Daniel A. Bochner, Ph.D.

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 one's. 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...

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