Psychotic: what’s in a name?

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.




About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards
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8 Responses to Psychotic: what’s in a name?

  1. Red says:

    Well said! I also get very frustrated by people misusing psychiatric/mental health language, often in a very inappropriate and offensive manner. I think it’s both due to and perpetuating massive misconceptions about mental health, such as that psychosis involves violence, schizophrenia is multiple personalities and OCD refers only to repetitive cleaning. I might write something about this at some point too
    I think mental health terms are also used by lazy journalists as an attempt to sound edgy, describing a piece of art as psychotic or similar. ARGH. .

  2. Names, labels, are things we put on things after we have measured or observed them, they are not the same as the things themselves. Perhaps you would find this interesting?

    Meditation, psychosis, psilocybin – all the same.

    In a ‘normal’ mind, it is impossible to be awake and focused and experiencing a dream at the same time. In psychosis, the switching mechanism fails and the two experiences mix. Yoga or meditation do the same, albeit more slowly and not as completely. As for psilocybin, I guess that would depend on the dose.

    Did you know, a deeply religious person or a yoga enthusiast is less likely than the average person to be diagnosed with psychosis when presenting with the same symptoms?

    • Of course I am aware that diagnosis of psychosis is culturally determined; I have been told that Gandhi accepted that the voice that spoke to him would probably lead to the involvement of psychiatrists had he been living in the west. I’m afraid that I disagree that psychosis is a sort of waking dream. That is simply not how it feels in any way. Most people I know *know*, like me, that they are hallucinating/delusion, and that is one of worst things about it. Completely different experience from waking from a nightmare and thinking, “Oh, phew it was just a dream!” I might carry the feelings from a dream around with me all day. But some of the fears generated by psychosis have stayed with me for MONTHS. Qualitatively a completely difference experience. I’m afraid it therefore doesn’t matter much to me if they appear to have similarities with other forms of “untrue experiences” – for me, the whole point of trying to work with people with psychosis is to accept their experience, the meaning they attach to it, and so forth. The meaning of the experience in the context of people’s lives is so much more valuable in their move towards recovery. I don’t want to be told I’m mistaken in singling out psychosis as different from other similar situations – I want to be listened to. I want to be top, “Wow, that sounds scary!” I want my experience validated, not explained away. How that makes sense.

      • Hi, yes I agree, I’m not quoting from a pubmed ivory tower here, I’ve experienced a psychosis-like experience myself, though I identified it as Kundalini release and my psychiatrist wrote it off as me playing with special energies, in the way deeply religious people are unlikely to be diagnosed with psychosis when presenting with the symptom of visions and the voice of god and the energy of a titan.

        In no way was my experience anything like a dream, but then one would not expect a dream to be recognisable as such when you are still wide awake and both the dream and the current reality are both visible at once, with open eyes, overlaid on each other.

        Yes we know we are hallucinating, it is not a frank hallucination of the kind caused by ingestion of Datura or scopolamine, or to a lesser extent, alcohol. It is more like the full immersion in distortion you get from psilocybin or DMT.

        When I had my ‘experience’, it came on very quickly and I couldn’t explain it other than assuming I had somehow blacked out and gone into my loft to look for my 20-year old stash of two black microdots (LSD – one will give a full trip, two…?)
        Anyway, I found my stash, so that wasn’t the explanation but as I could not trust my novel state of mind / reality, I flushed them down the toilet.
        My next thought was “Did I take two microdots then hallucinate flushing them down the toilet?” I realised about 24 hours if could not be LSD because the experience was not abating according to what I know about the half-life of the substance.

        This was back in the summer of 2010, and the fears, ideas, and lessons stayed with me strongly for months, and only really faded about 2 years after. The trajectory of the experience, in terms of intensity, is the same timescale that falling in and subsequently out of love follows: 2 weeks of absolute crazy, 6 weeks or seriously crazy, then getting less and less crazy over the next 18 months until you are free to decide if it’s a sensible way forward…

        I hope this means you accept my validation of your experience? I know psychosis, I know it’s real, and I know it is the proper reaction of a normal healthy person when faced with the things which you and I both know can cause it.

        When I was having ‘early psychosis’, the only people who were able to make me feel safe and slowly lead me back to solid ground, were those who went along with my ‘novel ideas’ from the start. My family and the medical profession seemed to make things worse, and I only found peace with the ‘druggies and wasters’ in South London squat-land.

        The experience made me want to fight for the rights of people with schizophrenia and all other affective conditions, in addition to my fight for the rights of Asperger’s like me and other autistic people 🙂

        In case you’re wondering, God was female, and if I learnt one thing from my psychosis, it’s that the idea of god being male is the most ridiculous thing ever.

        I hope I haven’t offended? Thank you 🙂

        Your humble servant,

  3. Pingback: It’s only words: psychosis, ‘evil’, & (self-)stigma « zedkat

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