Child Abuse and "Mental Illness": The State of Play

Sometimes a cigar is just a cigar. And sometimes it isn't.

A recent leader in the venerable British Journal of Psychiatry (founded in 1853 as the Asylum Journal) summarizes the state of research on the relationship between childhood abuse and mental illness. It seems that on that score, things are moving fast. “At a staggering pace,” in the words of the article's authors.

You may recall that, back in the nineties, brain scans of schizophrenics showed abnormalities? And this was supposed to prove that schizophrenia, like everything back in the 90s, was genetic?

It turns out that scans of abused children show the same brain abnormalities. They more or less got cause and effect reversed.

Things have changed. “[R]esearchers have recently established that a broad range of adverse childhood events are significant risk factors for most mental health problems, including psychosis.” Childhood abuse has now been linked to adult depression, anxiety disorders, phobias, eating disorders, sexual dysfunction, personality disorders, dissociative disorders, substance abuse, and the psychoses (manic depression, schizophrenia). The most reasonable assumption based on the evidence so far is that childhood abuse is the primary cause of all “mental illness.” Another recent article in the BJP indeed concluded that “childhood adversities … were the strongest predictors of disorders.” Even the severity of childhood abuse can be directly correlated with the severity of psychiatric symptoms.

This fact has been hidden in plain sight since the very beginning of modern psychiatry. Freud himself found that virtually all of his patients reported being abused as children. He simply refused to accept this. As the BJP piece notes, “the public all over the world (including patients and their families)” have always placed most emphasis on adverse life events in accounting for schizophrenia. It has only been psychiatrists who have denied it, almost up to the present day. The authors of the BJP piece claim that an article on this subject, like theirs, would not have been published twenty years ago. Even now, the authors find it necessary to throw in a defense against the charge of “family blaming.” (What exactly is wrong with “family blaming,” if it is indeed the family's fault?) They claim in their defense that prior abuse of the parents, and general poverty, can be seen as the real culprits.

This is bollocks. Freud's original patients, of course, who consistently reported abuse, came from the upper echelons of Viennese society. Mental illness is notoriously no respecter of social class. Rather the reverse: it seems at least anecdotally more common in “great families.” It is just that the poor are more likely to get blamed for it.

And this is just the problem. This is why psychiatry as a whole has been for so long “in denial.” The “people of the lie,” the truly evil people of this world, those who would without conscience abuse their own children, are disproportionately likely to be socially prominent, as were the scribes and Pharisees of the New Testament. Evil people put self-interest first. It is not in anyone's self-interest to be either poor or criminal. Ego, the devil is likely to be a gentleman.

Accordingly, the instant Freud, or psychiatry in general, point the finger at the real problem, they are up against a very powerful opposition. Not only will the accused be prominent members of society, with lots of money and connections; they will also be prominent members of society who know no scruple in fighting for their own self-interest, and no concern for the truth. Freud no doubt saw clearly that his own career was at stake, and was no great lover of the truth, or his patients' wellbeing, himself. It was and remains far safer to blame the victim, scapegoat the child, or call it a disease and blame the imaginary chemistry of the brain.

It is all now coming unravelled. It only took psychiatry about a hundred years to discover what most people everywhere already knew.