Psychosis is one of the most elusive of mental health issues, and is often met with the perception that there is little hope for recovery. The past decade or so of psychosis research has brought to light that psychotic disorders tend to develop through a variety of stages rather than having a sudden, insidious onset.
The staged approach to psychosis offers a more hopeful outlook on these disorders; rather than a degenerative illness, psychosis can be seen as one that occurs gradually over time, thus offering many opportunities for intervention. Understanding the nuances and progression of psychotic illness can help lessen the anxiety and fear that often comes from experiencing symptoms or receiving a diagnosis of a psychotic disorder.
Like other mental health issues, psychosis is considered to occur from biological and environmental causes. There are many risk factors for psychosis, ranging from childhood trauma to birth complications to having a first-degree relative with a psychotic disorder. This goes to show that no one is responsible for their psychosis – it can happen to anyone.
The course of psychosis is thought to begin with low-level symptoms in young adulthood. These symptoms are typically of the same nature as psychosis (e.g. suspiciousness, unusual thoughts, perceptual distortions), but occur less frequently and severely than full-blown psychosis symptoms.
One of the most unique things about this phase (called the at-risk mental state or clinical high risk) is that Individuals experiencing it have good insight. Recognizing one’s symptoms, though distressing, is very helpful in therapy. In fact, studies show that having mental health treatment at this stage can reduce the likelihood of developing a psychotic disorder in half.
Only about one-third of individuals experiencing this at-risk mental state go on to have a psychotic episode. This episode is characterized by severe positive symptoms (symptoms in addition to healthy psychopathology; e.g. unusual experiences such as delusions or hallucinations) and little insight – essentially a break from reality.
Equally, if not more, distressing are negative symptoms (symptoms that detract from healthy psychopathology; e.g. loss of pleasure or emotion) and difficulties in thinking and speaking. Hallucinations are often experienced during psychotic episodes, but are also common in the general population after experiencing things like sleep deprivation or recent death of a loved one.
A key difference between nonpathological and pathological hallucinations is distress. The biopsychology behind hearing voices is still a mystery, but it is clear that voices become a problem when they are insulting, aggressive, cause someone to change their behaviour, or affect one’s self-esteem.
If someone has persistent psychosis, or attenuated (i.e. less severe) psychotic symptoms for more than two years, a mental health provider may give them a psychiatric diagnosis. There are many psychotic illness listed in the DSM-V (the psychiatric diagnostic manual), such as schizophreniform disorder, schizotypal personality disorder, bipolar disorder with psychosis, etc.
Additionally, psychosis can be a comorbid experience to other mental illnesses, such as depression and anxiety. Intuitively it may seem that the best way for an individual with psychosis to heal is by getting rid of the voices they hear. But many psychologists believe the goal of therapy should be to lessen distress, not get rid of symptoms.
An individual’ problem is not their hallucinations, but that their hallucinations often lead to feeling poorly and having trouble doing everyday activities. These “problem areas” can be addressed through skills training or cognitive therapy, seeing a psychotherapist, or meeting with a psychiatrist regarding medication.
Treatment for psychosis often addresses secondary issues as well, such as problems with family, work or school. Comprehensive treatment teams in programs like Assertive Community Treatment and Coordinated Specialty Care that incorporate many different types of providers or community members are ideal avenues for recovery.
Psychosis is by no means a simple disorder. It occurs in a variety of stages with varying severity. It is essential to know that a diagnosis of psychosis or schizophrenia is not a death sentence. Therapy and medication are extremely helpful in preventing the onset of or the worsening of psychotic disorders, especially if you get help early.
As someone who has studied mental health, one of the most upsetting things is knowing that some people who have had unusual experiences do not seek treatment because they feel their distress is invalidated or they are scared of being stereotyped as “crazy.” My intention is to encourage you that there are many resources and opportunities to treat psychosis, and that recovery is definitely possible.