By CRISTINA JANNEY
Imagine someone was constantly whispering negative comments in your ear. “Don’t trust them.” “Is he looking at you?” “Why are you talking him?”
A group of Mental Health First Aid students experienced what this might felt like recently. One person whispered in their ear while they tried to carry on a conversation with a second person. All the students reported it was difficult to concentrate on the conversation, and it was difficult to respond to the person they were speaking with.
Hearing voices can be a symptom of psychosis — one of the topics discussed in Mental Health First Aid, which is offered by High Plains Mental Health.
Just the word “psychotic” is scary to most people. They don’t understand it. They think it means the person is going to be violent, and it is has become synonymous with “crazy.”
However, those who suffer from psychosis are people who deserve compassion, MHFA trainers said. Despite stereotypes, people who suffer psychosis with proper treatment can be good friends, neighbors and employees.
“As a teenager I did watch the original ‘Halloween’ movies, and I did remember Michael Myers,” said Kaley Conor, MHFA trainer. “He is running around and he is killing everybody. Who is chasing after him? It’s a psychiatrist. Because he is ‘crazy.’ He is ‘psycho.’ It paints this picture that people who are experiencing psychosis are violent. They are serial killers. They are people you need to be really terrified of, and we know that is not true …
“I think stigma is especially prevalent with psychosis and with disorders in which psychosis would occur.”
According to the Mental Health First Aid curriculum, psychosis is a general term, which is used to describe a mental health issue in which the person has lost some contact with reality. It can disrupt thinking, emotions and behavior and as a result impact relationships and work and make self-care difficult.
Conner noted just because a person is experiencing psychosis doesn’t mean they are completely gone or completely out of touch with reality.
“We don’t ever want to speak about someone with psychosis as if they are not in the room, as if they don’t have ears on their head, or as if they don’t understand you,” she said.
Disorders in which psychosis is present are less common than other mental illnesses. They can include schizophrenia, bipolar disorder, psychotic depression, schizoaffective disorder, drug-induced psychosis and delirium. For example, bipolar disorder affects 2.8 percent of Americans, while schizophrenia affects just 0.3 percent to 0.7 percent of Americans.
Most people who develop schizophrenia do so between the ages of 16 and 30. The illness can develop quickly over weeks or take months or years. People who are in the early stages of psychosis can go undiagnosed and untreated for a year or more.
“That is a long time to wait,” Conner said. “If you are seeing things that are not there or hearing voices that aren’t really speaking to you, a year seems a really long time to wait to ask for help.”
People suffering from psychosis might be afraid to tell someone about their delusions for fear of hospitalization or that they may be laughed at, she said.
Trainer Amy Bird, said, “Even though I believe they are so real, I know if I call [someone] and tell her I think aliens are coming into my house, she is going to be ‘Wow!’so I am not very likely to reach out. I also might be really scared to reach out to somebody.”
A person can suffer psychotic episode as a symptom of their mental illness, but that does not mean that they will be constantly psychotic, Conner said.
The symptoms of psychosis could differ depending on the type of disorder from which the person is suffering. Schizophrenia is not split personality. It is an illness in which thoughts and perceptions become disordered, according to the MHFA curriculum.
Major symptoms of schizophrenia include:
- Delusions: False beliefs of persecution, guilt, having a special mission or being under outside control. Although a person’s belief’s may seem very bizarre to us, they are very real to person experiencing the psychosis, according MHFA.
- Hallucinations: Most commonly hearing voices, but can include seeing, feeling tasting or smelling things. Conner gave the example of a person feeling bugs crawling on him or her.
- Thinking difficulties: Problems concentrating, with memory, ability to plan and communicate.
- Loss of motivation
- Blunted emotions: The person may be oblivious to the things happening around them and may not react appropriately
- Social withdrawal
Conner tried to further explain blunted emotions, “Their face might be completely slack. They are terrified. They’re shaking. They’re trembling. They are very scared of things only they can see, but it is like there is nobody home. There is absolutely no emotion displayed on their face.”
Because senses can be heightened during a psychotic episode, a person might be constantly wearing headphones or sunglasses, Conner said. Someone who is hearing voices may have difficulty responding to questions and directions, she said.
People who suffer from bipolar disorder can suffer from severe depression, periods of mania and then have extended periods of normal mood in between, according MHFA.
A person who is experiencing mania, which is the upper swing of the bipolar mood, can have symptoms including:
- Increased energy and overactivity
- Elevated mood
- A need for less sleep: A person may go for days without sleeping
- Rapid thinking or speech: The person may keep changing topics and may be hard to follow
- Lack of inhibitions: The person may disregard risk, spending excessively, being very sexually active, excess drinking or drug use
- Grandiose delusions: Inflated self-esteem, such as a belief that the person is superhuman, especially talented or intelligent, or an important religious figure.
- Lack of insight: Person may not realize they are ill
“If someone is in a manic state, they might decide, ‘I am going to paint my house.’ They might start painting their house and then they are remodeling their kitchen,” Conner said. “All at the same time. Then they get bored with remodeling their kitchen, and they are organizing their bedroom. They have all these different projects going a the same time, and then they crash and nothing was actually accomplished.
“It was just a lot of hyperactive energy moving from thing to thing to thing.”
They might have grandiose ideas such as they might believe they are a secret agent on a top secret mission.
“You might have really inflated beliefs or ideas about yourself,” she said.
“These signs and symptoms might not seem very alarming on their own,” Conner said, “but when you start stacking them up, you can see how it might be more of a problem.”
Early intervention and treatment of disorders that include psychosis can be important in long-term functioning and recovery. Delayed treatment may result in increased risk of suicide and depression, can delay maturation, hurt relationships, disrupt employment, increase the instance of alcohol and drug abuse, and increase the chance the person may have problems with law enforcement.
Although people who suffer from psychosis might encounter law enforcement because of disruptive behavior, it is a myth that people mental illness are more prone to violence. Less than 4 percent violent crimes in the U.S. are attributed to people who have mental illness.
The course offers the acronym ALGEE to help first aiders remember the steps in aiding in a mental health crisis.
- Access risk of suicide or harm.
- Listen non-judgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
Risk of suicide is high among people who suffer from disorders that include psychosis. About one-third of people who have schizophrenia will attempt suicide, and one in 10 will complete suicide. People who have bipolar have a lifetime risk of suicide that is 15 times higher than the general population. It is estimated that 25 percent of all people who kill themselves have bipolar disorder.
If you believe someone is an immediate threat to you or others or is acting out violently, call 911.
Other helping strategies include:
- When you approach someone, do so non-judgmentally.
- Chose a private time and place free from distractions. Stay calm and portray confidence. Be aware of body language.
- State the specific behaviors that concerns you without blame.
- Be sensitive to the way the person is behaving.
- Let the person set the pace and style of the interaction. Speak quietly and in short sentences. Repeat things when necessary.
- Don’t touch the person without permission.
- Allow them the person to talk about their experiences and beliefs, but don’t force it.
- Comply with reasonable requests
- Offer help at the moment or when they are ready.
- Offer practical help during crisis and after? Send get well cards, offer to make dinner, offer to help them do grocery shopping or laundry. Think about what you would do for someone who has been the hospital for a physical illness.
Don’t take delusional comments personally, raise your voice, use sarcasm, dismiss delusions or hallucinations, laugh at symptoms or inflame the person’s paranoia or threaten. Don’t restrict movement, which may agitate the person.
Instead of telling someone to stop a behavior, try asking them to do another behavior. Instead of telling a person to stop pacing, you might ask them to sit down, Bird said. If you do the same, this may also help.
“Don’t whisper,” Bird said. “People who are paranoid are scared. I may go over and say something to Kaley that has nothing to do with that person whatsoever, but if they’re scared and on alert, they are going to think they are conspiring and they are going to do something.”
A person who is experiencing psychosis may not have insight they are unwell. Unless a person meets the criteria for involuntary committal, they can’t be forced into treatment, the MHFA curriculum said. “If the they are not at risk of harming themselves or others, be patient, as people experiencing psychosis may need time to develop insight regarding their illness.”
High Plains has a 24-hour crisis line that can be reached at 1-800-432-0333. The local National Alliance on Mental Illness (NAMI) group meets on the first Monday of the month at 6 p.m. at the Hadley Center. The group also offers support for family members of those who suffer from mental illness. For more information contact Ann Leiker, coordinator, at 785-259-6859 or email her at email@example.com.