Trauma and Serious Mental Illness: Is the Pendulum About to Swing?

For enough decades now, that many of our junior colleagues may not be aware that it was ever otherwise, we have known that serious mental illnesses (SMIs)–most notably schizophrenia and bipolar disorder–are a manifestation of disordered biochemistry. Before we knew this to be the case, in an earlier, now all-but-forgotten era, a prevalent belief was that these and other syndromes were not reflections of neurotransmitter malfunction, but responses to horrific experiences. In the glow of current scientific knowledge, the long-outdated notion that the major contributor to SMIs was nurture rather than nature may appear at best quaint and at worst terribly misguided. A logical extension of the conclusion that SMIs are biologically-based disorders is that treatment must consequently be biologically based as well. Therefore, the primary intervention approach for these disorders has been pharmacological. Those in treatment for SMIs are routinely told that their disorder is chronic, and that unless they continue taking their medication for the rest of their lives, their symptoms will unquestionably worsen. And because it is widely assumed that people with SMI diagnoses are experiencing the effects of disordered biochemistry, for the most part mental health professionals have stopped