On BBC1’s One Show Alex Jones recently aired a 2009 quote from Danny Boyle. To be a film-maker, according to Boyle, “you have to be psychotic in your desire to do something.” Around the same time, Caitlin Moran tweeted about Coronation Street Actor Bill Roache’s “celebrity with hunt” comments, asking, “When can we start openly saying ‘His massive psychotic breakdown’?”
I saw members of Twitter’s mental health community immediately take exception to these misuses of what is, after all, a very specific clinical term. It got me thinking about the word, and how and why our culture uses it. On paper, everything’s fine. The Oxford English Dictionary holds no other definition of the term than, “relating to, denoting, or suffering from a psychosis”. The first few pages of a Google search for “psychotic” are entirely filled with mental health resources. Even the Urban Dictionary gets it more or less right (including a welcome reminder that there is no correlation between psychosis and violence).
Despite this, inaccurate use of the word still crops up in the media fairly regularly, with people being described as being in “a psychotic frenzy”, or referred to as “psychotic” when they are actually just extremely angry. Search Twitter for “psychotic” and you will frequently find it deployed where people actually mean enraged, strange, unpleasant to others, or off the scale in terms of intensity (it often seems to be used to refer to obsessive fans of boy bands or teen idols, but I guess this is also what Boyle was driving at when suggesting the necessary qualities of a filmmaker).
I distinctly remember when I first came across the word. It was 1993 and I was sitting on the top floor of my university library, going through a pile of abnormal psychology books. Something had been wrong with me since adolescence. I didn’t know what, and nobody in the medical profession seemed in any hurry to tell me, but combing through the textbooks I began to wonder if I might have manic depression (as it was then referred to). Yet I wasn’t sure. Some of the symptoms listed – the mood swings and the periods of sleeplessness – sounded very familiar, but others were outside my experience. I didn’t have delusions or hallucinations, but the book stated that there were only two categories of mental disorder, and that bipolar sat in the psychotic, not the neurotic, camp. The message I took from this was that psychosis was something that could potentially happen to me. I wasn’t fundamentally different from those manic depressives who did experience psychosis. I had just been dealt a different hand of symptomatic cards.
The first time I ever heard someone speak the word aloud came about a year later, not long after I had been formally diagnosed as bipolar. I was studying a module called The Modern American Novel, and I had to attend a lecture on Brett Eaton Ellis’s American Psycho. The lecturer had a lot to say on the subject of protagonist Patrick Bateman’s mental pathology, not much of it accurate. He spoke repeatedly about “the psychotic person”, their propensity for violence, and their inability to empathise. It was clear to me that the lecturer was confusing the terms “psychotic” and “psychopathic”. Every time he used the word, and used it incorrectly, I sank lower and lower down in my seat. I could have challenged him, but who would want to out themselves as having a diagnosis that might result in psychosis, when the whole class had just been told psychosis drives people to torture and murder?
In theory, the classic psychotic presentation involves someone completely losing touch with accepted reality. No matter how much evidence to the contrary others provide, their beliefs remain fixed and unshakable – hence the term “psychotic” often goes along with the term “break”, implying a fissure between the person and the reality everyone else subscribes to. Actually, of course, it’s much more complex and subtle than that and, as with many psychiatric symptoms, there’s probably something of a continuum or spectrum. After all, a study in the British Medical Journal found that 12.5% of the general population (so that’s people without any mental health diagnosis at all) reported experiencing at least one psychotic symptom such as a paranoid delusion or a hallucination. So once you ask the right questions, you find that psychosis is neither rare, nor restricted to the seriously mentally unwell.
In any event, somebody must’ve shuffled the deck again, because these days I do have delusions as well as hallucinations. Not many, not often, but the ones I have are weird and very scary, not just because of the content, but because they make me doubt my own ability to know what’s real and what isn’t. I don’t think I could possibly explain, even if I wrote for an hour, just how frightening it is to have the boundaries between “real” and “not real” become permeable, how you can never quite trust yourself again once that has happened to you.
For me, as I think for many people, there is a moment when I know on a gut level that something dreadful is happening, and that it’s down to certain forces that wish me harm. Some people know that they are being persecuted by agencies such as the security services, or by specific individuals with something against them. For me, the source of the threat might best be described as dark forces. Sometimes I feel that I am under scrutiny by an evil, omniscient being who uses technology to get at me (especially my computer – my smartphone is fine, even when using the same wireless connection, because that’s the thing, there is no logic here). I feel that I can be seen through my screen, but it’s like one-way glass. I never get to see who’s watching me, even if I wanted to, and I really don’t think I do.
At other times the dark forces are less clear, stranger. Last summer certain fabrics felt dangerous because their colour or pattern was aligned with the dark forces; one skirt in particular was out to get me and I was desperate to get it out of my house, but I couldn’t touch it. Yes, I know that’s ridiculous, but it’s a classic example of how even if I only believe the delusion 50%, if the other 50% of me tries to analyse it and intellectualise it, I still can’t talk myself out of the belief. The delusions work on an older, more primal bit of my brain and I have all the ancient, physical responses that animals display in a threatening situation. My palms sweat, I feel cold. I shake. I can’t breathe properly. I want to run, but I don’t believe for a minute that I can outrun the dark forces.
My psychiatrist seems uncomfortable with defining my experiences as psychotic. Maybe for him, my disconnection with reality isn’t enough compared with his other patients. In the letters he sends to my GP, he describes them as “psychotic-type phenomena” which sounds to me like a way of describing a thing without actually referring to the… thing. And I note with interest that I while writing this post, I have been tempted to put terms like dark forces or get at me in quotation marks, maybe to prove to myself and anyone reading that I know what nonsense it all is. But I took those quotation marks away, because actually they were a kind of self betrayal, a denial of just how real it all felt to me at the time.
So there it is, psychotic, or at least as close as I get to it, anyway. No freaky obsessions; no violent anger; no callous murder and dismemberment. Just a 38-year-old woman under the duvet, hiding from her own skirt.