Depression, anxiety and the need to blot out bad feelings are all experiences that most of us recognise to some degree. However, there are MH issues that appear very different to ‘everyday behaviour’ although increasingly it is recognised that many people have some symptoms in milder formats.
Psychosis is the experience of hallucinations: information received through sight, sound, smell, taste or touch that is faulty or unreal. It must be petrifying not just to have these things happen but then to have others say your experience is not real when you know it is. Alongside this people often develop strange views or belief systems (delusions) which may act as an explanation for their ‘unreal’ experiences. For example:
A man lives alone and is watching TV late at night. He turns it off but then hears a voice speaking to him which is threatening and unpleasant. This is repeated several times. Seeking a rational explanation, he decides that it must be the TV talking to him, nothing else in the room ‘speaks’. So as it is turned off it must be being controlled from outside, perhaps by enemies, spies or aliens. The person will then pay attention to things that back this up (as we all seek evidence to confirm our own beliefs). There may be a strange car outside or a piece of wire not previously noticed coming through the wall. This becomes a frightening view of the situation, that people are out to harm him and help doesn’t happen because no one believes him.
People experiencing hallucinations won’t have them constantly. They can be reasonably open to communication sometimes and at others seem withdrawn, may talk to themselves or stare at a spot on the wall. They may be very grandiose and see themselves as superior, or be extremely fearful and withdrawn.
This is the most well know psychotic condition, but it also has several other symptoms besides hallucinations. These include having intrusive thoughts that are repetitive and often very negative, harassing and belittling the person. It may include feeling that people can read your mind or you can read theirs. It may impair thinking skills and make a person noticeably lacking in any motivation.
Just under half of people newly diagnosed will experience few long lasting effects, especially with early treatment. Some have occasional relapses but the remainder have more long lasting serious effects to adapt to. There appears to be a genetic factor, but often the person has experienced traumatic or stressful events too. Increasingly it is becoming clear that children may show early signs although the illness may not fully develop until adolescence or early twenties.
Hallucinations and delusions are a major symptom of schizophrenia but may occur also in severe depression and bipolar affective disorder, conditions which share much in common and seem to be genetically related.
Bipolar affective disorder
This is well publicised these days and most people are aware, as the name suggests, that this produces extreme mood swings. The lows are depressions with all the problems that brings, while the highs produce elation with feelings of being powerful and special – and can be very, very enjoyable.
The high bit brings irrational behaviour that can be extreme, including spending, reckless sexual behaviour, unrealistic schemes and risk taking, often making people very vulnerable. They may also experience ‘pressure of speech’ which means talking fast or being unable to be quiet. It is far more extreme than the moods most of us experience and can be very disabling. The pattern of these changes is a very individual one although depression occurs more frequently than mania.
The person may also be convinced that people are holding them back or are against them because they are ‘special’. These delusional beliefs may be reinforced by hallucinations such as voices telling the person they are superior or capable of impossible feats, although these voices can be punishing and critical as depression sets in.
Medication is crucial in treating this condition, but unfortunately the mania can be so enjoyable that the person will not comply with treatment until they come to realise that there is a high price to pay for those wonderfully exciting feelings. Often all a Carer can do is to act as a reminder that medication is necessary, often a very difficult and thankless role.