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The word psychosis is used to describe a condition that affects the mind, where there has been some loss of contact with reality. This means a person is not thinking clearly and may believe things are true that are not. When someone becomes unwell in this way it is called a psychotic episode. Psychosis is most likely to occur in young adults and is quite common. Around three out of 100 people will experience a psychotic episode, making psychosis more common than diabetes. With treatment most people make a full recovery from their experience. It is important to remember psychosis can happen to anyone and, like any other illness, it can be treated.
The extract below from 'Alice in Wonderland' by Lewis Carroll describes quite well the loss of identity one can experience when mentally unwell. It is one of several extracts and poems discussed in the art therapy groups.
'Who are you?' said the caterpillar.This was not an encouraging opening for a conversation.Alice replied rather shyly, 'I …I hardly know sir, just at present – at least I know who I was when I got up this morning but I think I must have changed several times since then.''What do you mean by that?' said the caterpillar sternly.'Explain yourself!''I can't explain myself, I am afraid, sir,' said Alice, 'because I'm not myself, you see.'
Psychosis directly affects thinking but can also affect mood and behaviour. Everyone's experience is different but listed below are common symptoms:
Confused thinking. Everyday thoughts become confused or disorganised. A person may have difficulty concentrating, following a conversation or remembering things. Often thoughts seem to speed up or slow down. Sometimes the things they say don't make sense. Confused thinking in this way is referred to as thought disorder.
False Beliefs. It is common for people experiencing a psychotic episode to believe certain things are true which are not true beliefs within their religion and culture. They are so convinced of these beliefs that logical argument cannot make them change their mind. These beliefs are known as delusions.
Hallucinations. Someone experiencing a psychotic episode may hear, see, smell or taste something that is not actually there. These are hallucinations. The most common hallucinations are hearing voices.
Changed Feelings. How someone feels may change for no apparent reason. They may feel strange or cut off from the world. Mood swings are common, so they may feel unusually excited or depressed. People's emotions may appear flat. That is they feel less than they used to or show less emotion than those around them do.
Changed Behaviour. People with psychosis behave differently from the way they used to. They may be extremely active or not do much at all. They may laugh at unusual times or become angry or upset with no apparent cause. Often changes in behaviour can be explained by the symptoms they have. For example, a person believing they are in danger may call the police. People may stop eating because they are concerned that the food is poisoned or have trouble sleeping because they are scared of something. It is important to remember that symptoms vary from person to person and may also change over time.
Art 1 and Art 2These pictures represent what is was like to be mentally ill and were drawn by Totara House consumers while participating in an art therapy group in May 2009. During this group, the consumers wrote a poem describing what it was like to be unwell:
The day begins at eightWho now decides my fate.Wandering bored around the house,Being watched when you are not, I feel like a blob, no motivation.Lying dull on my bed, Not wanting to get up.Won't someone please fix my head.
Art therapy group consumers, May 2009.
No-one is absolutely sure of the answer to this. It does seem that there is a vulnerability to psychosis that some people are born with and some aren't. This makes it more likely for that person to get psychosis as a teenager or young adult. Often symptoms occur in response to stress, drug use or social changes. Some of these things will have more effect on one person than another. What we do know is that when people have symptoms like thought disorder, delusions and hallucinations, then there is an imbalance of brain chemicals that can be corrected. Image 3During the Art Therapy Group consumers drew a representation of the journey they are on, looking at the obstacles that they might face and what supports they have to help them reach their goals.
Alcohol and other street drugs also effect brain chemicals. A number of drugs can cause psychotic symptoms and can also trigger psychosis in someone who is at risk. Use of drugs can also mask the signs of psychosis, which can mean delays in getting help. Further information on the effects of drugs is provided on our drugs and alcohol page.
When somebody presents with psychosis it is difficult to make a diagnosis or know for sure what is likely to happen in the future. Therefore it is often best to treat the symptoms without making a diagnosis. However it is useful to know in what illnesses psychosis may happen.
Drug Induced Psychosis. Using or withdrawing from drugs and alcohol can cause psychotic symptoms. Sometimes these symptoms settle quickly but sometimes the illness is set off by drugs and symptoms can take a long time to settle.
Brief reactive Psychosis. There are sudden psychotic symptoms after something very stressful in a person's life. Symptoms may be severe but the person usually recovers quickly.
Schizophrenia. This diagnosis is made when there have been mainly psychotic symptoms but not significant mood symptoms for a period of at least six months. This means the diagnosis can include a range of people, not just those severely ill. Many people with schizophrenia lead happy and fulfilling lives, many making a full recovery.
Schizophreniform Disorder. This is just like schizophrenia, except the symptoms have lasted less than six months.
Delusional disorder. The main feature is a strong belief in things that are not true.
Bipolar Affective Disorder (Manic Depressive Disorder). In this disorder a person experiences swings in mood where they have had at least one period of being abnormally elevated (overly energised and/or overly happy) in mood and may also have episodes of depression. Psychotic symptoms, when present, often fit in with the person's mood. For example, people who are depressed may hear voices telling them they should commit suicide, whereas someone who is manic may think that they are Jesus Christ or have special powers.
Schizoaffective Disorder. This diagnosis is made when someone has an illness, which on some occasions presents like a mood disorder with psychotic symptoms and, on other occasions, only psychotic symptoms are present. It has features of a mood disorder and schizophrenia but is not typical of either.
Psychotic Depression. This is a severe depressive illness in which the person also experiences psychotic symptoms. Further information is provided in our glossary of terms.
This is different for each person. Some people recover quickly without much help. Others need more support over a longer period. Recovery from the first episode usually takes a number of months. If symptoms remain or return it may take a lot longer. Sometimes people have ongoing symptoms but this is not usually the case. The important thing to remember is that psychosis is treatable and most people recover and are able to lead normal lives.