Psychosis Explained

Psychosis Explained

      Psychosis is defined as difficulty recognizing what is real and what is not real. It starts with an idea. The idea was conjured by something that happened in the past or in the future, something they had seen, heard, felt or even tasted or smelled.  The point is the idea stemmed from something that really took hold of the person and created a feeling inside of them whether it’s paranoia, anger, sadness, or even grand happiness. (Rarely does the psychosis appear out of the blue.) This is called the pro-drome phase. There is a gradual change in psycho social functioning in which there are changes in cognition, affect, thought content, and physical changes such as sleep disturbances or even a gain in sleep, as well as change in socialization. Without education the person will take hold of this idea like a football and run to the end zone smashing their way through the people they love, and like Forest Gump, they keep running. These strange experiences create stress and anxiety on the brain functionality and the person may get worse as time goes on if the psychosis is left untreated. This is called the active phase where the delusions, thought disorder, and hallucinations are very prevalent.

Psychosis is unique to the person, just as unique as their personality. This is why it is so hard to generalize and create specification guidelines for psychosis. Some might get angry and beat the hell out of the only car they own, and then sit and have a grand ole’ time at dinner that night, then wake up the next morning and ask in a very sincere and frustrated voice, “ Who the hell..?”  That would be called a micro-psychotic episode. Others might get so happy they take a drive halfway across the country at night with twenty bucks and a flashlight in their pocket not realizing where they are. Then when they get where they think they are supposed to be they think they are a blessed holy savior there to save the people of such town. While the family is in a frenzy trying to find the person going through a psychotic episode the time keeps ticking.

But really psychotic symptoms can be summed up in five categories: hallucinations, delusions, confused thinking or speech, change in daily functioning, and mood changes. Hallucinations and delusions are the keys to psychosis.

There are many types of hallucinations. Visual hallucinations are seeing things that are not there and are not attributed by external stimuli. These can be anywhere from seeing shadows, moving specks, light specs (especially in the dark), colorful orbs of light, odd shapes that can’t be given a name, to seeing actual images such as people, animals, angels, demons, aliens. Auditory hallucinations can be heard within the head and outside the head. These hallucinations can be heard clearly or they can be heard as a dull murmur that can be very distracting and cause the person suffering to lose focus a lot. Other hallucinations such as: olfactory, which is smelling odors that are not there such as sulfur in a restaurant, tactile which is the illusion of touch and could be demonstrated as having felt a hand brush down the arm or back, and gustatory which is the phenomena of tasting something unpleasant such as rubber or gasoline.

That brings us to delusions, a strong belief in something that is not feasible or logical, in which hallucinations go hand in hand with delusions during a psychotic episode. Let’s say that a person (Jim) with psychosis keeps seeing a man with a black tie and a purple suit following him. He says he talks to the man in the suit and the man in the suit says he will be a guaranteed millionaire if he plays the lottery ticket numbers: 1, 34, 25, 36, 67 etc…  Thus, Jim plays the lottery numbers and continues to lose week after week. If the Jim is left uneducated about his disorder or in denial about the illness, then he is going to believe the man in the suit. With all that said, he is hallucinating and delusional. First, hallucinating the man in the suit. Then, believing that the man was really there and that those specific numbers will guarantee him a win in the lottery.

Delusions can go solo though. The person might think that they have powers or abilities that are special and that they were the divine chosen one. They may think the radio is giving them a message, or that they are being controlled by an outside force, or even have thoughts broadcast into their head. These are just examples because they are the most common for the newly diagnosed person with a psychotic disorder. You can tell this person that they are delusional but more than likely they will take what they believe to the grave. Delusions can be very minute as well.  A person might think that their sleeping patterns are off because of the medicine, then in turn proceed to not take the prescribed medicine (usually refuse to take the medicine).

Mood changes are another key element but not always present during the episode. Some of the time, they start to display after the episode has happened. This is not the key with the bipolar with psychosis diagnosis, in which the psychosis is completely dependent on the level of the mood. Schizo-effective disorder is somewhat contrary where the level of the mood changes and the psychosis (hallucinations and/or delusions most of the time) are completely independent from one another. A person’s mood can change in an instant good left to bad. They can also feel like their mood has been dulled, masked, or even elevated.

Changes in daily functioning are signs that a person might be psychotic or even precursors to being psychotic. Staying up later than usual and staying up all night are signs and also can affect the brain into an episode. Performing daily routines such as hygiene and self-care are minute but very important signs. Socializing too much or too little can also be alarming.

Treatments for any kind of psychotic disorder, or disease, usually require medicine and therapy along with lifestyle changes, and then management. But what they don’t tell you is education. To fight the illness you have to be educated about the illness. You can’t mindlessly walk in and out of the doctor’s appointments, hospitals, and therapy offices without going home and researching every possible detail there is to know about the illness you, or a loved one, has. You must get online and look up every question that pops into your mind, when it pops into your mind. Join forums, read forums, medical journals, autobiographies, and biographies to learn what other people have experienced. Then, learn every single little thing about your medicine. Learn the effects and side-effects. Learn what they do and what they are used for. This will help you better explain to the doctor what is wrong and what is right.

Let’s say you have NEVER eaten a hamburger or ANYTHING on that hamburger and someone hands you a hamburger to eat. You take a bite and chew it up, it’s amazingly tasteful, and then that person who gave you the hamburger says, “How’s that mustard? You like it?” You have no idea! You’ve never had mustard or a hamburger for that matter. That’s how medicine works, in the beginning, thus when starting treatment ask your doctor to do one medicine at a time. It might take longer to get stabilized, but it will eliminate a ton of trial and error.

During all this, chart your moods with an excel program. It will help you remember what happened and it will help the doctor visualize the moods during the time period. Write notes on a word program. Document one day at a time. Highlight the key part of your day. Take the graph and notes into the doctor’s office and show the doctor how you have been feeling. Use this as your reference (you can change it to fit your feelings, perception, and situation):

11 Psychosis. Need to be hospitalized
10
9
8 Mania
7
6 No sleep
5
4
3 Hypomania
2
1
0 Base level
-1
-2
-3 Mild Depression
-4
-5
-6 Suicidal thoughts
-7
-8 Planning suicide
-9
-10
-11 Going to commit suicide. Need to be hospitalized

All this education will really extend your ability to read out into the darkness of your illness and allow you to guide yourself back into the light when you’re lost. You will be able to tell when you’re lost, you might not be able to do anything about it, which I will explain later, but at least you will have the recognition of your illness. This recognition is insight. I tell the doctors, when they say I have a lot of insight, that it’s not just insight but education too. It’s the education that led to the insight.

You must recognize that something is wrong, that your behavior is erratic and as my grandfather would say, “out of line.” You must see and feel that something is wrong and then you must desire help. If you don’t take the first steps then you can’t get to the top of the mountain, and believe me you want to be at the top of the mountain, we all do!

A majority of the time, after the first psychotic episode, a person gains the knowledge of what it was like to be psychotic. Whether it was drug induced or purely brain malfunctioning, if the person remembers the episode, then they are aware of what psychosis feels like. Therefore, with education and treatment, the person will, from then on, have psychosis with insight. Psychosis with insight will help you better predict when you are about to go into a psychotic episode, again, you might not be able to control it, but you will be able to have your caretaker help you.
What does it feel like to be psychotic? Well, I think that’s very circumstantial in which it depends on which kind of psychosis the person is experiencing and how deep it is. Is it a full blown psychotic episode from a seizure, a drug-induced episode, psychosis with hallucinations and/or delusions, psychosis from mania, psychosis from depression, psychosis from grief? The list goes on and that’s what makes psychosis such a unique thing. Someone doesn’t have to be completely unconscious to have psychosis, shoot, drink a handle of Tequila and you (somewhat) fit the criteria of being psychotic, not because you did it, but because the inebriation is what it feels like to be psychotic. The intoxication takes you out of reality and places you into an altered state of mind and that, according to the definition of psychosis: a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality, is psychotic (minus the “severe mental disorder part”). Some psychosis is anger and rage, courageous and energetic, impulsive and rebellious, fascinated and absorbed, powerless and miserable, frightened and threatened. These are just some examples, but psychosis is really a feeling that is being over felt by the brain. Chemicals are going wacky in the head, but the brain processes it in one word, or feeling rather. Then actions are brought on by that feeling, and that’s why someone with psychosis will dance with glee, obsess to no end, rage like a bull, or try to commit suicide.

I always tell people that psychosis feels like this: your body is a car and there is a little man in your head driving that car, sure sometimes your subconscious is the passenger (sometimes), that’s when you have to let your subconscious try to grab the wheel and drive. Learning about the illness and gaining insight will allow your subconscious to know what is going on. Learning will plant a seed in your subconscious and try to drive you in the right direction when times get tough.

That’s where your caretaker comes in, they are there to guide you, and keep you safe no matter how bad it gets. The most important thing is to trust them. You must understand, when worst comes to worst, you are the one living out of reality and they are the ones living in reality. If you have hallucinations on a daily basis your caretaker might have to remind you that nothing is there, over and over. It might take you a little longer to process, and even longer when you’re alone, but when you start realizing they aren’t there then it’s easier to process and get on with the day without being paranoid or possibly overzealous. Your caretaker might need to remind you to take your medicine and even possibly eat. It works the other way around too. You need to keep your caretaker informed about how your mental status is. Use the number system as it has tremendous power to allow for relation and communication with your caretaker and doctor. This will also develop your insight.

Insight is the key to management. Education is the key to insight. Acceptance is the key to education. Trust is the key to acceptance. Get all that wrapped in a bundle and thrown in a backpack and start hiking up Mountain of Life. Once you get to the top, it’s the best view you’ll ever see in your life… so I have heard anyway.