In the United States, there are some estimates that suggest that approximately 50 in 10,000 people may experience psychosis or a psychotic episode at some point in their lifetime. At the same time there are estimates that 1 in every 100 people in the U.S. alone carry a diagnosis of schizophrenia, which is suggestive of a much larger presence of psychosis. Then again, there is the estimate put out by the hearing voices network, an international movement, that 1 in 10 people hear voices worldwide. The differences in these different statistics are shocking. Why do estimates vary so widely?
It is arguable that there are political reasons for suggesting that “psychosis” is so infrequent. When psychosis is depicted as rare, it helps justify that subjecting people to long term incarceration or warehousing is appropriate treatment. It suggests that nothing else can be done for this small percentage of ill individuals. In fact, I believe that having bouts of psychosis is much more frequent and tends to be underreported because people are afraid they will be called crazy and subjugate to demeaning treatment.
I have often heard that psychosis exists on more of a continuum and that it affects people to varying degrees. Some people are influenced to a lesser degree and can sustain important roles in society, while others become totally overwhelmed and lose the ability to function due to associated distress. I think if we understand psychosis as a wide array of experiences that many more people can relate to having these experiences. Many people have these experiences and develop thoughts that aren’t so realistic. When understood in this manner there are more therapeutic strategies that start to make sense and a lot more help to be made available.
Witnessing a psychotic episode can be terrifying. It can be nerve-wracking when you don’t know what to do when a loved one needs help. Indeed, it is common for many family members to start out being overly protective and scared about the safety of their loved one. Often this period of overprotection can be followed by a sense of hopelessness, a worsening relationship, and eventually referring the family member to a system that promotes warehousing. Read on to learn more about what you can do to get your loved one the support they need to heal and sustain a full recovery.
Psychosis: What Is It?
Often people think of psychosis as a diagnosed mental disorder, but this isn’t true. In the DSM (the diagnostic statistic manual of mental disorders,) psychosis is a cluster of behavioral observations regularly seen in several mental health disorders.
I have learned to treat psychosis across diagnostic divides and tend not to believe that disorders exist as they are described in the DSM. I propose that a better definition is to identify a long list of experiences that many people may be able to relate to that so preoccupy the mind that it can seem to an outsider that the person has trouble telling the difference between what is real and what isn’t.
According to the DSM, a person dealing with psychosis may experience hallucinations and delusions. When experiencing hallucinations, a person’s brain will pick up on sensory inputs that others do not experience. These hallucinations can affect all five senses, leading the person suffering from psychosis to hear, see, smell, taste, or even feel things that no one else can observe.
Again, according to the DSM, delusions are when someone believes in something that most people would suggest is untrue. I believe they continue to experience the world in ways that cause them to think in different kinds of manners. For example, some people with delusions believe they are being followed. For another example, a person suffering from delusions may firmly believe that someone or something outside of themselves has control over their thoughts and actions. This can lead to behaviors that can be observed and labeled psychotic because of the associated conflict and distress.
In fact, when a person experiences trauma-related dissociation a different alter or part of a person can take over the body and control their thoughts and actions. Many times, when people have their views invalidated repeatedly as they do when they are told they have a delusion, they may develop this same phenomenon of dissociation in concert with their delusions. In fact, as I have worked with people who carry psychotic labels over the years, I have found that ultimately this overlap is extremely common. Understanding this can help us understand behavior that is thought to be psychotic.
What Are the Common Causes of Psychosis?
Certain mental health disorders include episodes of psychosis as a symptom. According to the DSM-5, Schizophrenia Spectrum and Other Psychotic Disorders fit this category. Common mental disorders that can cause psychosis include:
- Brief psychotic disorder
- Delusional disorder
- Psychotic disorder due to medication
- Schizoaffective disorder
- Schizophreniform disorder
- Schizotypal (personality) disorder
- Substance-induced psychotic disorder
Still many other disorders that are in the DSM V also can result in psychosis. For example, those with bipolar disorder and major depression can develop psychosis symptoms. Medical conditions such as Alzheimer’s can cause a person to experience psychosis. Research shows that 1 in 500 women experience postpartum psychosis after giving birth. Additionally, those who have severe head injuries and traumatic experiences can develop psychosis symptoms. Often extreme experiences with developmental disorders such as ADHD, Dyslexia, Autism and OCD can result in a person developing psychosis. Also, substance abuse can result in psychosis.
I have calculated that there are a total of thirty disorders in the DSM 5 that involve psychosis and so I have trained myself to listen to peoples’ experiences across diagnostic divides. Additionally, there are often other mental health struggles that are going on beneath a person’s psychosis that can be harshly exacerbated by receiving “treatment” associated with psychosis. Things like trauma, anxiety, depression, and substance abuse can become much worse because of experiencing what is thought to be a “psychotic” break.
People with lived experience develop very interesting thoughts about the cause of psychosis, as do professionals. Often, getting better involves diversifying one’s causation ideas. It is very positive when people with different perspectives work together to understand new facets. I believe that there are styles of causation theory. I teach that there are: political, spiritual, traumatic psychological, scientific, and artistic explanations for a person’s journey through madness. Understanding all perspectives is an important part of getting better.
Psychosis Risk Factors
Some individuals are thought to have a higher risk of developing psychosis than others. I tend to want to dispel these risk factors as I think they reflect a lot of stigma. Psychosis risk factors are thought to include:
- Family history of certain mental disorders
- Drug or alcohol abuse
- Severe mental, emotional, or physical trauma
- Brain cysts, tumors, or damage
- Genetic mutations
- Certain medical conditions, including dementia, HIV, and other infections
There is a widely publicized link between genetics and the risk of developing psychosis. While there is a large amount of funding that has been put to proving the genetic link, little definitive evidence has been produced. What we hear from experts is that so much more research is needed to possibly prove a link. When something is suggestive of a genetic link, it is amplified in the literature because so many people want to hear that psychosis is caused by genetics.
Many people with lived experience are open to the idea that they are spiritually gifted. I believe that many individuals in a psychosis crisis do have psychic abilities that complicate matters and confuse people. Perhaps it is arguable that there is a spiritual gene that might be isolated and proven to exist. I believe that many people who presume a genetic link, presume there are inferior or problematic genes and tend to have eugenic misconceptions. Unfortunately, this can result in a lot of stigma and mistreatment of people who have experienced psychosis. This is often seen on psychiatric wards when staff people think they are above the patients, and it is unfortunate.
I am partial towards understanding the role that abuse and social exclusion plays in developing psychosis. Consider the famous psychologist, Carl Jung, who fell into madness when Sigmund Freud betrayed him or the famous sociologist Emile Durkheim who fell into madness during his massive suicide study under the social pressure of people who did not think that he would not be able to complete the project. Such examples suggest that under the right conditions any body could fall into madness regardless of their role in life.
Early Psychosis Warning Signs
Early warning signs of psychosis can be challenging to detect since it is usually a gradual process that starts with seemingly small changes in behavior. To make it even more difficult to identify, early warning signs can affect nearly any area of a person’s behavior, from thought processes and speech patterns to emotional and social changes.
While there are a huge number of early warning signs of psychosis, some of the most common may include:
- Belief that their environment has changed
- Change in language structure or speech patterns
- Difficulty focusing or thinking clearly
- Withdrawing or isolating from social situations
- Extreme, unwarranted aggression
- Decline in self-care and personal hygiene
- New or worsening sleep disturbances
- Showing a decrease in emotions
- Acting suspicious or paranoid
I have heard of many stories of people who heard voices as kids at certain points and how they never had problems until they told others about their experience. Often speaking about voice experiences cause voices to become critical and threatening causing them to get referred to treatment. Unfortunately, what many people with lived experience report is that many forms of “treatment” cause things to get worse. Treatments like psychiatric incarceration, involuntary medication, seclusion, and restraints often take intolerable situations and make them worse. This is why I advocate for the public to get a better understanding about what psychosis is and learn basic interventions so that the more traumatic treatments become less necessary.
How Can You Help a Loved One With Psychosis?
It can be difficult to know and understand what you can do to provide psychosis help to a loved one, especially if they are in a psychotic episode. If you’re trying to offer good support and care to a loved one dealing with psychosis, here are some suggestions:
Don’t fight with them: People struggling to grasp reality will perceive things others are not experiencing. Your first reaction may be to get angry and argue with them about what’s real. Instead, stay calm and discuss with them what they’re experiencing.
Ask them how you can help them: If your loved one seems to be in distress during a psychotic episode, consider gently asking them what you can do to help. While this may not always work, in some cases they may be able to direct you in a way that is specific to their needs.
Discuss the importance of seeking help: Your loved one may hesitate to seek treatment for their psychosis. As I stated before, a great deal of mental health treatment can be perceived as negative and indeed have negative outcomes. Thus, it is important that you don’t advocate for those measures. Learn about recovery-oriented help that does not involve a future of being warehoused. Ask yourself if the suggested course of action is likely to lead your loved one down a path of recovery and healing or trauma and abuse. Then it makes sense to advocate for them to trust the help that is available to them. Additionally, it can really be helpful if you are willing to work with them to find the right treatment.
What if They Become a Danger to Themselves?
Many people benefit from medication and other treatments that help them stay in touch with reality. After receiving proper medical and mental health attention, it’s not uncommon to see improvement in psychosis-related symptoms. Of course, it helps when you can help to assemble a team of trusted professionals that respect the self-determination of your loved one and believe in their recovery. However, symptoms can still occur despite appropriate intervention. This can get your loved one down and even lead them to become a danger to themselves or others.
Thus, it becomes important for your loved one to learn about how they want to be treated and how to advocate for the type of treatment they need at a particular time. A good resource to help them develop these skills is wellness recovery action planning. WRAP groups will teach your loved one to develop a crisis plan. Learning to plan for crisis ahead of time and to collaborate with others to learn about the best resources that are available to them is very valuable.
Thus, if psychosis does cause your loved one to become a danger to themselves or others, lean on the crisis plan they have developed to get them to where they have determined would be most fitting for them. Call 911 only when all else has failed as that is truly a last resort. Having police called can become traumatic for many people.
What Psychosis Treatment Options Are Available?
Psychosis has been around for a long time and was once blended with religion and social order in earlier epochs. Before there was oppression from the state, psychosis might have caused social status to elevate. It is only when there is a great deal of oppression and a medicalized view of psychosis that treatment starts to be a negative thing. Now, it can be hard to find treatment for psychosis that doesn’t involve warehousing and suffering in the United States.
In some situations, anti-psychotic medication can help control the symptoms. Still even while on medication it often takes a lot of hard work to get to the point where voices, other hallucinations, or “delusions” disappear. Additionally, when there is miscommunication between the psychiatrist and the patient, or violence during incarceration, there is the problem of overmedication. When there is too much medication there is often sedation which adds to the negative symptoms of schizophrenia. When used properly, I believe medication can function as a tool for some people. Even so, some people may be able to taper off their medication at some point.
I have said a lot about treatment that is negative. If your loved one becomes a threat to themselves or others, temporary inpatient treatment may be a resource you must use. Still, I discourage people from thinking that long term psychiatric incarceration is a reasonable option. Too often, long- term incarceration just confines people and fails to address any issues. Many long-term facilities just train your loved ones to accept warehousing. That said, there may be times when long term treatment beats other warehousing circumstances or homelessness.
Many people don’t believe therapy is helpful when people are in psychosis. To counter this argument, cognitive behavioral therapy for psychosis has been set up and is thought to be a best practice and can be used to help build the skills and knowledge necessary to cope with psychosis.
I believe that individual, family, and group therapy can all be beneficial. However, it’s important to remember that not everyone responds to therapy treatments the same way, and different styles may need to be tested to find the most effective styles for your loved one.
I believe that hearing voices network groups are a great potential resource for people who experience psychosis. From fifteen years of running these groups in an outpatient program, I have learned to identify four areas of treatment off which I base my work.
First, learning to tell your story and articulate the experiences associated with your internal process in groups or with another individual helps a person be more mindful and aware that other people have similar experiences and that there are other explanations for what is going on with you that exist. This can take a while because many people are taught through hospitalization that it is not safe to talk about their experiences with anyone.
Two, collaborating with others and learning about new explanations for these experiences can help one become more flexible in how they make meaning of their experiences. This can help people realize when they are getting tricked and how to avoid getting tricked into negative self-fulfilling prophesies when they get stigmatized.
Three, behaving against your negative symptoms or emotions and working toward social rehabilitation is likewise very important. To do this it is important to learn about aspects of treatment you have found traumatic and learn to accept limits to which you can share your internal experiences with others outside of groups and practice social skills toward social functioning in the right contexts. For many people these contexts need to be work related, but not for everyone.
Four, as people start to improve, they start to recognize the existence of stigma. I believe it becomes important to work against internalized stigma through checking your thinking using cognitive therapy. I believe that stigma and being treated badly makes people with psychosis think poorly about themselves. I consider rational thinking and cognitive therapy to be a tool, much like medication is a tool, that might help.
Choose a Specialized Psychotherapist for Psychosis Help
If your loved one is suffering from psychosis, they may be very afraid of coming for help or even interacting with other people for fear of being invalidated and mistreated. Still, there is a lot of hope for your loved one and it is important to highlight the positive things that your loved one does do. If you are looking for individual therapy I can help.
I am a psychotherapist in California with over 25 years of experience. I offer treatment for psychosis across diagnostic categories. I also offer treatment for trauma, anxiety, depression, auditory hallucinations, and substance abuse. If you know someone needing therapeutic support, contact Tim here.