Find a therapist to treat psychosis

Psychosis is the experience of finding reality confusing or unclear.

Psychosis exists on a spectrum.

We have all had some experiences that are akin to psychosis.

I have had both the responsibility and the privilege of giving many people and their loved ones the diagnosis of psychosis.

Technically, psychosis is not a stand-alone diagnosis; it's actually a syndrome, a collection of symptoms that does not make any assumptions about causation or prognosis. This is in contrast to a diagnosis like schizophrenia, which allegedly makes assumptions about causation and prognosis—but which really just means ongoing psychosis without any other known cause.

When I say that delivering the diagnosis is a privilege, it’s because I get to offer people—at a time when they often are half-afraid of what I am going to tell them—a description of psychosis without the burden of stigma or excessively negative prognosticating.

I define psychosis as the experience of finding reality confusing or unclear: confusing because people with psychosis have difficulty distinguishing what is real from what might be imaginary—both can feel equally real to them—and unclear because often, especially in the beginning, the person feels like they can tell what is real or not, but it gets cloudier over time. I like this definition because from these simple, non-threatening words, we can start to talk about hearing things (auditory hallucinations), seeing things (visual hallucinations), feeling things on or in the body (somatic hallucinations), and believing things that others do not (delusions).

But the main reason I like this definition is that it resonates with experiences we have all had. Walk into a room and feel uneasy that the conversation suddenly stopped? Hear your phone ringing when no one was calling? Feel startled by something you saw out of the corner of your eye, only to realize that nothing was there? We have all had moments of confusion or uncertainty about whether something we saw, heard, or thought was real. The difference is less a matter of kind than of degree.

This is a point that I make to patients, family members, medical students, residents, and really anyone who will listen: Psychosis is not an on/off switch. It is, like every mental condition, on a spectrum. And no one gets through life without moments of uncertainty about their own experiences or thoughts.

At its extremes, yes, psychosis feels otherworldly, and sometimes difficult to imagine. But in its earlier iterations, it might look mighty familiar to most of us.

I want to make this point to, well, everyone, because stigma towards psychotic disorders comes from an othering of those with these experiences—a (false) belief that their illness puts them outside the range of “normal” human experience. But this is a wish to take a frightening outcome and assign it to “someone else” and thereby banish it from the possible paths of one’s own life.

The truth—like the psychotic experience itself—is murkier. And if we can tolerate the murkiness, we can feel less afraid of and hostile toward those of us who are, for now, finding reality confusing or unclear.

Find a therapist to treat psychosis

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