There are many mental health conditions/diagnoses that as a society we have made huge leaps to understand and accommodate for in modern life. Conditions such as depression, general anxiety disorder and eating disorders such as anorexia nervosa and bulimia have all had diverse and increased representation in media, resulting in empathy and understanding.
However, there are some conditions and diagnoses that come with a whole host of misconceptions, stigma, misinformation and at times, fear, as well as frequent controversy over the diagnosis itself from professionals and those who live with it too.
In this series of articles, ‘Breaking down stigma’ we will attempt to elucidate and inform our readers on some of these conditions and diagnoses, as well as to raise awareness for those living with them, and to act as an educational tool for anyone who might need it.
In this article we discuss: psychosis, why it still holds stigma today, why it is frequently misunderstood, what it is, ‘mythbust’ some common misconceptions and what we can all do to help fight stigma.
Types of psychosis
Due to the word ‘psycho’ and ‘psychotic’ being misused and appropriated for slang in the modern day, many people incorrectly believe to experience psychosis you have to be experiencing some kind of long-term ‘madness’, interestingly, in direct conflict with this the most common form of psychosis is what is known as a ‘psychotic episode’ and can last for a very short period of time or for longer.
The list of diagnoses that can include what is understood as an ‘experience’ of a psychotic episode are:
- severe depression
- bipolar disorder
- schizoaffective disorder: psychotic symptoms and mood disorder symptoms together
- postpartum psychosis
- and some personality disorders such as: paranoid personality disorder, schizotypal personality disorder
Diagnoses that involve more persistent psychotic symptoms include:
- delusional disorder
Most examples of a psychotic episode or ‘experience’ fall into one of three categories:
- disorganised thinking and speech
All of which can overlap and co-occur. There is a misconception that an experience is only psychosis when it is at its most extreme, such as hearing clear and distinct voices, vivid visual hallucinations and extreme delusions such as someone believing they are Jesus Christ or god.
This is not to say that those who do experience these symptoms at the more severe end of the spectrum should not be listened to or given the space to talk about their experience, only that in our culture we have a habit of only portraying psychosis, or a psychotic episode when it is at its most severe and ‘scary’. This is damaging because it often leads to misconceptions or misunderstandings, that in turn can lead to people’s psychosis not being identified.
Many people experiencing a psychotic episode can experience only very mild versions of these three symptoms and can also experience them infrequently. For example, the visual hallucinations might be something far more subtle than seeing people or animals that aren’t there, such as objects distorting or moving. Similarly, auditory hallucinations may not be very clear or distinct, instead they can be experienced as a low, muffled murmur or as if they are in the distance.
It is also important to emphasise here that not all experiences of hallucinations are negative. It is common in popular media to only focus on the traumatising, fear-inducing side of psychosis – especially as it most frequently appears in horror and thriller films. Auditory hallucinations can also be positive and soothing to the person who is experiencing something distressing.
The second two symptoms, delusions and disorganised thinking also fall on a vast and varied spectrum of less severe to more severe. Many are familiar with the term ‘delusions of grandeur’ and as mentioned previously, studies on people who experience very realised delusions such as believing they are someone very important (like Jesus Christ), are often the ones that gain the most attention. However, somewhat more common for a person experiencing a psychotic episode are paranoid delusions.
Paranoid delusions can revolve around something as simple as believing a certain food might cause you harm, to more complex paranoid delusions such as believing you are being monitored by the government and that you are wrapped up in a conspiracy.
Paranoid delusions, as with negative hallucinations can be extremely distressing and upsetting. Especially if they are more severe and the person experiencing them isn’t believed or is outcast by those around them.
It can be especially hard for a person experiencing hallucinations or delusions to understand and believe that what they are seeing/hearing/believing isn’t reality, this is because it often doesn’t matter how many times a friend, loved one or family member contradicts this delusion, or existence of a hallucination, they still persist.
Disorganised thinking and speech are usually described as ‘racing thoughts’ and ‘flights of ideas’. Racing thoughts can be distressing as they often feel ‘too fast’ or ‘out of control’. A ‘flight of ideas’ can cause you to change the flow or topic of a conversation very quickly, which might be noticeable to the person listening, a person might also stumble over their words as they jump from one thing to another. This experience of psychosis is also very common in those who have co-occurring mania and psychosis as a result of their bipolar disorder.
- See also: 'Living through psychosis'
- See also: 'Lived experience advisors should become a standard for TV and film'
- See also: 'Gaining a PhD and living with schizophrenia'
Treating and identifying the causes of psychosis
Treating a person’s psychosis or psychotic episode is inextricably tied up in what might have caused it in the first place. For those who are experiencing psychosis as a result of a physical illness such as Alzheimers or a head injury, the correct antipsychotic medication might be all they need to manage the symptoms.
If a person is experiencing psychosis as co-occurring with some of the diagnoses mentioned above, a mixture of antipsychotic medication (possibly intermittently and only when the symptoms are at their more severe) and therapy might be the best course of action.
A variation of cognitive behavioural therapy, specifically for psychosis (CBTp) can be really helpful to create crisis plans (that can be communicated to friends, loved ones and family), coping strategies and to identify triggers – especially if psychosis is brought on by a trauma trigger linked to abuse or neglect.
Importantly, when the correct mix of medication and talking therapies is identified for a person experiencing psychosis and they are understood with care and empathy, not judgement, psychosis is absolutely treatable and should not prevent a person from living their life.
Why the stigma?
For a long time, the word ‘psychotic’ has had strong derogatory connotations of ‘madness’, ‘insanity’ or even ‘dangerous’. Media portrayals of psychosis such as in Alfred Hitchcock’s Psycho solidified, very early on in the history of psychiatry, that a psychotic person is dangerous and could be more likely to commit violent crimes.
Despite the fact that time and time again the literature has contradicted this, and more often than not shown that people experiencing a severe mental health condition such as psychosis are actually more likely to be hurt by someone else or by themselves – especially as experiencing psychosis can be extremely isolating; the image the public has in their minds is a hard one to shake.
Damaging depictions such as in Psycho or Stanley Kubrick’s The Shining of someone who appears to have ‘gone mad’ are tightly bound with what people think psychosis is.
If we are to move past these damaging representations, it is important to depict psychosis as the vast and diverse experience that it is, especially as it relates to more commonly understood diagnoses such as depression.
Popular media has an unquestionable impact on our cultural understanding of complex matters such as mental health, and so it is our duty to demand that modern depictions of psychosis do better.
We recently covered a story on Antonio Ferreira, who has worked as a lived experience advisor on the set of UK soap opera, EastEnders to ensure that the portrayal of a character diagnosed with schizophrenia “wouldn’t be offensive or sensationalised.”
This is a move in the right direction. It is only in including those who truly know and understand what it is to experience psychosis, that our portrayals of it won’t fall back into the harmful stereotypes of horror and thriller films that perpetuate misinformation and misconceptions, such as: a person experiencing a psychotic episode is automatically violent or dangerous.
Living with psychosis, whether it be more persistent that requires daily medication, or intermittent brought on by stress, depression or mania, does not and should not have to be debilitating. With a more nuanced understanding of psychosis, instead of a reductionist misinformed view, we can, as a culture, encourage more people experiencing it to get the help they need.
To read more about psychosis and the diagnoses associated with it you can find further information through Mind, here. If you or a person you know is experiencing psychosis it is important you make contact with a GP so that they can get the help they need.