Why Psychosis Scares People

Why does psychosis scare people? Maybe it's because they think it means psycho/psychopath (except it doesn't)

People tend to fear the unknown. Psychosis is arguably the group of symptoms that the average person finds the most frightening when it comes to mental health problems. There is stigma associated with many/most/all mental health conditions, but psychosis kicks it up a notch.

Symptoms of psychosis: types of delusions 'and hallucinations - from Making Sense of Psychiatric Diagnosis by Ashley L. Peterson

What psychosis is

As a quick explanation, psychosis refers to a cluster of symptoms involving hallucinations, delusions, and/or profound disorganization.

It can occur in primary psychotic disorders like schizophrenia or schizoaffective disorder, and also in other conditions like bipolar disorder or major depressive disorder.

To the uneducated person, though, there’s likely to be a lumping together of psychosis = crazy = schizophrenic = frightening = dangerous. The reality of psychosis is simply not a part of the social dialogue.; Since it is not understood, stereotypes are clung to more tightly when evaluating or contextualizing someone who appears to have psychosis.


There are quite a few stereotypes about psychosis, and while some of them may have a germ of truth for some people some of the time, overall, they’re most certainly not accurate.

Talking to themselves

One classic stereotype of psychosis is someone talking to themselves. This is a bit of a misnomer in that people aren’t actually talking to themselves, they’re responding to their hallucinations. This can be observed sometimes, particularly when people are highly unwell, but as a broad generalization, it’s just not accurate. It’s most likely to be observable in someone who is very ill or someone whose illness is treatment-resistant.

Tinfoil hat

Another stereotype is the tinfoil hat. While it’s true that severe paranoia may lead some people to take steps to protect themselves from perceived outside energies, radiation, or mind-reading attempts, this is not a run-of-the-mill occurrence seen in most people experiencing psychosis. When this kind of paranoia manifests, it’s most likely to trigger perceived protective measures around the home; in 15 years of nursing, I’ve never seen an actual tinfoil hat, although I’ve witnessed some elaborate strategies in people’s homes.

Poorly groomed

There is the stereotype of the dishevelled, malodorous person living on the street. This is the person whom the rest of society views as somehow less human and a lost cause. It likely stems at least in part from an underlying fear that the onlooker could someday end up in that position.

When people with psychosis do end up resembling this stereotype, it’s because the system has failed them on multiple levels over and over again. It is not the unkempt homeless person that’s to be feared, it’s the system that’s so broken that it can’t catch people when they first start to fall.


Then you have the violence stereotype. There’s yet another mass shooting? All of a sudden everyone’s clamouring to say the shooter must have been crazy. Forget about better gun control laws, people want to lock up the crazy folks. Because after all, how could someone do something like that and not be psychotic? Easy answer – a psychopath.

Psychotic ≠ Psychopath

That brings us to another issue, the idea that psychotic, psychopathic, and psycho all refer to the same thing. Psychotic is an adjective for someone experiencing psychosis. Psychopaths are kind of an extreme version of sociopaths. They lack empathy, but psychopathy is not considered an illness. Psycho is a slang term that derives from the Latin word psyche, meaning mind or soul, but gets tossed around loosely to label anyone who’s seen as being crazy.

The Cambridge Dictionary defines psycho as “someone who is crazy and frightening”, along with an American English definition of “a psychopath”. The Merriam-Webster thesaurus lists several synonyms of psycho; many of these are derogatory, and psychotic is on the list. As unhelpful a word as it is, though, psycho probably isn’t leaving the popular lexicon any time soon.

And really, the word psycho is a minor issue compared to the fear around psychosis. Fear flourishes in silence, which means we need to talk about what psychosis actually looks like.

Experiencing psychosis

With my depressive illness, I’ve experienced some psychotic symptoms, both hallucinations and delusions. They haven’t been a big part of the overall illness picture, and tend to appear mostly when I’m really sick. Sometimes it hasn’t been entirely clear if what I was experiencing was psychosis or not. During one of my hospitalizations I kept hearing whispering, and it was plausible that I was overhearing conversations from a distance, but then the whispering stopped not too long after I was put on the antipsychotic olanzapine.

Have you experienced psychosis as part of your illness? Have people reacted with fear because of it?

Book cover: A Brief History of Stigma by Ashley L. Peterson

My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.

You can find it on Amazon and Google Play.

Stop the stigma: Resources to challenge mental illness stigma

You can find more on mental illness stigma on the Stop the Stigma page.

58 thoughts on “Why Psychosis Scares People”

  1. I’ve had a couple of borderline-psychotic episodes, but they only lasted for a couple of seconds at a time, so it’s hard to get a firm diagnosis of what happened during them. I have worried at times about becoming psychotic, though. The fact that the depression books/sites I was reading acknowledged that people with depression can become psychotic without really going into detail about what psychosis entailed, which probably added to the fear (this was a number of years ago; I hope things have changed).

    Re: psychotic people being blamed for mass shootings, I think that’s as much about our understanding of mass murder as it is about our understanding of mental illness (that and the NRA looking for a scapegoat). That we assume that someone who could kill dozens of people for no obvious reason must be not ‘normal’ in some way.

      1. I think the assumption is that the psyche is, on some level, what makes us moral, so a killer must have a damaged psyche rather than e.g. diabetes.

  2. I haven’t experienced a psychosis where people feared me, (thank goodness).
    This was an excellent post, Ashley. I couldn’t agree with you more when you stated the gun laws need to be examined more closely. That, they do need!

  3. The first time I was hospitalized was because, as the doctor said, of psychotic depression. This was in 1995 so I don’t think people were as aware as they are now, of mental illness. I can only imagine what people were thinking/thought when I sat down on the floor of a crowded train car.

  4. I can honestly answer yes to both of your questions. I sometimes scare myself even. I am on anti-psychotic meds and they help some, but I’ve learned what can trigger these things in me and try to avoid them. Not always easy considering it’s usually rudeness or stupidity that will set me off, I stay home mostly. LOL

      1. Thank you. At least I know what they are. I feel for those that are at the whim of something they can’t identify, how do you protect yourself from that?

  5. Have you experienced psychosis as part of your illness? I suppose I have. Three ..no scratch that… FOUR times. Three during major surgeries and once because someone triggered an anger episode that I’ve never experienced since and hope to heaven I never do. I was out of control. In the surgery situations, I didn’t realize, initially, that I’m allergic or highly sensitive to general anesthesia, or components of it. It’s probably the pain meds they mix in to that stuff that causes my psychosis (if that’s what it was). I become highly paranoid (during one of them I called a good friend in the middle of the night and claimed ‘they’ were trying to kill me and she needed to come break me out). I’m combative, angry and act out during these episodes. Fortunately as the effects of the anesthesia wear off, so do my symptoms. The first time it happened, it scared me to death. The last time (after my knee surgery), it was so severe that I lost an entire week of time. I have no idea how I acted, although a family member said they came to visit me and I kept ranting about what a horrible mistake it was having my knee ‘fixed’ and how I was so stupid to put myself in the situation again.

    Have people reacted with fear because of it? Sometimes yes. But it had its upside in a weird way. After the knee surgery I was in a rehab facility for about three and a half weeks roughly. Initially the facility overbooked and I was given a cubbyhole in a wall behind a curtain. I shared a bathroom with four other women, two of whom were apparently highly incontinent. I know I scared the staff into giving me the first private room they had come available because I said I didn’t know what I would do to those women who soiled the bathroom so badly and that I was going to sue the facility for putting me in a ‘room’ that had no handicapped modifications (not even a bed rail for me to hold onto to get out of bed at all), and that wasn’t even a room.

    I am, under the surface, a highly angry individual at all times. Maybe anger is the most dangerous part of a psychotic episode.

  6. Very interesting read and one I can identify with completely. Anything that is deemed as not acting ‘normally’ or ‘not coping’ is automatically seen as being crazy or unstable.

    I hate that. I hate both those labels.

    Thank you for sharing.

    – Nyxie

  7. I’ve never had a true psychosis, but the thought of it does scare me. I think what would be scariest to me is the loss of control over yourself, your decisions, reality itself…

  8. Ended up in jail after a psychotic manic episode a few years ago. Started my ongoing recovery soon after I’ve been on since.

  9. “It is not the unkempt homeless person that’s to be feared, it’s the system that’s so broken that it can’t catch people when they first start to fall.” 👏👏👏

  10. I’ve had delusions and visual & auditory hallucinations but most of mine were being unmedicated plus being on meth. And you don’t sleep when you’re on meth, which of course, also creates hallucinations. Outside of drug use, I’ve only had minor delusions. I still hear whispers when I’m alone. I can’t make out the words but it’s like someone is whispering in my ear but idk if it’s my bipolar or something else. It happens a few times a week & it’s not bad. Just weird.

  11. I suffer with psychosis/psychotic episodes due to being diagnosed with schizophrenia, anxiety, eupd.
    It’s truly terrifying. Most times I can’t remember what has happened in these episodes but my meditation seems to be working right now. Best wishes to all of you. Xx

  12. seeing you write “psychotic = psycho = psychopath” is the realist thing I’ve seen today. I know the damage this assumption does, it’s one of the reasons I have trouble admitting my own psychosis. If more people understood the differences I think it would be easier for me to face this issue.

  13. Our delusions are like waking nightmares usually. We know they are not real at the time, and still the body reacts chemically/hormonally to the stress. It’s later when we can get confused as to whether or not the delusion was real. Same with dreams. We can get lost in time: past, delusion, dream, future maybe. Have been working for 2.5 years on being present and can sometimes do it now! Good post

  14. I’ve been writing in depth about narratives of how people would become psychotic and why sometimes paranoia and distrust are rational for the individual. I’m attempting to destigmatize the disorders by increasing the awareness of what they really are.

    As an example, I currently don’t believe schizophrenia necessarily makes you think weird beliefs, but I think weird beliefs are a risk factor to becoming psychotic. Strange ideas are socially ostracizing. I think there is a predisposition towards strange ideas or deviation from culture in some people who have schizophrenia but for others it could be that their physical body is strange and they are outcast and ashamed over this. It could be racially related even.

    I’ve shown that even biochemical mechanisms of these narratives align with the current popular theories of schizophrenia. It presents a more cohesive conceptualization, binding most of the theories together into one more subjectively relatable idea.

    You might be interested in some of the pieces I’ve written such as Dynorphin, Nexus, Xenotypy, and AntiNarcissism.

  15. Unfortunately, night terrors and hallucinations have taken over my life in the last few years. Talking about it to my doctor is just as hard as having the issue. along with a jumbled large amount of other bullcrap problems… Great article… Thank you

          1. I don’t leave my home much. Maybe once a month… It is difficult for more than just physical levels. Though that a big part of it… anyway… Yeah, I suck as a patient. The paranoia of prescribing pain meds for people and living with it for so long… Made me a bitter patient I guess, lol…

            1. It’s okay 😉 not trying to get sympathy, just complaining is all, lol… Anyway, very informative blog! I look forward to reading more.

  16. Yes, psychosis scares people because they do not understand. After living for 6 years with acute paranoid psychosis, I started a blog at my therapist’s suggestion, to tell my story. I hope my words educated, inspire, and help erradicate harmful stigma.

    Take a look at some of my stories on http://www.breathingwithanoose.com. I would love any comments, questions, or feedback.

    Much love to all who wrestle with this illness!

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