Psychosis and Schizophrenia: Whose Reality is This, Anyway?
|Copyright (c) 2008 by Kevin Thompson.
We all receive information about the world through our senses, in a
manner that seems unremarkable. Our common sensory experiences enable
us to build models of reality that are similar, and this shared
understanding helps us to live and work together in a reasonably smooth
These models are not completely consistent with each other, of course,
or we would not have different beliefs. We also wouldn't make the
common mistake that just because we believe something, everyone else
should believe it, too! However, these differences are the result of
different priorities and thought processes, not disagreement about the
reality we perceive through our senses.
Yet not everyone shares this consensus. Some people perceive a reality
that is both quite different from the norm, and has elements that are
clearly wrong. They suffer from a set of symptoms called "psychosis."
The most dramatic symptoms of psychosis are hallucinations (false
perceptions), and delusions (false beliefs).
- Hallucinations are sensory perceptions that do not
physical reality. Because these are perceived as coming from the
senses, it can be difficult for the person to tell that they are not
real. Hallucinations can take the form of false images, sounds (often
voices), physical touch, or even smell and taste.
- Delusions are powerful beliefs that are clearly wrong and
impervious to evidence. Delusions are often paranoid in nature, with
individuals believing, for example, that secret government agencies are
spying on them, or trying to control their minds.
Hallucinations and delusions are the primary symptoms of psychosis.
They are often accompanied by an inability to recognize that anything
is wrong. This lack of insight, which is called anosognosia
treatment very difficult.
People who are in the grips of a severe psychotic episode seem "crazy"
to onlookers, but their behavior makes perfect sense from the right
perspective: The psychotic person is responding rationally to
experiences that the rest of us do not share.
Psychotic episodes can arise from many different reasons. Many illegal
drugs and prescription medications (such as cocaine and amphetamines),
taken at a large enough dose, can cause psychotic symptoms. Psychotic
episodes can also occur during severe manic episodes, for people who
have bipolar disorder. However, the illness most associated with
psychosis is schizophrenia.
Schizophrenia is a very serious illness. While it includes psychosis as
the most obvious set of symptoms, this illness often causes severe
suppression of the normal range of emotions as well. The blunted
emotions can rob the ill person of all joy in life, and produce a
strange, almost emotionless style of behavior ("flattened affect") that
is very disturbing to others.
Treatment for schizophrenia is less advanced, and less satisfactory,
than for depression and bipolar disorder. The newest generation of
"atypical" antipsychotic medications does a better job in treating
schizophrenia than the older "typical" antipsychotics, but is far from
ideal. On the positive side, these medications frequently help with
both psychosis and blunted emotions. On the negative side, they seldom
do a perfect job of either, and the side effects can be severe. Side
effects include diabetes, permanent movement disorders (such as Tardive
Dyskinesia), Parkinsonism, serious weight gain, depression, and sexual
Treatment for psychosis arising from bipolar disorder tends to be more
successful, partly because the psychosis is more episodic than for
schizophrenia, and partly because there are fewer to treat. Atypical
antipsychotics are used in this case as well, so while the treatment
may work, the side effects remain as significant problems.
The bad news is that much remains to be done in understanding and
treating psychosis, in all the cases where it arises. The good news is
that the last few decades have seen much progress, and more will come.
Ph.D. is the author of Medicines for Mental Health: The
Ultimate Guide to Psychiatric Medication
You can find information about treatments for depression, bipolar
disorder, schizophrenia, and sexual problems on his Web site at