My Reality or Yours?*
Some of you may know that Lila has first-hand experience of mental illness in that her mother suffers from Schizophrenia. Lila said that until I explained it to her many years later, she had never quite understood her mother’s illness and asked if I could clarify mental illness from the viewpoint of the patient.
To put it in very simple terms there are a whole host of mental illness, but generally they fall into the two categories. Neurosis and Psychosis.
With Neurosis, patients behave oddly, for example, someone with obsessive compulsive disorder, they may wash their hands repeatedly but they are fully aware they are doing it. In the case of a Psychotic patient (someone with Schizophrenia or Bipolar disorder) their delusions and hallucinations don’t match the reality of others, but are nevertheless very real to them.
Hallucinations involve seeing, hearing or sensing things that are not present. So the patient may respond to the voices they hear by talking to them out loud, they may focus on people who are not visible to anyone else or they may describe sensations like smells or something crawling on their skin. They also exhibit anxiety and inappropriate reactions like laughing when there is nothing funny happening. This is known as Anosognosia where they are totally unaware that their behaviour is inappropriate or irrational.
Delusions on the other hand are beliefs that are often paranoid or grandiose. They may also believe that others are sending them messages or that they are controlled by certain people. They sometimes also believe they have serious illness which is usually physical in nature.
In bipolar depression, the mood swings result in hallucinations during the depressive stage and grandiose delusions in the manic phase. In Schizophrenia, the hallucinations and delusions are not intertwined with mood, but there are random thinking patterns, lack of motivation and a flat affect.
There is a neurological basis to psychosis in areas like the prefrontal cortex which is involved in reasoning and perception is affected, so the hallucinations like hearing voices for example, are caused by the overstimulation of the auditory neurons and are therefore as real as someone actually talking to them. So rationalising and saying to them that the voices are not real and to ignore them is a denial of their perception and has little effect apart from making them anxious or aggressive.
Sadly, relatives and friends of the patient believe that the person is just being
difficult and can snap out of it should they wish to do so. Actually, their perception is just as real as yours and mine and it is just that their brain processes reality differently. They have absolutely no choice in this and cannot shrug it off. They need professional treatment.
One of the best ways of dealing with it is to be compassionate. Instead of pretending that you can also hear the voices and condoning the hallucinations, you could say something on the lines of “I can’t hear them, but it sounds like it is very real to you.”
At all costs don’t argue with them or try to dismiss what they are saying and by keeping calm yourself you can allay their anxieties.
If you feel they may harm themselves, remove anything they could use to do so and persuade them to see a professional or in extreme cases contact emergency services as they may have to be sectioned.
People also confuse hallucinations and delusions as manipulation. The way to tell the difference is that manipulation has an end goal and the symptoms are often inconsistent and abandoned once this is achieved. Whereas with true delusions and hallucinations the symptoms remain consistent and worsen if not treated.
It is important to note that in Schizophrenia there is a prodromal stage before the acute crisis stage. Here, the symptoms are not fixed and you might persuade them that their hallucinations or delusions are not real. Sadly, this stage often goes unrecognised and the decline in personal hygiene, inability to experience pleasure and social withdrawal are often misdiagnosed as depression.
So all in all, kindness and empathy is the key requirement and the knowledge that just like a patient can’t ignore acute pain in a physical condition, neither can someone with psychosis deny their version of reality. As the Buddha said, reality is based on the way we experience the world and it is shaped by our interpretation.
*This article was written by ‘The Common Sense Therapist’, a retired psychologist who lives overseas and wishes to remain anonymous. She has many decades of experience in dealing with various people and aspects of psychology, and is a great source of enlightenment on many things in life.
