Let’s Talk About Psychosis

Let's talk about psychosis - a group of symptoms, not a diagnosis - graphic of multicoloured head

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?

Psychosis symptoms: formal thought disorder, hallucinations, delusions

42 thoughts on “Let’s Talk About Psychosis”

  1. I had two psychotic episodes, both caused by severe stress and insomnia and I think I should consider myself lucky that I am not on any long term medication now (side effects!) and yet, I’m coping. I only take olanzapine occasionally, when I get a lot of stress and, if I take it early enough, one tablet is enough to calm me down.

    I remember, a few hours before my hallucinations started, during my first episode, I posted to my Facebook page that I feel on the edge of psychosis. I meant, that’s how stressed I was, but I thought I was making a joke.

    I then travelled to Poland, to my family (I’m Polish but I live in the UK) and I had this impression that I’m being monitored to get there safely, but also, to assess if I’m fit enough to be on the plane. I then had the same impression when I was in Poland: my mum was taking me to places and people there were suggesting I need to see psychiatrist, but they were behaving in such a strange ways, their body language was extremely exaggerated and their vocabulary was very direct. This is not something that you’d expect people would do to somebody who is psychotic. I also had an impression that I received a deadline to do something, but didn’t know what it was, and this way I came up with the idea that I really need to see psychiatrist, even though I was still delusional. Later however it wasn’t that easy and my other symptoms (panic attacks) were totally ignored by Polish doctors for like 4 months.

    The second psychosis happened a little bit over two years later and I got sectioned. It was completely different at the time, but I recovered quicker. From this experience I remember how I knew that I was psychotic and I spoke about it openly with psychiatric staff from the beginning, yet I believed my delusions. I thought psychosis can be something I can pop in and out as I see fit and that being psychotic can be my superpower as long as I learn to control it.

    I heard loads of voices during my first episode but barely any during the second.

  2. Johnzelle Anderson

    Great post. I’ve never heard the term “micro psychosis” before. I’ll add that to my list of psych words!

  3. Thank you for a frank and honest post, this is so important for awareness. I have also learnt a few new terms.

    Do you know much about research into the phenomenon where people who experience voices report they sound friendlier in a different country… then when they move to a Western country they sound aggressive and harmful? That’s really boggling if patient reports are consistent and I wonder what that is.

  4. I have a friend and I remember she used to talk about having psychosis when we were 15 (now both 19), however she never talks about it now, even though we are both very open about mental health eg. Anyway, it was an interesting read and now I know far more about it than I did before.

  5. The consensus now is that I do not, nor have I ever, experienced psychosis. However, some idiot 7 years ago decided to tell me I did and it derailed everything. I’m incredibly grateful that I have no lasting effects from the 6 years of antipsychotics that I never needed, but I’m still picking up the pieces.

  6. This post was helpful because you shared your experience. It seems less scary then. This can help stigma in our view.
    We talk to a person/ghost who lives in our hearing ducts. Sometimes, we can hear the whisper people talking in small fans like the one next to our bed. Sometimes they play a symphony, which is lovely. The Crows watch over us as we drive to make sure we’re safe. These don’t sound logical, when we read them back, but we think it could be real, true. None of these are problems for us right now, so we wouldn’t use energy to address them. We like the connection with these people.

    1. I’m glad the connection is a positive one. I had a client once who had a not-real boyfriend that kept her company and talked to her all the time. I wish more people could have comforting experiences rather than scary ones.

  7. Yes, I have experienced psychosis as part of my bipolar illness. Breaks and mini-breaks have been largely psychotic in nature and occurred earlier on in my bipolar illness when the meds were not so great (1980s and 1990s). More recently since 2008, clozapine has been largely successful in limiting or eliminating psychotic tendencies. The thing that is difficult about psychotic thinking is that as a person you have to own up to having these thoughts but at the same time these thoughts feel like they’re being introduced from outside the self. It is weird to “own” psychotic thoughts when they feel like they are coming from an outside source. At least that’s my experience.

  8. I don’t have psychosis, and never have, but apparently one third of folks with OSDD-1/DID have hallucinations.

    Alter chatter can be perceived as coming from outside one’s self though that’s a lot less common than the characteristic “inside” “not me” voices.

  9. This is a great post. I only learnt that I was diagnosed with major depressive disorder with psychotic features when I asked for a referral letter. I am not sure what made my doctor think had psychotic features though. I know I used to think that people were talking bad about me behind my back. I also thought people were following me. And I once thought that my sister had stolen my medication. I am not sure if those experiences count as psychosis though.

  10. Thank you and everyone who is sharing their personal experience. Absolutely! I feel that this phenomenon should not be entirely in the hands of “professionals”, and that especially with these kinds of experiencing, people should talk more.

    Personally, often, if feel, the idea that such experiences amount to a “disorder” is not particularly helpful. Sometimes it is just an institutionalized way of confirming to people that something is wrong with them for the sake if money and medicine (though I feel meds can help in some instances).

    However, beings have a broad range of experience, and categorizing people as normal and disordered I feel just compounds the problem for such people, but more pointedly, opens the door for them (you?) being passive and feeling powerless.

    There was a study I read about about I think in New Zealand. The Maori. People in that culture who heard voices are otherwise had psychotic ideas and experiences were supported by that culture. Their experiences were placed in a context which was more helpful to them to continue to function and be a human being with self-esteem and purpose, even if they were taking medicine by “WestrÑ“ prescribers and psychologist. This is because, it is hypothesized, that the culture views those people differently than merely being “disordered“ or having a “mental disease”.

    Thank you so much.

    For those interested. I found this site:

    https://www.hearing-voices.org

    1. I’ve heard of the Hearing Voices movement before. I think a lot depends on what a given individual experiences. For me, my illness has always felt like an illness, not so much because it’s considered abnormal in an absolute sense, but in a relative sense, as it’s a significant departure from the way my mind works when I’m well.

      1. I agree, yes. I feel it is important that the individual realize their own situation, as an empowerment into their own lives.

        Not everyone’s experience is “disordered” just Because I might want to see it as that for whatever reason. And often to tell people they have a disorder is a disempowering label. Yet for Some people it is empowering. 🤙🏾

        Thanks for your blog!

        1. It feels like an illness that’s superimposed on top of who I am. I had a good childhood and it’s never felt like a proportionate response to things that are happening in my life. No one in my immediate family has mental health issues, but there’s a strong genetic background on one side of the family. My condition has always responded best to biologically-based treatments. So putting all of those things together, an illness with a reasonably strong biological element seems to make sense.

  11. I do get intrusive thoughts sometimes as I imagine myself throwing myself off the balcony every time I stand on the railing, imagine myself deliberately burning my face with an iron while I iron clothes, or imagine letting go of a mug and watching it smash in slow motion whenever I carry a mug.

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