) and a member of the Executive Committee of the International Society for the Psychological Treatments of Schizophrenia (http://www.isps.org). Paul Hammersley is programme director for postgraduate studies in family and individual cognitive-behavioural therapy for psychosis at Manchester University, UK. He has written and lectured extensively on the relationship between childhood trauma and psychosis, and is a member of a multidisciplinary team offering training on how to ask about childhood abuse and researching the effectiveness of that training. Thom Rudegeair is clinical director of the psychiatric in-patient unit servicing central Auckland. He trained in the USA, earning a PhD in zoology (evolutionary theory) from the University of Florida, then an MD and psychiatry credentials from the University of Massachusetts. His current research interests include formulating an evolutionary model of 'madness' focusing on the role of childhood trauma and developmental derailment. AbstractSubscribers to the medical model of the causation of madness and distress emphasise the role of genes and can severely underestimate the impact of traumatic events on the development of the human mind. This bias persists despite the worldwide popular wisdom that mental illness arises when bad things happen to people. Childhood physical and sexual abuse and neglect are extremely common experiences among those who develop serious mental health problems. Unfortunately, victims are typically reluctant to disclose their histories of abuse and practitioners are often reluctant to seek it. We explore the nature and extent of the problem and the apparent reasons for the pervasive neglect of this important area of care. Then, on the basis of our experience in New Zealand, we provide guidelines on asking patients about childhood abuse and describe an ongoing initiative in the UK to further advance our understanding of the impact of abuse and our skills to detect it and treat survivors.1. We have not exhaustively referenced here every result discussed. Instead, we have cited only key studies or reviews. A full list of references is available from J.R.

For several decades the conceptualization and treatment of mental health problems, including psychosis, have been dominated by a rather narrow focus on genes and brain functions. Psychosocial factors have been relegated to mere triggers or exacerbators of a supposed genetic predisposition. This paper advocates a return to the original stressvulnerability model proposed by Zubin and Spring in 1977, in which heightened vulnerability to stress is not, as often wrongly assumed, necessarily genetically inherited, but can be acquired via adverse life events. There is now a large body of research demonstrating that child abuse and neglect are significant causal factors for psychosis. Ten out of eleven recent general population studies have found, even after controlling for other factors, including family history of psychosis, that child maltreatment is significantly related to psychosis. Eight of these studies tested for, and found, a dose-response. Interpreting these findings from psychological and biological perspectives generates a genuinely integrated bio-psycho-social approach as originally intended by Zubin and Spring. The routine taking of trauma histories from all users of mental health services is recommended, and a staff training program to facilitate this is described.

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