Until it really mattered to me, I never realized how often people joke about “seeing things” or “hearing things”.
Just think actually about it for a second. What would it be like to see or hear or otherwise perceive something that isn’t there? To think that something is real because you can see or hear it, then to find out that it isn’t? Well, I’m here to tell you it’s terrifying.
When someone says the word “psychotic”, what do you think of? Probably “crazy” or “insane”, right? These are all words people throw around frequently without much thought. Well, it turns out that psychosis is defined in the DSM-5 as a disconnection from reality, often involving hallucinations or delusions.1
Hallucinations occur when someone sees, hears, or otherwise senses something or someone as real when it/they are not actually present. A delusion is when someone holds a firm, often absurd belief that isn’t based on real information (like “My every move is being recorded by a secret organization”, as an example).2
A lot of people tend to write off behavior like hallucinations or delusions as “he’s just crazy”, “she’s a drunk”, or even laugh at it. But it’s not that clear-cut, and here’s why.
Let me tell you a bit of my story – and the real story about psychotic symptoms.
I was always the over-achiever, the good girl, the nice one. I excelled academically, did extracurricular activities, got scholarships, had friends, held jobs. I’ll bet you a pretty penny no one expected what came soon after I started college. My mental and emotional state deteriorated, and later my physical state as well. The next few years would be a whirlwind of depression and anxiety, doctors and fear, therapy and medications. I’ll go into that more in a later post, but I do want to tell you about psychotic depression.
After having major depressive disorder for three years or so, with severity that disrupted my everyday life and my ability to work or go to school, I started to have psychotic symptoms. I didn’t recognize them as such at first, but having studied psychology in my undergraduate college years I soon realized what might be happening.
For me, the psychotic features of my depression came in the form of auditory hallucinations – one of the most common types of hallucination3 – and I’ve also experienced some derealization/depersonalization episodes (feeling detached from reality and feeling as through you and/or your surroundings aren’t real). These experiences are scary, disorienting, and confusing. I found that especially after having these experiences, I found it more difficult to trust myself and my perceptions. I’ll hear someone saying my name, but when I ask those present who said it I’m met with blank stares. When I think I hear someone calling me or speaking to me, I’ve started waiting until they say it again to respond so I can confirm that it’s not in my head. I don’t want to sound crazy by answering to a voice or sound that only I can hear.
At first, I was very hesitant to speak to others about my psychotic and derealization episodes, even to my therapist and doctors. Maybe they wouldn’t believe me, maybe they’d lock me up, maybe they’d write me off as just plain nuts. But after realizing that this was an important part of my mental health journey, I started talking to my treatment team about it and was put on lurasidone, an antipsychotic medication. Since then, the auditory hallucination symptoms have improved.
It’s important for people to know that schizophrenia is not the only psychiatric disorder in which psychotic symptoms can be present, although this is probably the one most people think of. There are actually several different disorders that can include these symptoms, such as schizoaffective disorder, delusional disorder, bipolar psychosis, psychotic depression, and postpartum psychosis. If someone is experiencing hallucinations or delusions, they may also be caused by a brain tumor, dementia, a stroke, or neurological disease, or may be a result of substance use.4
The stigma surrounding psychotic symptoms and associated mental illnesses may be one of the worst. The image portrayed in media, film, literature, and other forms of entertainment or drama is that of an insane person doing and saying things that make no sense, often isolated from society and generally worthless. While this portrayal may be based off a kernel of truth, that’s simply not how it is, and it has created a stigma that makes it very difficult for people suffering from psychosis to reach out, get help, and recover.
In fact, it’s estimated that around 50% of people living with schizophrenia are not receiving proper care. Many live in low-income areas and don’t have access to mental health services, but polls report that many also are unlikely to seek care due in large part to the stigma. Some also don’t realize these symptoms and illnesses are treatable. The negative stigma along with the untreated symptoms also contribute to the very high unemployment and homelessness rates. The World Health Organization also reports that people suffering from schizophrenia are 2-3 times more likely to die early than the general population5, and an estimated 10-13% of these deaths are suicides. This mortality rate is also caused in part by the higher rate of physiological diseases due to my previous points such as homelessness.6
It pains me to know that some of the populations that are most in need of help for their mental illness are the ones that have the hardest time getting it. Reducing the stigma associated with psychosis is imperative to our goal of reducing mental health stigma, and it starts here and now.
1 Diagnostic and Statistical Manual of Mental Disorders, 5th edition
2 National Alliance on Mental Illness: Early psychosis and psychosis https://www.nami.org/earlypsychosis
3 National Health Service UK: Hallucinations and hearing voices https://www.nhs.uk/conditions/hallucinations/
4 Medical News Today: What is psychosis? https://www.medicalnewstoday.com/articles/248159.php
5 World Health Organization: Schizophrenia https://www.who.int/news-room/fact-sheets/detail/schizophrenia
6 Treatment Advocacy Center: Schizophrenia – fact sheet https://www.treatmentadvocacycenter.org/evidence-and-research/learn-more-about/25-schizophrenia-fact-sheet