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.
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. They 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.
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.
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 = psycho = psychopath. 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.
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?
You can find more on mental illness stigma on the Stop the Stigma page.