Understanding the Reality of Psychosis
- bsmspsychsoc
- Dec 5, 2021
- 8 min read
Vincent van Gogh. The Starry Night. Saint Rémy, June 1889.
Inspired by the view from his window at the Saint-Paul-de-Mausole asylum in Saint-Remy,
in southern France, where the artist spent twelve months in 1889-90 seeking reprieve from
his mental illnesses.
When you hear the word ‘psychotic’, what is the first image that comes to mind?
Is it a ‘crazy’ person yelling to themselves in the street? Or perhaps a thriller where the character turns ‘insane’ and hurts people?
These common stereotypes are portrayed in the news and media and paint a misunderstood picture of psychosis. The terms ‘crazy’ and ‘insane’ have negative connotations in society and portray damaging messages about psychosis.
Here are some of the most common misconceptions and stereotypes about psychosis:
1) People with psychosis are psychopaths.
Psychosis is not the same as psychopathy. Psychosis is an acute condition that can lead to full recovery when treated, especially if treated early [1]. On the other hand, psychopathy is an antisocial personality disorder that is defined by a lack of empathy, manipulating behaviour, and disregard for the consequences of their actions [1].
2) People with psychosis have split personalities.
Psychosis is not the same as multiple personality disorder or split personality.
“The schizophrenic mind is not split, but shattered” [2]
Psychosis is defined as the experience of being ‘out of touch with reality’ [2]. The experience varies greatly between people and can come on suddenly or gradually [3]. It is characterised by positive symptoms (add to/distort the person’s normal functioning) and negative symptoms (normal functioning is lost or reduced) [3].
Positive symptoms include: [1-4]
· False sensory experiences (hallucinations) i.e., seeing or hearing things that other people cannot see or hear
· False beliefs that are firmly held, not responsive to evidence, and not in keeping with the person’s culture (delusions)
· Limited experience of motivation and pleasure
· Disorganised speech, thoughts, or behaviour i.e. rapid and constant speech, rapidly switching topics, loose associations (putting together words that sound alike but don’t make sense)
Negative symptoms include: [3]
· Restricted emotional and facial expression
· Restricted speech and verbal fluency
· Difficulty generating ideas or thoughts
· Reduced ability to begin tasks
· Reduced socialisation and motivation
Elyn Saks is a Law Professor at the University of Southern California that has chronic schizophrenia. In her TED talk, she vividly describes her experience of delusions and hallucinations: [2]
“For example, when I'm psychotic I often have the delusion that I've killed hundreds of thousands of people with my thoughts. I sometimes have the idea that nuclear explosions are about to be set off in my brain. Occasionally, I have hallucinations, like one time I turned around and saw a man with a raised knife. Imagine having a nightmare while you're awake”
1) People with psychosis are dangerous.
It should not be assumed that people experiencing psychosis are dangerous to others. Individuals experiencing a psychotic episode are often unaware that their delusions or hallucinations are not real and might be very frightened or distressed [1,5].
People with psychosis are more likely to be a risk to themselves than to others. For example, individuals with psychosis have a higher-than-average risk of self-harm or suicide [6]. People with psychotic experiences are at significantly increased risk of suicidal ideation, suicide attempts, and suicide death [7]. The greatest risk is during the first year after onset [8,9]. Therefore, it is crucial that people with first-episode psychosis are screened for suicidal thoughts.
Following NHS guidance, if you are experiencing suicidal thoughts or behaviours, you can:[6]
· Make an urgent appointment to see a GP or your psychiatrist or care team
· Call the Samaritans support service (free of charge, 116 123)
· Access information and advice from the charity Mind
· Go to your nearest A&E and tell the staff how you’re feeling
· Contact NHS 111
· Speak to a friend, family member or someone you trust
2) Psychosis can’t happen to me.
About 3 out of every 100 people will experience an episode of psychosis in their lifetime [3]. Psychosis affects men and women equally and occurs across all cultures and socioeconomic groups [3]. The age of onset for psychosis is usually 16 to 24 years old [4]. It is often due to combined biological and environmental factors, such as: [3, 6]
· Genetic predisposition
· Adverse childhood experiences
· Traumatic events
· Stress
· Drug/alcohol misuse
· Other conditions (schizophrenia, bipolar disorder, severe depression, brain tumour, malaria, syphilis, lupus, multiple sclerosis, etc.)
3) People with psychosis are ‘crazy’.
In Elyn Saks’ TED talk, she describes being mechanically restrained for much of her stay in a psychiatric hospital, despite never striking or harming anyone. As a Professor of Law, Psychology and Psychiatry, she later asked a fellow professor who was also a psychiatrist about the use of mechanical restraints in psychiatric hospitals. He said to her, “these people are psychotic. They’re different from me and you. They wouldn’t experience restraints as we would” [2]. This false belief that individuals with psychosis are ‘crazy’ and thus different from the general population makes it extremely difficult for people to openly seek help and communicate their symptoms to loved ones or healthcare professionals.
6) There is nothing you can do to help a loved one with psychotic symptoms.
It can be difficult to know how to help, especially if the friend or family member you are worried about does not want help or does not think that anything is wrong. However, the earlier the person’s symptoms are recognised, the better chances they have of effective treatment and faster recovery [10].
Increased distress and lack of insight during psychosis may mean that the person cannot recognise their symptoms. They may be reluctant to visit a GP if they believe there is nothing wrong. However, loved ones can still help someone that is experiencing psychosis.
Many people do not realise how much they have to offer, even if they are not trained mental healthcare professionals. If you know someone who is experiencing symptoms of psychosis, you can help immensely by providing ongoing support and checking in with them regularly. If someone has very severe psychosis, they can be detained at hospital for assessment and treatment under the Mental Health Act (1983), but they must have a mental disorder to a degree that makes admission to hospital appropriate and should be detained in the interest of their own safety, protection of others, or both [11].
In her TED talk, clinical psychologist Rachel Waford provides advice on how to help people that are experiencing psychosis. Due to the significant consequences of delayed diagnosis and treatment, she suggests looking out for early warning signs, such as confusing speech, unusual thinking, paranoid ideas, and changes in performance or mood [4].
There are also mental health first aid courses, which teach you how to identify early warning signs and how to initiate the steps for seeking help. For example, the charity Grassroots Suicide Prevention hosts various courses and events to help people support those that are at risk of suicide. These include Applied Suicide Intervention Skills Training (ASIST) and Suicide First Aid.
7) Psychosis cannot be treated.
There are gold standard treatments for psychosis that are effective. Medicines that reduce the effects of dopamine in the brain also reduce symptoms of psychosis [12]. These medications are called ‘antipsychotics’ or ‘neuroleptics’ and are usually recommended as the first treatment for psychosis [12, 13]. Cognitive behavioural therapy (CBT) can also be used to help patients achieve goals that are meaningful to them and helps patients to regain a sense of control [12].
Antipsychotics are mainly used for schizophrenia and bipolar disorder, but also in severe or difficult to treat anxiety or depression [12]. They are more effective at alleviating positive symptoms, but often the negative symptoms remain [12].
8) People with psychosis cannot lead productive lives.
One reason for this misconception may be that schizophrenia and other psychotic disorders are highly prevalent among homeless populations [14]; however, this correlation is largely due to delayed diagnosis and treatment of psychosis. The longer a psychotic episode persists without treatment, the longer the recovery will be [4]. Consequences of untreated psychotic illness include medical comorbidities, involvement with the legal system, drug use, homelessness, and isolation from friends and family [4]. Early recognition can avoid these outcomes by minimizing the impact of a psychotic episode on the individual and supporting them to receive help at the first sign of symptoms.
The following videos provide perspectives from people who have personally experienced psychotic episodes, which I found useful for gaining a better understanding of the condition. Thank you for reading!
“A tale of mental illness – from the inside” by Elyn Saks
"Is it okay if I totally trash your office?" It's a question Elyn Saks once asked her doctor, and it wasn't a joke. A legal scholar, in 2007 Saks came forward with her own story of schizophrenia, controlled by drugs and therapy but ever-present. In this powerful talk, she asks us to see people with mental illness clearly, honestly, and compassionately. [2]
“The voices in my head” by Eleanor Longden:
To all appearances, Eleanor Longden was just like every other student, heading to college full of promise and without a care in the world. That was until the voices in her head started talking. Initially innocuous, these internal narrators became increasingly antagonistic and dictatorial, turning her life into a living nightmare. Diagnosed with schizophrenia, hospitalized, drugged, Longden was discarded by a system that didn't know how to help her. Longden tells the moving tale of her years-long journey back to mental health and makes the case that it was through learning to listen to her voices that she was able to survive. [4]
“Psychosis and Me” by David Harewood | BBC:
At 23 years old, David Harewood had a psychotic breakdown and was sectioned. As he puts it, he ‘lost his mind’. On World Mental Health Awareness Day 2017, David took to Twitter and spoke publicly about his experiences for the first time. He was overwhelmed by the response. Now David wants to tell the full story – to piece together what happened to him and help other people understand what it is like to experience psychosis. In this film, David lets viewers into the realities of experiencing a psychotic breakdown, opening up in a way he has never done before – and in a way that viewers rarely, if ever, have seen anyone, let alone a well-known person do [15].
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