Let’s Talk About Psychosis

I was reading a post a while back on Life In Unreality about how we need to talk more about psychosis, so I decided to chime in. In this post, I’ll talk about psychosis in general as well as my own experiences.

The basics

We’ll start with some basics. Psychosis is a group of symptoms, not a diagnosis in and of itself. Psychotic symptoms include delusions, hallucinations, and/or formal thought disorder.

Hallucinations can be in any of the five senses. These are termed auditory (the most common), visual, tactile, olfactory (smell), or gustatory (taste). Hypnagogic and hypnopompic hallucinations, experienced while falling asleep or waking up, are not considered psychotic in nature.

The APA Dictionary of Psychology defines delusions as “an often highly personal idea or belief system, not endorsed by one’s culture or subculture, that is maintained with conviction in spite of irrationality or evidence to the contrary.” Delusions may have various themes, including persecutory, religious, somatic (involving what’s going on in one’s body), grandiosity, control (e.g. thoughts being put in or taken out of one’s head), or referential. Ideas of reference are beliefs that things happening in the world are connected to or directed at the self, such as interpreting messages directed towards oneself in tv broadcasts. Experiences like jealousy and guilt may reach delusional proportions, meaning they go beyond what would be considered reality-based. I’ve got a post coming up that takes a closer look at delusional themes.

Formal thought disorder is a term for highly disorganized thinking. It can include things like clang associations (connecting words based on sounds rather than meaning) and word salad (patterns of speech involving words that are totally disconnected). The term word salad has been co-opted by people online talking about narcissism, but what they’re talking about has nothing to do with thought disorder.

Diagnoses

Psychotic symptoms can happen in the context of a variety of different illnesses. They can also be induced by some medications (such as prednisone) or other substances (such as marijuana or cocaine).

In primary psychotic illnesses, like schizophrenia, schizoaffective disorder, and delusional disorder, psychosis is the primary feature of the illness.

Psychosis can also occur in other disorders, like bipolar disorder and depression. Some people with borderline personality disorder experience micropsychosis, with brief periods of psychotic symptoms during times of intense stress.

My own experiences

I have a diagnosis of major depressive disorder, and I sometimes have psychotic features as part of that. I’ve never experienced severe psychotic symptoms, and generally, my logical brain is online enough for me to recognize that why I’m experiencing doesn’t logically make sense, although that doesn’t stop me from experiencing it.

Hallucinations

During my first episode of depression, I would occasionally hear a couple of words, like “go away,” when there wasn’t anyone around. During my second hospitalization, I kept hearing whispering without any distinct words; that stopped after they put me on the antipsychotic olanzapine. I occasionally have olfactory hallucinations involving body odour that seems like it’s coming from me even if I’ve just showered. I remember during my first hospitalization asking my mom to buy me a different kind of deodorant because I thought there was something wrong with mine and it had totally stopped working.

Delusions

During my first hospitalization, they apparently thought I had delusional guilt, but I don’t remember enough of that time to know what that felt like.

I sometimes get ideas of reference. One instance that felt particularly weird was when I was driving home and I came across a car that had been in an accident. I was sure that the accident had happened because of me, even though it had already happened before I came along and, from a logical perspective, it clearly had nothing to do with me. There have also been times when I thought people were doing things or making noises directed at me, even though it didn’t make any sense that that would be the case.

I only recall a single instance of being paranoid. I was driving at the time, and I was sure the person in the car in the lane next to me had a gun and was going to shoot me. There might be some realistic chance of that in the US, but it would pretty darn unlikely in Canada. The fact that the driver wasn’t even looking at me made no difference.

At one point, thoughts appeared in my head that I had to throw Casper the guinea pig against the wall and that I had to cut off a bunch of my hair. It was weird, because there was no sense of where the “have to” was coming from, but it was strong. It wasn’t like an OCD intrusive thought involving anxiety, a “what if I do this” scenario, or any sort of judgment of myself for having that thought in my head. I didn’t feel like the thoughts were being inserted from a particular outside source; it was more like they were rules that I was suddenly aware of. I decided to give in to chopping off the hair but steer clear of the guinea pigs altogether, and luckily, all of that settled down fairly quickly after increasing my antipsychotic dosage.

Over to you

While my own experience with psychosis has been pretty limited, I thought it would be good to share in the spirit of fostering more open conversation about it.

If you’ve experienced psychosis, what’s that been like for you?