11. Making Sense of Psychosis

Across different eras and cultures, societies have always needed to somehow make sense of the puzzling phenomena we now call psychosis. The views adopted varied greatly, from revering those individuals as prophets or shamans, to shunning them as lunatics affected by the full moon or fearing their demonic possession. For the past few decades in the medically advanced West, the biomedical model has gained widespread acceptance.

The Biomedical Model

The biomedical model of psychosis is not wrong, but it has been over applied and eclipsed other empirically supported models that may better suit some cases. The truth is, psychosis and conditions like Schizophrenia are umbrella terms that capture a vast array (experts count >200) of different problems lumped together in our rudimentary classification system. Some forms of psychosis are said to be “hardware” problems that reflect disorders of the brain (argued to be neurological instead of mental disorders), while others are said to be “software” problems that reflect disorders of the mind (with bio-psycho-social aetiology and bizarre symptoms are often meaningful/interpretable and psychologically treatable).

The Psychological Aspect

Then, within the so-called “software” types, there are many different subtypes. A classic one pertains to how unbearably shocking and painful realities can be mind-shattering, making us “lose our minds” (while this sounds archaic and crude, it does capture the phenomena in ways that the modern and sterile lingo of “diathesis stress model” cannot). Examples include the conviction that lower-body pain and pregnancy was due to alien abduction and experimentation, instead of sexual abuse from a loving family member, or that losing one’s fortune was the result of some convoluting government conspiracy, instead of a mistake one has made.

Whether it be CBT for Psychosis (CBP-P) or Psychodynamic therapy, effective treatments involve helping the person reality-test and come to terms with the harsh realities instead of relying on delusions. Of note, how much one can humanly endure before a “breakdown” in basic functioning (eg, ability to distinguish external sound vs internal voice, or what was imagined vs experienced) varies based on many things including one’s psychological maturity and resilience.

Even More Variety and Nuance

Normally mature and resilient individuals who just suffered beyond their limit and “breakdown” (perhaps temporarily) are another subtype to those who seem developmentally arrested and (regularly) operate at children’s psychotic-like but actually age-appropriate levels. For example, young children can live in fantasy and engage with imaginary friends (ie, experiences need not be grounded in reality). Before maturing beyond Egocentrism, they cannot solidly grasp the separation and privacy of minds, tending to assume what one sees, thinks, feels and such are shared with others (in adults, this could fuel thought broadcasting).

As well, they tend to assume everything that happens relate to them (in adults, this would be termed ideas of reference). And before developing Theory of Mind, they struggle to read people’s intentions (in the adult world, this would create confusion and fear – note that paranoid individuals often hold delusions of grandeur, perceivably to feel somewhat safe via fantasies about being powerful and untouchable). Effective treatments thus focus on developing the stunted capacities needed to enable mature and grounded ways of comprehending and navigating the world.

Again, these are just examples within a small subset of the incredibly diversified, incompletely understood, and poorly classified forms of psychosis.