoccupation with the voices goes up

31. Hearer of the thought Speaker of the thought Normal identity in our culture: we see ourselves both as who is saying or “thinking” the thought to ourselves, and as the person who is registering or hearing the thought. Our identity is not centered in either saying or hearing the thought.

32. Hearer of the thought: another “ alter” Speaker of the thought: an “alter” Dissociative identity: person may have a conversation with “alternate personalities” within themselves. At any given moment, a person may see themselves as a particular personality or self listening to or talking to another personality or self that shares the same body.

33. Hearer of the thought: Identified “ self” Speaker of the thought: a “voice” Hearing voices: Person sees thought as coming from outside themselves. They may be “heard” as though spoken aloud, or just heard “inside one’s head” but there is the sense or the belief that they are coming from something completely outside the self.

35. My feelings and emotions tell me what is real: if I'm feeling down then I'm doing terrible, if I feel scared, then I’m in danger, etc. My feelings and emotions are my enemy: I need to block them out (or drug them away) My feelings and emotions give me suggestions about what may be real. I decide whether they are accurate or not. If they are accurate, I act on them, if not, I just accept them and let them go. “ Emotional Reasoning” versus Not Tolerating Emotions

36. My voices tell me what is real: if they tell me I’m doing terrible then I am, if they tell me I’m in danger then I am, etc. My voices are my enemy: I need to block them out (or drug them away) My voices give me suggestions about what may be real. I decide whether they are accurate or not. If they are accurate, I act on them, if not, I just accept them and let them go. Dominated by Voices vs. Overly Distressed by Voices

37. Excess focus on conflict: I am always ready to do battle with the voices, my goal is to drive them out of existence. Excess focus on appeasement: It’s better to give in to the voices, even when they are unreasonable, rather than risk upsetting them. Focus on living a good life: I don’t waste energy opposing the voices just for the sake of conflict, but if they push for something that will harm my life, I will stand firm against it. Excess focus on conflict vs. excess focus on appeasement

41. Experiential Avoidance: Attempts are made to not have thoughts, emotions, impulses, perceptions etc. which are evaluated as “bad.” Emotional reasoning or fusion: Emotions and other mental content is just taken as true in itself, and allowed to determine the person’s direction, without rational criticism. Some ability to practice mindfulness: Willingness to experience whatever is in one’s mind, but also able to disengage from it and see other perspectives. Mindfulness as a middle ground between experiential avoidance and fusion