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Loss of Self in Psychosis and CBT Psychological Theory and Practice Simon Jakes
Psychosis and the Traumatised Self explores what it is like to experience psychosis for individuals with histories of childhood physical and sexual abuse.
The book additionally explores how meaning expressed in psychosis might originate from the effects of abuse, but also long-term life difficulties, motivations, memories, social history, and struggles to narrate and understand. One chapter focuses on refugees who suffered trauma as adults and later became psychotic. Another chapter examines how trauma leads to the destruction of certainty and trust, thereby opening a pathway to persecutory ideas. Drawing on a developmental model of trauma, it is proposed that dissociated parts of the self that developed during childhood contribute to psychosis in adults when undergoing difficulties and stress.
Presented with case illustrations, the book will be useful for those who work in the area of psychosis and abuse to understand the experiences of individuals, and how we might develop appropriate therapy and care.
John Rhodes is a Consultant Clinical Psychologist and a Visiting Lecturer at the University of Hertfordshire. He wrote Narrative CBT: Distinctive Features (2014) and co-authored Narrative CBT for Psychosis (2009). He has published articles in the areas of psychosis, trauma, and depression.
The right of John Rhodes to be identified as author of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Rhodes, John, author.
Title: Psychosis and the traumatised self : understanding and change / John Rhodes. Description: Milton Park, Abingdon, Oxon ; New York, NY : Routledge, 2022. | Includes bibliographical references and index. |
I wish to thank Richard Gipps, Natasha Vorontsova, Luke Bosdet, Simon Jakes, Peter Howson, Natan Barreto, Joanna Farr, who have all contributed in many different ways.
I also wish to thank Louise Healey, Nathan O’Neill, Neil Parrett, Pieter Nel, and Oliver Mason for the contributions they made in carrying out the research presented in the book.
Finally, I wish to thank and acknowledge the bravery of the participants who kindly agreed to be interviewed for the research.
1
PSYCHOSIS AND TRAUMA
After just a few years of working with psychosis, two new clients began therapy with me and asked to talk about the abuse and trauma that had occurred in their lives. One had experienced extreme physical abuse in childhood and the other had been in a war as an adult. Of course, I had known about the possibility of abuse and trauma beforehand, but meeting individuals who were motivated to talk through this, and who later said that the therapy had helped, changed my way of understanding and doing therapy. It taught me that some clients were able to explore such issues, could benefit from this, and would not deteriorate or somehow come apart. This book presents research and therapeutic applications which came out of such initial explorations and draws on the growing body of relevant findings and theory. In this chapter, I will discuss types of trauma, the general effects of trauma, and consider the relationship between trauma and psychosis in terms of long-term effects and causation. Finally, I will describe how the research for the various chapters was carried out and give a brief overview of the book. DOI: 10.4324/9781003044956-1
Types of abuse and trauma
There is a range of types of abuse and trauma: the Child Trauma Questionnaire (Bernstein & Fink, 1998) lists physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. While the term ‘trauma’ includes the impacts of abuse, it can also result from a wide range of events such as parental death, loss, becoming ill with physical or mental conditions. Sometimes the word ‘adversity’ is used to include wider phenomena such as poverty or living in difficult environments.
This book explores the experiences of three groups of individuals experiencing psychosis: those who have suffered sexual abuse or physical abuse in childhood and those impacted by trauma in the context of political violence such as torture or war. The wider range of traumas is not covered. In this section, however, I wish to make some comments on the relevance of two sorts of trauma which have typically also occurred in the lives of the three groups looked at in the book, that is, child emotional abuse and the trauma of the onset of psychosis and hospitalisation.
Child emotional abuse and neglect
Child emotional abuse and neglect (Glaser, 2002) can involve any of the following: parental emotional unavailability, parental negative attributions about a child, developmentally inappropriate interactions, failure to recognise individuality and psychological boundaries, using the child for fulfilment of the parents’ psychological needs, and failure to promote the child’s social adaptation. It has been consistently found (e.g., Cawson et al., 2000; Mason et al., 2009) that some form of emotional abuse usually accompanies other severe forms of child abuse such as sexual and physical abuse. It was assumed that this would probably be true of those participating in the research reported in this book.
Hospitalisation and the onset of psychosis
The onset of psychosis may in itself be such an extreme and negative event that it constitutes a form of trauma. Hutchins, Rhodes, and Keville (2016) noted a very wide range of powerful emotions including shame and guilt following the trauma of breakdown and hospitalisation. The personal
meaning of experiencing a mental health crisis can substantially impact an individual’s identity, with long-term consequences. In addition to experiencing the disturbing effects of psychosis, a person is often put under the care of the psychiatric system or hospitalised against their will. It is perhaps not surprising that some patients describe their experiences as incarceration, and the fact they are being detained in hospital adds negative meaning to their already heightened concerns.
A review by Berry et al. (2015) showed high levels of post-traumatic stress disorder (PTSD) resulting from the trauma of psychosis or hospitalisation or both, with prevalence rates for PTSD resulting from these traumas varying from 11% to 67%. They also noted that there was some evidence that the severity of psychosis-related PTSD is influenced by the person’s previous trauma history. Inpatient psychiatric experience often features disempowerment, coercion, and the restriction of liberty, which can echo conditions of childhood adversity. Given this finding, it is possible that those who have experienced child abuse might find involuntary treatment particularly distressing.
Lu et al. (2017) carried out qualitative work using semi-structured interviews to examine the experience of sixty-three people on an inpatient psychiatric unit who had experienced either a first or multiple episodes of hospitalisation. The main finding was that both the experience of having psychosis and being hospitalised were potentially traumatic. Some features of psychosis which were found to be traumatic included frightening hallucinations, suicidal thoughts, thoughts about harming others, delusions, and unusual behaviours. The patients reported that the psychosis itself also induced anger, sadness, confusion, anxiety, and numbness. In terms of the actual treatment they experienced, the patients mentioned: being kept in hospital for a long time; forced medication; upsetting side effects; coercive treatments involving the use of restraints; being exposed to aggressive patients; and mistreatment by professionals. It is an extremely vivid and worrying picture but, I believe, will be one recognised by those who have worked on wards. Of course some patients somehow cope better with psychosis and many patients do seek help and find their care helpful. It is certainly the case, however, that some patients have a terrible struggle as they are admitted to hospital, particularly during a first episode; and even the most compassionate care may be involuntary and thus constitute a severe challenge to an individual’s sense of autonomy and personhood.
The long-term effects of abuse and trauma
Reviewing the experiences of those who have suffered child abuse and protracted trauma in adult years, Herman (1992) suggested a series of criteria for what she termed ‘Complex Post-Traumatic Stress Disorder’. Whether this is a useful specific diagnostic category or not, the list of symptoms is certainly an illuminating overview of the effects of abuse. She states that abuse affects a person’s ability to regulate and live with their emotions and involves experiencing extreme negative emotions. There can be effects upon consciousness itself such as amnesia or derealisation and specific features of PTSD such as reliving. It affects the person’s perception of the self and is associated with feelings of shame, guilt, and self-blame. Herman noted how a person may feel themselves to be completely different from others. There are changes in relationships such that a person can become isolated, withdrawn, and experiences persistent mistrust. There can be a loss of meaning and a sense of hopelessness and despair. In situations of being held captive (e.g., domestic abuse) there can be alterations in the perception of the perpetrator.
A great deal of research has examined the specific long-term effects of early abuse. A review by Anda et al. (2006) noted that the more childhood adversities a person had suffered, the greater the incidence and severity of negative outcomes. Outcomes included the risk of panic reactions, depressed affect, anxiety, and hallucinations; sleep disturbance, severe obesity, and multiple somatic symptoms; substance use and abuse; smoking, alcoholism; risk of early sexual intercourse, multiple sexual partners, and sexual dissatisfaction; impaired memory of childhood; high perceived stress, difficulty controlling anger, and the risk of perpetrating intimate partner violence. A review by Heim et al. (2010) described a similar picture, noting the long-term prevalence of a range of mood and anxiety disorders, schizophrenia, attachment disorder, eating disorders, and personality disorders. They underlined that childhood trauma also dramatically increases the risk for later substance abuse and suicide attempts.
There is now a growing body of research looking at changes that may occur in terms of the brain and nervous systems of persons who have survived childhood abuse (Van der Kolk, 2014). A review by Teicher and Samson (2016) suggests that not only are these changes long lasting, but that there may be specific changes in the brain according to the type of
abuse suffered. The authors concluded that ‘structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse’. Some reviews have focused specifically on the effects of physical or sexual abuse, and these are given in chapters two and three. From the many pieces of research we can say with confidence that experiencing abuse in childhood is one of the most destructive things possible in a person’s life, and leads to a wide range of psychopathologies and other forms of suffering.
Does childhood abuse lead to psychosis?
A great deal of research has now shown that various forms of childhood abuse are highly prevalent in the histories of those diagnosed with psychosis: a review by Read et al. (2005) suggested that 48% of female participants reported sexual abuse and 48% physical abuse, while 29% of male participants reported sexual abuse and 50% physical abuse. The results of a meta-study examining the relation between psychosis and childhood abuse (Varese et al., 2012) suggested that those who had suffered childhood adversity were 2.8 times more likely to have psychosis than those who had not. Matheson et al. (2013) in their meta-study reached the same conclusions. Read and colleagues (Read et al., 2005; Skehan, Larkin & Read, 2012) have argued that such evidence points to the probable causal role of abuse.
Longden et al. (2016) added to the evidence for a causal effect of abuse by demonstrating a dose-response relationship between childhood adversities and psychotic symptoms. They used randomly selected records from New Zealand community mental health centres and found that the higher the number of childhood adversities in a patient’s history, the higher the number of psychotic symptoms they later experienced, including hallucinations, delusions, and negative symptoms. Longden and colleagues did not find evidence for specific links of sexual abuse with hallucinations or physical abuse with delusions, although these had been suggested in previous reports. The data were consistent with a model of global and cumulative adversity, in which multiple exposures may intensify the risk of psychosis beyond the impact of single events.
Social and psychological features of those with psychosis and abuse histories
What social or psychological features might be commonly found in adults who have suffered childhood abuse and who have a diagnosis of psychosis? In terms of social problems, Skehan et al. (2012) pointed to higher levels of homelessness, impaired intimacy, and extensive use of psychiatric services. These patients were also more likely to have attempted suicide than patients with psychosis who had not been abused. A recent metaanalysis of features by Rodriguez et al. (2021) noted a wide range of cognitive alterations in working memory, attention, social cognitive processes, and emotional perception.
As well as mapping the psychological profiles of those with psychosis and a history of abuse, research has tried to identify specific features which might perpetuate a person’s difficulties, and potentially even constitute causal pathways between childhood trauma and psychosis. Such features have included: 1) post-traumatic sequelae including dissociation, 2) affective dysfunction and dysregulation, and 3) maladaptive cognitive factors such as negative beliefs about self and others. Williams et al. (2018) in a meta-study found evidence for all three of these features mediating the trauma-psychosis link. Another meta-study by Alameda et al. (2020) has in general confirmed the findings of Williams et al., demonstrating particularly solid evidence concerning pathways from childhood abuse to psychosis via post-traumatic symptoms including dissociation, and via negative cognitive schemas about the self, the world, and others.
Isvoranu 2016 et al. (2016) examined evidence for an affective pathway using statistical network analysis (i.e., where any possible relation between all specific symptoms and a very wide range of outcomes is investigated and the strength of statistical association is given). The most common pathway between childhood trauma and all types of later psychotic symptoms was shown to be the experience of anxiety; that is to say that many different types of abuse led to anxiety, and anxiety in its turn was associated with all psychotic symptoms. Two lesser additional pathways indicated by the analysis were via poor impulse control (which connected to areas such as grandiosity and excitement or hostility) and via motor retardation in adults, following neglect in childhood, and leading to later negative symptoms.
Explanatory models
All of the above findings in different ways, and to different degrees, may contribute to the building of causal models, that is, an explanation of how abuse actually leads to psychosis. Several causal or explanatory theories have been suggested; I will not give here detailed accounts but simply highlight some well-known models. Read and colleagues (2014) have explored potential long-term changes in neurological functioning and the central nervous system: their work suggests that trauma in children leads to lasting changes; in particular, they note over-reactivity to stress of the hypothalamic–pituitary–adrenal axis and the dopaminergic system. They also note changes in the hippocampus and frontal lobes. They argue that the changes formed by abuse lead to the same sorts of cognitive deficit found in participants with psychosis.
Cognitive models have emphasised the importance of meaning and interpretation of experiences. Morrison et al. (2003) argued that those experiencing psychosis, as well as those with trauma history, suffer from ‘intrusive’ experiences (e.g., thoughts, memories, impulses), and that in psychosis these intrusions are interpreted in culturally unacceptable ways; a person might believe that an intrusive thought relating to past trauma has been inserted by an external agent, rather than coming from a part of their own mind. Steel et al. (2005) argued that ‘contextual integration’ is a central feature in understanding trauma and psychosis; it is noted that a traumatic experience might be so overwhelming that normal memory processes are interrupted such that instead of remembering a terrible image as something from the distant past, it may be experienced as occurring in the present moment. This triggers a search for meaning; the person may imagine, for example, that they are under attack or surveillance by a gang.
Hardy (2017) has developed a model that includes an interaction of memory processes, dissociation, emotional dysregulation, self and other cognitions, and appraisal of intrusions and their consequences. In brief, emotional dysregulation makes it more likely that intrusive experiences associated with memory disruption and dissociation are triggered, negative cognitive structures make it more likely that these are interpreted in a threatening way, and the combination of these with avoidant coping strategies can prevent reprocessing of memories and reappraisal of beliefs.
Dissociation is a concept with an extensive history as a core process in trauma and psychosis (Ross, 2004; Van der Hart, Niejenhuis & Steele, 2006; Moskowitz, Dorahy, Schäfer, 2019). Dissociation has been conceptualised in many ways, from subjectively experienced states of depersonalisation and derealisation, through to ‘structural dissociation’, that is, a state whereby mental processes that normally cohere, interconnect, and function together are to various degrees rendered separate and can in extreme cases involve an apparent fragmentation of the personality. I will return to this concept in later chapters.
Given the multitude of diverse findings and theories, it might be that eventually all these different ways of describing and explaining the phenomena could be fused into a multilevel integrative model and one that includes social events, meaning, social processes, psychological processes, and neurological change. I believe it will also need to include findings from the first person perspective, qualitative research, and phenomenology.
Research presented in this book
Clearly trauma is an extremely important issue concerning those who experience psychosis, and that is the case whether we consider it primarily as a causal factor or as an additional burden. In the literature it has been suggested there are several pathways to psychosis, some being initiated by biological events and others from trauma. It is possible that for some patients they suffered both biological causes and abuse simultaneously. Whatever the pathway, it is important that we understand the nature of the experience. Earlier in the chapter I presented quantitative research which maps not only potential causes and effects but the actual features and processes which may be contributing to the development of psychosis. However, all of these quantitative pieces of research cannot describe what participants perceive as occurring or important, or the experience of everyday life in its complexity, or how for an individual the different features may interact or amplify each other.
In addition to understanding abuse in general it is also important that we understand the possible effects of specific types of trauma; for example, are the long-term consequences suffered by participants who survived sexual abuse different from those who have experienced physical abuse? Furthermore, what are the immediate experiences of those who have
undergone terrible traumas during adult years such as domestic violence or war? Are those who suffer trauma in their adult years affected differently from those who experience abuse in childhood?
The importance of understanding the actual experience of participants in its complexity led to the various pieces of research upon which this book draws and expands. In the first part of the book three separate but coordinated pieces of research carried out by myself and colleagues are reported in detail: chapter one looks at child physical abuse, chapter two at child sexual abuse, and chapter three at refugees who have suffered forms of political violence. For these pieces of research a deliberate effort was made to find participants who had suffered only physical abuse or only sexual abuse and not several types of child abuse simultaneously (except of course emotional abuse, which we assumed would also be present as described earlier). We hoped that by investigating the different types of abuse separately, we would have more confidence in any findings concerning the different effects and experiences.
For the research we used a methodology called interpretive phenomenological analysis (IPA), developed by Smith and colleagues (Smith et al., 2009). The approach involves interviewing in depth a small number of participants. A central aim of this methodology is to capture a participant’s experience of a phenomenon and the meaning it holds for them. While it is concerned with personal experience, IPA’s primary focus is those experiences that are important to people and prompt reflection. The method is interpretive or ‘hermeneutical’ in that it assumes that meaning is central to experience and that the meaning of an experience for a person only comes to light, and can be seen, through the interpretative process. The approach draws from phenomenology, in that it tries to capture the world and self as experienced, as it appears, and not as it might be assumed in a psychological or other theory. While phenomenology emphasises the immediate experience of the person, it also sees the person and their experiences as immersed in a practical, historical, and cultural context and inseparable from it. In fact, the tradition of phenomenology asks us to think of persons as existing in concrete and cultural contexts and that individuals and social contexts co-created each other. IPA, however, is a psychological method and is not a way of doing a type of philosophy. After the initial analysis of findings, and the generation of themes, it aims to stay
close to a person’s experience and rooted in the data; quite often IPA then relates findings to ideas in psychology or social sciences and might also draw, if appropriate, upon ideas from phenomenology and other philosophies during extended conceptual analysis. I would argue that IPA does not rely upon phenomenology as a ‘method’ but rather as a conceptual framework or as a ‘topic’ area, the latter being the lived world, the self, the other, and context as manifest and given in experience.
IPA was also used because it is idiographic, focuses on experience, has a well worked out set of procedures that specify how the interview should be structured, and how the interviews can be analysed. It specifies how each case is analysed ideographically, and a table of themes is established before moving to the next case. A cross case analysis of the table of themes from each participant is conducted to create a superordinate table of themes for all participants in the study.
The themes may occur at different levels, for example, quite specific themes or more general themes which capture variations. The process is, however, complex, and involves discussion, comparison, and further thought and often new cycles of analysis until a coherent set of ideas is generated. The themes generated from the three groups are presented in chapters two, three, and four. This book, however, also involves further extended analysis. In chapters five, six, and seven there are comparisons made between the three groups and explicit links are made to a range of psychological and sometimes phenomenological concepts and theories.
The participants
The three groups were interviewed with a similar set of questions (though with some altered details for each group). The questions were about the participants present lives, their experiences over the years, what difficulties and problems they were suffering from, and issues such as ‘voices’ if these were mentioned in the interview. There was also a focus on how they saw the effects of abuse over their lives. We did not, however, focus on details of the abuse itself which we thought would be not necessary for this research and might be disturbing for the participant. We aimed not to introduce psychiatric language into the interviews, but did find that many participants would spontaneously use terms such as ‘voices’ or ‘paranoid’ which allowed discussion of these features.
To find possible participants we relied on information in notes and reports from psychiatrists and psychologists based in a community psychiatric service and hospital. Trauma histories were assessed using the Child Trauma Questionnaire (Bernstein & Fink, 1998), which has been used in many pieces of research with trauma and psychosis. The questionnaire is succinct and does not go into disturbing detail.
For the study of refugee experiences, we sought asylum seekers who had reported histories of exposure to violence in their countries of origin and had displayed psychotic symptoms, as recorded by psychiatrists, while in the UK. Permission to carry out the research was given by the local ethics committee. All potential participants were given a full explanation of the project and choice as to whether to participate. Furthermore, if participants were not happy about the interview they were able to request that the data would be erased (no one requested this).
Outline of the book
After the introductory chapter the book has three main parts. In the chapters two to four, detailed findings are presented from research with participants who suffered sexual or physical abuse in childhood or suffered in the context of political violence and became refugees. In chapters five to seven, comparisons will be made across the three groups and further analysis on key topics is given. In chapter five it will be argued that psychotic meanings found in voices and delusions, but also in everyday social perceptions, relate to specific past traumas. There is also a review of the many contributions to delusional meanings and a full case study. Chapter six presents evidence describing extreme emotional and interpersonal states and how these may be transformed in psychosis: this is also linked to the perception of others and voices. In chapter seven it is argued that psychosis involves the disturbance of a person’s grasp of the shared everyday world, of basic certainties and trust, and that these are influenced by trauma. Finally, there is a focus on therapy; in chapter eight models of therapy suitable for work with trauma and psychosis are discussed and ideas for modifying schema therapy given. Chapter nine contains detailed examples of such work and an extended case illustration.
References
Alameda, L., Rodriguez, V., Carr, E., Aas, M., Trotta, G., Marino, P., … Murray, R.M. (2020). A systematic review on mediators between adversity and psychosis: Potential targets for treatment. Psychological Medicine, 50, 1966–1976.
Anda, R., Felitti, V., Bremner, J., Walker, J., Whitfield, C., Perry, B., … Giles, W.H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186.
Bernstein, D.P., & Fink, L. (1998). Childhood trauma questionnaire: A retrospective self-report manual. San Antonio, TX: Psychological Corporation.
Berry, K., Ford, S., Jellicoe-Jones, L., & Haddock, G. (2015). Trauma in relation to psychosis and hospital experiences: The role of past trauma and attachment. Psychology and Psychotherapy: Theory, Research and Practice, 88, 227−239.
Cawson, P., Wattam, C., Brooker, S., & Kelly, G. (2000). Child Maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect London: NSPCC.
Glaser, D. (2002). Emotional abuse and neglect (psychological maltreatment): A conceptual framework. Child Abuse and Neglect, 26, 697–714.
Hardy, A. (2017). Pathways from trauma to psychotic experiences: A theoretically informed model of posttraumatic stress in psychosis. Frontiers in Psychology, 8, 697–717.
Herman, J.L. (1992). Trauma and recovery. New York: Basic Books.
Heim, C., Shugart, M., Craighead, W.E., & Nemeroff, C.B. (2010). Neurobiological and psychiatric consequences of child abuse and neglect. Developmental Psychobiology, 52, 671–690.
Hutchins, J., Rhodes, J., & Keville, S. (2016). Emotional earthquakes in the landscape of psychosis: an interpretative phenomenology. The Cognitive Behaviour Therapist, 9, e30. doi: 10.1017/S1754470X16000167.
Isvoranu, A.-M., van Borkulo, C.D., Boyette, L.L., Wigman, J.T.W., Vinkers, C.H., & Borsboom, D. (2016). A network approach to psychosis: pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin, 43, 187–196.
Longden, E., Sampson, M., & Read, J. (2015). Childhood adversity and psychosis: Generalised or specific effects? Epidemiology and Psychiatric Sciences, 25, 349–359.
Lu, W., Mueser, K.T., Rosenberg, S.D., Yanos, P.T., & Mahmoud, N. (2017). Posttraumatic reactions to psychosis: A qualitative analysis. Frontiers in Psychiatry, 8, 129. 10.3389/fpsyt.2017.00129.
Mason, O., Brett, E., Collinge, M., Curr, H., & Rhodes J. (2009). Child abuse and the content of delusions. Child Abuse and Neglect, 33(4), 205–208.
Morrison, A.P., Frame, L., & Larkin, W. (2003). Relationships between trauma and psychosis: A review and integration. British Journal of Clinical Psychology, 42, 331–353.
Moskowitz, A., Dorahy, M.J., & Schäfer, I. (2019). Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology, (2nd ed.), London: Wiley.
Read, J., Fosse, R., Moskowitz, A., & Perry, B. (2014). The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry, 4, 65–79.
Read, J., van Os, J., Morrison, A.P., & Ross, C.A. (2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330–350.
Rodriguez, V., Aas, M., Vorontsova, N., Trotta, G., Gadelrab, R., Rooprai, N.K., & Alameda, L. (2021). Exploring the interplay between adversity, neurocognition, social cognition, and functional outcome in people with psychosis: A narrative review. Frontiers in Psychiatry, 12: doi: 10.3389/fpsyt.2 021.596949.
Ross, C.A. (2004). Schizophrenia: Innovations in diagnosis and treatment. New York, NY: Haworth Press.
Skehan, D., Larkin, Q., & Read, J. (2012). Childhood adversity and psychosis: A literature review with clinical and societal implications. Psychoanalysis, Culture & Society, 17, 373–391.
Smith, J.A., Flowers, P., & Larkin, M. (2009). Interpretative Phenomenological Analysis: Theory, Method, and Research London: Sage.
Steel, C., Fowler, D., & Holmes, E.A. (2005). Trama-related intrusions and psychosis: An information processing account. Behavioural and Cognitive Psychotherapy, 33, 139–152.
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Van der Hart, O., Niejenhuis, E., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatisation New York, USA: Norton.
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechbauer, … Bentall, R.P. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661–671.
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2
PHYSICAL ABUSE AND PSYCHOSIS
Introduction
Physical abuse is a terrible and harmful assault on the person, and may cause or contribute to psychosis. The focus of this chapter is to present first person experiential reports of adults diagnosed with psychosis and who underwent physical abuse in childhood. In short, what has their experience been like over recent years, what are their concerns? The chapter is a revised version of Rhodes and Healey (2016).1 First, however, I will briefly present some specific research findings connecting child physical abuse (CPA) with psychosis.
The long term consequences of child physical abuse
Several studies have mapped out the long-term consequences of experiencing CPA. In research by Springer et al. (2007) looking at data from 2,800 adults in the general population, the results suggested that 11.4% reported CPA; those with physical abuse were found to have high levels of
DOI: 10.4324/9781003044956-2
depression, anxiety, anger, physical symptoms, and medical diagnoses. In another community survey (Sugaya et al., 2012) looking at 43,093 participants, 8% were found to report CPA; controlling for other variables the research suggested that there is an increased chance among those with physical abuse of going on to experience attention deficit hyperactivity disorder, post-traumatic stress disorder, and bipolar disorder. They also noticed that there was a ‘dose-response effect’, that is, the more abuse experienced, the more likely one would be to be diagnosed with these conditions. Clearly the effects of CPA are powerful and destructive in the lives of adults.
Child physical abuse and adult survivors with psychosis
Chapter one summarised the research looking at a range of types of childhood abuse and included the potential link between physical abuse with later psychosis. Fisher et al. (2014) reported a specific association between CPA and psychotic symptoms; furthermore, their analysis suggested that this association was independent of family psychiatric history, that is, they were able to account for the possible genetic influence of parents and to still show that CPA was an independent predictor of later psychosis.
Bullying
The focus of this chapter is not on bullying, which is conceived as being carried out by a person’s peer group outside the family, and is not usually classified as CPA. However, it is clear that the two involve similar elements of physical violence and intimidation. It is therefore interesting to note that research (Cunningham et al., 2016) has suggested that bullying itself may be another influence on a pathway to psychosis, particularly late onset psychosis.
The participants
All the participants for this research scored highly on the Childhood Trauma Questionnaire (CTQ; Bernstein & Fink, 1998). The CTQ defines
CPA as ‘bodily assaults on a child by an older person that pose a risk of, or result in, injury’. This is the definition we assumed for this book. Eight adult participants experiencing psychosis were recruited from a psychiatric facility in London. Diagnoses were identified from clinical records. As is recommended in interpretive phenomenological analysis (IPA), we aimed to recruit a small number of participants, and those recruited were the first eight to meet our criteria. Participant details and abuse histories are shown in Table 2.1.
The participants were asked when the physical abuse that they experienced began and ended, the frequency, and who carried out the abuse. In sum, the abuse was mainly classified on the CTQ as ‘severe to extreme’; the abuse had been carried out by one or both parents, often started below the age of eight, and ended during the person’s late teens. The abuse occurred regularly, often on a weekly basis. The participants had no documented experiences of childhood sexual abuse and did not score for sexual abuse on the CTQ.
The themes expressed by participants
The following themes were generated: aggression-permeated world; dehumanising self attack; pervasive mistrust and the ‘front’ of others; damaged intimacy; the fluctuating ‘thread’ of meaning and identity
Table 2.1 Characteristics of participants
Participants Age (years) Gender Ethnicity Diagnoses
Mirza 53 M Asian British
Schizoaffective disorder
Peter 42 M White British Bipolar disorder with psychotic features
Chris 34 M Nigerian British Paranoid schizophrenia
Lesley 23 F White Irish Paranoid schizophrenia
William 48 M White Irish Paranoid schizophrenia
Greg 32 M Black Mixed Heritage British
Drug-induced psychotic episodes
Sally 32 F White British Schizoaffective disorder
Rita 38 F Black British Paranoid schizophrenia
transformations; dread of murderous obliteration; distress and perceived links to the past.
Aggression-permeated world
All the participants saw other people in general as difficult and often dangerous. The other might actually attack physically, but short of that, is seen as emanating hate, rejection, and sometimes contempt. Mirza said:
I’ve been mugged and beaten up quite a lot walking the streets, you know? Sometimes I feel scared to go out Well you’re just locked up in a prison, you know? And you feel locked up, umm, even though you’ve got your freedom you know? You can go out that door anytime you want to, you don’t, you’re scared to go out that door.
He states that he is in danger and that someone will attack him: further, this is how things are every day. It is not just a possibility, but an actual threat. The door seems a slender barrier. He went on to say:
You see people abusing each other in the papers. People are generally that way … life’s not a bed of roses many people die in the hurricane.
To be alive is to experience a hurricane: it is to be exposed to a huge uncontrollable violent force. While the rose image is well known, perhaps a cliché, the next phrase conveys both sadness and fear. All one can do is try to shelter and hide, but then one is a prisoner. In the hurricane,
Many don’t get to see the end of their lives.
They do not see what is supposed to be the natural end, but rather, what they see is their own untimely violent death. Mirza’s hurricane, however, is not one of nature, it is other people and what they are willing to do. For some participants, the zone of threat is more specific:
You’ll follow a certain crowd and you end up in certain parts of society, and in those certain parts it’s, that’s the only thing that goes on, fights, stabbings, shootings and all that. (Chris)
The world he lives in is one of violence; it is the norm, the ‘only’ thing. With a similar emphasis on violence, Sally stated about her ex-partner:
He would go off big time. He’d start throwing me about, getting nasty.
This partner of seven years was not only violent but ‘nasty’, suggesting he did this not just as a sudden explosion of emotion, but with deliberate hostile intention. The reported world of the participants was one of extreme fear of violence. Whether this was just what might be thought of as a misperception, or that in fact they did live in social worlds with more violence, cannot be answered here.
Dehumanising self attack
Six participants spontaneously described negative attitudes to themselves: two were almost violent in their self attack. Greg stated:
Always looking and seeing myself as ugly and fat and unattractive… it’s just like ‘there’s a pin, there’s another pin’ like a voodoo doll, ‘there’s another pin’ .
He represents himself as a ‘voodoo doll’ which he torments with pins. A ‘doll’ is usually childlike and here it is as if he attacks some part of himself that is childlike. A voodoo doll is used to hurt someone: the person in this case appears to be Greg himself. In this one complex blended image he expresses attacking and being attacked within himself.
William also described ‘self attack’:
Running myself down, you know, saying you’re a fool, you’re an idiot, you’re, very nasty things to myself … your brain is screwed, you’re never going to be right in the head.
The image seems very much one of one person shouting at another an endless stream of insults. In the above, William speaks in the second person, as if in a dialogue. He seems to be speaking in the voice of one who is superior and aggressive to one who is silent and inferior, who just takes this stream of attack. It is reminiscent of someone authoritarian and of ‘telling off’.
While six participants directly held negative views of themselves (from extreme to moderate), of these six a further four also expressed the idea that others saw them in negative ways. While Sally felt that she was ‘disgusting and dirty’ she also noted how difficult her relationship was with her son,
I feel he’s not knowing me as me, he’s knowing some monster …
Her son not only perceives her apparent state as monstrous, but he ‘knows’, suggesting a deeper knowledge perhaps developed over many encounters. But what is a monster? Perhaps something that is destructive and not even human. Further, if he ‘knows’ he is unlikely to change his view easily. The statement suggests a sense of pessimism.
In contrast to several others, Peter did not criticise himself, but was tormented by how others saw him and in particular, a neighbour:
They see a monster. Each day she turns me into a monster … I seem to be wearing this big sandwich board saying ‘freak, pervert’ , and whatever, you know.
That she is able to turn him into a monster seems to suggest not only that she sees him in that way, but that she contributes to this process doing it bit by bit each day. It is interesting to note how two participants used the actual word ‘monster’.
Pervasive mistrust and the ‘front’ of others
Six participants expressed a sense of extreme mistrust, either directly or indirectly. While mistrust and the theme of a hostile world were often found in combination, it was clear that mistrust and confusion extended to many other contexts. Lesley stated:
I don’t really know when a friend’s a friend.
For most of us this is not a problem, we know our friends and continue to feel confident even during arguments. But Lesley does not know: she is cut off from whatever it is that creates trust. Sally claimed that a social worker
(in fact there for her child) had begun a relation with her boyfriend: ‘ and I felt her going off in the car with him’
It is interesting to note how she says ‘felt’, that is, not something seen or heard. She has a feeling of the person actually going off with another. The ‘going off’ appears to be both spatial and social. Her mistrust is much deeper than a mere guess or idea. Peter also does not believe the appearance of everyday events and interactions: ‘ … being able to quite often see through lies and mistruths, through people’s body language, through their, just general vibe’.
What is presented by the other is not believed. He says the above as if it were a general truth of his social world. There is something to ‘see through’, that is, what is said and how others behave, and this surface must conceal the truth. The experience of the everyday world as having some sort of surface that conceals was conspicuous for Mirza:
They are just putting on a front … inside they want to kill you, they want to murder you, they want to do bad things to you.
In the world of Mirza, there remains, despite appearances, the likelihood that others hide murderous intentions. In the everyday world, we assume, more or less, that the friendliness we see in others is just that. His world seems a lonely and fearful one: it contains Mirza, the ‘front’ of others, and their unknown but suspected malicious intentions. The behaviour of others has no intrinsic meaning or worth: it is just a surface that conceals.
Damaged intimacy
This theme concerns damaged intimacy, that is, the person’s profound difficulty in maintaining good relationships with partners or friends, and with it a sense of loneliness. All the participants reported difficulties with intimate relationships, and few were in relationships. While four explicitly mentioned anger or aggression by the other affecting their relationships (see Sally in the theme of hostility), four thought others saw them as angry, and of these, two were sure of their own repeated extreme anger at others. Rita spoke openly of being:
Verbally abusive, umm, emotionally abusive … I tremble and shake with temper.
She is out of control and appears transformed. The body ‘shakes’ as if some force had overwhelmed her. Over time she found herself in the situation of being: …
very, very lonely and isolated.
In all, six participants described intimacy difficulties involving hostility from self or from the other. William described feeling great anger at others (which he hid) but was also very aware of his isolation and disconnection from others:
I’ve never really, I’ve never really been truly involved with people, you know, on an emotional level.
He added that throughout his life he had been:
Incapable of the emotions, of the deep emotion, or I’ve been unwilling to involve myself with it.
He knows there is such a thing as ‘deep emotion’, yet is not able to have this experience. He qualifies his statement by adding that he might have been ‘unwilling’ to be involved, as though he sometimes blamed himself, as if this was somehow voluntary. Irrespective of blame, his predicament suggests the most profound long-term loneliness. It is to live in a world where one is alone and interaction is only superficial and distant. And in a sense, he performs this lack of involvement in the apparent calm of coolly presenting his statements as being either/or, as if making a legal or scientific argument. Peter reported feeling no anger at others but stated that others feared him and did not understand him. In the following Peter describes profound loneliness:
People’s misconceptions of me, their misunderstanding, their inability to be able to talk to me, … That hurts the most, that has the largest impact on my life … I do need communication like all human beings need on occasion. And if I’m starved of that, then it hurts and I start frowning and they think I’m angry, so now I’ve gotta smile, but the smile, a false smile, yeah with the hope that someone will say ‘hello’
This paints a picture of someone not with others, not understood, and struggling to know how to cope in loneliness that hurts. He does not even receive
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might not be amiss.”
Hugh had heard enough. He crept back hastily, locking his door. He must escape from this house, and quickly He began to dress in the clothes Pascal had given him. With a groan he remembered that he had left his revolver in the pocket of his coat. Too bad, that!
Fully dressed, he went to the door and listened again. Doctor Bergius and Castelli were being shown upstairs to their rooms, one on each side of his own. He heard them enter, then Pascal descend the stairs again. All was quiet.
He opened the window very softly and peered out. It was a drop to the ground of about twenty-five feet. He dared not risk the fall. Then his heart leaped. At the side of the window was a rain pipe running from the roof to the ground. It would be easy to slide down that. He did not know their plans, but they would wait, no doubt, until Pascal had gone to bed before attempting anything.
A long silence.
Now there were stealthy steps in the corridor and whispering. With his ear to the door he listened. His hearing was unnaturally acute, and he distinctly heard Castelli:
“Gamba, where is Golaz?”
“Waiting by the door, Master.”
“Right. Our man is trapped. He can’t escape this time You and Golaz watch to see he doesn’t descend by the window. If the innkeeper interferes, settle him. And mind, we must take the Englishman alive. No reckless shooting. After we’ve got what we want out of him, you can do as you please. Now go.”
Again a long silence.
Hugh thought, “They suppose I am asleep. Soon they will try my door.”
He waited. Ten minutes, a quarter of an hour passed. Everything was still. One might have thought that all the house slept.... Some
one was gently trying the handle of his door, turning it softly first one way and then the other. He heard a harsh whisper: “Locked.”
Again he heard the grating voice of the doctor “I thought so. Well, there’s nothing for it but violence. Put your pistol to the lock and burst it.”
Crash! In the silence of the house the explosion seemed terrific. There was a splintering of wood and the lock was torn from its fixings. But the bolt still held, and though Castelli shook and hammered on the door it would not open. Again he heard the voice of Doctor Bergius.
“Brace yourself against the wall of the corridor. Come, we’ll both put our strength into it.”
Hugh heard the door strain, crack. It was stout and still held. But it could not last long. In another minute it would give way. He ran to the window and leaned out. Then he drew in sharply, for from the darkness two bullets shattered the pane. Golaz and Gamba were on watch down there. No escape that way.
He wheeled around, desperate. The door under the combined weight of Castelli and the doctor was beginning to bulge, to crack. In another minute they would be in the room. He was trapped, unarmed, helpless. He was lost.
Then suddenly the pressure on his door ceased. They had paused to listen to what was going on below. The inn-keeper had jumped out of bed and run into the kitchen.
Hugh heard him cry: “What’s wrong! Nom de Dieu! What’s the matter? Ho! there, you two fellows!... Why, they’re gone. Ah! the door’s open....”
Daring another shot Hugh leaned from the window. Golaz had taken up a position behind the door and as the inn-keeper came out, threw his arms around him. In that bear hug of a grip, Pascal was as helpless as a child. He gave one great, hoarse cry, then Gamba had him by the throat.
The three were locked in a silent, deadly struggle. All at once Hugh heard again the ominous crack of the breaking door. Now was his time, now or never. He would slip down the pipe and then ... leave the rest to luck. As he climbed out on the sill of the window he heard a cry of alarm. Golaz and Gamba had seen him. They still gripped the inn-keeper. When he slipped to the foot of the pipe he, too, would be seized and held. No, that way was madness. What to do then?
There was another way ... up! The eaves of the house were only a few feet above his window. That was it, the roof.
So instead of slipping down the iron pipe, he wriggled upward. He clutched the gutter that collected the rain. It held and with a fierce jerk he pulled himself level. A second later he was sprawling on the slope of the roof.
From below came a howl of baffled rage. Golaz and Gamba were cursing both him and themselves. At the same instant Castelli and the doctor burst into the room. Soon came the voice of Doctor Bergius from the window.
“Where is he? Have you seen him?”
“Yes, the roof. He’s on the roof.”
“Oh, you fools, you cursed fools! Why did you let him get away again? What have you got there?”
“The inn-keeper. He tried to interfere.”
“Seems to me he’s lying suspiciously still. Hold on, I’m coming down.”
There was a pause; then again the voice of the doctor. “Gamba, you little devil, the man’s dead!”
“Yes, Master,” said Gamba humbly, “I’m afraid I squeezed a little too hard.”
“Bah! well, too late now. Take the body and throw it into the stream at the back. People will think he was drowned. Where’s the Englishman?”
“One can’t see him. The angle of the house hides him. But he’s up there all right.”
“Very well. You two men dispose of that body; Castelli, you run back a bit and see if you can see him.”
Hugh realized that, where he lay flat on the snow-covered roof, he was an easy mark. A belated moon gleaming through the cloudfleece, would direct their aim. On the other side of the house was darkness and the protection of the stream. He must gain that. Keeping his feet in the gutter he worked along the roof till he came to the end of it, then gripping the slate edge, desperately he pulled himself up until he was astride of the ridge.
A shot whistled past him. That would never do. Castelli could pick him off as he crouched low on the ridge. He allowed his body to slip a little way down the side next to the stream. Thus hidden from them, half embedded in the snow, he clutched desperately at the angle of the ridge and waited. What would they do next?
Everything was very quiet, a quiet full of menace. Beyond a doubt they were carrying out some fresh scheme. The suspense was too great to be borne; he must know at all costs what they were doing. With a great effort he drew himself up and peered over.
He saw a sight that filled him with terror and despair ... the head and shoulders of Gamba, appearing over the edge of the roof. Stealthy and catlike the little man was climbing with no apparent effort. Now he was sliding like a monkey along the gutter, now he was drawing himself up to the peak, now he was astride the ridge. Hugh stared into his black vindictive eyes, saw his lips parted in that grin of incredible evil, the revolver held ready in his hand.
“Don’t shoot, Gamba,” he heard the doctor say from below. “Get him alive. Make him come down.”
Gamba bent over and seized Hugh by the arm; behind the pointed pistol, his eyes glittered malignantly.
“Come,” he hissed.
With a sudden wrench Hugh freed himself from the hand that gripped him, and as he did so, he felt himself sliding. He clutched desperately at the angle of the roof, but in vain. The snow on which he lay was slipping, slipping. Gamba clawed at him frantically. Too late! the whole snow mass crashed down like a miniature avalanche. Helpless, turning over in the descent, Hugh went with it, down, down over the edge of the roof into the black depths below....
He felt himself rushing through space. His one agonizing thought was: “When I stop falling what will I strike? Is this the end?” Then....
He plunged into deep water Instinctively he broke the force of his descent with his arms and legs; but even then he struck the rocky bottom forcibly. He rose quickly to the surface.
He realized that he was in the fish pool, swirling round and round. He put out his hand and clutched at an object. Ugh! It was the dead body of the inn-keeper. Horror and fear maddened him. With half a dozen swift strokes, he had gained the opposite bank. He clutched hold of some bushes and pulled himself out.
The men had rushed around to the back of the house, and were firing into the black pool. It was so dark that they did not see him as he staggered up the rocky bank. He heard Doctor Bergius shouting in violent anger:
“Gamba, I’ll flay you for this. By God, I’ll kill you. He’s escaped us again.”
Yes, he was safe—at least for awhile. He stumbled through the darkness of the forest, half crazed, walking like a blind man, fear and despair urging him on.
It seemed to him he must have walked for hours, over rocks, through bush, knee deep in streams, always climbing. His hands and feet were torn and bleeding. At length he could go no further....
Some one was shaking him, telling him to get up. Reluctantly he roused. Above him were a pair of grim, scornful eyes and a face stern as Fate.
Over the hills the dawn was breaking.
CHAPTER SIX THE OUTLAW
1.
“WHO are you?”
The voice that addressed Hugh was rich and imperious.
Hugh looked at the strange face with startled eyes. “A hunted man,” he answered.
The other laughed. “I, too, am a hunted man. Come, you are faint with cold and fatigue. I will give you shelter.”
Hugh clutched his arm. “Don’t let them get me,” he said with a shudder.
The other laughed scornfully. “Don’t be afraid. With me you will be safe. Come.”
He lifted Hugh to his feet, and, half supporting him, led the way up the rocky path.
“You see the door of my home?”
“No, I see nothing.”
“Yonder black hole in the mountain side. That is my front entrance. Incidentally there is a back one for my private use, and only known to myself. But maybe you have heard of me. I am Angelo Rocco.”
Hugh started.
“The ... ah! Celebrity?”
The man laughed again.
“Do not be afraid. You are no enemy of mine, and he who is not my enemy is my friend. Come, you shall bear witness to a bandit’s hospitality.”
They reached the mouth of the cave.
“See,” said Rocco, “from here I can overlook the whole mountain side. If twenty men came to take me, I could shoot them all down before they reached the door. If fifty came I could shoot half, and the other half would look for me in vain. But then no one troubles me. It is understood if I keep out of the way they will leave me alone.”
They crossed the threshold of the cave. For some distance it was well lighted by the circular entrance. Blankets were hung over the walls; furs were strewn on the floor. A hammock swung from staples fixed in the rock. On either side were two long banquettes of oak, and near one of them a black cupboard, on the door of which hung a large ivory crucifix. Rocco threw open one of the banquettes.
“Look! there are some dry clothes. Change into them. Wrap some of these blankets about you, and lie down. I will make a fire and give you some hot soup.”
Hugh did as he was told. He had almost dropped off to sleep when Rocco brought him a big bowl of soup. It was rich and meaty. After he had drunk it, he could no longer fight against his drowsiness and closing his eyes, slept as he had never done before.
2.
He awakened gradually, and with a growing sense of tranquillity. The cave was brightening in the light of another dawn. Outlined against the sky and framed in the circle of the doorway he saw the superb figure of Angelo Rocco. The bandit turned and greeted him.
“A moment ago,” he said, “I saw a shadow moving at the edge of the pine wood. Ha! there it is again.”
He snatched up a rifle and fired.
“There! that will frighten him, whoever he is. If he means no harm, let him come out into the open. Now I will give you some breakfast. My friends keep me supplied with food from the city. I shoot game, but once in a while it is good to eat civilized food.”
They had a breakfast of coffee, bacon and bread. Afterwards they smoked, and Rocco talked. Hugh watched him in admiration. Never had he seen such a perfect man. He was tall, strong and springy as a panther. He had ebony black hair, and a clipped beard and moustache, which did not conceal the strength and character of his face. His fine lips had a haughty twist and his dark eyes were full of stormy fire. He moved with grace, carrying himself like a king.
“You must stay here for some days,” he told Hugh. “Rest your nerves. I am glad of a guest. With me you will be safe.”
He rose, looked keenly over the mountain side, then came slowly back.
“I see no more shadows. For a time at least we have driven off your wolves. Who are they?”
Hugh gave an account of the fight at the inn. When he came to the death of Pascal, Rocco’s face grew dark.
“They killed him, the devils! My good friend, Père Pascal. And who is there then to avenge him? You know, here in Corsica, a life must pay for a life. I had no wish to kill another man. There has been too much killing. But my friend ... my old friend ... well, we will see.”
After that Rocco grew restless. He strode up and down the cave, constantly stopping at the door to stare out. At last he said to Hugh:
“If you do not mind being alone, I will go down into the forest. If any one should come, you must retreat by the passage to the left. In case you want to sleep I will show you where you will be safe.”
A jut of rock nearly closed the passage, but further on it opened out again. At the end of fifty yards it appeared to come to a stop. Rocco held up the light he carried, and showed Hugh a cleft high up in the rock. It was lined with furs and formed a kind of natural bunk.
“Here is where I sleep when the gendarmes are in the neighbourhood. You will be safe here. If you should be further pursued, you have only to roll over that boulder at the far end. Under it you will find a hole down which you can lower yourself. It leads to a subterranean gallery which has many branches and where no one
can find you. Only be careful not to get lost. And the boulder too,—I fear it may be heavy for you to move. But I do not expect to be long absent. In the meantime I do not think any one will trouble you.”
3.
As he descended the mountain, the bandit kept well under cover Hugh watched him till he disappeared into the forest. From the mouth of the cave a magnificent panorama outspread. The mountains looked as if they had been hacked out by an angry god. Their flanks were naked. Moving cloud masses scarfed them for a moment, only to be rent aside again, and reveal new vistas of desolation. The vast abyss of the valley was packed with pines.
The time passed slowly and Rocco seemed to be long in returning. At noon Hugh relit the fire and cooked himself some food. He found that one of the banquettes was stored with provisions, the other with clothes. Rocco had things well arranged.
When he had finished eating, he let the little fire go out, and sat gazing over the valley, dreaming away the hours.... Margot would be married on the seventeenth, that day week. The thought made him miserable. He felt he would give anything to prevent the marriage. He tried to analyze his feelings. He wanted her and yet he did not want her. He wanted her because another man wanted her; or rather, while he didn’t want her himself, he did not want any one else to get her,—a most dog-in-the-mangerish feeling. He told himself that it had all worked out for the best. She would probably be happier with the other man. He envied him. Margot was a jewel of a girl, sweet, gentle, devoted. She would make a ripping little wife. He was sorry he did not love her, at least not in the mad, passionate way that mattered. He just couldn’t care for people in that crazy, headlong fashion. He was a cool, unsentimental sort of a chap. Or was he, really?...
Heigh ho! the time was long. What was keeping Rocco? What a pity about that man, condemned to pass the rest of his life in a prison of
infinite earth and sky He looked around at the few primitive comforts of the cave. There were some books, all on political economy or sociology. Yes, a great pity! A man of force and ability sacrificed because of a youthful excess of ardour. His friends said that Rocco had fired in self-defence; but the friends of the dead man were in power. All at once Hugh had an idea, a fantastic idea. Yes, that was what he would do....
Heigh ho! again. The time was infernally long. It must be about three in the afternoon. How still the mountain side was. Nothing moved. Suppose he slept a little! Taking a blanket, he crawled along the dark passage to the left, climbed up into the cleft and curled snugly in his blanket. Heigh ho!...
4.
He was awakened from a sound sleep by hearing some one moving in the outer part of the cave. The bandit must be wondering what had become of him. He was about to jump down from his perch and greet Rocco when the thought came to him:
“Perhaps it is not he after all. I must be cautious.”
He crawled along the narrow passage, and peered around the shoulder of rock that blocked its entrance. Then he drew a deep, gasping breath, for this is what he saw:
Seated on one of the oak banquettes was Doctor Bergius. He was leaning forward in an attitude of fatigue; his eyes—so wide open that their yellow pupils looked like rings—glared at the rock behind which Hugh was peering. Hugh thought himself discovered; fear paralyzed him. From the darkness he stared back at the doctor. But it was evident the doctor did not see him, did not see anything in fact. His stare was that of abstraction; his mouth had the twist of a savage beast; his face was set in an expression of rage and despair.
Then Hugh saw Castelli, at the mouth of the cave, looking anxiously down the mountain side. He, too, looked weary and desperate. The third of the party was Gamba. Gamba alone showed no sign of
hardship. The little man, compact of all that was fierce and tenacious, was hunting round the cave like a nosing terrier. Hugh started to draw cautiously back when suddenly he heard a hoarse shout from Doctor Bergius.
“Castelli.”
Castelli wheeled round sharply.
“Well, doctor?”
“Castelli, you and I have got to have a heart-to-heart talk. Here and now is a good time. Castelli, you distrust me.”
The Italian started, made a gesture of protest. The doctor strode up to him.
“Oh, I’ve noticed it for some time. The others, too. All of you distrust me. If I thought there was anything in the nature of a conspiracy between you, I’d blow you to hell this instant.”
The doctor was glowering down at the Italian. With a savage gesture he drew a revolver.
Castelli looked at him coolly.
“Go ahead, doctor,” he said. “As a matter of fact I don’t distrust you, but I can’t answer for the other two. You must admit that things aren’t very clear. You played all the other men false. You left them stranded on the Italian shore without a sou of the money. You brought it here for us to make a divide. Then you told us you had lost it; that it had been stolen from you by that fool of an Englishman in a manner you must admit to be fantastic. Can you blame them if they think you want to bilk them, too? Now, personally, I believe you; but if we don’t find this Englishman and recover the money, I give you fair warning there is likely to be trouble. It’s no use threatening me, doctor. Remember we are three against one, and none of us very squeamish about taking life.”
“By God, it’s true, Castelli. I’ve been outwitted, and by a fool. Aye, that’s what hurts. He must have spied on me at the hotel. I could not take the bag about with me everywhere. He profited by an hour’s absence, only an hour, to get possession of it. He’s got it, got it all.
He’s hidden it till he can come back safely and get it away That’s why we’ve got to find him, got to hunt him down. He mustn’t leave the island. He’s here somewhere in these cursed wilds. He must not escape us. We’ve got to get him, Castelli; and, when we do, I’ll torture him till he tells; then kill him afterwards with my own hands. Ha! that will be the happiest moment in my life,—when I kill the dog.”
“Well,” said Castelli, “we haven’t got him yet! There’s no use wasting time; it’s evident he’s not here.”
“Leave no stone unturned. It was just a chance that he might have taken refuge with this Rocco. Where is the fellow? He might at least be able to give us some information.”
“Gone off hunting probably. Still he’s been here not so long ago. See, the ashes of his fire are still hot.”
“We may as well go. We’ve no time to spare. Stay! as we are here, we might as well search the place. There are three passages. I’ll take the centre one; Gamba can search the one to the right, while you examine the one to the left. Got an electric torch?”
“No, matches.”
“All right. Go ahead.”
Feeling his way along the wall, Hugh ran back into the darkness. There was not a moment to lose; Castelli was almost in the passage. He must escape. Ah! the boulder that concealed the secret exit! He reached it and tried to move it. In vain! Again he tried with all his strength. He was able to budge it only a few inches. Castelli was already at the opening. No, he could not shift this cursed boulder; he would be caught like a rat in a hole! Castelli was in the passage now, trying to light a match. As Hugh flung himself flat against the rocky wall, his uplifted hands came in contact with the ledge of the cleft where he had been sleeping. Quick as thought he drew himself up and shrank back till he was wedged into the rock itself.
Castelli was fumbling and stumbling. He was striking a fresh match every minute and swearing audibly. Hugh saw a faint glow, then darkness, then the glow again. Castelli did not like his job; but he
was taking no chances. Nearer and nearer he drew Now he had come to the end of the passage, just below Hugh’s hiding place.
“Sapristi! My last match,” Castelli muttered. He struck it, holding it high above his head, and examined the opposite wall. The light just came to the ledge within a foot of Hugh’s face. Then Hugh did something for which he was proud as long as he lived. Reaching forward, he softly blew out the light.
He heard Castelli curse; but the Italian had his back to him and did not realize where the draft had come from.
Hugh breathed freely again as he heard Castelli groping his way out. He could scarcely realize his luck. On such small things human destiny often turns. Had Castelli possessed another match he would surely have been discovered. He raised himself, confident of his safety, and listened. He heard the distant voice of the doctor.
“No sign of any one. The passages Gamba and I examined dwindled away in the rock.”
“Mine, too, came to an end,” said Castelli. “I felt the walls all round. Not even a rat-hole.”
Then the voices ceased and Hugh heard the men scrambling out of the cave.
Darkness had fallen and still Rocco did not return. The cave-mouth was a ring of velvety blue patterned with stars. The air was exquisitely cold and pure. As Hugh cowered in the darkness he wrapped himself in a blanket. The silence was breathless, acute. Staring up at the blue circle of sky, he listened to the beating of his heart. Then suddenly, noiselessly, a dark form loomed up between him and the stars. It was Rocco.
The bandit walked like one very weary. He threw himself down and lit a cigarette. After he had drunk the soup Hugh heated for him, he drew a deep sigh.
“You have been long,” commented Hugh.
“Yes,” said Rocco; “I have done much, seen much, learned much. Incidentally I have killed a man.”
Hugh gazed at Rocco in silence. After a deliberate pause the bandit went on:
“Yes, I killed him, or was the means of his meeting his death. I will tell you.”
Through the mouth of the cave came the pure air perfumed with pines. Hugh wrapped his blanket around him and settled down to listen. In the darkness he could see the glowing tip of a cigarette, and from behind it hear the roll of a rich voice.
“When I left you,” said the voice, “I went to the inn. I found the body of poor Pascal in the pool. There was a bullet wound in the head. They must have struck him when they fired at you. However, that does not matter Pascal has an enemy The crime will be put down to the vendetta. A convenient institution, the vendetta; it covers a multitude of sins.”
There was a reflective pause. The cigarette glowed and faded; then the sonorous voice went on:
“I took my poor dead friend out of the water and carried him into the kitchen of the inn. I laid him on the table, straightened his limbs, folded his hands over his breast, and put a crucifix between them. Then I knelt down and said a prayer for the welfare of his soul....”
The voice was silent for a little. The round mouth of the cave was brightening, and the stars shrinking back affrighted. The voice grew tense.
“It was while I was praying that the man entered. He saw neither myself nor the body, for the place was in darkness. He went over to where your clothes were and began to search them, the pockets, the lining. It was while he was doing this that I put a pistol to his head.”
A deep laugh awoke the echoes of the cave. Into its circular mouth crept the silver edge of the moon.
“I never saw a man so scared. You should have seen him jump. I backed him against the wall with his hands high in the air. I pointed to the dead man. ‘You killed him,’ said I. He shook his head. ‘Then,’ I said, ‘you helped to kill him. Tell me, and I’ll give you a chance for life. Otherwise I’ll shoot you where you stand.’ Then he told me that he had seized and held Pascal while his comrade had strangled him. ‘So,’ I said, ‘that was the way of it. Well, you are equally guilty, but you shall have a chance for your life. Have you a knife?’”
Rocco’s cigarette went out. He took his time to light another. The velvet circle cut the moon in half. Hugh could see the face of Rocco now, a pale, grim, tragic face. The bandit went on:
“‘Yes, I have a knife,’ answered the man. ‘And can you use it?’ I asked. ‘None better,’ said he. I marched him out of the place to the clearing in front of the inn. ‘Now,’ I said, ‘look ... I throw away my rifle, my pistol. Knife to knife we will fight it out. You for your life; I to avenge my friend. Is it well?’ And he answered me; ‘It is well.’”
Rocco rose and stood before Hugh. The full round of the moon was framed in the circle of the cave-mouth. It lit up the magnificent figure of the bandit, as he went on:
“The man was a brute, but he was brave. His eyes gleamed. I could see in them the joy of the fight. He thought he had me. He drew a long bladed knife. I drew mine. There in the forest we circled round, watching each other like two cats. Suddenly he leaped. He was holding his knife like a sword, point up to strike at the belly. I caught his wrist as he stabbed. Then I dropped my own weapon. I reached round him and forced his knife hand behind his back. He was strong; I never wrestled with a stronger. We had a tough struggle; and they say there is not in all Corsica my match for strength. Slowly, surely, I twisted his knife hand behind him; then suddenly I tripped him up. He fell, fell on the point of his own knife. It went right through his back and stuck. He died quickly. You would not say I killed him, would you?”
“No; without going into details, one might say he stabbed himself.”
“That’s it. Damn details. I do not want to have another death at my door Well, that’s one of your enemies settled. And the other three.... Oh, I know they came here. I was afraid they had got you; they are hunting for you high and low. They have horses and spies. The stations are all guarded; the country people warned. A dazzling price is set on your head. So much I have heard from some wood-cutter friends of mine. Alas! my young friend, I fear Corsica is too hot for you. The sooner you are out of our brave little island the better.”
“What must I do?”
“There’s a boat sails for Marseilles to-morrow. You must catch it.”
“But how?”
“I will conduct you by a secret trail through the woods to the railway, at a point only fifteen miles from Agaccio. After that you must take your chance. See, I have brought your clothes from the inn. Now we will both sleep, for we must be up at dawn; you have a long, hard day before you. Believe me, I do not exaggerate the danger you are in. But I will do my best for you, and I hope you will get through. Now sleep....”
Hugh stretched himself out in his blanket; as he closed his eyes, the moon sailed out of the pool of sky and the cave was plunged in darkness.
CHAPTER SEVEN THE LAST LAP
1.
A LITTLE after daylight they left the cave and descended the mountain. With Rocco leading they plunged into the first fringe of forest and by a a little toe-trail travelled swiftly, keeping high above the valley. Hugh saw nothing but the sombre pine trunks. They encountered no one and the silence was profound. Rocco spoke little. Once or twice he stopped to listen, then, seemingly satisfied, went on at the same rapid pace. At noon they made a short halt for lunch.
They were gradually descending. The sharpness of the mountain air had given way to a softer temperature, the pines had yielded to oaks. At first the oaks had been bare branched, then they were clothed with leafage. Underfoot, too, the grey had given way to brown, the brown in turn yielded to green. They were dropping through the temperate zone to the warmer one of the coast.
It was early afternoon when Rocco stopped and turned to Hugh.
“This is as far as I dare go,” said he. “I think you can manage alone. You must descend that path to the railway. You will then be about fifteen miles above Agaccio. The road almost parallels the railway. You will have to wait to travel it until the dusk, and should get to the town about nine o’clock. The boat leaves at ten. If nothing happens you should catch it. Have you any money?”
Hugh had not thought of that. He searched his pockets.
“No, they got all.”
“Take this. I have no use for money as you can see.”
He handed Hugh a note for five hundred francs.
“Oh, I can’t accept that.”
“Come now. Consider it a loan. You will repay me some day.”
“All right. But let’s sit down and have a smoke before we separate.”
They flung themselves under a tree and lit their cigarettes.
“Look here,” said Hugh suddenly, “what would you do if you had a lot of money, say three million francs.”
Rocco showed his white teeth in a derisive smile.
“What would I do with three million francs? Why, first of all I would buy my pardon; then I would go into politics again. I would devote my life to the welfare of Corsica. With all that money one could almost change the destiny of our people. Ah! what a dream....”
“I can tell you where you will find three million francs. You can take or leave them as you choose. Only let it be a secret between us.”
“That is understood,” said Rocco gravely.
Hugh described where he had hidden the money, and sketched the events which had led up to its coming into his possession. When he had finished, Rocco sat in silence; his eyes brooded sombrely, his brows below his lofty forehead knitted in thought. Hugh watched his face, that fine Roman face so full of virility and courage. Beyond a doubt he was stirred by ambitious dreams. Hugh was reminded of Napoleon. Might this, too, not be a man of destiny? Suddenly Rocco roused himself.
“I do not know. It needs reflection. It is too stupendous. I may take the money and use it for my country; but if I do not, you will be sure it will remain there untouched, perhaps forever.... But now you must be on your way. You have far to go; see, already the sun is declining. You must reach the Agaccio road before dusk, and then hurry, hurry to the boat. And now good-bye. Good luck to you.”
“Good-bye. I’ll never forget you.”
The two men shook hands with a long grip. As Hugh turned on the downward trail, he looked back at the tall, graceful figure of Rocco, standing erect with folded arms. He waved his hand and Rocco took
off his broad-brimmed hat. Then a turn of the trail parted them forever.
2.
It seemed to Hugh that he must have taken a wrong turning, for the trail, which had been growing less and less defined, suddenly disappeared. He was lost in the forest. Night was approaching. However, by keeping on down the hill, he must eventually come to either the road or the railway. He struck into a brisker pace, and, as there was no underbrush, made rapid progress. He had been descending for perhaps half an hour, when he heard a welcome sound, the whistle of a train. A little further on the forest lifted, and the line of railway lay below him.
Less than a kilometre away, was the station; a freight train laden with logs was drawing ponderously out. He decided to let it pass, before continuing down the track. He waited impatiently. It had occurred to him that perhaps he was exposing himself too much; and he was drawing back when he heard a shout, ... a shout of fury and of triumph.
With a heart leap of fear he recognized the three men who were hunting him. What ghastly misfortune! They were on horseback too. Castelli, who had been searching the hillside with a pair of powerful glasses, had been the one to discover him. He handed the glasses to Doctor Bergius and pointed to Hugh. At the same instant Gamba leaped from his horse, crossed the railway track and launched in pursuit.
For a dazed moment Hugh cursed his folly in thus exposing himself, then turned and crashed back into the brush. It was very thick and he made progress with difficulty. At this rate he would surely be caught. Then to his joy, he came upon a little trail that descended and skirted the railway. He raced along it.
Once with panting lungs he stopped to listen. Was he being followed? He heard a cracking of underbrush; Gamba had taken a
short cut and was appallingly near Hugh tore on again. The trail broke from the forest and skirted a bluff that overhung the railway, running along it for about three hundred yards. As Hugh came out on this exposed stretch his heart sank. Here at last he was surely trapped. To his right was the steep cut to the railway, to the left the dense brush of the forest. The only way of escape was straight ahead. If only he could make the end of the pathway before Gamba reached him.... Well, he must do his best.
He had gone but a short distance when Gamba crashed into the open. The little man was as fleet as a deer, as sure-footed as a goat. Hugh knew he had no chance; but with the strength of despair he pounded on. There was a roaring in his ears. The train! It was puffing and clanking below him. Gamba was gaining on him fast. As he dashed on, Hugh noticed that the bluff dipped, so that in one place it was only about ten feet above the track. If he could make this gap, leap the track and reach the gully that lay on the other side, there was a chance he might yet escape. He made a desperate spurt to gain it.
But he had reckoned without the train. As he got to the lowest point of the cut, it was passing just below him. Again luck was against him. He must wait until all those heavy wagons had lumbered by. Gamba was only fifty yards behind him. Oh, that cursed train! Would it never pass! But why wait? Why not ... ah! that was an idea. Desperate, maybe, but he would stick at nothing.... Nerving himself he leaped, and fell sprawling on the train.
Fortunately he landed between two huge logs. He was bruised and shaken, but he raised himself immediately. He had alighted about midway in the line of wagons and there were three others still to pass the place from which he had jumped. Now one had passed, then the second, then, just as the third and last wagon was rumbling by Gamba reached the point.
He hesitated, stared for a moment as if confused, then caught sight of Hugh. He looked down at the last of the passing wagons. Was he, too, going to jump? Hugh held his breath. No, Gamba could not
