What Not to Do When Someone You Love Is Psychotic

There have been a couple of disturbing news reports lately about terrible crimes committed by people in psychotic states, including the actor Michael Brea’s savage murder of his mother and a Seattle killing that took place in front of school children.

Although it’s been proven that people with mental illness are more likely to be victims of violence than perpetrators of it, these reports underscore the fact that untreated psychosis can lead to tragedy.

It’s imperative, then, that you do everything you can to get your loved one the help he or she needs.

When John became psychotic due to a manic episode that escalated into psychosis, I learned a few hard lessons about what not to do when you’re trying to help a loved one beat this frightening illness.

*****

First and foremost, if someone you love has entered a psychotic state, don’t assume that it will subside by itself. Do everything you can to get him to a doctor or a hospital.

Prior to John’s hospitalization, I knew he was acting weird. He was saying strange things, sleeping very little, and going for abnormally long periods (up to 24 hours, for example) in between meals. Because he was in the midst of a stressful project at work, however, I chalked his behavior up to stress and assumed that as soon as he got some sleep, he’d be fine.

Even after his first hospitalization, I let some of his odd behavior slide. He was seeing a psychiatrist, and I assumed that she had everything under control.

Both times, the situation escalated into a crisis before John got help. In the first instance, his employer called the police because he was “incoherent about his family,” and they were concerned for both his and my safety.

In the second instance, his psychiatrist prematurely tried to taper him off the antipsychotic Risperdal, which led to a night during which he thrashed in our bed so violently that I was afraid he would inadvertently hurt me before he ordered me into the living room. He spent the next few hours chanting, storming around our apartment, breaking his laptop, and laying obstacles on the floor.

It’s hard to convince someone who’s psychotic that he needs help. Lack of insight into the illness is a symptom of the disease, which means that your loved one—as mine did—will probably insist that he’s fine.

But don’t give up trying! Psychosis does, sometimes, subside by itself, particularly if it’s associated with a manic episode, but as John’s psychiatric team told me, the longer someone stays in a psychotic state, the more danger there is that his false beliefs will persist, and the greater the danger of recurrence.

Second, don’t try to talk your loved one out of his delusions.

On a recent episode of 30 Rock, Jack Donaghy (as played by Alec Baldwin) said, “You can’t reason with irrational people.” A psychotic person is a picture perfect example of irrationality.

If you try to explain away your loved one’s delusions with logical explanations (“Those people in your therapy sessions on the psych ward weren’t actors designed to trick and confuse you, they were social workers.”), you will only make him suspicious of your motives.

I’ve never seen fear like the fear that shot through John when I tried to explain that he had not, in fact, been hypnotized by his colleagues. It was intense and animalistic, and it escalated his level of anxiety by a hundredfold. Instead of being convinced by my reasonable explanation of events, John sought to shield the rest of his delusional beliefs, trotting them out for me in great, and frightening, detail.

Confronting someone’s delusions is usually counterproductive. Instead of convincing your loved one to let go of his odd ideas, you will drive him to defend them, which only serves to entrench them more deeply in his mind.

At the same time, however, you don’t want to reinforce someone’s delusions by agreeing with them or listening to long explanations. Here are two approaches you can take:

  • My husband’s therapist suggested changing the subject whenever John said something delusional. If, for example, he told me that the sky was neon green, I’d simply nod and say, “How would like spaghetti for dinner?”
  • At my NAMI Family-to-Family class, the instructors suggested focusing on how your loved one is feeling rather than the content of what he’s saying. For example, if someone tells you the sky is neon green, you would say, “Wow, it must be really scary to see such a weird color in the sky. How does it make you feel?” That way, you’re not confirming what your loved one is saying; instead, you’re giving him a chance to express his fear and anxiety so that you can provide some reassurance.

Finally, don’t forget that your loved one is far more frightened than you are.

It’s terrifying to see someone you love caught up in the chaos of psychosis. It’s even worse when that chaos is swirling around inside your brain.

In a post on the Schizoaffective and Loving It blog about the onset of a psychotic episode, the author writes, “The other thing I wish people understood is how terrifying it is to be in a psychosis; it’s like a sinister nightmare, with distortions of reality lasting for days or even weeks until the antipsychotic medication has a chance to work.”

John described a blackness in his mind, and later said it felt as though his brain had been ripped apart.

No matter how frightened you are, it’s important to stay calm. The more upset and emotional you get, the more upset and emotional your loved one will get, which will only escalate his psychosis.

Call the police or the psychiatric response team if you fear for your own or loved one’s safety, but try not to yell, cry, scream, slam doors, etc. As you can tell from my earlier post on the importance of staying calm during a psychiatric crisis, this won’t accomplish anything good.

23 Responses to What Not to Do When Someone You Love Is Psychotic

  1. mydualities says:

    Wow, I loved this blog. I know what it is like to be psychotic and it really is very scary. I write about my opinion on the subject in my own blog. I wrote a blog called “Greg House Versus the System” that talked a lot about the same things you covered last year. http://mydualities.wordpress.com

    Anyway, I have a question. How do you like NAMI’s “Family to Family”? I always want to do something with NAMI, but since I’m the one with bipolar disorder, I don’t see a lot of programs available for me. What do you suggest?

    Duals

    • Hi Duals — thanks for your comment, and for the link to your blog! I love House, and I thought the episode where he’s in the mental hospital was really, really interesting. (I knew his approach to that kid’s flying delusion was leading somewhere bad. I was glad the kid didn’t die.)

      I also loved the Family-to-Family class. I have great friends who were very understanding about the whole situation and totally willing to lend an ear, but being with other people who’ve been down the exact same road and understand, on a gut level, what you’ve been through is so helpful. I learned a lot, and I was able to work through a lot of the leftover trauma I was still hanging onto.

      I’ve heard that the Peer-to-Peer class, which is designed for the people with the diagnosis, is really great as well. Here’s the link to it if you want to check it out: http://www.nami.org/template.cfm?section=peer-to-peer

  2. mydualities says:

    Thank you for this information about NAMI. I have two different chapters I can go to because I live near both, but only one of them mentions offering Peer to Peer, so I’ll try there first.
    Thank you!!!
    Duals

  3. Heather, this is a fantastic post with valuable suggestions! It’s so important for family members to get educated about psychosis so they know how to respond. I can’t imagine how tough it is for the person and his or her family to go through a psychotic episode, but again, your suggestions are spot-on in helping to minimize anxiety – and increase safety – all around.

  4. Melinda says:

    This really helped me in knowing what to say later, if my son relapses. He is getting treatment now, but it is one day, and sometimes one minute, at a time.

  5. Confusing says:

    Is obsessive love disorder something to take action…
    I have come across one of my married friend’s girlfriend, after falling in love with the family man is unable to let it go and thinks he is the only one who is the whole world to her and can make her stay alive and happy. She becomes very ill and shows signs of withdrawal and dying when he talks about there is no future for them together becoz he has a wife and family he would not leave. It is to a point she us agree to be treated in degreeding manner and yet does not want to let him go… Is this a midage married woman crazy in love or is this a mental disorder???j

    • I am sorry to hear about this. Sounds like a bad situation all around. Your friend’s girlfriend may be having trouble with codependency. I would encourage her to talk to a professional.

    • Heidi says:

      I think this is called menopause because I’m 52 and going through the same heartache. I am married but don’t want to be, have kids who are pretty much grown up, and fell madly, obsessively in love with someone from England who I can never have, not because he’s married, but because he’s homeless and suffers from psychosis of all things! What a combination, huh? I just can’t get over him, either, and his psychosis makes me feel like I just want to take care of him because no one else seems to care. I’m not sure where my life is headed but if this person is prescribed anti-anxiety drugs, tell her to beware – they can make you feel worse. That’s what I’ve been given to help get over this guy and I hate them. Sometimes I think menopause is put there for a purpose – to make us really evaluate our lives and if we need to change – even if we feel like we’re going to go stark-raving cuckoo. I still am crazy about this guy, but I’m trying to figure out where my life should change. Good luck to that love-obsessed woman. Just try to listen to her and give her support. Time will take care of the rest, hopefully.

  6. Morris says:

    You are wise. Nothing you said in this article you said is wrong, it’s not really debatable either, kudos.

  7. vkennedyart says:

    Yes, great article! My husbands delusions have been suttle sometimes and almost unrecognizable. There have been a few times when I think he may have heard voices, but I didn’t want to scare him by asking him about it or scare myself by his reply. His seem to be set off by a scense of being cornered. I didn’t recognize this major one either until much later; He was drinving me to work one morning. He stopped at a stop sign looked and proceeded to cross when we were hit on his driver side door. Suddenly he freaked out, yelling I got to get out of here. Erratically driving away. We had insurance on the truck, his license was good and the women who hit us was obviouly speeding. I kept saying to him, why are you running There is no reason to do this! He seemed out of his head. He had also hit his head on the windshield or somewhere. Finally after being confused not knowing where he was and how to get out of the area and heaeing me telling him to calm down and go back he tried making his way back. Unfortunalty he was pulled over before we could get there and was pulled out onto the ground and handcuffed and taken to jail for a hit and run. It was all unnessary and caused alot of heart ache for us. That may have been the first major delussion. Since that there have been several others causeing the same outcome. Thank you for the the great advice. I will react more carefully if it happens again. I did not realize they were dellusions until more recently as I have educated myself on the web. I didn’t know how ill he has been getting until things just worsened.

  8. Mary says:

    Thank you very much for this information! I work for a New Zealand service called “Supporting Families in Mental Illness” and have previously worked for NEAMI in Australia! Would love to go on the family to family course!!! Would love my families to be able to access it here!

  9. rain says:

    I thank you so much for this advicemy husband has been going through a psychotic episode for over a month now and I can say its one of the hardest things I’ve ever had to deal with we have 3 beautiful children together and they are suffering also its scary and it is killing me watching him suffer I have no one to talk to that understands so again I thank you please pray for me and my family we need it

  10. Concern about our marriage says:

    My husband of only one year has been dealing with this for 15 years. Everything you said of what not to do was exactly what I did. Even when I tried not to get to emotional. It would back fire. Several occasions he felt like he was be monitored by the TV, neighbors, secret agents, CIA, and he kept sayin that I was involved. Also that I had a secret circle and how can I be so unfaithful. It got to the point that he was stocking me at work, gesturing that he is going to cut my throat, and slapping and pulling my hair throwing me to the ground. I couldn’t handle this so I left. I’m no longer with him, but my question did I give up on my husband and didn’t give a chance to get better or help?

  11. bassboard says:

    Hello, nice article. My wife suffers from something like bipolar, schizophrenia, schizoaffective, extreme anxiety, and psychosis. She has no clear diagnosis; she has symptoms of all of the above. She doesn’t do well with any kind of stress. Most of the time she does reasonably well on meds, but when stress pops up, watch out.

    Anyway, wanting to tell tell her that her delusions and audio and visual hallucinations aren’t real is a very difficult thing for me. This is especially true when she first starting an episode and I don’t even know that she is experiencing psychosis yet. She will just subtlety accuse me of something non-serious (like breaking a dish) I didn’t do and then get angry when I deny it. It is very difficult sometimes to distinguish between her normal self and the start of a dangerous episode.

    As the episode progresses, she’ll accuse me more serious things like having affairs (I never have), being gay (I am not, not that there is anything wrong with that), beating her up (I have never laid a hand on her and I am by nature and practice a pacifist), or other similar things. You can’t really ask someone what they want for dinner after being accused of something like that.

    I did the family to family class. It was excellent. The thing that stands out most for me was one exercise where we were asked to complete a series of moderately difficult math problems while a bunch of people were yelling things behind me, among them some very loud, accusing, horrible name calling. That was an eye opener for me. I met some good people in that class and some I still keep in touch with. I highly recommend it.

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