Let's have a talk about psychosis

As you can see I'm back and not dead, so it's time to get back in the saddle, so to speak. I've decided to talk today about psychosis. This is prompted by a post I read on another forum. Possibly more than any other disorders with gross misconceptions about them, I am very touchy about psychotic symptoms in the media. Whereas most mental illnesses are portrayed as exaggerated stereotypes of the real thing, psychosis is just the catch-all term for crazy (particularly violent crazy) and why not? Morphologically speaking, it sounds like it should be, right?

What it really is: Psychosis is a symptom of various other mental disorders that impairs a person's ability to accurately interact with the world and respond appropriately. The most common psychoses are hallucinations and delusions.

Who can get it: Lots of people. People who have depression, bipolar, and personality disorders, for instance, can have psychosis symptoms. On the other hand, Schizophrenia is a psychotic disorder, due to the symptoms being the main component of the disorder.

Delusions are when a person has an unshakable belief in something that could be possible, but is unlikely. A person suffering from delusions may, for instance, believe that a person is in love with them and take it as far as stalking the object of their delusion and/or attacking the person's actual love interest. It could also manifest as believing a person they see regularly is stalking them, so they make habits of taking needlessly complicated routes everywhere and never taking the same route twice. A delusion could even be a belief that you have supernatural abilities (more on this later).

Hallucinations are when a person experiences things no one else does. Possible types of hallucinations include visual, auditory and even smells. These can be frightening for the person experiencing them but most often are completely harmless. They become a problem when the sufferer loses the ability to distinguish what is and isn't real. Sounds like a lot of psychological thriller plotlines...

Brief Reactive Psychosis is a temporary affliction where a person has psychoses only in times of stress. These episodes may be as short as one day and as long as a month.

Treatment: Other than taking anti-psychotic drugs like Zyprexa, it seems that many treatments mirror those for depression. These can be found in the reference link for interested parties.

I used to regularly have auditory and visual hallucinations before I was diagnosed and put on meds. Nothing major, just a black cloud on the corner of my vision or short amounts of "white noise," as I called it. Not the same as the white noise on TV, I described it as many voices speaking all at once so you can't make out any single one. The auditory ones got steadily worse, then suddenly stopped. The last one was a flat sounding voice calling out to me. It scared me because it was the first time that a voice I heard was directed at me and not one I just happened to "overhear." My parents were there and saw me frantically checking doors and windows, even the neighbor's doors. I probably freaked them out, honestly.

These hallucinations stopped for over a year. Then this past spring when I reached the middle of the semester and I was panicking because I hadn't finished a spring semester in two years and didn't think I could do it, add in problems with my apartment neighbors, and I had two days of the worst visual hallucinations I'd ever had. I saw a man holding a large kitchen knife, a figure running across the room, and then an ant crawling on me (that I knew wasn't real because I couldn't feel it on my skin). It's enough to make a person paranoid. On that third day I still couldn't trust my eyes but there were no more after that.

My friends will tell you I am pragmatic and rational to a fault. Despite this, and because of my past psychotic episodes, I can't trust in the world that everyone else sees. I believed that those auditory hallucinations were other's thoughts, as the white noise only happened in crowded places, and that the voice that called to me was another consciousness reaching out to me. A part of me still believes that, after all, who's to say that it isn't true? Even my highly rational mind can't just rule it out. Am I delusional? Probably. But I'd love to see you try it without developing some kind of warped sense of reality!

Resource: http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html

Short break

Just wanted to let everybody know that For the next four weeks I will be unable to post. My summer language course is grueling-- 8-10 in the morning, 5 days a week, 4+hours of homework a night (and more on the weekends). I'll be back after if I survive!

Imagine sitting at home, watching tv, after a long day doing whatever it is that you do when you aren't at home. It's an alright show, not particularly thrilling but better than anything else that's on, it hold's your attention. You shrug your shoulders--maybe you didn't even realize you were going to do it--you shrug them again. This is a simple motor tic, one creates a chain reaction. Now that you know it's happening you can try to suppress it, but you know that suppressing the tic will cause a flood of them once you relax. This is Tourette's syndrome.

Tourette's syndrome is a neurological disorder that causes various verbal and motor tics. Tics can be divided into simple and complex depending on the difficulty. Simple tics might be a bark, blinking, shrugging. Complex tics include repeating a word someone says, hopping; one of my old tics was dancing. The best way to combat the tics seems to be keeping your mind busy. Whether it stops the tics from happening or distracts you so you don't notice them, I don't know.

Reactive ticcing--if you've ever seen two or more people with Tourette's in the same space, you'll know what this is. Essentially, one of them tics and causes the others to start ticcing. Thinking about ticcing alone can cause them, seeing or having one has an even stronger effect.

Coprolalia--Ah, coprolalia, the go-to Tourette's stereotype. When people think of Tourette's, they automatically think of swearing randomly. But how common is it really? Only about 10% of Tourette's patients exhibit compulsive swearing. Usually it stems from an impulse to say something forbidden, not any desire on their part.

Tourette's Plus--Tourette's is a disorder that rarely occurs on it's own. OCD is the most common comorbid disorder and studies have confirmed a correlation between the two. ADHD is also common, though studies to find a neurological correlation have been inconclusive.

I think I have Tourette's, what do I do now?
If you have severe tics that hinder your daily life, such as tics where you touch strangers, then a doctor can give you medicine to lessen the severity of your tics. For most people, medicine is unnecessary and unwanted.  The comorbid conditions tend to cause more distress than the Tourette's does.

Tics themselves can change, must be present for at least one year, with a tic free period of no longer than three months, for a diagnosis. The onset must be before the age of 18, to meet the current diagnostic criteria. Even though I was diagnosed at 22, I had had symptoms for years, going all the way back to age six or seven, they were just not severe enough to recognize. I hummed and twirled mostly. My family was bothered by the humming more than anything else but assumed they were just normal childhood behaviors. I didn't notice anything was strange until I was 20 and started meowing. Fortunately it's low-key and often reactionary, so most people I meet don't notice it for weeks. If I'm around people who like to make sounds, however, it can happen to the point where I become self conscious--even anxious.

Even though the tics can be annoying, I find that I have a certain pride about it. Unlike many disorders, there is no associated pain or a shortened life-span, and mild cases like mine can easily be accepted as a quirk. I've actually had friends say they wouldn't want me to get rid of the tics, because they associate them with me. And they can be an awesome screening system to identify and get rid of jerks in the friend-making process.

Dear Matt,

I know you will likely never read this but, as I no longer have your address or phone number, this is my only outlet. I need to get this off my chest and I do hope that someday you will read it. I'm sorry, truly sorry, that we had to part. Whether you believe me or not, it was the hardest thing I've ever done and sometimes it still plagues me. I don't doubt that it was the right thing to do; I just wish I knew how you were (and if you are still alive).

I did love you. Not the way that you wanted me to, but in the only way that matters to me. I loved you as a friend. To have you as a boyfriend might have actually lowered your importance to me. I didn't understand this then. I wrote you a letter when you were in the ICU. Two actually. I wanted my mom to deliver it to you in case you woke up but I never did. After a while I felt that too many days had passed and that it would be better for both of us to just let it go. A clean break, I suppose.

When I got a new phone last summer, I didn't transfer your number. I thought it unnecessary and just too painful. I started to get these calls from an 817 number, always during my 11:30 class and never with a message. Because these phone call happen every few months, it is impossible for me to see if they come from the same number but I finally got to answer one last week--and the caller never responded. If it is you, I would have liked to speak with you, to know you're okay.

I don't regret meeting you again. You were a good friend to me and made that second stay at Millwood tolerable! I was still in recovery and I was afraid that I couldn't continue getting better if I was always worried about you. A part of it was manipulative as well, I'll admit. I knew that I was important to you and I hoped that, by carrying through with our boundary, I could help you. I had offered to help you through any crisis as long as you would reach out to me, and it still did nothing. That day I learned that I cared even more for your life than my own. I had to hope that my leaving would help you see that.

I'm happy now and (somewhat) sane. And I think of you every time I hear Blue October's "Picking up Pieces." A song I loved now gives me a knot in my stomach, and all I can think of is you. I hope that you are still out there and that you are happy. I want you to know that I don't hate you and I didn't hate you then either, just very sad. Please don't give up. And for God's sake, please don't die.

Your friend,
Ashley

If you could go back, knowing what you do now?

Disregarding the obvious and ultimately pointless answers like not taking all those pills, this is an easy question for me. Preventing a single regrettable act is a moot point in this case, because people in tough spots are surprisingly hard to deter. If those things didn't happen then/in that way, I don't doubt they would have happened in some other manner. No, if I could change something, anything, I would have sought help much sooner.

It's been only about three years since I was diagnosed with Major Depression. That doesn't seem like long, but I have suffered the effects of it my entire life and I'd just been too scared to come forward. I remember looking up the symptoms and thinking it sounded like me, but dismissing it because surely Depression had to be worse than what I felt. By the time I did learn that I did in fact have it, I had to be hospitalized, withdrawn from school, and gotten myself neck-deep in a destructive friendship.

I am not one of those people that believes that all labels suck or all you need is to take vitamins/think positive and your depression will magically vanish. Maybe those things are true for you and maybe they aren't but I know that two years of therapy have rendered me very capable of dealing with a crisis constructively (and I've got an amazing self-esteem) but only when my meds are in working order. I have a true chemical-depression and understand that now. I am still learning everyday how to work with my disorders to improve my symptoms and quality of life. I've made great strides in three years, but I wish sometimes that I had been able to start sooner. How wonderful four years--five years--would be!

Pre-admission

Before you can be admitted into a mental hospital, they make you answer questions. A lot of hard questions. It can take hours. Then they take away your gadgets, spiral notebooks, pens, pencils, anything with string or a blade, they screen media, they check your body for scars or bruises and do a blood test. You don't know how long you will stay there and most hospitals only allow visitors at certain times.

It's a different world in the hospital. You learn a person's deepest darkest secrets before you learn their name, major, or favorite color. But their triumphs and tribulations are shared by every patient. You learn to cherish every second spent outside (or even out of the ward).

And how does that make you feel?

Like a number. In fact, I still remember my first patient number: 3361. In order to have a visitor or get a phone call, they must have that number.

People in the outside world don't understand what it is to be hospitalized. They think of long-term facilities with violent paranoid schizophrenics, severe RNs and electroshock therapy. It's more like a week spent in group therapy with drug addicts, alchoholics and severely depressed individuals and a lot of free time. I learned that I was insanely good at jigsaw puzzles and even began analyzing the other patient's puzzle-solving styles.

Hospitals serve to help you reach a point where you can function outside and continue to work towards recovery. There are bad hospitals and good hospitals (I've been in both) but there should not be the stigma against going into a hospital for treatment. My first hospitalization was back in 2009. I had just been diagnosed with MDD (Major Depressive Disorder) and the doctor feared I would self-harm so she had me admitted.

I had twenty years' experience at repressing my illnesses. The world didn't know, my parents didn't know, I didn't even know. I had suppressed for so long I'd convinced myself--but that is so damaging for a psyche, and when I fell apart I broke in a big way. I now know that I have three chronic disorders and a personality disorder. Learning to cope isn't easy and living in a world that doesn't understand doesn't help. I put my disorders out on the table because I believe that there can be no understanding if the afflicted don't speak up and show that we can be happy, functional members of society like everyone else.

Co-morbidity - Not just for Goths

What it means:
Having more than one disease or disorder

How common is it in psychiatry? Very. Some disorders, like Tourettes syndrome, rarely occur on their own while others just like to hang out together, like mood and panic disorders.

Co-morbidity causes a special problem for sufferers--incredulity. I can't tell you how often I've heard people say that they can't help but think people with 'lists' of mental disorders are lying or self diagnosed.

Once while talking to an acquaintance, he asked why I knew so much about OCD and I told him that I had it. I didn't know him well, so I didn't feel comfortable telling him about my other disorders. He seemed interested and understanding. Later on when I felt better about it, I shared the rest and suddenly he treated me like I was some gullible sap who mindlessly accepts any diagnosis a doctor says.

In reality it makes perfect sense when you break it down:
Tourettes frequently coexists with OCD
Depression often occurs with panic disorders (like OCD)
Axis II disorders (aka personality disorders) are common among patients with one or more Axis I disorders (Tourette's syndrome, OCD, and Major Depressive Disorder are all examples of Axis I disorders)

Criticism:
Not all psychologists agree with the current diagnostic system, in part because of the high co-morbidity rates. It was put together this way originally because just because two disorders usually occur together, doesn't mean they must. Attempting to draw hard lines between them all is messy but straightforward. Some psychologists propose a system in which severity corresponds with the complexity of the patient's manifesting symptoms.

References:
Maj, Mario. 'Psychiatric comorbidity': 
      an artefact of current diagnostic 
      systems? The British Journal of Psychiatry 
       2005 186: 182-184.