In psychiatry I suffer from what is known as ‘false beliefs’ or ‘delusions’ – I hold a fixed belief that I am or will soon be Britain’s most wanted criminal.
Psychosis literally means ‘out of touch with reality’ and for two decades I have lived with it. For me, psychosis means losing touch with reality and this has been near fatal at times as my paranoia can leave me feeling suicidal.
During acute psychotic episodes I have locked myself away at home as I’ve felt that this is where wanted criminals belong. Even from a place as safe as under the duvet, psychosis still affects me. During an episode, often brought on by stress, if I hear a helicopter outside I think it is the police closing in on me. I also believe the police have fitted spy equipment into my bedroom to watch me suffer. At the time of the episode these beliefs are unshakeable.
Psychosis isn’t a diagnosis in itself but it can be the tip of the iceberg for many conditions including schizophrenia, bipolar disorder, and psychotic depression – all diagnoses I’ve had at some point. For me, it took the best part of a decade for schizophrenia to be diagnosed, and with support my diagnosis has changed to schizoaffective disorder.
Often people will develop psychosis in their teens from either a family history or sometimes through taking illicit substances. But even at this stage of acute psychosis not all of this group will develop schizophrenia. This can take years before a psychiatrist may conclude that a person has schizophrenia.
There are also many other different factors to all the ‘schizophrenias’. Depression, anxiety, and mood swings are all put together to determine my diagnosis today of schizoaffective disorder.
Professor Stephen Lawrie, Head of Psychiatry at The Univeristy of Edinburgh, says:
“When mental health workers use the word psychosis, it is usually because the person they are seeing has one or more psychotic symptoms. These are usually delusions ('bizarre beliefs') and/or auditory hallucinations ('hearing voices').
“A diagnosis of a psychotic disorder (or condition) is usually only made if the symptoms are distressing or interfering with everyday life, but it often also means that the person does not realise that they are ill – in other words, in psychiatric jargon, they 'lack insight’ that their experiences are products of their mind rather than real”.
The difficulty of disclosure
A psychiatric assessment is given before diagnosis and this will be clinical. Psychiatrists will assess the mental state in which the patient is presenting. Sometimes patients are scared to express the full extent of their experiences, making a schizophrenia diagnosis less likely.
For example, a lady with bipolar disorder with psychotic features might not tell her psychiatrist about all her symptoms for fear of the outcome or even being locked away. She may confide in a professional other than a psychiatrist such as a Support Worker or Occupational Therapist who can then refer her back to her psychiatrist who will likely commence anti-psychotic medication.
Dr Vijayakumar Motappashastry, Locum Consultant Psychiatrist, Midlands Partnership NHS Foundation Trust, UK, tells me: “I have treated patients with schizophrenia for 25 years as a psychiatrist. It’s a very complex condition and not at all straightforward to diagnose.
- See more: The label of bipolar disorder has freed me rather than pigeonholed me
- See more: What it’s like to hear voices and how ‘democratic psychiatry’ can help
“We cannot diagnose schizophrenia immediately – rather, it takes several assessments, plenty of time, we need to take into account the patient’s family history, and collateral using a structured assessment. Only after all of these steps can schizophrenia be diagnosed. I must stress the time it will take clinicians like me to make a diagnosis”.
Being psychotic, or ‘out of touch with reality’ can thankfully be managed. I have lived with this condition for almost two decades and manage it with a combination of anti-psychotic medication, talking therapies, and lifestyle choices such as regular exercise and eating well. While it has been a hard illness to cope with, not least because of stigma from others, it is not a life sentence.
Erica Crompton is the co-author of The Beginner’s Guide to Sanity: A Self-Help Book for People with Psychosis – written with Professor Stephen Lawrie (published by Hammersmith Health Books)