It is well-established in the mental health field that traumatic experiences, and especially adverse childhood experiences (called “ACEs”), can lead to the development of mental illness later on in life. In fact, this correlation dominates the discussion of the relationship between trauma and mental illness: one—trauma—comes before the other—mental illness.
What is not talked about, though, is the symptoms of a serious mental illness as traumatic experiences. Rather than trauma only existing outside of and leading to symptoms of mental illness, these symptoms are in and of themselves traumatic.
This is a largely unstudied perspective of mental illness—but it is one based on my own experiences living with schizoaffective disorder.
What Is Trauma?
Trauma is an emotional and physical response to extreme stress or the survival of a dangerous or even life-threatening situation, the psychological effects of which make it difficult to function in everyday life after the event.
Someone who is traumatized will have trouble readjusting to life after the trauma. They might suddenly find it hard to interact with others, even people to whom they are very close; they might have trouble functioning at work or taking care of themselves on a day-to-day basis.
After experiencing trauma, you might find yourself having intrusive flashbacks to the source of the trauma, trouble sleeping because of nightmares, depression or anxiety, or even physical pain. All of these symptoms can interfere with daily life—which is the difference between a normal stress reaction and trauma.
Trauma and Mental Illness
Most people have heard of post-traumatic stress disorder—a diagnosable mental illness brought on by a traumatic experience. And this traumatic experience could consist of just about anything. A car crash, an attack, the sudden and/or violent loss of a loved one, even a physical injury (for example, I have a friend who is a dancer who brutally and unexpectedly tore some muscles in her leg and needed trauma therapy to recover from the ordeal).
This follows the simple pattern of traumatic event → trauma response. And in this case, the trauma response is a specific mental illness, PTSD.
Being exposed to adverse childhood experiences, or ACEs, has also been proven to make you more likely to develop a mental illness as an adult. ACEs include everything from divorce to witnessing or being a victim of domestic violence to living through a natural disaster. Depending on how you react to these experiences, they may make you more prone to chronic conditions like depression, anxiety, mood disorders, and of course PTSD.
So, that’s the understood and proven correlation between trauma and mental illness. A traumatic event can lead to mental illness.
But what about the trauma of mental illness?
Mental Illness as Trauma
What I am talking about here is the inverse of the widely accepted connection between trauma and mental illness. Based on years of lived experience, I would argue that the symptoms of serious mental illness themselves can actually be traumatic events, and affect your brain and your health the same way an outside trauma would.
I had my first psychotic break when I was 22. I was in a group therapy session when suddenly, all around me, the room turned green—as in, I was literally seeing everything in the room as the color green. Then, I saw a giant bug appear in the middle of the room, whose legs were comprised of every other person in the group. I saw this. It was just like it was actually happening. The room was green. There was a giant bug.
To this day, that memory, that experience, is burnt into my brain, and I return to it often.
I was experiencing these things, these hallucinations, as if they were real life. And who would argue that the world suddenly changing around you for no apparent reason and there suddenly being a 10-foot-tall enormous bug taking up the entire room is not a traumatic experience? That in one moment, one flash, nothing you thought you knew about the way the world worked made any sense? That the impossible—and objectively disgusting—was actually possible?
How would you react?
I remember that experience as the day my entire life changed. I was no longer a normal person who experienced normal things. Something was seriously wrong. The world that I knew, that I felt relatively safe in, was no longer safe. I couldn’t trust my senses. I couldn’t trust my relationship with reality. There was no denying that my life would never be the same.
And isn’t that trauma, after all?
How Symptoms Can Be Traumatizing
This has happened to me again and again and again, to varying degrees of severity. Every time I have a hallucination, my brain reacts as though whatever I am seeing is real. Usually, I see bugs (normal-size ones), and sometimes I see people, and those things in and of themselves are usually not trauma-inducing. However, there have been times when my hallucinations have convinced me that I was in danger—real, physical danger.
For example: I was working as a bartender in a Broadway theatre and was setting up the bar for intermission. At one point, I looked up, and a stranger in a dark hoodie standing directly across from me on the other side of the bar reached over the counter and tried to grab me. I ducked, terrified, convinced that someone had just tried to assault me. I had seen him, I had felt the air whoosh past his arms as he reached out. I knew at that moment that I was in danger, that someone had attacked me. My heart was pounding, and I could hear the blood pumping past my ears.
But when I stood up, he was gone.
I looked to either side, up and down the aisle—there was no sign of anyone having been there. It had only taken a few seconds, there was no way he could have made it anywhere without me seeing him. It wasn’t real.
I sat down behind the bar and cried.
Even though this clearly had not actually happened—there was no hooded man, no attempt made on my safety and wellbeing—my brain and my body were reacting to this scare as though it were real.
And that’s the nefarious part of psychotic symptoms: you believe that they are real. You react as though they are real. Because, for all intents and purposes, they are real. Your blood pressure rises, your brain flips into defense mode, your body physically prepares for danger.
From this perspective, there is no difference between your reaction to a real-life danger and your reaction to a hallucination or delusion. In that moment, the danger is real. It’s just what happens afterward that draws the distinction.
I still look back on that experience, that man trying to grab me, with fear. I remember it in my body. It still triggers me. And not only because I truly believed I was in danger, and acted accordingly; no, it triggers me because I know that it can, at any time, happen again.
And it has.
I have had countless delusions where I am absolutely and utterly convinced that I am in grave danger. I’ve experienced everything from being certain that if I go outside an apocalyptic event will take place, to knowing that my therapist has been replaced with a bodysnatcher who is trying to kill me.
I have deeply and truthfully feared for my life, the same way somebody being mugged might fear for their life. The danger, in those moments, is palpable and real. And I think you’d be hard-pressed to find someone who wouldn’t say that believing you are in a life-threatening situation isn’t traumatic.
How the Trauma Is Ongoing
But the truly traumatic part of all of this is that I never know when it will come back. I never know if and when my brain will fail me, will turn on me. One minute I could be absolutely fine, minding my own business, and the next minute I am convinced that I am in danger.
Or I might wake up one morning and find that it is impossible to think. And when I say that, I mean literally impossible—it feels as though I am not able to string together a complete thought, I can’t understand what I’m trying to read, I can’t communicate with words because those words just aren’t there.
Imagine how terrifying it would be to wake up one day and not be able to think. Not be able to do your job, not be able to even explain what is happening to you. Then, imagine how terrifying it would be to never know when it will happen. To know that it could happen any time, and not know how long it will last; to not know how long you won’t be a functional human being. Your entire consciousness could be stripped away at any point, with absolutely nothing you can do about it.
I speak from experience when I say losing yourself in this way is traumatic.
This happened to me about a year ago. I forgot to take my pills one night—I am on an antipsychotic and an antidepressant—and the next morning, I woke up unable to think. I could not read or write, and my job consists entirely of reading and writing; I couldn’t even put into words what was happening to me.
This experience made me question my entire identity. Who am I? Am I the person who has held down a challenging job for a year and a half—not only held it down, but flourished in it? Am I the skilled writer and editor I have come to associate as my true self? Or am I the severely mentally ill person who, at any given moment, is just a few pills away from completely falling apart?
I spent months in therapy trying to resolve this. It was truly a traumatic experience, losing myself like that. And I still carry that fear with me. Even though it has been years now that I have been feeling stable, I still wake up every morning with the understanding that it might all go away again at the drop of a hat, and for no apparent reason.
Not only do I sometimes and unpredictably fear for my life, I constantly fear for my quality of life. I fear for what my mental illness can take away from me. I fear for the ways it punishes me without warning.
This fear, this uncertainty, this instability? This is trauma. And the hypervigilance that follows—the constant preparation for another attack—is a clinical and pathological sign of trauma.
How This Could Affect Treatment
Because symptoms of mental illness are not considered traumatic in and of themselves, most people living with serious mental illness are not being treated for trauma. I think this is a mistake, and a missed opportunity.
I feel many of my symptoms, and memories of my symptoms, somatically—my body is still connected to those experiences, much in the same way the body holds on to trauma. Physical pain like headaches and muscle aches, changes in appetite and sleep, and memory problems are all corporeal indications of and reactions to trauma. I, personally, have experienced pervasive loss of memory—and I wonder, if I had sought treatment for trauma specifically, if that would not be true.
Trauma treatments, like EMDR (eye movement desensitization and reprocessing), dig to the source of the trauma by disconnecting the physical attachment from the traumatic memory. I think, because so many symptoms of serious mental illness activate the body’s nervous system (by initiating a fight/flight/freeze/fawn response), trauma therapy could mean the difference between retraumatization after every psychotic episode and being able to move forward without experiencing another trauma response.
Clinical trials experimenting with trauma therapy as treatment for schizophrenia or schizoaffective disorder, both on its own and in conjunction with other therapy approaches, would be an interesting step forward in this discussion. This would be a quantitative way to evaluate the effect trauma has on people living with serious mental illness, and could directly affect treatment approaches in the future.
What This All Means
By recognizing mental health symptoms as traumatic experiences in and of themselves, I hope to help change the conversation about how to interact with those living with severe mental illness.
If you are experiencing symptoms like these, you should never be embarrassed or humiliated by responding to these threats as real. To you, they are real; and any person in any situation that poses the possibility of bodily danger would react the same way.
The goal is to recognize, eventually, that the threat was not real. But you shouldn’t be afraid of turning to people you trust during these episodes and telling them what you are feeling. The best way they can support you is if they know what you are reacting to and why.
And for those who have loved ones living with severe mental illness: please understand that their reactions are very, very real, even if the cause or catalyst is not. They are truly afraid; they are truly triggered; they are truly traumatized. Trying to convince them that they are not only teaches them not to confide in you.
Instead, ask what they are experiencing. Let them tell you what is happening to them. It might not make sense to you, but even just saying something like “That sounds really scary” or “I’m sorry you’re going through this” or “I am here for you no matter what” can help your loved one realize that they don’t have to go it alone.
Assure them that they are safe, but without discounting their experiences; saying “I know it doesn’t feel like it, but I promise you are safe” or “I understand that you’re feeling unsafe right now, but I’m not feeling that way” can help them reality-check.
Maybe later, you can have a conversation about what actually happened, or what didn’t; but in the moment, recognize that their reactions—and subsequent trauma—are real.
Final Thoughts
Based on my personal experiences as someone living with severe mental illness, I think that the symptoms of mental illness should be recognized as trauma. These symptoms, especially psychotic symptoms, are able to convince the person experiencing them that they are in very real danger; and a trauma response to very real danger is in itself natural. There is validity in these trauma responses, because the person feeling them also feels, in that moment, like they are truly in danger, and they react accordingly.
There is also trauma in the possibility of these symptoms cropping up at any time—this can leave someone feeling perpetually off-kilter and destabilized, constantly vigilant for the next bout of symptoms—and this hypervigilance is a clinical sign of trauma.
By shining a light on this unexplored aspect of mental illness, I hope to help those living with severe mental illness realize that they should not be ashamed of their fear reactions to their symptoms nor the potential trauma those symptoms may induce, and to help those with loved ones with severe mental illness understand what we experience when symptomatic and how that can affect us and our mental health.
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