How can psychoses be understood?
“Unlike other living beings, human beings must struggle for their self-conception.” We can have doubts about ourselves and at the same time also despair, outthink ourselves and also lose ourselves in the process: anyone who is distraught for a long time without consolation and support, anyone who can no longer communicate his / her feelings or can no longer endure them, can become depressive or, if he / she takes flight, also manic - anyone who is very thin-skinned, can become so porous that he / she loses his / her limits. The perceptions can become wayward / intractable, and thoughts erratic. If this state persists, we speak of psychoses. Anyone who becomes psychotic is therefore not a creature from another planet but is reacting in a profoundly human way.' (Source: “It is normal to be different”, 2007, which can be ordered from firstname.lastname@example.org).
A psychosis is concerned with human possibilities generally, but also with an individual person, his / her particular life story and his / her specific situation. Many factors interact; there is never just one explanation. Often the loss of reality must be understood as a protective mechanism if for example contradictions between the inside and outside world can no longer be papered over readily; it is no longer possible to endure feelings, expectations cannot be fulfilled, necessary decisions become impossible and upcoming developments are blocked. Without help this way can lead into a blind alley.
Schizophrenic (cognitive) and affective psychosis
Each psychosis is different and filled with very personal contents, just like each dream and every human being is different. Distinctions in psychiatry concern above all formal aspects and the issue what psychological areas are most influenced. The following are distinguished:
- schizophrenic / cognitive psychoses, if primarily perception, thought and speech are altered, and
- affective psychoses, if primarily mood, feeling of being alive and drive are altered and the cognitive changes in this connection remain (unipolar or in the event of swings in both directions bipolar).
At the same time perception and mood cannot be completely separated but influence each other: We can “see everything black” and “float on pink clouds”, can develop “tunnel vision” or keep a low profile. (Source: T. Bock, Basiswissen: Psychosen, Psychatrieverlag, Germany)
Becoming psychotic means..
- Falling into “a state of extreme thin-skinnedness”. The limits between inner experience and outside reality are lost. One becomes so to speak porous: inner conflicts and difficulties are externalized and take form (hallucinations). Conversely, external influences reach inside unfiltered without the possibility to assess these. Everything appears to be connected to one's own character (paranoid perceptions).
- Gaining “a perception comparable to that of a child”. It relates everything that occurs around it to itself and correspondingly feels guilty if its parents argue with one another. In small children, this “egocentric” perception is development-related: brain and mind do not yet permit the child to disregard itself (abstraction). Later, it is then possible readily to accept relationships independently of one’s own character. When human beings become psychotic, they fall back on this form of perception; the brain so to speak goes on to an emergency circuit; the mind feels backwards. This may be out of touch with reality and inappropriate for an adult; however it also means recourse to an earlier time – for whatever reasons.
- Sensing “an experience comparable with that in a dream” – however without the protection of sleep. In a dream it is not dangerous to feel like a bird, in psychosis it is. Just like there is wishful thinking and there are nightmares, in psychoses as well wishful and anxious components are mixed: in allegorical terms in paranoid psychosis as a mixture of meaning and danger. Sometimes the anxiety functions in the foreground and the wishes remain encrypted. And yet in therapy and in search of the subjective meaning it is helpful to look in both directions: wherefrom and whereto?
- Developing a special “waywardness” of body and mind – the senses go their own ways: images and voices that are no longer influenced only by the eye and ear develop. No wonder, for only 30% of the nerves in the visual and auditory centre come from the eye or ear, 70% from other brain regions! Seen in biological terms, it is therefore rather amazing that not many more people hear voices or have visions. The mind struggles for autonomy, withdraws itself into a “last stronghold of idiosyncrasy”, signals to all others “until here and no further”.
A psychosis means …
- an altered perception and processing of reality even without drugs.
- a“particular “waywardness” of body and mind – the senses go their own ways: images and voices that are no longer only influenced by the eye and ear develop.
- an extreme thinskinnedness – internal life forces its way outwards and gets a life of its own (hallucination), external events reach inside without a filter and assessment (risk of paranoid processing).
- dreaming without the protection of sleep – dreaming that one is a bird is not dangerous but the same perception in psychosis can be risky.
- an access to unconscious experience – as in wishful thinking and nightmares, the psychosis also has wish and anxiety components. Comparably, delusion of grandeur or paranoia in psychosis can also signify "something valuable", however at least not insignificant.
- a kind of recourse to childlike perception – a child of 2-3 year relates everything to itself. If its parents argue the child feels guilty. In psychosis we fall back on this form of perception.
- a desperate struggle for autonomy – somebody withdraws him / herself back to the “last stronghold of idiosyncrasy”: until here nobody can follow me.
- a loss of self-image – every action requires effort; nothing occurs any more by itself, everything is significant.
- an expression of deepest ambivalence – force fields such as e.g. between attachment and autonomy or adaptation and resistance, in which everybody has to find their way are given existential significance.
- A struggle for idiosyncrasy and sense – where are my physical and existential limits? What is my disposition? What significance do I have for others? What responsibility can I bear?
Psychoses as a reaction to life crises
A psychosis can afflict Anyone
Anyone can be forced to escape from reality, e.g. in situations of extreme stress / traumatisation or too great isolation. In particularly sensitive people and in times or particular thinskinnedness even normal life crises can exceed one’s own comprehensive faculty.
The significance of crises
All people pass through stable and instable times in life; in certain phases they are forced to reorient themselves, relocate and develop a new self-image, e.g.:
- in puberty and when breaking away from the parental home,
- during the completion of training and in the transition to professional life,
- during attachment to a partner and during the birth of a child or
- during the loss of important functions and relationships etc..
Psychoses as life crises of thin-skinned people
Most people become psychotic in times that are critical for everybody. Persons afflicted with a psychosis react more sensitively and existentially in these times than others, but at the same time in a profoundly human way. That may not mean that they wish to avoid all crises. Avoiding crises would mean avoiding life. Depressions would be the consequence. In this sense, the requirement by all means to prevent psychotic relapses also meets limits: psychiatry must become friendlier in times of crisis, accompany life; otherwise, it can contribute to depressions and withdrawal.
A psychosis is different in everybody
Each psychosis is different; just like every person is different. It is always an individual process, which can only be understood with subjective interpretations in the personal and social context. Each symptom tells its own history. Diagnoses may be important for the professional understanding; they cannot however create new facts. Diagnoses should not fool anyone into treating only a general ailment and no longer an unmistakable human being.