Uprooting and late-life psychosis

Abstract

Biographical information was collected on 60 patients suffering from late-onset (> 50 years) paranoid psychosis (with and without hallucinations), 38 by chart review and 22 by personal examination. Of the patients 28 (47%) had been war refugees expelled from the eastern territories that Germany lost after World War II. This is more than twice the rate of the Bavarian general population. The onset of paranoid symptoms was usually 3 or 4 decades after immigration into western Germany. Among patients with Alzheimer's disease and with endogenous depression the proportion of former war refugees was significantly lower (22% each). The possible relevance of early uprooting and expulsion to the development of late-life paranoid psychosis is examined.

Life Events in Late Paraphrenia and Depression

“…As we expected from the results of our pilot study [8], the majority of paranoid patients had experienced events or conditions during earlier life which could have fostered a reserved and suspicious stance towards their environment; experiences of discrimination or stigmatization, expulsion or threat, and fragility of interpersonal relations.…”

“…The percentage of expellees in the depressive group (18%) was significantly different and is in accordance with the proportion in the normal population, amounting to about 20%. Possible connections between expulsion and paranoid psychosis manifesting decades after have been discussed by the author in an earlier study [8]. Several transcultural investigations have shown that forced migration and uprooting can favor a disposition to later paranoid illness even with an onset years or decades after the migration; the period of delay was especially high in women [19][20][21].…”

“…In a previous retrospective study [8] of patients with late-life paranoid psychosis, we found evidence of a connection between the origin of this disorder and a past history of uprooting, flight or expulsion caused by war events. The present prospective study on late paraphrenia and depression was designed to further substantiate the role of biographical history and personality in the predisposition to paranoid or depressive illness in later life.…”

Psychosocial correlates of late‐onset psychosis: life experiences, cognitive schemas, and attitudes to ageing

“…Adverse life experiences have, of course, also been found in people with depression (Brown andHarris, 1978, Perris, 1984), but different themes are evident; for instance, some studies suggest that people with late-onset depression are more likely to report a history of serious early losses, such as death of a parent in childhood or death of a child (Fuchs, 1999a). Fuchs (1994) reported an over-representation of expellees among paranoid compared with depressed older patients (47% compared to 20% respectively). He hypothesised that the trauma of forced flight may have resulted in feelings of distrust, resentment and injustice (Fuchs, 1994), and similarly that stigmatising-discriminating conditions may have fostered a reserved and suspicious attitude towards the environment, leading to a lifetime of feeling like an outsider (Fuchs, 1999a).…”

“…Early life traumas have consistently been associated with LOP (Gurian et al, 1992;Fuchs, 1994;Rockwell et al, 1994;Fuchs, 1999a); in particular, discriminating-stigmatising environments such as illegitimate birth or having an illegitimate child, amputation of a limb, or physical handicap, and threatening-persecutory experiences such as rape or expulsion from home. Adverse life experiences have, of course, also been found in people with depression (Brown andHarris, 1978, Perris, 1984), but different themes are evident; for instance, some studies suggest that people with late-onset depression are more likely to report a history of serious early losses, such as death of a parent in childhood or death of a child (Fuchs, 1999a).…”