The Nature Of Psychosis

  • Delusions can also be of Mixed type (combining categories without one category dominating ), or of an Unspecified type (for those occasions when truly novel delusions are encountered).
  • Where the presence of hallucinations is a pretty clear indicator of a brain problem, this is not necessarily the case with regard to delusions. Delusions and hallucinations can and do frequently co-occur, but delusions can also occur just fine when no sign of hallucinations are evident. Brain damage or impairment is not necessary in order for delusions to occur. I'd like to say that you can use the bizarreness of delusions as an indicator of brain impairment, where the more bizarre the delusion is, the more likely the person exhibiting that delusion is to have a brain impairment, but this isn't necessarily the case. To clarify, it is the case that more bizarreness suggests a greater likelihood of brain impairment, except when those bizarre beliefs are widely held within the cultural group that the person happens to belong to. This is to say, if the delusion is a societal or sub-cultural delusion and not just an individual one, a person holding that delusion could be very much delusional but have a perfectly healthy brain and mind. From their own perspective and from the perspective of those around them sharing in the same culture, they would be sane. From the outside perspective of a different culture, they would appear delusional. Again, psychosis is in the eye of the beholder; it is a social process, and what makes sense within one society may not make sense in another.

    Nowhere is this phenomena more apparent then when you compare cultures with high-contrast belief differences. A good example occurs in America today when people talk about evolution. On the one side of the evolution divide are scientists who take an empirical approach wherein the theory of evolution represents the best way currently known to account for the carefully accumulated and scrutinized data concerning human and animal origins. On the other side are people from faith-based backgrounds who practice bible literalism wherein if the bible says that creation happened as it says in Genesis, then that is exactly the way it happened. Each side's position looks fully delusional to the other side, I suspect. There is no way to say who is right without making a commitment yourself to one or another ways of understanding the nature of what is reality, so there is no ready resolution to the issue.

    Psychosis is not the same thing as Psychopathy!

    A few more things ought to be said before I close. You hear people talk about Psychopaths sometimes. Despite the similarity in the name, being a psychopath has little to do with being psychotic. Psychopaths are otherwise normal people (from a cognitive perspective) who for one reason or another have a terrible empathy deficit with regard to other people. They either cannot appreciate that other people have rights and feelings and lives that matter, or do not care for other reasons. Whatever the cause, they act as though they are the only important person in the world. Some psychopaths are skilled con-artists who are very good at leading people to trust them or fall in love with them, only to betray those people later on. Some become criminals. And, yes, some become violent murderers. So far as a diagnosis goes, psychopaths are more likely to be categorized as Antisocial Personality Disorders or Narcissistic Personality Disorders than as Schizophrenics, or Dissociatives. It's not hard to argue that psychopaths are delusional (due to their extreme empathy problems), but if this qualifies them for being psychotic it is a very different kind of psychotic than clinicians normally encounter.

    Anyway, there is this myth that won't die that Schizophrenic and other psychotic patients are particularly violent, and this is just not the case by and large. Most of the psychotic patients I've know have been rather sweet people when you get to know them. Some act very strangely, and sometimes in alarming ways, but as a group they are not a particular threat. Its not that psychotic patients are never violent, but rather that they are not more violent than other groups of patients like substance abusers, for instance. I have this idea that people confuse psychotics with psychopaths and that may account for the persistence of this myth, but I'm not really sure.

    Having made the points I wanted to make, I'll stop here. There is a lot more to say on the subject of psychosis (such as how it can be treated) but instead of making this essay overly long, I will refer people who are interested in additional material to our Schizophrenia topic center where a whole lot more on the subject is available.

    Please feel free to ask further questions on the topic below at the bottom of the essay. I'll do my best to get them answered. And, should anyone who has experienced psychotic episodes read this, please add a comment describing your experiences so that they can become more clear and understandable to people who have not experienced what you have. When it comes to psychosis, having the right perspective counts for a lot.

    • Norine Shima

      Thank you for the clear and nonjudgemental explanation of psychosis.

      Psychotic is what my teacher/psychologist called a person in my self-help group.

      This is because this man told me that he loves me, sent me 4 emails a day, wanted us to soulmates, have a lifelong relationship etc. But no intimacy between us because he was the "Bride of Jesus" and in fact had sex with Jesus. And he had a doll that was a empty instant coffee bottle.

      When I told another woman in the same self-help group she thought he wasn't taking his medications.

      The man broke it off with me after I told him (this is all by email-that was the primary means of our communication.) that I thought it would blasphemous to invite Jesus under my sheets.

      That is my story. I am still shaking from the less than a weeks time conversing with him by email and meeting him for coffee. I feel I should have pulled away from his "courting" when he told me about the Bride of Jesus story.

    • Lynne C., therapist

      As a therapist who is looking for material to help members of the community understand mental illness in an objective way, your article was extremely helpful and some of the adjectives were particularly useful Thank you. I would wish that more people would become less afraid of mental illness and more interested in understanding it clearly and correctly.

    • Anonymous-1

      My mother, who is 80 years old, recently started to exhibit signs of psychosis. She is very interested in the current presidential elections and has been claiming to have political discussions with TV commentators. Whenever Hiliary Clinton (who she claims is her friend) comes on the TV she smiles and waves at her and claims that she is talking directly to her. When I try to explain to her that those people on the TV are unable to see her she strongly disagrees and asks me to sit and watch how they talk to her. I notice that when the TV personality is looking straight into the camera, as if they are looking directly at her, she thinks that their comment is for her directly. There was a time that she called a friend of hers crying that she had a fight with Chris Matthews and the friend thought she had called the TV station and had a conversation with him and he started to yell at her, but not through the TV screen. She also tells my father he needs to turn the TV off when she changes her clothes as they can see her. She has also told my father to straightn the bed as she does not want them to see her room a mess. I try to explain to her that this is not the case. My father and I do not know what to do about this.

      Editor's Note: What you describe is known as "ideas of reference" if the delusions are non-bizzare, or "delusions of reference" if they are bizzare. This is a common symptom of paranoid style (e.g., positive symptom ) psychosis. It would be a good idea for your mother to be evaluated by a psychiatrist.

    • Cynthia

      My 22 year old sister is a wonderful person. She is a mother of 2 beautiful babies, a wife, a sister, a daughter, a niece.

      A little before the New Year (2008) she was asleep in bed with her 2 daughters, while her husband and my brother were playing a game in the living room. She opened her eyes and saw a hand reaching toward my older niece. She grabbed the hand and threw it at the wall. The hand fell and ran under the bed. My sister grabbed her babies and ran to the living room.

      After that incident, she started to turn toward God to prevent any evil from happening to her family. At first her husband wasn't as supportive, but he asked for forgiveness one day and since then it got worse.


      I was at work when my little brother called me. He said "Your sisters trippin". I asked what was wrong and I started to panic, thinking about my nieces and just what could be wrong. He said they were 2 cities away, he didn't know where and my sister just stopped in the middle of the road. She had her foot on the break, and wouldn't respond to ANYTHING. Her babies were in the back of the car and my brother got out of the car and went to a nearby restaurant. He later told me that he thought my sister was taking him out there and dropping him off. I asked "Why would you think that?!" He thought she was mad at him because a few days prior she told him to get out of her house because the devil had a hold of him...

      I called my mom and told her what my brother had told me...then I got back to work. Don't get me wrong, I was still crying and worried, but I had to keep my mind off of it or I would have drove myself crazy.

      My sister lives in Odessa, Texas and she drove to Seminole, Texas. But she told the doctor that she wasn't the one driving... God was. She said God told her to drive there and to stop at the green light and wait there. My mom and brother in law met her in Seminole and the paramedics came. She was diagnosed with "Psycosis and manic depression". They admitted her to the State Hospital.

      We visited her yesterday (Feb 13) at the hospital. My mom, my brother in law and I got to visit with her for an hour. She goes into these trances, she stares at the same spot and she won't talk or move. It's like she's listening to the voice. She says it's God talking to her. She would act like a little girl and then she'd be normal for a minute and then she seemed confused. She went back and forth for that whole hour. It broke our hearts, we were right there crying and she would just smile or go into that trance. We're desperate. I just want my sister back, and her babies miss her. We all miss her terribly. She has a 1 year old and a 2 year old. She didn't even ask about them, but we talked about them to her and told her how the 1 year old walks around the house saying "Mama". She would just smile and nod her head. Her world revolves around her babies and it just hurts that she can't be with them and she doesn't react the way she used to. My mom asked her why she hadn't taken a shower and my sister replied, "You don't ask for anything in here. When I'm ready they will let me know." This concerned us, so we asked when she would be allowed to take a shower and the lady said "Oh whenever she wants to, all she has to do is let us know when she's ready." My sister has never been one to complain or try to manipulate others. She's very meticulate, it was saddening that she didn't know what she was allowed to do. We handed her some money and she just looked at it as if she didn't know what it was. It was so hard to leave her, she just stood there smiling as we walked out the door. She didn't even cry. She's so strong and we need to be strong for her, but it's heartbreaking. I would take her place if I could, I would trade places with her so she could be here with her family.

      Today (Feb 14-Valentines Day) my mom told me that my sister has to go to court tomorrow because she wont take her meds because the voices tell her not to. The doctors said my sister told them the voice asked her if she would sacrifice her babies and she answered "I don't know". We don't believe that's God talking to her. And the doctors said it wasnt schitzophrenia.

      I just want to get inside of her head, I want to understand. We wanna know why, how to stop it and how to help her. She has a very strong support system and we are ready to fight for her. We are ready to do whatever it takes. We have asked The Lord to prepare us for this battle because we don't know what we're up against. It's NOT gonna take her from us, we won't let it.

      It's difficult not to be scared.

      "Peace I leave with you my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid." John 14:27.

      Someone who knows, please help us understand. Please.

    • Beavis Christ

      Is it wrong of me to find humor in mental illness? I found the previous story to have elements that were funny. The mentally ill see things that I could never imagine! How creative.

      On a more serious note, I thought the movie "A Beautiful Mind" gave some perspective on how real delusions can seem.

    • suzanne

      A good friend I have known for over 30 years told me yesterday that he had "seen and smelled Jesus in the flesh, and that Jesus was a bronze man with a prominent nose, in a white robe, annointed in oil that smelled like a goat. "He didn't look at me, but put his hand on my hand and I immediately had a strong vision of my younger son in the womb".

      This happened 8 years ago and he continues to drink and stay away from his family and home. He goes to church in different towns as he travels with his job and tells this story to anyone who will listen(so he told me). He is convinced that he is a "chosen one".

      All this happened after his brother died in a tragic accident. But he says "strange things were already happening around him" prior to the brother dying.

      I am desolate, so sad for this very good friend. Is this obviously a psychotic disorder? He said he waited to tell me because he was afraid I would reject him. I think he is right. At this stage of the game, even if we could get him in for treatment, is there any chance it would be successful? He is a life long alchoholic.

    • Anonymous-2

      when i heard voices i was afraid to tell anybody

    • Jamie

      My teenage half brother has accused our father of sexual molestation.

      He has been depressed and going to therapy since my father and step-mother's divorce about 5 years ago. He has been on several anti-depressant medications and recently a drug to treat ADD. He most recently tried to commit suicide by taking prescription medications and has been having psychotic episodes.

      No one but his mom, the doctors and child protective services has been allowed to have contact with him.

      My step mom swears that these things happened and that my brother could not make them up. I've pointed out that he's had psychotic episodes but she says he's made the accusations after being off the meds for a few days. He was back on a new medication within a week, which doesn't seem long enough to have a clear mind.

      My sisters (one fully biological sister and one half sister)and I don't think the molestation charges are true just from knowing our dad for so long, and that all of his allegations started when he began having the psychotic episodes and that we have not been able to talk to him. We are told it is because we don't believe him that we are not allowed to talk to him.

      I'm truly concerned that during this time my brother really needs his family around to support and love him. I've tried to convince my step mom that I would be non-judgemental and show him unconditional love, but she does not believe that I can do that. And that I'll only upset him.

      Everyone has tip-toed around his depression because our step mom continually told us that we would only aggravate his problems and let his therapist handle that part of his life. We all have listened and now he is away without his loved ones.

      Can anyone point me in the right direction to find research on this matter? Can a person believe that they were molested by their own parent when it's not true? Can their be something else wrong with my brother, like schizophrenia? He's almost 17 and while always being shy and introverted like my dad, he never has displayed symptoms of any psychotic behavior before.

      Thanks for any advice you can provide.

    • John McCabe

      Realy enjoyed the information but I would like to know what makes people self harm, as I'm relitively new to social care.

      Dr. Dombeck's Note: I wrote an essay some time ago titled "Six reasons why people self-injure" which you might find to be a useful read.

    • Anonymous-3

      Hi, I'm a sixteen year old girl that has been in the hospital for nearly 3 months. And this is how it started.

      I'm a very curious person. One morning I was lying in bed wondering about this boy. I don't know this boy well, only as a classmate. I use to go to his school and I thought he was kind of smart. Anyways, I suddenly thought about him because 2 weeks ago or so I had this dream about him dedicating this picture of his family to me. That was weird. My mind was feeling conscious as I looked out to a tree standing outside of my bedroom window. And then I decided to think about him again. Then, I felt something conscious happening in my mind. The image of the boy's face appeared inside my person... like the inside where you look out to the world. I was intrigued. Some seconds later, my insides felt some kind of other being around.. I was guessing it was that boy's insides.. (?) ... I know I had absolutely no clue what was happening so I ignored it and closed my eyes. Then I heard him speaking.. I really thought it was him inside connected to me, speaking to me. That sounds so absurd. I began to reply in my mind in a alarmed voice, "Who are you?", while thinking I might be hallucinating. There was this stranger meet stranger feeling between us. I thought I was in big trouble and needed to clarify things up. So I said to him, "Sorry, I didn't mean to. Bye." I'd bet he left, but there wasn't a response and I could still feel and see him. Could you imagine what I would be feeling? Perplexed and quite alarmed. 2 or 3 days passed, I could still feel what I thought was his presence. I was sick of the stranger feeling so I decided to try to rid him away from me and my emotions because obviously it seemed to me some stranger was invading my privacy. Also the feeling of his presence was growing closer to me as more of the days passed. It could feel that and the feeling of my inner presence. And then I thought that I would start to lose who I am? I was terrified and didn't know what to do. I didn't tell my parents because I wouldn't know how to explain it. I thought maybe it's not so serious and decided to forget about it. A week passed, and as much as I could feel his presence, I feel or sense his mind slightly hovering and touching my mind... Then this inner attention took most of my attention away from my attention to reality. I can't not face it because it was really bothering me and I begged it to go away (not literally) because the longer it was the heavier it was carrying two minds. It was not confirmed that I was carrying his mind, though my inner attention/awareness could sense his whole size of the mind.. which I suppose was the size of his head. This was seriously out of my mind.. I was believing this to be true. Although there was no response I could sense a reaction from the presence of his mind.. by that time after 2 or 3 weeks I couldn't even concentrate. After sleeping I feel that my mind has been thoroughly searched by him.. or his mind. But it should be his mind because a part of the size of his mind was submerged into the back area of my mind. And the longer he/ I stayed there like that the more that he went further into my mind. I thought what he was doing could damage my mind. I was really scared, and thought I must be all messed up by now. Still, I haven't told anyone. And still was confused, invaded, and possibly messed up for life. I couldn't even imagine how I could live life like this I can't even focus on my outer life. I thought he was actually intending to do this. I don't know how to deal with him. He did so much that when I pay attention to the inside I could see words and sentences in the area of my forehead. Then one day just a week before the start of school, he said he won't leave. So I replied, you have to. Seems he might've enjoyed finding about my mind. ( and then he might know about my life?) This "messaging in the mind" thing I called it went on for 30 minutes. Dude was I pissed off. So I finally said, "What do you want me to do?", feeling irritated. A really long pause and then the next experience I'm going to tell you is frightening. His presence or spirit I think felt fierceful and intense. My emotions were even more scared. I didn't say anything to him or talked out loud. I remained silent, and then this really bad feeling came over me.. as cold as hatred ( maybe it was) inner presence was being killed to death. Well, everything felt dead solemn inside me and in a matter of seconds I lost .. my whole self I would call it. I could feel no strength, and since my inner presence was gone my being was empty. I felt like a nobody. Even my personality couldn't be felt. I was still alive but when I walked my limbs felt so light like nothing walking across the floor. I thought I was done for. Maybe in a couple of days I would be dead without myself. I thought about letting my parents know to call the doctor but I didn't really have a real reason about my problem. His presence was shortly drifted away from me as my presence was no longer there, and I noticed my parents look in their eyes.. They had watery eyes but they weren't crying. The emotion on their faces looked very emotional and I caught a slight movement of shaking like they were sobbing in their emotion. Their voices sounded hollow. As if they were hollow, like me. I was guessing maybe what was happening to me they could sense subconsciously? ( I know nothing about subconscious) I went to the washroom and let myself cry. For the next few days I could feel no better. I hoped he came back to help me. His presence was no longer there but I could sense a part of him still connected to my mind.

      Long story short, it became hard to focus in school and I felt like throwing up as a result of feeling empty. I was so weak I could hardly make it out of bed, or have the energy to eat, but I didn't feel hungry. And I was looking worse. There was no energy in my eyes. I talked it over with my counselor and went to the hospital for a check up. And things escalated from there. The people who made an assessment about me said I have psychosis. I didn't know what to do. The real stuff was happening to me and I was about to be sent into a psychotic hospital but no one had a clue about what happened to me on the inside.

      So I don't know if I this was a psychological thing, but this entire experience was unbearable.

    • Rebekah

      My older brother has schizophrenia. Naturally, my family and I have been reading up on how to be supportive, how to better understand it, and how to try and work through the illness so that our lives can retain some degree of normalcy.

      Recently, my mother was reading a book a woman wrote about her experiences with her son, who has schizophrenia. The woman said that she had read on an internet blog that other parents had noticed that their children's rooms smelled like a goat when they were having a psychotic episode.

      Is there anything to back this up? My mother isn't entirely sure what goat smells like, but she thinks his room smells...odd. Has any research been done concerning anything like this?

    • Lisa

      My son was diagnosed as bipolar with pshchotic symptoms in december 2008 at age 18. I still do not understand what he went through. He heard horrible voices and was unable to sleep and began using street drugs. He took his life last month, he was 20. Naturally we are devasted and confused. He was our small town quarterback, very popular, friendly, loving and honest. Since his passing, we have discovered many writings that give us much more insight into what he was battling every day. I dont understand how he was able to hide all the pain and fear. We never saw suicide coming, although in hinesight, we should've. He actually felt PAIN, physical pain for all the suffering in this world. He saw demons and dark figures. They said hateful things to him that he would never talk about. The day he shot himself, he was hearing the voices. I told him we could handle this, that we just needed to get back on his medicine and he said "I dont need medicine mom, it's different this time, I just need to love myself." OHHH! This hurts sooo bad..... Will we ever understand?

    • margaux

      i recovered from bulimia at age 18. i probaly am lukiest person alive. as with that i almost lost touch with reality an came back stronger. it was two months after my healing and summer of my coming home honors from school my father woulld have me abused for 15 years and torute me with drs after i healed inflicting abuse torture on a life that just recoveredf rom a traumatic three years of hell. through 15 years i saw my brain and survival instincts strain to not let him make me go back to that. despite i suffered extreme ptsd condtions,, i refused to break and go mad , but i suffered. then again i applied experience and escaped his abuse and prison he kept me in to see again miracle two. a full healing, it was like am amazing thing. it was like being a hostage for 15 years like being kidnapped and coming to your own life again whole. my body began to heal and i was a child like person and began to regain my tlaent back. it was the most horrible thing to be dosed daily with what i knew could take me back to waht was my darkeest hell inever wanted to see again that life was cold dark isolated and i came out a whole person twice. i got 17 years of amazing rise up.i did not crack despite people tried to play on this and to make me mentaly ill i remained healty. this came from seeing and surviving one experince. i didn ot take drugs or turn to drugs like family members. or lose idenitty or get sickly i came out better again and but i would not wish this to happen again. so i got to drs but they ignored me. they were told by my family to ignore me. it was a ride up in life and to see mybody fullly healhty and mind again was amazing. why would they not follow me on this and help me . as they wer ealso detached from realit long time ago and wanted me to be them. that was also waht a dr told me.

      world is full of scary people , i suffered ptsd but not psychosis or break from reality. at times i was pushed alost to that but my brain must have at age 18 learned a step to back up. i also got to drs but was not given care. so i was left at risk. i tried to et persons to help me get care. and they were calous.. so idid it all alone. for 17 years i had an amazing life. until, i faced some lethal factors in this story which were put on me by someone trying to fond out what made me sick as a teenager..

      they put some toxic abusers boys in my life.. persons who tried to inflict wounds in me.but i steil did not crack. howver this year, it was lke the set all circumstances on me to try to make me have a break while drs ignored th warknig signs and dangers threats to me despite my history i begged them to rmove me. they ignoredme. i also began to suffer heart and brain problems from so much stress on me and challenges. adn they ignored that to. this month i suffered a break down, and now im like bak in a hell i suffered 38 years ago. not one thing i did to make sure this did not happen or ever get a chance to happen helped. drs shit on me ignored me. wnting me to suffer mental illness and forcced me to it. can isue them? now my life which was blessed is a mess and i may never see a normal life again. i loved my life. and now my talent is gone my hard work and miracles. god gave me a miracle to do good with it so others cursed me.. and got off with it.