Monday, January 31, 2011

Understanding Psychosis

By  Sara Coffey, D.O.

Often patients and family members have a hard time understanding how a person can be psychotic.  Psychosis is defined as grossly impaired reality testing. Psychosis can be present in several mental illnesses including, schizophrenia, schizoaffective disorder, bipolar disorder and even depression.
The stigma or lack of information surrounding these disorders leaves them feeling guilty or ashamed. I often explain to them that the brain is an organ just like the heart, the kidneys or the liver. And just as our heart, kidneys or liver can become diseased, so can our brain.
The brain is a complicated organ with several different functions. It helps regulate our breathing, our heart rate, and our temperature and handles more complex tasks such as vision and hearing, pain sensations as well as processing complex thoughts or emotions. It is easy for us to understand that if the heart becomes damaged it might not pump as effectively, but it is often harder for us to understand what happens if the brain becomes compromised or unwell. A brain with mental illness may start to hear things that are not there, or experience thoughts that cannot be explained and seem irrational.  A person may become excessively anxious for no reason, or depressed without warning or cause.
In the world of mental illness we use terms to describe such experiences like hallucinations and delusions.  A patient with hallucinations might experience voices talking to them when no one is present. When we recall that one function of the brain is to process and interpret sound it is easy to see how auditory hallucinations might occur if that part of the brain is compromised.
Patients can have delusions that people are out to harm them for no reason, and without proof, or delusions that they are famous powerful figures in history. And again, when we look at how the mind works, how complex processes are taking place that help us navigate who we are and what we do, it makes sense that if something wasn’t working normally in the brain that a person could have a belief that was false.
Although these symptoms might make sense when we look at the brain as an organ, or a tool performing a function, it doesn’t lessen the impact mental illness has on families. Often mental illness takes away what we consider the heart or personality of person and this can be extremely difficult to cope with. Furthermore, the simplicity of understanding is not without criticism. For instance although we are learning more and more about the brain every day, there is still no cure for mental illness, only treatment for symptoms, and often times the treatment cannot fully clear the symptoms of certain diseases.
However, it is important to know that psychosis, like other mental illness symptoms, is not the fault of the person with the illness or the family who cares for them. These symptoms are part of a complex illness that affects patients unwillingly every day.


  1. Wow, I am a trained counselor, MA Vocational Rehabilitation Counselor. I sat down today reflecting on my own personal therapy sessions, and dealing with a lot of stressors that did at one point in time cause mental illness, a low case of depression. As, I re-discovered my childhood past from sexual traumas, and the many relationships I encountered before marriage, I almost just wanted to run from my present realities. The fact that I married a young man at 20 years old when I was 25, 20 years ago today, and the facts of our suffering financially, and the fact that today I am high in debt training to earn a 3rd degree (Phd) to rescue my family from debt and financial struggles, and to this note I am touched by the term psychotic, I am actually working in Higher ED earning only $31,725.00 with a earned BS degree and MA degree. My husband of 20 years is earning about $40,000 as a stock-room manager, and is a Pastor of a small local congregation in Winnsboro SC. I am thinking too deeply about live to be mentally ill or Pscychotic.

  2. Yolanda, thank you for your response. Certainly terms like "psychosis and mental illness" can illicit emotional and powerful responses. As I stated in my blog, they are extremely personal symptoms and illnesses that can transform patients and families. It is important for mental health professionals, patients, and our communities to become comfortable discussing mental illnesses and its symptoms for the sake of our patients and their families. The Healthy Minds blog is intended to provide accurate information and to reduce stigma related to mental illness so people will feel more comfortable reaching out for help. The blog is not intended to provide medical advice; I hope you will take personal concerns to your therapist. The Healthy Minds resource page may be helpful.

  3. My grandson has suffered bipolar and psychosis for about 1.5 years, during his 2nd year at college.

    He will take lithium for the bipolar, he can agree with that diagnosis. He doesn't agree with the psychosis so keeps refusing to take the medicine and back into the hospital again to be force medicated. Then they release him after 3 days to 2 weeks and he again refuses the anti-psychotic meds.

    He was so scared of the hospital that he was missing for 5 days and thanks to a silver alert we found him safe living in the streets.

    We live in Maryland and tried CooperRiis, but after 1.5 weeks off his meds he became psychotic again and they had us come and get him and he can't come back until he's stable and medicine compliant for several months.

    So now he's in the hospital in the Carolina's again and will be stable again soon.

    We cannot find anywhere or anyone to convince him that he does have psychosis and to take the medicine.

    We also can't find any place like CooperRiis that will teach him life skills, etc.

    Can you please help? We don't know what to do when he gets out again in about a week.

    We really prayed and hoped that CooperRiis would take him back, but he said no. The hospital settings would make me psychotic. (sorry about that comment, but I have found it to be true)

    What can we do to get him stable and have professionals work with him in a safe environment and not just let him go downhill then make him leave, or put him in a mental hospital where he's scare?

    Thank you,

    We live in Maryland. We have looked eve

  4. Dear About Alec,

    I am truly sorry to hear about the difficulty you and your family has encountered in acquiring treatment for your grandson. Unfortunately you are not alone, as several families find themselves in similar situations. Thankfully there are organizations like the National Alliance of Mental Illness or NAMI that can help.

    You can access their website at and look up your local chapter. Your state psychiatric society might also have information about resources in your area. Maryland's psychiatric society website is

    I hope these resources can be of some help to you and your loved one.

    Dr. Coffey

  5. Dear "about Alec": instead of trying to convince him the meds are for "psychosis",maybe encourage him to take them b/c they will help with (fillintheblank with a couple of his symptoms that are distressing to him like lack of sleep or anxiety). Hope that helps.


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