Psychotic Disorders
by Dr. Daniel A. Bochner
When your average person says the word “psychotic,” they're typically
referring to someone “weird” or “wacky” or “wild.” The word “psychotic”
actually means that a person has lost touch with reality. At the time of a
psychotic break, a person with a psychotic disorder is not seeing things in a
way that is consistent with generally recognized facts, or is finding it difficult
to communicate or find common ground with anyone else. There is more
than one way to lose touch with reality. A person can have hallucinations
and believe they hear voices or other noises that don't exist, or they can
actually see things. A psychotic person can also start to feel confused,
disoriented and jumbled. Yet a third kind of psychosis is to become
delusional and believe things are happening that are not, or that one is part of
a grand scheme or is being plotted against in some kind of grand conspiracy.
People can have some of the symptoms related to psychotic disorder
for other reasons. Substances and other chemicals can lead to some of these
symptoms, either when ingested or absorbed (substance, chemical or
hallucinogen intoxication), or when the body has become accustomed to
those substances or chemicals and then develops withdrawal (delirium).
Sometimes when the brain malfunctions in various ways that are not related
to psychosis, such as when someone develops dementia, confusion can
develop that is not completely dissimilar to psychosis. But psychosis
develops for very different reasons than substance abuse, delirium or
dementia, and thus the character of psychotic symptoms differs quite
significantly from those experienced due to chemicals or deterioration of the
brain.
In psychosis, confused symptoms, hallucinations, and/or the experience
of special importance within strange and twisted conspiracies occurs due to
the experience of extremely intense and seemingly destructive emotions
quaking and churning within a person who is desperate to deny such
emotions. Psychotic symptoms can arise due to either the intensity of the
emotions, or the rigidity of the need to deny the emotions, or both. The
more intense the emotions, the less rigid one's denial and repression must be
for psychosis to develop. The more rigid one's denial and repression, the
less intense the emotions need to be for psychosis to develop. Psychotic
symptoms are most typically a part of two particular diagnoses, bipolar
disorder and schizophrenia.
When psychotic symptoms occur in the bipolar patient, the primary
cause is the intensity of emotions. Human emotions are animalistic in
nature. That is, human emotions are a more developed version of the
survival instincts of the lowest creatures, whether those creatures are more
the vicious type or the timid type. Thus, the intensity of human emotions at
the extremes can often and easily develop into murderous thoughts or a
desire to rip and shred and split. On the other hand, one might become so
frightened of violence and aggression in the everyday workings of common
day to day experience that one develops a desire to vanish completely or
disappear. It's also a common human experience to feel as though one's
swallowed up by the chaos of the world and is out of control, or that one's
importance is so ubiquitous that one is the controller of life itself or that life
itself is the story of that person. In the bipolar person who becomes
psychotic, it is primarily the intensity of the emotions that makes it difficult
to contain those emotions. The feelings themselves simply have too much
potential for destruction to oneself or to loved ones. The intensity itself is
not, however, the entire problem. Without some need to deny or repress
these intense impulses because they are so destructive, there would be no
need for the impulses to be twisted into psychotic symptoms.
In the schizophrenic patient, psychotic symptoms often arise primarily
due to rigidity of thought and defense against harmful emotions. The same
kinds of emotions described above are often at the core of the problem, but
they need not be so intense to cause psychotic symptoms because the
schizophrenic has a need to twist and distort the feelings merely because
they believe so strongly that these feelings are horrible and unforgivable.
The schizophrenic typically has an extremely powerful belief in right and
wrong that can be either genetic or trained into them from experience. The
schizophrenic often sees any thoughts even remotely close to those described
above as extremely damaging, inappropriate, bad, and deserving of
punishment. Beliefs about right and wrong in the schizophrenic are so
powerful, in fact, that normal feelings of anger, desire, embarrassment, fear,
guilt or shame, can lead to psychotic symptoms even though such feelings
are so common and not typically thought to be particularly dangerous or
harmful to others.
The psychotic need to create symptoms that make little sense, or that
do not fit with what others perceive to be reality, or the need to lose touch
with what others view as safe and reasonable, often comes from getting too
close to the feelings described above because those feelings are potentially so
damaging to oneself and to others. In the bipolar patient, psychosis will
often occur due primarily to the intensity of the emotions, but also because
those emotions could be dangerous if allowed to dominate ones mind
unabated. In the schizophrenic patient, psychosis will often occur due
primarily to the feeling that even small amounts of these extreme emotions
are completely unacceptable. But in identical fashion to the bipolar patient,
with the schizophrenic it is the dangerousness of the emotions that remains
the central problem.
If one is extremely threatened by the aggressiveness or chaos of the
world, it might make sense to withdraw into oneself rather than to perish or
disappear. When the mind is convinced that the only other option is
psychological death, psychosis can appear to be a far preferable alternative.
If a person is having murderous or suicidal impulses and they have been
taught to be “good,” it can make sense for them to start hearing voices or
start seeing things that express those feelings rather than to ascribe those
feelings to oneself and being “bad.” Within the mind, it is a far better
alternative to hear a voice telling one to kill others or oneself than to think of
oneself as a killer or as suicidal. Likewise it is a far better alternative to see
images related to death than to actually make those images occur in real life.
When a person is feeling like they are the ruler of the world, or that their
importance is magnificent to the extreme, it can make sense for them to build
up a grandiose scheme of their own instrumental importance for the
existence of the world. A paranoid plot becomes the clear choice when the
only alternatives appear to be accepting ones lack of importance or soberly
facing disdain from others who will not tolerate solipsistic grandiose beliefs.
The psychotic process involves a conflict within the mind between
horrible, life threatening and relationship damaging emotions on one hand,
and the fear of what will happen if those thoughts are directly expressed on
the other. Interestingly, it is the expression of the psychosis that results in
the ultimate alienation of the individual with psychotic symptoms.
Psychotics are generally shunned due to their odd and nonsensical behavior.
Nevertheless, those symptoms present a far better alternative, and much less
destruction to the world or oneself, than the direct expression of the intense
emotions the psychotic fears within themselves. Those emotions, if
unleashed, would lead to the most unabashedly aggressive and violent and
suicidal impulses imaginable.
Given the circumstances of the particular individual afflicted with
psychotic disorder, its symptoms can arise due to extreme intensity or
extreme rigidity or both. Intensity can be innate or developed. Rigidity can
also be innate or developed. But no matter the particular reason the
psychotic symptoms arise, the fact that psychotic symptoms do arise, as
opposed to unadulterated animalistic instincts, is far preferable to the
extremity of emotional behavior that would occur without the psychosis. In
an odd way, psychotic symptoms are actually an expression of an
individual's desire to control their animalistic instincts so that they and others
are not severely damaged.
In that way one can come to understand why there always appears to
be some real sense of humanity in those who become psychotic. With very
few exceptions, individual's who become psychotic have been taught to care
about others very deeply, or have an inborn and tenacious connection with
others. Even if most of the people in their lives have been abusive or
manipulative, for some reason the psychotic individual has typically made
some significant connection with others that prevents them from being able
to act upon extreme emotions.
Some individuals with bipolar disorder or with severe personality
disorders act out on extreme emotions with little or no compunction. The
intensity of their rage, grandiosity, intimidation, depravity, paranoia or
isolation manifests within their relationships often creating terrible trauma
and immeasurable pain. Psychosis, as terrible as it is, especially for the
individual plagued by its confusion and interpersonal alienation, is from a
social perspective, a far safer alternative than the wild, self-centered,
manipulative, vitriolic, and often aggressive behavior observed in the
unbridled and tumultuous behavior of the most degenerate personality
disorders or bipolars. Although psychosis is often thought to be the very
worst kind of mental health problem a person can experience, it is somewhat
contradictory that psychosis generally indicates some level of the one trait
that truly differentiates relatively healthy personalities from relatively
unhealthy personalities. A person with psychosis almost always feels some
level of responsibility for his fellow man.
The treatment of psychosis has most recently become much simpler
than it had ever been before. Medicines for psychosis are almost always
effective in helping bipolars and schizophrenics to avert psychotic
symptoms. Although at one point in time, psychotherapists believed it was
possible to treat psychosis with interpersonal therapy alone, powerful
medicines are almost always a part of successful treatment today. A mixture
of antipsychotics, mood stabilizers, and antidepressants are typically
prescribed. These medicines both calm ones intensity and relieve some level
of rigidity. Psychotherapy does continue to be useful on a variety of fronts.
Individuals with psychotic symptoms can learn to calm their own emotions
and become less judgmental of themselves. Since they often have
experienced trauma, discussion of traumatic events is often necessary. In
addition, individuals with psychotic symptoms have often been traumatized
by their own experience of becoming psychotic, both because they have
completely lost control, and due to the interpersonal alienation experienced
during a psychotic break.
Psychosis is the clinical term for losing touch with reality and really
doesn't mean that the afflicted person is wild, flipped out, or wacky in the
way most people seem to think. There are a variety of ways that psychosis
takes form, including complete and utter confusion, the experience of
hallucinations, and the belief in intricate delusions related to ones
importance. Psychotic symptoms are caused by a combination of extremely
intense emotions and a brittle rigidity of thinking about ones intense
emotions. Bipolars who experience psychotic symptoms do so because their
emotions are immoderately intense. In contrast, schizophrenics generally
experience their rigidity as their primary difficulty. In both types, it is the
perception that the expression of intense emotions could lead to interpersonal
destruction that leads to the twisting of these feelings into psychotic
symptoms. From an interpersonal perspective it is far better to withdraw
into confusion, create elaborate plots or schemes regarding ones importance,
or to hallucinate in symbolic ways, than to psychologically eviscerate others
or oneself. Strangely, the experience of psychotic symptoms indicates some
level of humanity within the person with such symptoms, as opposed to how
the most antisocial of the personality disorders seem to directly express
intense emotions regardless of how damaging to others that might be.
Although individuals who develop psychotic symptoms suffer horribly, and
may even be a burden at times, the purpose of their symptoms is to protect
themselves and others from the licentious and savage violence their emotions
are enacting within them. Thankfully, a mixture of medicine and
psychotherapy can help those plagued by psychotic symptoms to regain a
sense of normalcy.
With the right help, in fact, those with psychotic symptomology often
return to lives of extraordinary and singular vision, of exquisite interests, and
of intricacy of thought. With the right help, those afflicted with perhaps the
most alienating of all illnesses, psychosis, make use of their most important
attribute in regaining their lives. With treatment the relatedness and
humanity within the psychotic, the same tendency that led to the urgent and
severe sense of responsibility and need to protect others from the seemingly
terrible eventuality of exposing others to the psychotics unbridled animalistic
nature, begins to grow in a natural and organic fashion within themselves and
helps to nurture lively, loving, and fulfilling interpersonal relationships.