When it comes to understanding and being able to identify psychosis in another person, we tend to avoid doing so. Why is that? Well, as I hope I made clear enough in my last blog post....it all begins when someone you love and/or care about says or does something that makes you question their relationship with real-life reality. Instead of asking questions to find out more about what is going on with your person, whomever he/she/they may be, our natural bent is to ignore it. It just is. I am hoping that this series on the topic of psychosis will help remove the fear from your perception(s) of what psychosis actually is and how it can show up in our day-to-day exchanges with other people. If I can assist even one person in getting (or assisting someone else in getting!) proper help and support for this issue, then I consider this series worth having presented here...
So, last post I began talking about "hallucinations" as one of the four major areas of symptomology that identifies psychotic behavior. I presented information about auditory and visual hallucinations, as these two types of hallucinations are most commonly experienced by people with psychosis. I want to make clear here that "how" a person becomes psychotic is another topic altogether, and it will be addressed in a future blog post. For now, however, I am staying focused on presenting the facts about what psychosis is and looks like in real life.
Beyond auditory and visual hallucinations, a person experiencing one or more psychotic episodes may also experience any one or combination of the remaining "types" of hallucinations: olfactory (smelling things that aren't truly present in the current environment), gustatory (tasting things and/or having a "taste" of something specific in one's own mouth that won't go away that, once again, is not a reflection of real-life reality in the current environment), and tactile (feeling and/or touching things that aren't truly present in the current environment).
What does this look like in real life? A stranger you see on the street seems to be jammin' to some music, while also talking out loud, and making gestures as if someone is in their presence, while boppin' down the sidewalk. The "music" and the "person" are reflections of both auditory (music and voice) and visual (person present) hallucinations. I know in today's modern age, people can actually be listening to music and engaging in conversation through their phone/earbuds; this isn't the type of "real" interaction that I am referencing here. Just to clarify....
Getting back to our stranger on the street, you may notice that he/she/they are dressed inappropriately for the weather outside. Too many clothes on if it is "hot" out...and not enough clothes on if it is "cold". Also may be wearing gloves when gloves are not an appropriate choice for the situation you are observing. Or a hat with glasses with a face mask on when it's 85 degrees outside. You may see the person scratching at the same or different parts of their body and/or reacting to a perceived threat to their physical body (ducking, flinching, jumping back, going "around" something when their body should be moving forward, etc.). These would be examples of tactile hallucinations (clothing choice(s) and scratching issue(s)) in combination with a visual and/or auditory hallucinations (dog approaching and barking, person running up and threatening, etc.).
If I had to throw in the remaining types of hallucinations with our stranger on the street, olfactory and gustatory hallucinations might involve picking something out of a trash recepticle to eat at one end of that spectrum...or refusing to eat and/or drink anything at all on the other end of that spectrum.
With hallucinations of any type, these are considered "positive" symptoms when it comes to psychotic behavior. The next two areas of positive symptoms are Delusions....and Disorganized Speech and/or Behavior.
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Delusions are very firmly held false beliefs that are not consistent with the reality of one's culture. I put it that way because some cultures engage in belief systems that we, as Americans, can't compute in any way, shape, or form. Like cannibalism. Like marrying off our own small child(ren) in exchange for $$$. Like ingesting noxious substances as a "cure" for...you name it. I could go on...but you catch my drift.
Delusional beliefs cannot be shaken despite logic, despite facts, and despite proof to the contrary. Delusional beliefs are going to be unique to the person who suffers from them; it is often extremely difficult for other people to understand why the person they love and/or care about adheres to the delusional beliefs he/she/they adhere to. One category of delusions has to do with persecution which, in fact, represents the most common type of delusion with psychosis.
The other types of fixed false beliefs humanity struggles with when psychotic can involve jealousy-based delusions, grandiose delusions, paranoid delusions, somatic delusions, religious delusions, nihlistic delusions...and the list goes on from there.
In all cases, whatever we are capable of believing about the Universe and how it operates, about God, about the "Illuminati" of our current culture (celebrities and/or "super rich" people), about ourselves, about other people we do and don't know personally, and about the way the world is and operates...these are the very "topics" that are subject to the focus of our own delusional belief system....
I remember when the Son of Sam serial killer back in the late 70s was finally caught and prosecuted for his crimes. When evaluated by the court-appointed psychiatrist, he indicated that he was obeying the command to kill from his neighbor Sam's black lab, which Son of Sam believed was possessed by a demon. I also recall a young woman on the psychiatric unit where I worked decades ago. She had taken some Ecstacy at a club a couple nights beforehand...and experienced psychosis for the first time. When she was on our unit, she told me I had "red" eyes. I mentioned they might be bloodshot from lack of sleep. She replied, "no", they were red all the way around my eyes. Upon further questioning (by me), she indicated she saw red all around my eyes as if I were wearing red eyeliner around the top and bottom of each of my eyes. She was not a predator. She was not "dangerous". She was sick. When she melted down on the unit, it was because she was fearful of one of the male nurses who she claimed was "going to rape me". Not to change the subject too much, but that nurse eventually was discharged due to repeated inappropriate physical contact on the unit. Just saying.
What we don't understand as John Q Public is that people experiencing psychosis aren't all like David Berkowicz or any other murderous predator. In fact, the majority of people who struggle with psychosis are more fearful than anything else, like the young lady on the unit where I worked. As such, being too afraid to verbally engage with a person in psychosis is often the excuse which keeps us from better understanding their situation when we find ourselves in it....
Next post, we will discuss disorganized speech and/or behavior, as well as the "negative" symptoms of psychosis, which represents the third and fourth areas of psychosis examined as part of this blog series.
Until then....