Overcoming Trauma by Dealing With Deathby Ann Reitan, PsyD | December 13, 2013
I’ve argued before that all or most diagnoses of severe psychopathology involve trauma. Trauma represents an aspect of diagnosed psychopathology, even though it may not meet the criteria for a diagnosis of post-traumatic stress disorder. Trauma often involves confrontation with death, and fear of death can bolster trauma. It’s a vicious cycle.
Trauma can be seen in the diagnosis of panic disorder. The circumstances of panic disorder cause the individual to fear death as an aspect of impending doom, both while he is experiencing panic attacks and while he is not experiencing them. The individual may come to fear having panic attacks in specific situations, and he may view panic attacks as deleterious to his safety.
He may imagine, for example, the act of driving his car to be anxiety provoking due to the fact that he may have a panic attack in his car. Having a panic attack in this setting may be rationally perceived as compromising his safety. His fear and panic may escalate to the point where his perceptions of danger may induce panic attacks. This type of disorder can be very traumatic, and it involves a confrontation with death.
An individual who suffers from major depression may also be viewed as experiencing trauma. This individual endures circumstances of self-blame and hopelessness, experiencing perhaps life-threatening suicidal ideation. Although the person with depression may be suicidal, he fears the escalation of depression and consequent suicidal ideation. It is my opinion that the individual with a diagnosis of major depression experiences what might be understood as a gravitational pull toward suicide, and this individual struggles again the insistent, almost obsessive, thoughts regarding suicide.
The experiences involved in both panic disorders and depressive disorders are clearly associated with trauma, whether the disorders are caused by trauma or are sources of trauma, and they are probably both.
Schizophrenia is often exacerbated by exogenous trauma in its emergence, but, as a matter of course, it results in trauma as part of its presentation. This is especially true of the paranoid schizophrenic. Paranoia often takes the form of fear of many seemingly possible eventualities that the schizophrenic may imagine as emerging in his mental and physical environments. Clearly, delusional material in the mind of the paranoid schizophrenic may involve fear of death. Indeed, many schizophrenics contemplate and commit suicide. As in major depression, this experience of suicidal ideation is traumatizing.
Confrontation with death is then a realistic correlate of dealing with trauma. A near death experience can contribute to symptoms of trauma in one who has a diagnosis of severe psychopathology, and, as outlined here, many diagnoses other than that of post-traumatic stress disorder can entail the symptoms of trauma. Individuals with panic disorder, major depression and schizophrenia, especially paranoid schizophrenia, deal with life threatening circumstances as part of their illnesses.
A near-death experience differs from confrontation with life’s finiteness. Near-death experience can produce symptoms of trauma, and confrontation with one’s finiteness is an existential crisis from which one may emerge with a deeper sense of life’s meaning. The confrontation with death that people experience as a result of existential crises may allow them to deal effectively with their mortality, especially if this experience is accomplished as a part of natural development. In middle age, many people begin to understand that their lives are finite and they comprehend and accept their own mortality.
An appropriate confrontation with death as a part of existential crisis in the life of the traumatized psychotic person may actually allow that person to deal more effectively with feelings of impending doom, the manifestation of suicidal feelings, and the paranoia resulting from delusional material.
It’s my theory that confronting death as a part of normal life and development may allow the paranoid schizophrenic to deal with trauma. It may help him in a way that will allow for effective diminishment of some of his paranoia and ease the symptoms of schizophrenia.
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