Demystifying “Psychosis” and Paranoia
“It feels like you’ve been thrown into a room full of wolves,” says Mark.
“Suddenly you’re on edge about everything. You’re in that fight or flight mode constantly. Your mind is running a million miles an hour through defence mechanisms. It’s constant panic.”
Mark is one of the 3 in 100 people who will experience “psychosis” at some stage in their life.
Dr Jim Geekie, a clinical psychologist at UoA who has worked “for many years” in early psychosis services both in Auckland and the U.K, notes that “psychosis” is not a universally agreed-upon term. However, it’s generally used as an umbrella, “covering a broad range of experiences”.
“The common thread is that how the person experiences reality [has] changed somewhat. That can be in the perceptual nature — the person may see or hear things other people can’t — or it can be in the area of unusual beliefs that are sometimes out of character for the person, or an exaggeration of previous beliefs.”
3% of the total population in New Zealand is roughly 150,000 people or 12% of the nearly 1 in 4 Kiwis who reported “poor” mental well-being in 2018. Keep in mind, mental health is a notoriously under-reported issue.
If you’re reading this, chances are you are a young person, or know a great deal of young people at the University of Auckland. Jim notes that “generally, the vast majority [of people with psychosis symptoms] present under the age of 35.” He went on to explain there is a type of psychosis that can occur in older adults, but it was best thought of as a different phenomenon, “rather than on a continuum with psychosis that develops in adolescence or young adulthood, which is by far the most common age to present.”
So if you are a young person, or know a lot of young people, chances are you’ve heard stories of people you know and love presenting these symptoms. And the more I personally noticed psychosis symptoms in those around me, the more I realised I couldn’t reconcile the media images of run-down people in straight-jackets with the reality of what I was seeing. Human beings, friends, whānau — people — struggling with things I also struggled with, albeit to a larger degree.
“If you know about stress and distress, then you know what it is to experience mental distress,” notes Debra Lampshire. Debra is an award-winning mental health worker, described by colleague Jim Geekie as an “expert by experience.” She runs groups at the DHB for people who’ve had similar experiences to herself, and she also works for the University in their Mental Health Faculty for nursing.
“I hear voices that other people don’t hear,” said Debra. “That can be very alienating.” For Debra, these symptoms started at a young age, but they didn’t become a problem until she reached intermediate and high-school age. Debra noted that these times in our lives are often when we have the most pressures on us. Social pressures, academic pressures, and self-afflicted pressures. “While [academic spaces] are fertile ground for knowledge, [they’re] also fertile ground for huge levels of stress,” she says. “It’s not so surprising what we see as a consequence of that.”
“I tend to think that what we call ‘mental illness’ as such are actually coping strategies,” says Debra. “Unfortunately we find some unhelpful or unhealthy coping strategies,” she laughed. “52% of people who hear voices have been bullied at school,” she told me. For Debra, that bullying was because she came from a poor, “notorious” area, and because she was seen as different.
She coped by isolating herself, but noted that it was a huge detriment to her mental health. “Generally we are social beings and crave social engagement,” said Debra. “I saw my voice-hearing as a way to fill that void. I was hearing people and whilst they weren’t physical beings, I had a strong sense of them as people. They became my friends and my enemies. They became a micro-community because I couldn’t engage with the “real” community.”
Mark’s paranoia came from a similar place, though he didn’t have an episode until his early twenties. “I was battling depression at the time,” he said, “[and] my coping mechanism for depression was always to isolate myself.”
“I didn’t want to deal with people, I didn’t want to put on a happy face, and a lot of the time I didn’t want to bring people down… I felt I was alone so much that I started making up reasons for people to be thinking about me,” he said. Mark explained he developed the sense that everyone around him was trying to kill him, and he believed it came from the need for connection.
“It was almost a comfort to know [people] were thinking about me all the time. It made me feel that I was important and that I had worth… a bad relationship is still a relationship,” he observed.
For Mark, “Weed was a massive trigger. I don’t know why. I smoked for years and then one day, paranoia hit and it was never the same.” He quit, knowing his relationship with the substance didn’t serve him anymore.
But drug stigma is also real for those who experience psychosis or paranoia, and Jim notes that “it’s not so cut and dried.”
“If you took a random sample of young people from the streets of Auckland.” he explained, “many of them would have used substances recently. Of course, as we know, the vast majority of people who use, say cannabis, don’t present to mental health services for psychosis. So there’s the suggestion that for some people, there’s a vulnerability that’s triggered by a combination of factors including but not limited to substance use.”
Additionally, he emphasised that increased drug use tends to be a response to increased levels of stress. “And it’s well recognised that increased levels of stress can amplify any mental health difficulties, including the risk [of] presenting to psychosis services,” notes Jim.
Above all, our interviewees stressed that psychosis is not a “big-bad,” and the people who have these experiences are not fundamentally different from other people.
“Human experiences fall on a continuum, not in discrete boxes,” says Jim. “What we call psychosis isn’t a category of experience that is divorced from other human experience. We all have dreams every night, and that’s a sort of fabricated reality that lasts for the duration of the dream. So there’s a normalising framework [for psychosis] that I think is much more helpful than a pathologizing framework.”
“People put mentally ill people and “regular” people into two different categories,” said Mark, “but they’re the same category… Mentally ill people are just hurt people. They’re not freaks… They’re regular people who need help.”
So people experiencing mental illness are not fundamentally different from people who are generally mentally-well. It’s a spectrum of experience, as Jim says. And all experiences deserve respect.
And so Mark, Jim and Debra all stressed the importance of empathy, especially from friends and whānau of those having these experiences. “[Someone experiencing mental distress] is just a scared, vulnerable person who isn’t able to express themselves,” said Mark.
For him, that translated into a need to feel safe. And “what made me feel safe was being treated like a ‘normal’ person,” said Mark. He said after being released from a period of institutional care — which he described as “horrid, the worst place on earth,” — he was given responsibilities and structure by his family. They relied on him to do things no matter how he was feeling.
“I was treated like someone who was capable,” said Mark, “and I started to become that again.”
Similarly, after being institutionalised for 18 years, Debra said it was only after she was released into the community that “I started to think in a slightly different way, and… make a conscious effort to work on my voices and try to understand them.”
Of course, if you or someone you know is experiencing early signs of psychosis, the first step should be to seek professional help. Jim recommends speaking to your GP, or contacting the local early psychosis service directly. If you’re not the person directly affected by psychosis symptoms, contact on behalf of a loved one requires consent.
But given all the stigma associated with psychosis — the misrepresentation, the other-ing — it can be hard to know what to do to support people you love working through these symptoms.
The first and most important, said both Jim and Debra, was not to directly challenge their beliefs. “Generally speaking,” said Jim, “when we have our beliefs directly challenged, they strengthen our conviction of the belief in the first place.” Debra and Jim both noted that arguing with someone in this way is likely to fracture the relationship, especially because this person now believes they can’t trust you. However, it’s also important not to collude with their unusual beliefs (should they develop), thereby confirming them.
“What can be helpful,” says Jim, “is recognising, whether you agree with the person’s beliefs or not, the emotions that are associated with that belief for the person are the same as they would be if the belief was true.”
“If I believe my neighbours hate me, that’s going to have an emotional impact on me regardless of whether the belief is true. So recognising and responding to the emotional impact in a supportive way can be helpful,” says Jim.
Debra further stresses that most precipitations of psychosis are a result of extreme anxiety. Assurance that they have others to support them through their internal thoughts and feelings is often the most important thing. Debra and Jim also note that taking care of someone in this state, encouraging them to move away from triggering environments, constantly “bringing them back to the now,” and focusing on the basics are the best things one can do to support loved ones. “It sounds stupid,” says Debra, “but proper breathing… is so important.” She goes on to specify deep breathing techniques, noting that physiological and psychological processes are linked.
Keeping an open dialogue is important too, stressed Jim. Hiding one’s concern might cause you to seem suspicious to your loved one, further alienating them from a source of support.
Jim suggests taking an active role in pushing them towards activities they once enjoyed and making sure they feel safe (just ask how!). “Express curiosity in a supportive way,” says Jim, “don’t undermine or invalidate what the other person is experiencing… [but] be open with concern, and [provide them] an opportunity to share what’s going on.”
“There’s a lot you can do,” says Mark. “[They’re] still the same person. Take them out, create safe spaces for them, safe spaces to express themselves. I’m a big fan of the late-night car chats myself,” he laughed.
Evidently, although there is a lot one can do, there is also a point where professional help is required. And Jim notes that good professional help includes whānau, (not limited to blood-relations), alongside their loved one.
If you or a loved one are experiencing psychosis-like symptoms, or you would simply like more information, you can find help at: https://www.healthpoint.co.nz/public/mental-health-specialty/early-psychosis-intervention-team-epit/
For urgent support with psychosis symptoms contact 0800 775 222 or (09) 265 400 at any time. In case of emergency call 111.