What it's like to experience psychosis
Psychosis, also called a psychotic episode, is a mental health problem which describes when someone experiences reality in a different way to those around them. People who experience psychosis are said to 'lose touch' with reality, which may involve seeing things, hearing voices or having delusions. These can be extremely frightening, or make someone feel confused or threatened.
Although it is a misunderstood term, around one in every 100 people will experience a psychotic episode in their lifetime, according to the charity Rethink Mental Illness.
Austin, 20, experienced psychosis in his late teens.
"My psychosis was comprised of audio and visual hallucinations. I believed my mind was split, with different personas holding a hierarchy of control over my thoughts, feelings, and actions," he says.
"It started with whispers, these bursts of incredibly violent thoughts of self-harm or suicide. Then these voices grew louder, bickering, arguing and eventually assuming their own form of control over who I was as a person. In my mind, I was a bystander to someone else at the wheel of an oncoming car."
Austin says his behaviour became increasingly erratic until he saw his doctor.
"They immediately recommended further treatment by CAMHS (Child and Adolescent Mental Health Services). It was an incredible struggle to get any words out at all, but I had to fight my case to get some help with them," he says.
What causes psychosis?
Anne Cooke, clinical psychologist and lecturer at Canterbury Christ Church University explains: "The term psychosis is sometimes used to refer to experiences like: hearing voices when there is no one there (sometimes called hallucinations), holding beliefs that others do not share (sometimes called delusions), or appearing out of touch with reality."
This may mean seeing things which others don't, experiencing sensations that have no cause, hearing voices or having false beliefs.
Psychotic episodes are often assumed to be the result of a mental health problem such as schizophrenia or bipolar disorder, but this isn't always the case.
"They can often be a reaction to trauma, abuse or deprivation," Cooke adds.
"Whilst for some, experiences such as hearing voices or feeling paranoid can be very distressing and even life-changing," she explains. "For many people, though not all, experiences such as hearing voices or feeling paranoid are short-lived. Even people who continue to experience them nevertheless often lead happy and successful lives."
"Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without."
There are a lot of misunderstandings surrounding the term psychosis and people often think the word psychotic means dangerous, which is not true.
"It is a myth that people who have these experiences are much more likely than others to be violent," Cooke says.
Although there is no quick and simple cure for psychosis, it's possible to manage symptoms and recover with the right treatment.
"Each individual's experiences are unique - no one person's problems, or ways of coping with them, are exactly the same as anyone else's," Cooke says.
If you are experiencing symptoms of psychosis, you should visit your GP, who will be able to refer you to a mental health specialist for an assessment and treatment.
Cognitive behavioural therapy (CBT) can help people understand their experiences and make sense of why the symptoms can be distressing.
"Psychological therapies - talking treatments - are very helpful for many people," Cooke says. "The National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy."
"More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them," she adds.
For Austin, therapy allowed him to control his symptoms.
"I was given CBT which built me a framework to dismantle my psychosis. These whispers are still around. They're just whispers and I'm okay with that."
A type of therapy called family intervention can help people with psychosis and their family to cope with the condition. The therapy involves giving advice on support and problem-solving.
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Clinical psychologist Lucy Johnstone says a 'trauma-informed approach' may help someone identify why they experience symptoms.
"Recent thinking has identified the role of traumatic events and life circumstances in some cases of psychosis. This may include abuse, bullying, neglect, bereavement, and so on. The trauma-informed approach sees the unusual psychotic experiences as, in some cases, clues to earlier traumas," she says.
Someone may hear the voice of someone who abused them, for example.
"This approach gives hope for identifying and working through some of the unresolved emotional issues, either through self-help organisations like the Hearing Voices Network, or through trauma-focused therapy when the person is stable enough to engage in it."
Antipsychotic medicines work primarily by blocking the effect of the brain chemical dopamine which transmits messages. These medicines may be recommended as the first treatment for psychosis. Around 50% of people need to take long-term medication to prevent symptoms recurring, according to the NHS.
"Many people find that 'antipsychotic' medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality," Cooke says.
Stephen Buckley, head of information at the charity Mind, says: "Most people diagnosed with a psychotic illness will be offered antipsychotic drugs. While not a cure, they can help control the symptoms and stop the distress caused by them."
It's important to ensure people who experience psychosis have the right support when it comes to employment and accommodation, as well as other social factors which can trigger anxiety or stress.
"It’s important that those prescribing treatment don't take a one-size-fits-all approach and offer people a choice of treatment options that may include medication, talking therapies, alternatives such as arts therapy or exercise, or a combination of some or all of these," Buckley says.
"What people find helpful in managing their mental health will vary from person to person, and what works for one individual may not for another."
Mind also stresses the importance of self-care, which can help alongside other treatments. Looking after yourself and managing your stress is important, as it can help you manage pressure. Peer support can help tackle loneliness and fear by talking to others who have had similar experiences, through organisations such as the Hearing Voices Network and Bipolar UK.
It's also key to recognise any triggers, such as sleeping problems, your diet or your mood. Understanding warning signs can help you avoid certain triggers or find out what has worked for you previously.
Mind also recommends having a 'crisis plan' prepared so people - friends, family or professionals - can help you when you're unwell. This can involve writing down the signs of a crisis or who your family should contact in a crisis.