Why Psychosis Scares People

Why does psychosis scare people? illustration of cartoon monster with the words "so crazy"

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.

Psychosis symptoms: formal thought disorder, hallucinations, delusions

What psychosis is

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

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?

The post Let’s Talk About Psychosis is the hub for all psychosis-related content on Mental Health @ Home.

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.

There’s more on stigma on Mental Health @ Home’s Stop the Stigma page.

56 thoughts on “Why Psychosis Scares People”

  1. 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

  2. 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.

  3. 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.

  4. 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!

Leave a Reply