[bowsamic]

How do you know it isn't true? Philip K Dick came to believe in his psychosis visions (he believed he truly was in Rome in 60AD or so but was being fed a created world by the Romans). But he had good personal evidence for it that he couldn't deny even in a non-psychotic state. Do you have anything like that?

I guess a better way to phrase it is, do you have compelling evidence that your beliefs are true that you have to force yourself to ignore, or does it just seem like nonsense when you aren't in a psychotic state?

[kayodelycaon]

Not OP, my manic episodes come with extreme paranoia, and I have had two psychotic breaks during really bad ones. This may be a completely different experience. Apologies if I sound a bit flippant.

For myself, my brain always knows what reality is because all of my senses work. Delusions are clearly internal. My self-awareness is firmly in reality but all I can do is watch myself react as if the delusions are reality.

Many people can’t grasp this. Awareness and control are always linked. “Blind rage” is just that. Awareness is gone.

I hope no one else ever has to experience being powerless in their own body and screaming uselessly in their head to make it stop.

As horrifying as this sounds, these experiences don’t haunt me. I thought they were just burnout from stress and carried on like nothing happened afterwards.

“Normalization of deviance” doesn’t even begin to describe my life experience. Eventually, I was convinced by my doctor to see a psychiatrist for ADHD. It wasn’t until my third visit she realized I had severe, high-functioning bipolar. Once I got over a month of denial, it was “Okay. That does explain a lot.” XD

[throw4950sh06]

You're not suddenly irrational in a psychosis, you still have your logic working, just with crooked inputs. So it took me months to sort through some details and make sense of what actually happened and what didn't. There are some things I'm probably never going to be able to explain and I just have to leave it like that. But I don't believe any of my delusions happened, I just would like to know what happened.

All the voices, and the sense of urgency and danger go away immediately when you wake up after a dose of antipsychotic medication. Your first thoughts are that you lived through some weird things which are not happening at all anymore, and now there's a psychiatrist untying you from a hospital bed and handing you a cigarette, which puts stuff into context. You also probably feel the best you felt in weeks/months because it's your first night of sleep since forever.

I can easily imagine someone thinking "well, I had a psychosis, but there was shit going on". Fortunately that's not me.

[saltcured]

This is your personal experience, but I'll note there are others who do become irrational along with having altered perception. It's hard to give generalized descriptions.

So, rather than just having some false facts, they will make bizarre "inference" steps in thinking that can border on free-association. In the case of one of my relatives, this process would accompany something almost like amnesia. After a burst of this illogical reasoning that gets way out into the weeds for tens of minutes or hours, she would seem to lose track of it and "reset" in some way to start again.

Out of this recurrence, you could start to sense an overall theme that was evolving at a different time scale, beneath all the illogical tangents. Even through different phases of treatment and remission, those themes would resurface as a sort of barometer of her illness. There wasn't always as stark of a difference between normal days and psychotic break days.

[Modified3019]

I really appreciate your responses (and ones others have made elsewhere in this thread), they give much better insight into what someone is going through internally than the clinical definitions I see.

[nathan_compton]

Just a general piece of advice: when a person is discussing their struggles with psychotic delusions, its kind of messed up to say "Yeah, but how do you know they aren't real?"

[kayodelycaon]

While incrediblybadly phrased, I feel it is an honest question on how psychosis works.

Then again, I treat my whole life is a fascinating science experiment and people have to beg me to stop talking about it.

[bowsamic]

Why is it "messed up"? It's a genuine question

[kelseyfrog]

The answer lies in this - can a question be both genuine and "messed up"?

[kybernetikos]

Given the context in this conversation about how confirming a delusion can be dangerous, I think the concern is just that there may be situations where asking this genuine and interesting question could cause harm.

I think probably that on balance you've got away with it though because the people commenting seem to be safely outside the other side of their psychosis and are able to answer interestingly without being harmed by the question.

[AStonesThrow]

Yeah, it was odd because the first time I told a psychiatrist that I heard voices, it was because of a split-second incident out in the street where I swear I heard a distinct vocalization from the vicinity of a traffic light. No human was there, of course, and the illusion was over before it began.

That was enough to slap a prescription on me for years to come.

Eventually I began to question why they kept wanting to prescribe this stuff and why one of the standard questions was always "do you hear voices?" and I also began to question their terminology. "What do you mean, by hearing voices?" "Oh, well, hallucinations." and I drilled down into their definitions and epistemology for a while.

I told them that I am a Christian, and of course I hear voices. People of faith, who are quite sane, discuss this openly all the time. We are always encouraged to listen to the voice of Jesus, the voice of the Holy Spirit, to listen to the voices of those who wrote Sacred Scripture. I told the doc that I'd be crazy (and lost, and significantly more troubled) if I didn't hear anyone's voice.

Of course they're probing for stuff to medicate, they're probing for irrationality, and they're probing for evil voices who goad us to do harm to ourselves or to others. And of course I was troubled by those types too.

But they weren't unreal. They weren't hallucinations because the sources exist in reality. They don't come from human bodies, but spirits are real to Christians.

The solution is not to medicate the voices or deny that the voices exist or to ignore the voices, it's to form our consciences so that we can stand up to lies, stand up to temptation, and resist evil. It's as simple as that. Whether the voices come from Mom and Dad, or social media, or television, or they're 100% in our heads, we need to discern their spirits, and deal with them according to our conscience.

It was so jarring that the doctors would be goading me to deny my faith in this way and to claim that if I heard a voice encouraging me in a moral direction, that it was fake, a hallucination, a disease. I have been so profoundly insulted. This is one of the many reasons I lost trust in them.