Talking to Someone In Psychosis

Grabbing my Tether

This week, in my abnormal psychology course, we had a very good class on psychosis. I was motivated to share some personal thoughts on the question, and will flesh them out here.

The most useful description of psychosis I can give is that the barrier between what’s going on inside the subject’s head and what’s going on in the outside world has broken down.

physic psychosis by dire knight.

When I last suffered a psychotic episode, my inner train of thought was no longer inner. Think about how you think about stuff. Some goal or need comes to mind, and then you figure out how to satisfy it by getting up and doing what you need, somewhat step by step. “Oh! It’s garbage night. I better go upstairs and get the bathroom garbage, I forgot that last week.” etc. There is a clear rational line of reasoning which is you, in your head, going back and forth down some course of action or logic.

In psychosis, salient features of the outer-world are popping out in their own sequence to become that inner line of reasoning. Your senses move along the naturally-revealed course of those things. A salient snippet of song lyrics you overhear on the radio might be a link in the chain. An old memory might also jump in. All things you are are sensing at, in the order you are sensing them, form the complete thought, like a mad-libs.

That’s what psychosis was like for me. My senses were improvising pseudo-rational thoughts using outside features of the world and recollected memories as content.

The question came up in class of how you deal with someone in this situation. My immediate answer was to not fake an understanding that you don’t have. If I am in a psychosis, and I muster the courage to say out-loud something I know is crazy and unbelievable, then it’s more reassuring to me for you to be predictable and gently not believe everything I say. I’m psychotic, I’m not an idiot. You can’t fool me into thinking you understand where I’m at, or that what I’m saying is plausably acceptable for you to take at face value.

When you talk to me, whatever you’re saying—and in fact all of you, yourself, as an object in my outer landscape—is just going to be just one part of larger thoughts coming together in my reasoning. I know you’ll be someone who doesn’t get it, but you can be someone nice and comforting or safe to be around while you don’t. Many bits of you who do manage to catch my focus for a second will get a turn.

It’s completely okay to tell me that you cannot relate, or don’t understand. It’s the truth—you can’t know what’s going through my head unless I say so.

That brings us to another consequence of this breakdown of inner and outer: I’m not sure that you can’t read my mind.

So when you tell me you can’t, it’s useful information. It’s reality. And I may like to hear that because I may worry that you do know what’s going on in my head directly. Or that my thoughts are polluting you somehow, like radiation or a curse. Or that I can read your mind.

When you speak, you’re not just let me know what’s going on in your head. You’re also demonstrating that I can only know what’s going on in your head by hearing you speak. When it turns out that I’m not reading your mind, because you say something I didn’t predict, that’s a subtle clue to me about where the boundaries between inner and outer are.

The more of these subtle clues about where the boundaries of inner and outer lay, the better.

What’s important in providing these clues is that you be predictable, stable, and honest. By stable, I mean like the strong-but-silent type. I don’t mean don’t talk at all—some small talk, in a basic describe what you see going on around you sense, is actually a great carrier signal. What I mean is you should demonstrate that you are sensing the room, sensing me, and are not freaking out like I am. You are in control of yourself and you are okay just existing in a calmer, more grounded relation to the scene than I am right now.

If I’m flying off into space, than exhibiting this grounding is how I’d ask you to go about grabbing onto my tether.