Emily Reynolds 1st December 2017
Anti-stigma campaigns have done a lot for the understanding of anxiety and depression. But conditions that are perceived as more ‘extreme’ are still hugely misunderstood.
One such condition is psychosis.
“Neurotic problems can be understandable as extreme variants of day-to-day life – anxiety before a driving test is understandable, but the same degree of anxiety whilst on holiday or resting home is not. Psychotic problems comprise something of a quantum jump into the abnormal,” Mark Salter, a consultant in adult general psychiatry in East London tells The Overtake.
“That is to say that the ordinary functions of the mind are so disrupted that the individual experiences a drastic change in a sense of self and a disconnection from the world around them” – something many people find difficult to understand.
So what actually is a psychotic episode? In simple terms, it basically means that someone has “lost touch” with reality. Many experiencing psychosis have hallucinations – seeing or hearing things that aren’t there, seeing ordinary objects warp or distort, or experiencing sensations that have no cause. Others have delusions – what Mind describes as “a false belief that no-one else shares…[that] you will still believe even if logically it doesn’t make sense or experiences show it can’t be true”. Delusions of grandeur may cause someone to believe they’re powerful, able to control the weather or influence other people’s thoughts; paranoid delusions, on the other hand, might make them feel as if they’re being watched or controlled.
Someone having a psychotic episode may also experience what is called “disorganised thinking” – their thoughts racing and mind moving from idea to idea incredibly quickly – or disordered speech. They might trip over words, link words together by sound rather than meaning, or frequently change topic within one conversation.
I’ve felt like my girlfriend or members of my family have been trying to poison me
Jake, a 30-year-old artist from London, has schizoaffective disorder. He describes his episodes as cyclical, and notes that they’re “partly triggered by stress”.
“It’s very distressing,” he says. “Things you’ve seen a thousand times before are reframed and appear utterly new: for me they often have mystical meanings. I’ll draw conclusions from things that aren’t rational: at the time they make total sense.”
“On one occasion, I thought a book of prayer had been placed in a bookshop as a message to me from God; on others, I’ve felt like my girlfriend or members of my family have been conspiring against me or even trying to poison me.”
This – maybe fairly obviously – can be incredibly frightening and distressing.
“The person inside a psychotic episode feels as though these events are real and responds accordingly,” Salter says. “Sometimes this can take the form of frenetic overactivity that may carry an angry, suspicious or irritable quality, sometimes it leads to complete withdrawal, locking themselves into their home – sometimes for years. Others get drunk, smoked large amounts of (usually tranquilising) drugs, or feel impelled to go to strange places driven by their ideas, hallucinations and moods.”
It’s probably best understood as a really weird, creepy, indefinable nagging feeling that something wacky is about to happen
Those experiencing psychosis are also likely to feel unnerved or unsettled before their symptoms properly kick in. “There’s almost always a subtle, often insidious change,” Salter explains, evident both to the person experiencing it and those around them. People can become quieter or more suspicious, he says, sad or irritable. Some begin to notice “small changes in their surroundings and the way they react to events, people and places”; others become “sad or inexplicably distant”. Jake tells me that a key warning sign for him is that he “retreats inside himself”, and starts finding it hard to “parse information properly”.
“The Germans call this Wahnstimmung – madness calling,” Salter says. “In English we call it ‘delusional mood’ – it’s probably best understood as a really weird, creepy, indefinable nagging feeling that something wacky is about to happen”.
Misconceptions still abound around psychosis – many of which are tied up in ideas about violence, risk or danger. 2016’s NatCen British Social Attitudes survey found that 44% of people would be uncomfortable working with someone with psychosis; 78% said they’d be uncomfortable having someone with psychosis marry into their family. 90% would be unhappy with them looking after their children.
“The most important misconception is that people assume that people experiencing psychosis are necessarily dangerous,” Jake says. “While that may be true in a small number of cases, most episodes of psychosis cause confusion and distress to the person experiencing it, not anger and violence.” Dr. Salter agrees, pointing out that despite the public association between psychosis and violence, you are “almost 1,000 times more likely to die in a fire in your home than you are to be murdered by a psychotic stranger”.
So many governments have simply failed to put their money where their mouth is
Dr. Salter also points out the idea that those with psychosis “never get better” – something he says is simply untrue.
“60% of people who develop an acute psychotic episode, from whatever origin, will get completely better and get on with their lives,” he says. “Watching someone undergo a transition from a state of terrified mental disorganisation into the healthy, thoughtful happy person they were a few weeks ago, leaving hospital and going back to their work in the family, is something that I see every week. You very rarely see it portrayed at talked about in the world at large.
Funding remains a huge issue. “So many governments have simply failed to put their money where their mouth is,” Salter says.
“Until we can achieve what psychiatrists call ‘parity of esteem’ mental health services and social services (which are really the same thing) will remain underfunded, waiting lists will get longer and longer, Harley Street will get richer and richer, and mental illness will remain all too common”.
Emily Reynolds 1st December 2017