- What is ‘mental illness’ and ‘mental health’?
- What is ‘psychosis’?
- Have I got psychosis?
- About diagnosis?
- Why have I got psychosis?
- Different kinds of psychosis
What is ‘mental illness’ and ‘mental health’?
Whilst in society we often talk about ‘mental illness’, its important to start by trying to understand what we mean by ‘mental health’.
“Mental health is the emotional and spiritual resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well-being and underlying belief in our own and other’s dignity and worth”
– Health Education Authority
This definition underlines the complexity of what we describe as states of ‘mental health’ and ‘mental ill health’. Our wellbeing is more than an individual state of health, it is inexorably linked with our emotional, spiritual, family and social worlds.
The term ‘mental illness’ is generally used when someone experiences a significant change in the way they think, feel or behave that causes either themselves (or others) significant distress. The terms ‘mental health problem’ and ‘mental disorder’ have a similar meaning. If a person has always had a problem in their thinking, feeling or behaviour, then this is not usually called mental illness. It may then be called a developmental problem or a difficulty with their personality (sometimes called a ‘personality disorder’).
However, these distinctions are not always clear cut and greatly oversimplify things. There is no simple dividing line between ‘mental ill health’ and ‘mental wellbeing’. Similarly, it is difficult to draw a simple line between someone with a supposedly healthy personality and someone with personality difficulties. We all go through challenges to our mental health, and most of us recognise that we have aspects to our personality (our patterns of thinking, feeling and behaving) that can be problematic. Equally, if someone goes through a period of being diagnosed with a mental health problem or a ‘personality disorder’ this does not necessarily mean they will struggle with these issues for life.
Finally, it is important to note that the definitions of mental illness used within the mental health system are open to critique. People who experience things commonly associated with a mental health problem may not find the label of ‘mental illness’ as useful or relevant to them. Conversely, others may find the term useful in helping them and their family understand their difficulties.
What is ‘Psychosis’?
Psychosis is a name used for a mental health problem in which there are changes the way a person understands and experiences themselves and the world. Sometimes when people are experiencing psychosis they are said to have ‘psychotic symptoms’, a ‘psychotic disorder’, ‘psychotic illness’ or ‘psychotic episode’.
If you are experiencing psychosis you may notice changes in your thinking, for example it may be difficult to think as clearly as usual and your thoughts may feel out of control. You may hear or see or feel things which others cannot (hallucinations) or you may develop unusual beliefs (sometimes called delusions). Some people with psychosis lose their motivation and interest in things, or feel they have fewer thoughts or less to say than usual.
The label ‘psychosis’ should only used when these experiences are severe and frequent enough to cause distress or affect the person’s life.
If someone is very overwhelmed they may be said to have ‘acute psychosis’, especially if the problems have developed recently. If a psychosis has continued for a long time, it may be referred to as ‘chronic psychosis’.
What is often viewed as psychosis can be seen in different ways by different cultural groups and spiritual traditions. For example, some people consider psychosis as an ‘altered states of consciousness’, ‘spiritual crisis’ or ‘spiritual emergence’. In a multicultural society it’s important to be aware of these perspectives.
Have I got psychosis?
If you are having difficulties that sounds similar to ‘psychosis’ it may be helpful to talk to your doctor, psychiatrist or another professional involved in your mental health care. If you are not in touch with mental health services, a good start is going to see your GP. Getting expert advice can be helpful as it can sometimes be difficult to decide whether this is the right diagnosis or not. For example, hearing voices – in itself – is not indicative of any mental health problem. Equally, people may experience psychotic-like symptoms in a range of emotional or physical health problems. However, some people who hear voices may experience difficulties that are helpfully viewed as psychosis.
Sometimes, when someone is experiencing psychosis they may not feel that they have a problem, even when there are big changes in their thinking and behaviour. This can be very difficult for friends and family members who feel very concerned, as well as for the person themselves who may feel overwhelmed or ‘hassled’ by people’s insistence that there is a problem. At these times, it can be really helpful to accept advice or guidance from people who know you well and who you would usually trust. Try to find some common ground – whilst you might not agree as to the source of the difficult, you may agree on certain issues that would benefit from some help (e.g. problems sleeping, anxiety or feeling overwhelmed).
A diagnosis is a name given to a health problem. In physical illness diagnoses often explain the cause of the symptoms eg. if someone has abdominal pain, getting a diagnosis of appendicitis means that the cause of the pain is inflammation of the appendix. Diagnoses of mental health problems usually do not explain the cause of the symptoms – they just tell us that the symptoms fit a certain pattern. For example, someone with a diagnosis of ‘schizophrenia’ may have a certain pattern of experiences that fall within that category (e.g. voices, unusual beliefs and problems thinking). The diagnosis does not tell us what is causing the problem.
There is no objective test for diagnoses of mental health problems, so they are given by professionals (usually psychiatrists) following a period assessment. The psychiatrist will usually use a combination of the experiences you tell them about, information from your close family and their own observations about the way you appear to them.
Some people find diagnoses helpful because:
- It may give a word to an experience that you’ve been struggling with for a while (making it seem more tangible)
- You may feel more confident that professionals know what is wrong with you and how to help
- You know what to look up when you are looking for information
- You know what to tell other people
- It may give your friends/family some context to understand recent changes in your behaviour
- It can help the practitioners treating you to know what research findings apply to you and to communicate efficiently with each other
Some people find diagnoses unhelpful because:
- People are individuals and many people don’t fit neatly into one ‘box’ or another
- People may feel stigmatised by some diagnoses.
- Some diagnoses are misunderstood by many people, and this can be upsetting. For example some people (wrongly) think that being diagnosed with schizophrenia means you are dangerous or can’t recover.
- An increasing number of academics, professionals and survivors are suggesting that diagnoses are not scientifically reliable or valid.
- Certain diagnoses can be difficult to lose once you’re feeling better.
- Some people may disagree with the diagnosis they’ve been given, or feel it does not take into account their views about their experiences.
Many people find that there are both helpful and unhelpful aspects to being diagnosed with a mental health problem – and this can change over time. The important thing is to find a way of thinking about your experiences which works well for you – whether you agree with your diagnosis or not.
Why have I got psychosis?
Unfortunately, getting a diagnosis doesn’t help you understand why you’ve begun to difficulties (an exception to this is ‘drug-induced psychosis’ where the diagnosis means that drugs have triggered the problem).
If you want to understand more about why you have become overwhelmed, it is usually more helpful to look in detail at your background, at what has happened to you in your life, and at what seems to make you feel better and worse. From your individual story it is often possible to see some meaning in your experiences and symptoms. Trying to make sense of things like this is called making a ‘formulation’. This may also give you helpful pointers about what may help you to recover and to stay well. It can be helpful to have assistance from someone experienced in developing formulations.
Different kinds of psychosis
Everyone is an individual, so their experience of psychosis will be unique. However, there are different broad patterns of psychosis that are described by different labels (diagnoses). Whilst having a specific diagnosis of a type of psychosis can be helpful for some people (e.g. suggesting a particular form of treatment) it does not always give extra information than the term ‘psychosis’ itself. Many people may experience symptoms which do not neatly fall into an specific diagnostic category. There are no concrete tests which help doctors diagnose a form of psychosis and, as such, there may be disagreement between doctors about the best diagnoses to use. In this case, some psychiatrists will prefer just to keen an open mind and not choose one diagnosis or another unless it becomes clear that one fits well.
Some of the different diagnoses of psychosis include:
Acute and transient psychotic disorder. This is a psychosis which comes on rapidly and also gets better quickly. It often happens at a time of particular stress.
Schizophrenia. Schizophrenia is an umbrella label which covers lots of different patterns of problems. Two people with the diagnosis schizophrenia may have very different symptoms. They may have no symptoms at all in common with each other. Some people recover completely after a single episode and are never ill again, others have persistent problems, many people have times of being ill but feel well in between.
Depressive psychosis. This is a psychosis which develops in response to severe depression. A person with a depressive psychosis often has symptoms which fit in with their depressed mood, for example they may hear voices which tell them they are a bad person or they may start to believe they have done something very wrong.
Mania. This is an extreme change in mood, the opposite of depression. Someone with mania feels unusually happy or irritable, and experiences other changes such as racing thoughts, extra energy, optimism and self confidence, and reduced need for sleep. They may behave in reckless ways out of keeping with their normal behaviour, for example spending more than usual, or losing inhibitions. People experiencing mania may have psychotic symptoms, which tend to fit in with their elated mood, for example they may start to believe that they have an important mission or are very famous or talented.
Bipolar disorder. This is a term used to describe when a person experiences both times of elated or irritable mood (called mania or hypomania), and also times of low mood (depression). These mood changes are different to the normal ups and downs in mood that everyone has. They are more severe, they last for longer (often for weeks at a time) and they have an impact on the person’s life, their relationships or their functioning. In Type 2 bipolar disorder, the main problem is depression, and the periods of elated mood are brief. Some people with bipolar disorder experience psychosis when their mood is very high or very low.
Schizoaffective disorder. This term describes a pattern where a person gets extremes of mood, either highs or lows or both, and also sometimes experiences psychotic symptoms when their mood is normal.
Drug-induced psychosis. Many people experience psychotic symptoms when they take certain kinds of drugs, for example cannabis, amphetamines or cocaine, or when they are withdrawing from drugs. If the psychosis disappears when the person has recovered from the effect of the drug, this is called a drug-induced psychosis. The recovery time is different for different people and different drugs, and sometimes it is difficult to know whether a psychosis is drug-induced.
Post-partum psychosis. This is a psychosis which develops shortly after childbirth. It is also known as puerperal psychosis or post-natal psychosis.
Some diagnoses that may be confused with psychosis
Dissociation is a term used for two kinds of experience. One kind is to do with an altered state of consciousness – feeling somehow alienated from oneself or the world. The second kind is to do with ‘compartmentalisation’ or a loss of connections between certain mental processes, for example being unable to remember something voluntarily or having different parts/identity-states. Dissociation can happen in people without any mental health problem, it can happen in response to trauma, and also in conditions such as psychosis.
‘Personality’ is a word used to describe the habits of thinking, feeling and behaving that make each of us who we are. An individual’s personality tends to be fairly stable or to change only slowly, though different circumstances may bring out different sides of someone’s personality. In psychiatry, sometimes the term ‘personality disorder’ is used when aspects of someone’s personality are causing great distress or difficulty for themselves or other people, for example severe difficulties in getting on with other people. Over a third of people in mental health services will have problems which could be diagnosed as personality disorder. However, for most of these the label ‘personality disorder’ is not used. A personality disorder can be the result of difficult life experiences, for example sexual, emotional or physical abuse. These experiences can mean that people don’t get chance to learn to cope with difficult emotions. This may lead to persistent difficult feelings, problems in relationships and destructive behaviours. It can also be associated with dissociation or psychotic symptoms.