Everyone is Psychotic Sometimes

We need to talk about psychosis. Psychosis is a completely normal glitch nearly everyone experiences from time to time. It’s not as terrifying as you think, but it is critical to understanding suicide.

Psychosis is simply defined as a loss of contact with reality. It doesn’t have to be a complete dissociation; a person just needs to have difficulty in some way distinguishing between what is real or not. Usually this is defined by if they see or hear things that other people do not or if they are experiencing outlandish beliefs or paranoia (delusions).

A few years ago, during an especially severe manic episode, a psychiatrist asked me, “Have you been having any hallucinations?”

My response was sincere: “How would I know?” She acted like no one had ever asked that before. 

Yesterday I wrote about rumination, which is only one of the many ways your brain thinks in stupid, non-efficient ways. With rumination, you can convince yourself your hallucinations or delusions are real. There are a lot of people on disability for psychotic reasons, and they don't just sit alone in the dark. Many are online trying to reinforce their beliefs about contrails and the Warren Report.

I don’t want to play to stereotype. Yes, I do believe that a lot of the conspiracy and cult cultures arise out of some level of psychosis, but I think all of us have that in our lives to some extent. A person who sees a ghost or an angel is experiencing psychosis. Sorry if that’s harsh, but those things aren’t real. Part of me still suspects they are, but that’s the psychotic part that also suspects I control the weather with my emotions, so no.

It’s easy to explain why old mental hospitals are always haunted. Everyone is afraid of and guilty about mental illness and asylums. We are haunted, not the place. Asylums were built in remote areas from cheap materials, so they look extra spooky when abandoned. Geometric buildings decay into organic shapes. That's just basic Lovecraft set dressing. Normal sounds echo through the halls, becoming distorted and freaking everyone out. 

It’s easy to understand how your hyperactive brain grafts these things together to create an image or sound, like a waking dream. Psychosis is not limited to humans, it's just a feature of consciousness. It’s not a big deal, or at least it shouldn’t be. 

The magic trick is when we ruminate on the psychotic incident, finding reasons why it must be real. That ghost vaguely matched the description of one of the 25 people who have lived in this house! God speaks to me, and only me, because only I’m willing to hear him. My grandfather must have come to me in that dream; how else would I have known he’d be wearing flannel on Christmas? If Obama was really an American citizen, he wouldn’t have felt the need to produce a birth certificate. Human beings are completely ridiculous.

It’s less fun when it becomes depressive. Some common depressive delusions are:

• Nothing will ever get better
• Nothing ever was better
• I am completely broke (when that’s not actually the case)
• My health is rapidly deteriorating (when there’s no reason to believe that)
• Everyone hates me
• People want to hurt me
• I hurt everyone
• I am not human
• I do not exist. I’m already dead and I don’t realize I’m a ghost

Excessive rumination on depressive delusions is like taking the express bus to Suicide City.

Many depressed, manic, and/or suicidal people isolate. That means there’s no one to check any hallucinations or delusions. If the reference for psychosis is outside, how can a person ever think their way out alone?

Most can't.

So, what do you do when you notice your friend or loved one exhibiting psychotic behavior? 

Common knowledge seems to be that you don’t challenge it, but that’s really only applicable in the most severe cases, where the delusion isn’t the main problem. If this person needs to be under professional care, don’t worry too much about the delusions until other stuff (addiction, mania, etc.) is under control.

Most depressive delusions don’t get to that point, though. If you wouldn’t commit that person, challenge their delusions. Don’t be an asshole, try to understand the germ of truth in their position (I promise there is one), but present evidence to the contrary. When little kids think there is a monster in the closet we open the door to show them nothing is there. When someone tells us they saw a lion in Texas we tell them why there’s no way they saw that. The main reason we don’t challenge the delusions of the mentally ill is because we’re afraid to.

Again, don’t be rude about it. If the person doesn’t remember any good times, print them some pictures or at least tell them how you remember things differently. If the delusion is something that could be disproven (i.e. broke, sick) help them make a budget or meet with a doctor. Touch and hug people even though they may not be as affectionate as they were before the depression. The loss of physical contact can trigger that “I’m a ghost” delusion in me.

If you notice these tendencies in yourself, I recommend writing down a list of depressive delusions that you know you obsess about. They may be different from the ones above. When I get really depressed, I leave that list out in plain sight. It helps me check myself, even when I can’t bear to be around other people. Maybe a certain delusion is a special red flag to seek counseling or a medication adjustment (or just get out of the house).

It won’t be easy. Perception is often completely warped by depression. Remember, just because you don’t feel like you made a difference doesn’t mean that you didn’t. Noticing the thoughts is enough of a first step. Changing them can come later. Few wars are won with one battle.