What is psychosis?

'Psychotic' is a term that is frequently misused in the media, and is often used synonymously with the words 'dangerous' and 'violent'; this is incorrect, and can serve to further increase the stigma surrounding psychosis and psychotic illnesses.

Psychosis can best be understood as 'losing touch with reality'1 and often takes the form of either delusions (unusual beliefs that do not respond to reason) or hallucinations (sensory perceptions such as sights, sounds, feelings, even tastes and smells, that are not the product of real things in the surrounding environment - hearing voices and 'seeing things' fall into this category). Experiencing psychosis does not make one a 'psycho', and my understanding is that the only situation in which a person experiencing psychosis is likely to become a danger to others is when their delusions or hallucinations are telling them that they are in grave danger themselves.

When I experience psychosis, it is usually in the form of delusions, though I do hear voices and see things very rarely. My delusions usually revolve around the belief that there are two parallel worlds, between which only a few people besides me can travel. Often I believe that one world is 'good' or 'normal' and the other sinister, and that the people in my life whom I am not getting along with, or who are causing me some sort of angst, have been swapped with their sinister counterparts from that other world. I also sometimes believe that I am already dead. My understanding is that these are fairly common delusions (feel free to correct me).

I always know that my delusions are delusions, which is something I never realised was possible until I experienced it myself. As with religious faith, it is possible to believe something and not believe it at the same time. This knowledge that what one believes or perceives constitutes illness is referred to as 'insight', and is seen as a positive phenomenon able to be worked towards through psychotherapy.

Opinions seem to vary as to whether delusions can or should be interpreted metaphorically.2 I think the two examples of delusions I've mentioned here clearly can be interpreted metaphorically: if I'm estranged or in conflict with someone, they are 'alien' to me, hailing from another, sinister world. Also, this belief in two different worlds tallies with my experience of living overseas as a teenager, and the culture shock I felt. The second delusion can be interpreted in terms of feeling that my life (or one chapter of my life) ended when I became unwell.

Psychosis can be experienced as the symptom of a mental illness (schizophrenia, schizoaffective disorder, bipolar disorder and others), as the result of drug use or a traumatic event such as sexual abuse, and for other reasons. Psychosis is often associated positively with spiritual experiences, and other cultures (eg. 'kundalini awakening' and shamanistic practices). As my exposure has predominately been to a medical understanding of psychosis, I can't comment on these ways of viewing psychosis, except to say (once again) further reading required...

1. Some would argue that psychosis is not in fact losing touch with reality but a special kind of sensitivity to a reality that most people do not have access to. I'm sticking to a medically based understanding of psychosis here, as it's what I'm most familiar with, and I think it's a good place to start in beginning to understand what psychosis is all about.

2. I'm not sure whether the same can be said of hallucinations, as my psychosis mainly takes the form of delusions, and so I've done more talking about it with doctors and others. If you know, feel free to educate me via a comment!

[Cartoon image of the Mad Hatter, downloaded 8th January, 2010, from:
http://www.fliktalk.com/?tag=alice-in-wonderland.