Difficulties in diagnosing psychotic patients with traumatic experiences. Why don’t we hear what our patients say?

The relationship between traumatic experience and psychosis is exemplified in this paper by two cases. The first patient was described by Maurycy Bornstein in 1916. The other is a Holocaust survivor currently provided psychotherapy by the author. Both cases demonstrate that trauma may underpin psychotic disorders and that the contents of psychotic symptoms may closely relate to traumatic experiences. Interpretation of symptom contents depends largely on the therapist’s ability to recognize trauma cues in the material provided by the patient. The Bornstein case shows how difficult it can be for us therapists to hear contents that relate to our repressed fears since such cues undermine our sense of security and comprehensibility of the surrounding world. The other case evidences the constant presence of the “Shoah complex” involving guilt feelings, and also the resulting difficulties in thinking and talking about the Holocaust in the community of therapists in Poland. The essential component of any therapy for people with psychotic symptoms and a history of trauma consists in helping them to connect these events and contain feelings of fear, shame and guilt.