Opinion: we need to realise that people who experience psychosis are not as 'mad' as we might have thought

By Grainne McAneeUlster University

Psychosis is a clinical term which describes an episode when a person has unusual thoughts and experiences. This may be where you see, hear, feel, taste or smell things that are not there (hallucinations), or you have strongly held irrational views or beliefs (delusions). These are experiences which people mainly associate with a particular psychotic disorder, namely schizophrenia

Many people think of those who experience such breaks with reality as the truly 'mad' among us. Stories in the media, and portrayals of people who experience psychosis on screen, often compound this image. The image of the unstable violent individual who is different from us. The actual truth is that people who have psychosis suffer from serious mental illness and are more likely to be the victims of violence.

What are the symptoms?

Symptoms of psychosis are described in the Diagnostic and Statistical Manual of Mental Disorders as being positive, negative or disorganised. Positive symptoms are those which are experienced by people with psychosis while not normally present in those without psychosis and include hallucinations and delusions. These are the symptoms we are most likely to hear about in the media or seen portrayed in films.

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From BBC, David Harewood on helping other people understand what it is like to experience psychosis

Negative symptoms are those which are absent in people with psychosis while normally present in those without. These include avolition, which is the absence of drive or motivation and may manifest in ways such as a person sitting still for very long periods of time. Another negative symptom is anhedonia, which is an inability to experience pleasure. A third negative symptom is alogia, which is an inability to speak. The third type of symptom, disorganised, is related to bizarre behaviour and inappropriate emotional reactions.

What causes psychosis?

There is a large body of research addressing the causes of psychosis based on a range of models. There is the medical model, which proposes that the origin is biological and genetic, and related to an excess of a particular neurotransmitter in the brain (dopamine). There is the diathesis-stress model, which states that there is a genetic predisposition which manifests as an oversensitivity to stress from the environment that results in a person moving from healthy to ill in the presence of such stress.

There are models which look to events in a person’s life such as the Traumagenic Neurodevelopmental model, as developed by John Read, which states that early traumatic events in a person’s life can act as a trigger for changes to the brain and open pathways to psychotic experiences or symptoms. One main feature is that the hypothalamic-pituitary-adrenal axis, which controls our stress reaction, becomes over-reactive which results in changes in the neurotransmitter systems controlled by it, including dopamine. 

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Professor John Read on the origins and meanings of psychosis

How to reduce the stigma around psychosis

Most people feel they can relate to what depression may be like, as we have all had a bad day and we have all felt sad. But when it comes to experiences in any way related to psychosis, we would less likely to feel we ‘get it’. If I were to ask you if you had ever had a psychotic-like experience, you would most likely react with a horrified 'no!'.

However, if I was to ask you if you had ever thought you heard someone call your name and then turned only to find you were alone, you would probably say 'yeah, that’s happened to me'. Or if you ever thought you saw someone or something out of the corner of your eye and jumped after, say, watching a scary movie or walking in a dark street alone at night, something which turned out to to be a shadow, you would again most likely have had this experience.

These experiences are referred to as perceptual anomalies, the voice that we could not have heard because no one is there or the shadow that wasn’t a menacing stranger. Our brains have simply misinterpreted what we heard or saw. Perhaps the scary person was in our head and our brain convinced us they were in the room? We may also have experienced disorganised symptoms: you may have inappropriately laughed on hearing someone’s bad news or had a fit of the giggles in the middle of a very serious situation. 

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From Attitude, young adults talk about living with psychosis

Maybe people who experience psychosis are not as ‘mad’ as we might have thought. Maybe there is something relatable between us. More and more as we understand the symptoms of psychosis, we can see that, yes, these are experiences we may not have ever had but that we can relate to in some way.

All of this this suggests there is continuum of experiences, a sliding scale, if you like. We can feel flat or sad for a few days and then these feelings can pass. Sometimes, they continue for more than two weeks and we may need some medical intervention and could possibly be diagnosed with depression. The symptoms have reached a point when they are interfering with our lives. Seeing a person that was merely a shadow, or hearing a voice when there is no one there are common experiences we all have.

Up to 30% of us will have experiences along this continuum of psychosis, according to research done by Jim van Os at Utrecht University Medical Centre. These experiences or beliefs do not interfere with our life and they don’t require medical intervention. For some people, their experiences do become symptoms that interfere with life and do require medical intervention. Seeking that medical intervention may be easier if we reduce the stigma which exists around these kinds of experiences. Because people who experience serious mental illness are just like me and you.

Dr Grainne McAnee is a Research Associate at the Bamford Centre for Mental Health and Wellbeing at Ulster University


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