Will I Go Crazy?

The Detailed Answer                              The Short Answer





The Review


What Is Psychosis?

Is this article going to be about psychotic persons?

No! There are no psychotic persons, no psychotic killers, no psychotic rapists. The word "psychotic" isn't supposed to describe a human being.

Psychosis is a temporary mental state. A person experiences a psychotic state for a while, then they come out of it. No one is born psychotic. Psychosis is not a personality trait.

A. Characteristics of Psychotic Episodes

B. Manifestations of Psychotic Episodes

C. FAQs About Psychosis

A. Characteristics of Psychotic Episodes

One or more of the following six things usually characterizes a psychotic episode:

1. an underlying chemical imbalance which makes the person vulnerable.

2. a trigger: something the person perceives as very stressful. 

3. a history. We all have histories, of course. 

4. a distinct change in the thought process. Your thinking is just fine -- until the psychotic episode begins. Episodes usually begin pretty quickly. They tend to taper off gradually.

5. pain. There is no happy psychotic episode. There is no neutral psychotic episode. Enduring a psychotic episode hurts like hell. We're talking about raw fear here.

Think back to the last time you were really afraid. Either your mind was busy trying to find a way out of the situation or it was trying to make you feel better, as in, "This dental work will be over soon." When you are experiencing psychosis, you are afraid, and your mind is what is creating the fear. Your mind just makes the terror worse, telling you that you are such a bad person that you actually deserve this horrible pain. If your mind does try to make you feel better, it does it in a misguided way, by creating delusions of grandeur.

6. lack of understanding of the real world. I have trouble with the phrase "out of touch with reality". You are quite aware of what's going on around you. In fact, you are hypersensitive, able to detect the slightest change in people's expressions.

B. Manifestations of Psychotic Episodes

A typical psychotic episode manifests itself in one or more of the three following ways:

1. Hallucinations: believing something is there that actually is not there. Hearing something strange and knowing that it is strange is not a hallucination. The hallucinator perceives the voice; their brain says, "That's Dad calling me," with no doubt at all. The non-hallucinator hears the voice and says, "Could that possibly be Dad calling me? But he moved out a year ago." If you are not sure what you heard or even if you wonder if it is a hallucination, it is not a hallucination. A hallucinator is absolutely positive (though they may have their doubts later on). So, during a psychotic episode, you usually "hear voices." 

2. Delusions: believing something is true that couldn't possibly be true. I'm not talking about believing that Bill Clinton never had sex with Monica Lewinsky. I'm talking about physical impossibilities or grandiose ideas such as believing that you were born on Mars or that you are Jesus Christ come back to life.

The most common delusion is paranoia: fear that gets way out of hand. You may be constantly afraid that bad things will happen to you or that people will hurt or betray you. You may pick up your gun every time you answer the door.

3. Problems With Communication

Probably the most common thing that happens during a psychotic episode is that you have a lot of trouble talking straight. Your words and sentences get garbled -- all mixed up like a "word salad." Each individual phrase or sentence makes sense, but they are out of order and you never quite get to the point.

C. FAQs About Psychosis

Be careful not to confuse the people who endure psychotic episodes with their symptoms. The symptoms are devastating. The people are good people struggling to keep living and loving through it all.

Q. Are hallucinations, delusions, and "word-salad speech" symptoms of psychotic episodes, of mental illness, or both?

A. They're symptoms of psychotic episodes only. Not all persons diagnosed with mental illness have psychotic episodes. So not every mentally ill person experiences hallucinations, delusions, or severe difficulty talking.

Q. Can you look at people (or yourself) and see symptoms of mental illness? of psychosis?

A. Mental illness? No chance. There is no way of walking, no way of talking that tells you definitely that somebody is mentally ill, unless, maybe, you are a psychiatrist. The rest of us will just have to trust psychiatrists' judgment on who is and is not mentally ill.

Psychosis? That can sometimes be easy to spot. If a person trapped in a psychotic episode comes out and tells you about his or her hallucinations or delusions, it can become pretty clear that they have psychiatric problems. A good rule of thumb is: Don't try to diagnose anyone unless it is necessary for survival.

A long time ago, on a bus late at night, I saw a woman several seats behind me who was clearly coping with a psychotic episode. I was afraid of her and got off the bus as fast as I could. Now I know that she was much more afraid than I was. Just because she was talking in a garbled way to no one I could see did not mean she would or could ever hurt me. The primary emotion in any psychotic episode is fear.

Q. Are you saying that, even if a person kills during psychosis, they never experience any emotion but fear?

A. Not at all. I'm saying that emotions are very complicated during psychosis.

In order for you, a person who is not undergoing psychosis (assuming you are not a hit person!), to get to where you kill somebody, you need to (1)be very angry, (2)decide to get revenge, and (3)kill the person. A severely mentally ill person who kills goes through exactly the same stages, unless the stress involved happens to trigger a psychotic episode.

Psychosis throws out all the rules. Under psychotic conditions, the anger can be repressed, converted to fear, glee, or any other emotion, exaggerated into an overarching hatred for the whole universe, or you name it. In psychosis, your anger melds with what the trigger person did to you to initiate disorganized thinking. Then that thinking may or may not compel you to kill.

If you do kill, you may well kill someone other than the trigger person. You probably won't kill at all. Thousands of people have undergone psychotic episodes. Only a tiny percentage of these people have killed anyone, and the vast majority of these latter killed themselves.

During a psychotic episode, you are just as good and just as smart as you ever were. But you are trapped in a frighteningly chaotic brain that is turning against its very owner. And you can't even have the comfort of telling anybody how bad you feel.

Added to that is the knowledge that you have been cursed, for some inexplicable reason, with the most humiliating of all possible diseases.

  Next Memo: Creativity and Psychotropic Medicines

Got feedback? Email Dr. Bradt at cassjmb10@att.net

Donít force behavior! 
Change attitudes.