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.