Misdiagnosed Trauma

Trauma is a real experience by people and should not be under rated – when it is the actual problem and not mistaken as the problem. Many people’s symptoms and traits are mistaken and they are then misdiagnosed with trauma. Misdiagnosed trauma is a problem as it leads to poor education, misaligned treatment plans and victim blaming when the wrong treatment fails to work.

We have covered what Trauma actually is before [Trauma LINK]. The brief summary of that is that a Traumatic Event occurs, which gives you Trauma, which you the heal from and recover from in most cases fairly quickly. Sometimes there is a minor life change, sometimes it can be profound. Mostly, people who are experiencing Mental Ill Health are not responding to Trauma.

Here we are going to take a look at why many people and health professionals over diagnose and mistreat patients for Trauma.

We have covered 5 Trauma Myths before [Link], where we covered that

  1. We DID actually evolve to manage complex trauma
  2. Most mental illness is NOT maladaptive behaviours from a traumatic event
  3. Most people DON’T need trauma therapy
  4. The root of all mental health problems is NOT trauma
  5. Not everything is traumatic to someone

This leaves us with some important questions.

  1. If Trauma isn’t the cause of most mental illness, what is?
  2. Why do many therapists seem to think that it is?
  3. If all of those things aren’t trauma, what is trauma?

Let us go through each and answer them.

The Cause of Most Mental Illness

There is no single cause for mental illness.

I thought that I would rip the band aid off quickly and get it over with.

Mental illness is an umbrella term for everything that isn’t mental health. Mental illness describes both the experience of having troubles thinking wisely and the perception from other people that your choices and behaviours are not healthy. That is, if you are thinking wisely and others perceive you to be making good choices and engaging in good behaviours, you will be considered to be mentally healthy.

While most Mental Illness is biological, a circumstance or poor food can also trigger ill health.

For a full look at what Mental Illness actually is and isn’t, take a look at our page on Understanding Mental Illness [LINK]. While Trauma can be a cause, it mostly isn’t.

Why Many Therapists Think that Trauma is the Key

This is a contentious issue. You will read lots of literature exploring how trauma is the key to mental illness and therapy. The arguments, on their own and in isolation, seem valid. Unfortunately, they aren’t.

Here why I think we have ended up here.

Not that long ago psychology didn’t exist. It was considered that mental illness was the result of either poor morals or some kind of brain illness. Brain illnesses could be treated with medicines and medical shock treatment such as cold baths, and later electricity and the modern “miracle” magnets. The medicines were accurate, the rest wasn’t.

Some clinicians broke away from the pack, such as Sigmund Freud. He believed that there was something a bit more mystical about the brain, and this hidden layer was called the “unconscious”. He created this interesting paradigm of ego, super ego and id, defining all human behaviours as a stress or misalignment between the three. This led to trying to understand why people behaved as they did, and therefore what you could do about it. Much like the doctors above, he had some right ideas and mostly he was wrong.

Modern psychology has moved past Freud. Sort of. Psychology is now mostly about trying to understand the nature of humans in human systems. A good deal of the degree is learning how to perform experiments on humans and how to interpret the results in a human context. People who gain a degree in psychology (double degree, honours and PhD) are primarily learning about how to perform and understand human experiments. There are some specialisations in Psychology that aim to help humans with their specific differences to the “normal”. In Australia, these psychologists are called Clinical Psychologists. A part of their degree includes some basic therapy concepts and a requirement to do 2 years field placement in mental health to be mentored into becoming good therapists.

This relies on a good therapist mentor to teach you how to do it. There are some excellent mentors out there.

The same is approximately true for other streams of formal education that mental health therapists come from. My degree is in Social Work. I specialised in Mental Health, which meant that my last few years of degree included abnormal psychology, mental health institutions and therapy. I then went on to do about a decade of field work in mental health and 2 years of specific mentorship before I gained the additional Feral Mental Health Accreditation to become a registered therapist.

* technically anyone in Australia can call themselves a therapist, whether you have any relevant qualifications or not. To get a fMHA, you need a degree in a relevant field such as Social Work or Psychology, 2 years of mentorship in the field, membership to a relevant peak body and then you need to pass an examination that shows you grasp the basics. Only then can you bill the government for certain kinds of work if the GP authorises it.

What this results in is, many people have graduated with a good knowledge of the basics of what it looks like to be mentally healthy, so long as that matches the WEIRD model, and what it looks like to be abnormal, but from an outsiders perspective. We gain some basic ideas of simple therapeutic techniques, such as simple CBT (Cognitive Behavioural Therapy), grounding exercises and how to speak with a confident calm voice. We don’t usually actually know how to give complex therapy to complex individuals.

  • WEIRD model – Most of modern psychology comes from American Universities using students as guinea pigs. Those students are Western Educated Industrial Rich and Democratic, an odd subset of all humans. This is what we define “normal” as. This is NOT normal.
  • Outsiders Perspective – most of the people defining abnormal psychology have not experienced being abnormal. This means that they describe the bit that they can see and generally don’t actually understand what is going on. Consider the idea of 3 blind people trying to describe the object in front of them, where the object is an elephant and the people can only describe what their arms can reach – the trunk, ear and tail would all be described very differently and none of the descriptions would explain an elephant.
  • Simple CBT – CBT is a good robust therapeutic model. It has the best evidence for working for conditions that are caused by choices. If you educated the cognition of why you would make a decision, then a person makes wiser decisions. If you can’t explain why because the person doesn’t yet understand, then convincing them to try a different behaviour that works leads to positive results, which you can now bring back to their understanding aka cognition. The Simple version is a text book with steps to do this for you, identifying core beliefs that are suspected of being a problem, challenging those core beliefs, identifying problematic behaviours, challenging those behaviours. This is akin to a professional giving you a self help book, and then charging you for their time. Real CBT is more complex than the self help text book.
    • If your mental health problem is simple enough for a self help CBT book, by all means use that, it’s a lot cheaper. If that isn’t working for you, find a professional that is able to go beyond the basic book

Therapists that are helping neurotypical people (people that fit nicely into the WIERD Model) who are only having a crisis situation aka Mild Mental Ill Health, do not need to look further than their basic training.

Then there is the other 95% of people in the mental health system. Therapists need something better than the basic training they got from their academic studies. If they had a great mentor, they will learn excellent therapeutic techniques. However, if they had a mild to mediocre mentors, an earnest therapist is going to go and look for better methods.

This is where they land in pseudoscience. Trauma Therapy for Everything, Schema and some other poorly evidenced but strongly promised therapy.


Pseudoscience is a thing that tries to seem scientific, even uses some trappings to look like science, but on closer examination is not scientific. For example, Schema has many studies that have found that it “works better than treatment as usual”, which is a very low bar. When Schema was compared to CBT, it was not very good. When Schema incorporated more CBT into its model, it started to score around as good as CBT, sometimes a bit worse, sometimes a bit better.

Schema Therapy – a Purple Hat Therapy

Purple Hat Therapy is when you do a regular therapy, but with a bit of fairy dust such as a Purple Hat. You then state that you got the good results because of you were wearing the fancy Purple Hat, not because you did the therapy.

Schema Therapy was made by combining concepts from Cognitive Behavioural Therapy, Psychoanalytic Object Relations Theory, Attachment Theory, and Gestalt Therapy. We have already quickly covered CBT. Psychoanalytic Theory is a modernisation of the bits of Freud’s theory that were shown not to be correct or science, and essentially useless for therapy. Attachment Theory is a good way to determine if there is a healthy or problematic relationship between a child and their parents, but doesn’t tell you what it is – and certainly should be used on adults. Gestalt Therapy is a bit similar to CBT, includes a bit about morality of choices and tries to look at the broader circumstances that may affect you. Gestalt Therapy has some good stuff.

So when we look at Schema Therapy, on its good side is CBT and a bit of Gestalt Therapy. On the side of things we know don’t work for adults is Psychoanalytic Object Relations Theory and Attachment Theory. Schema got as good as CBT when it increased the ration of CBT in its therapy… so they just did CBT with some fluff. That Fluff is the Purple Hat.

Schema Therapy isn’t the only therapy to indulge in some pseudoscience nonsense and then use poor studies to defend itself. What is concerning is that the people who should have studied science experiments and studied how to discern the difference between good and bad science, are still peddling this stuff.

Why Trauma is Over Blamed for Mental Ill Health

It is valid that some Mental Ill Health is exacerbated by traumatic events, and it is valid that some Mental Ill Health is primarily caused by a traumatic event. In these cases people should be diagnosed with PTSD (Post Traumatic Stress Disorder).

It is not valid to think that every most or all Mental Ill Health is caused by Trauma.

However, in the quest for finding a framework that explains things, in the absence of understanding biology (because that is a doctors or psychiatrists domain), we are left with life events. The bigger the life event was, the more it seems logical to expect that it would be the cause/contributor of the disruption we witness. It certainly matches people with Mild Mental Ill Health (see Understanding Mental Illness [LINK]), their normal life was disrupted by an event or series of events, and they don’t know what to do to manage that. With some CBT and a bit of mental health education, most people recover fairly quickly – sometimes with the aid of an SSRI medication.

The problems is that Moderate and Major Mental Illness/Conditions is not explained well by the Trauma Model.

If the tool you are holding is a hammer, every problem starts to look like a nail.

This is why so many therapists push for finding your Trauma, “treating it”, then blaming you when it doesn’t work. This is particularly grotesque when people are falsely diagnosed with cPTSD to avoid the stigma of BPD, or so that the BPD traits can be blamed on a concept of Trauma Causes First.

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