eiseEducation

The terms trauma, dissociation and psychosis have been used in a wide variety of ways since they were first proposed or adopted more than 125 years ago. The first two are metaphors, co-opted from the medical (trauma) and social (dissociation) domains in the 19th century, while psychosis was created in the 1840s as an alternative to the stigmatized terms insanity and lunacy. All three have since undergone considerable transformation in their use; the primary ways in which they are used currently raise thorny conceptual and clinical issues.

Following a brief discussion of ways in which different usages of the same term can be assessed in terms of their utility or usefulness, we will take deep dive into the concepts of trauma, dissociation and psychosis. We will highlight the various ways in which each term has been used historically, up to the present day, speculate on the reasons for key changes over time, and delineate the advantages and disadvantages of the different meanings. The clinical implications of the changing definitions of each term will also be explored. Finally, we will argue for a particular way of viewing trauma and dissociation that, in our opinion, maximizes each term’s clinical utility, including for purposes of differential diagnosis. The concept of psychosis, it is argued, is more problematic, and may, indeed, have outlived its usefulness. Special emphasis will be placed on the Schneiderian or first-rank symptoms of schizophrenia, many of which can be conceptualized as either psychotic or dissociative. The reasons why Schneider thought these specific symptoms to be predictive of schizophrenia instead of dissociative disorders, and the implications for the validity of the diagnosis of schizophrenia, will also be discussed. Participants should come out of the training with a deeper understanding of the use of all of these important concepts, along with a fresh view on how best to employ them for clinical purposes.