Childhood Trauma as a Neglected Factor in Psychotic Experiences and Cognitive Functioning—Reply

Comment In their Letter to the Editor reacting to Mollon and colleagues (February 2016) (1) Begemann, Heringa, and Sommer are right to draw attention to the role of childhood trauma in the etiology of psychosis (2).They also link childhood trauma to impairment in cognition or neuropsychological functioning. My own susceptibility to psychosis came, I believe, from an indecent assault by my music teacher 65 years ago. I am now 79. Actually, the indecent assault itself did not have as great an impact on me as the police procedure that it led to (3). The combination of the two resulted in cognitive impairment as measured by deterioration in my performance at school. I dropped from being regularly fifth in the class down to twenty-first or so.

Begemann, Heringa, and Sommer are also right to emphasize the importance of attention to possible confounders when studying the causal chain between childhood trauma and later clinical and non-clinical extreme experiences. They refer to Mollon and colleagues (1)  and similar studies as demonstrating an association between certain aspects of inferior neuropsychological functioning and psychotic experiences. Begemann, Heringa, and Sommer suggest that the cognitive deficit could be the mediator from the trauma to the psychosis susceptibility. However, it could be, as they say, that the environmental factors may constitute a common underlying vulnerability for both psychotic experiences and cognitive deficits. In other words A may lead to B; B may lead to A; or C may lead to A and B in parallel.

My own experience fits best with the third of these possibilities. I was good at school when I was thirteen, and had been good consistently until then. After my trauma my scholastic performance plummeted and it was only with great effort that I managed to gain admission at the age of 18 to Cambridge University in the UK. Then, when I took my exams at the end of my second year, I developed a psychosis. When it came to the time for my finals, I needed to be admitted to Fulbourne mental hospital. I was allowed to sit my papers while in the institution after my tutor had arranged for a special invigilator.

I do not believe my cognitive deficits contributed to my psychotic susceptibility. The underlying mechanisms leading from trauma to psychosis are as yet unknown to science. In my view that is because they are unconscious. I am only now, following a lead given me by Jacqui Dillon, national Chair of the Hearing Voices Network in England, beginning to unravel in my own case the direction of causality. I endorse Mollon and colleagues’ conclusion in their reply to Begemann, Heringa, and Sommer that the role childhood trauma and other risk factors play, either as covariates, confounders, or mediators, warrants careful consideration (4).

Author Affiliation: Anoiksis Patient Association, University Medical Center Utrecht, Utrecht, The Netherlands.
Conflict of Interest Disclosure: Bill George is Co-coordinator of Foreign Affairs of the Dutch Patient Association Anoiksis.
1 Mollon J, David AS, Morgan C, et al. Psychotic experiences and neuropsychological functioning in a population-based sample. JAMA Psychiatry. 2016;73(2)129-138.
2 Begemann MJH, Heringa SM, Sommer IEC. Letter to the Editor: Childhood Trauma as a Neglected Factor in Psychotic Experiences and Cognitive Functioning. JAMA Psychiatry Online First 2016.0924.
3 George B. Schizophrenia: a personal account. Social Work Today. 23 February 1987.
4 Mollon J, Morgan C, Reichenberg A. Letter to the Editor. Reply to Begemann, Heringa , and Sommer. JAMA Psychiatry Online First 2016.1170