Catatonic/psychotic symptoms owing to trauma of captivity in a cult environment

This is a summary of a paper which came out recently, namely:
Dunn, S. E., Kaslow, N. J., Cucco, D. C., & Schwartz, A. C. (2017). ‘Catatonic and Psychotic Symptoms Owing to the Trauma of Captivity in a Cult Environment’. Psychosomatics, 58(1), 77-82.

This case report concerns the treatment of Iasia Sweeting (named ‘Ms. A’ in the paper), who suffered at the hands of a follower of Nuwaubianism. Iasia was held captive in a motel room for over 4 years after being abducted at the age of 17 by her then-boyfriend’s father, during which time she was impregnated twice and regularly abused. Police were alerted after the corpse of one of Iasia’s children was taken to a local hospital, where the child was found to have died of malnourishment. Iasia weighed 59lbs when found and hospitalised briefly following her rescue before being placed with her family to rehabilitate. However, Iasia’s physical and mental condition declined to the point that, 6 months later on, when presented to a Psychiatric Service, Iasia was nonverbal, nonambulatory, and nonresponsive to social engagement.

Iasia was given a Lorazepam Challenge Test (1mg), which resolved her catatonic symptoms somewhat, to the point that Iasia was talking and moving around within an hour of administration. Given this positive response, Iasia was prescribed a maintenance dosage of Lorazepam (1.5mg/6hrs), as well as antidepressants and anti-psychotics, and this allowed her to then participate in a psychiatric outpatient day-program as well as a brief residential program for individuals who were survivors of sexual trafficking or cultlike experiences.

Dunn, Kaslow, Cucco and Schwartz (these are the people who treated Iasia) are at pains to state that, “Ms. A’s catatonia was likely a reflection of the profound deprivation, exploitative persuasion, and major trauma and abuse that she experienced when held captive by the cult member; it was not because of the cult itself” (p. 80, my italics). However, they do advocate the need for psychiatrists and other health professionals to be more familiar with, “…the effect of cult experiences on individuals’ mental and physical well-being and strategies for treating individuals who lived in cult environments” (p. 81). How do they arrive at this recommendation?

a) Similarities between hostages, political prisoners, battered women, and victims of captivity, including those in a cult environment [such as Ms. A], are noted, with particular respect to the stress responses that such patients display (often diagnosed as PTSD)
b) Severe trauma and abuse can precipitate catatonia, likely by way of tripping the GABA system (hence, why Lorazepam—a benzodiazepine—was effective for Iasia). This is in line with Kahlbaum’s original conception of catatonia as, “…an immobility induced by severe mental shock” (cited on p. 80). Less commonly, psychotic symptoms occur
c) “Patients who present with symptoms of catatonia must be screened for trauma. If catatonia has emerged in response to trauma, the conceptualisation and treatment of the patient must take into account the connection between prolonged trauma, a profound fear response, and the development of catatonic features” (p. 81)
d) Given that cultic environments/experiences can lead to trauma- and abuse-induced catatonic (and psychotic, to a lesser degree) symptoms, familiarity with cultic environments/experiences will lead to more efficacious treatment of patients who present with such symptoms

The paper gives quite a lot of focus to the treatment of catatonia with Lorazepam, and the GABA system abnormalities which are suspected to underlie catatonia. A friend of mine who is a Pharmacist at an A&E in the UK told me that they’d never heard of this treatment before, so it may not be such a common treatment outside of the USA. My friend did make the point, however, that if Lorazepam were effective in such a case as Iasia’s, it would be indicative that the catatonia was not ‘organic’, as it were, but rather the result of massive stress. This seems to suggest that medicating symptoms of trauma, at least in the short term and for very severe cases, is not only viable but probably appropriate, followed up, of course, by specialised mental-health treatment for the trauma. One of the big mistakes of this particular case was letting Iasia go home to her family for 6 months immediately after her rescue. There was a high risk that events could’ve turned out much worse than they did. So, I think I agree with the recommendations that the authors make – better strategies in place for similar future victims, with specific regard to knowledge of cultic trauma.

Although the paper’s title mentions catatonic and psychotic symptoms, it really only deals with catatonia. Even if psychotic symptoms may also be best understood as trauma-related, the authors do not seem interested in talking about their treatment, simply suggesting that such symptoms are, “…worthy of more attention and understanding by behavioural health professionals” (p.80). I guess the effectiveness of the Lorazepam treatment was a show-stealer. [One thing that seems worth mentioning is that, within this paper, much use is made of a reference—Dhossche, Ross & Stoppelbein, 2012—which suggests that catatonia can be caused by trauma, abuse and deprivation. However, the research that is referenced is concerned with paediatric catatonia only and Dunn et al. broaden out its conclusions to apply to adults too. It’s not a big deal, probably. Just not ideal not to mention that.]

Finally, perhaps the most interesting thing about this case study is the patient, Iasia Sweeting, a.k.a ‘Ms. A’. She has had a lot of press since her rescue and is currently in a court battle to regain custody of her surviving child, and of 2 other children who belong to her captor’s daughter (who was complicit in the abuse). Indeed, the paper ends with this remark: “The writers of this case report who may be called to testify [in the court case] feel a strong connection with the patient and are likely to want to protect, defend, and advocate for her” (p. 81). Here are a few links which explain more about Iasia’s story:

Recent news update on Iasia’s battle to regain custody of child (Dec 27th 2016)

A thread on a crime-messageboard with many media sources concerning the case

Iasia recites a poem at the 2016 National Poetry Slam in Georgia, USA