What Is Psychosis?
Talking with someone experiencing psychosis is always a challenge. With the right tools and understanding, however, you can communicate effectively and provide that person invaluable support.
Contrary to common misconception, psychosis is not an intellectual disability, a form of “split personality” syndrome, or any other specific illness or condition. Rather, it’s a general term in mental health care describing a state in which an individual “loses touch with reality.”
As a broader mental health problem, psychosis affects different people differently. People experiencing psychosis may become extremely distressed mentally, physically, or emotionally. Their behaviors may differ significantly from their norm. They can find the condition disrupts their relationships, work, self-care, or any other aspects of life.
Not only can psychosis cause the person experiencing it severe distress and disruption, but it can also have the same or similar effects on the people around him or her. It can therefore help anyone who cares about someone suffering from psychosis to learn effective ways to communicate with that person and, thereby, help him or her, themselves, and those around them to properly navigate the experience. By empowering yourself with proactive ways to talk with someone experiencing psychosis, you can potentially ameliorate the situation for all.
What Causes Psychosis?
Psychosis may be a symptom of another mental illness, like dementia, bipolar disorder, or schizophrenia. It can be the result of severe trauma, either physically or emotionally, and it can be the result of drug or alcohol abuse.
Signs to Be Aware Of
There are ways to observe when a person is experiencing psychosis. Noticing these signs can help alert you to the fact that the person exhibiting them may need support in that moment.
Picking up on these signs while you are speaking with that person can also help you stay sensitive to his or her mental and emotional state while the conversation is taking place. Then, you can adjust your approach as necessary to most effectively support that person.
Common signs of psychosis include:
• Becoming distracted by sounds, sights, or other perceptions you cannot sense
• Being hard to follow or comprehend
• Changing topics rapidly
• Speaking excessively fast or slowly
• Experiencing trouble with memory or focus
• Displaying lethargy, fatigue, or sluggishness
• Using language unfamiliar or unintelligible to you
Tips for Speaking With Someone Experiencing Psychosis
A conversation between you and a person experiencing psychosis may start at either of your initiatives. If the person comes to you to talk, make sure that you have the time to give him or her your full and undivided attention. If you can’t do that at the moment, gently explain this and suggest an alternative time when you can do so.
If you do the approaching, however, because you’re concerned that the person may be experiencing psychosis, be sure to do so in a calm and gentle manner in a safe environment. Do it when you can get the person alone, or with a trusted support individual present, but not in a group where the person may interpret it as confrontational.
First and foremost when talking with anyone experiencing psychosis is to come from a supportive and non-judgmental place. Allow yourself to feel empathy for what that person must be going through, and convey it in how you communicate.
Acknowledge what the person is saying and how he or she is feeling. Ask the person to clarify certain points, which shows the person you’re listening. Then, repeat in your own words what the person is expressing to ensure that your understanding is accurate. Often, showing a person that you understand them can be enough alone to help calm him or her down and alleviate symptoms.
Once you’re both clear you understand the person’s experience, you can express empathy for it. For instance, you might say “that seems very upsetting.”
Language and Body Language
The language you use to communicate with someone experiencing psychosis can do a lot to either help or hinder your efforts to support them. This includes both the words you speak and how you communicate with your body.
In terms of verbal language, avoid using overly simplistic words and phrases as they could sound patronizing. Don’t diminish or dismiss the person’s experience by using terms that stigmatize, such as “wacko,” “nut-job” or “insane.” Likewise, avoid using overly clinical language, such as medical terminology, even if you’re both familiar with it.
Rather, speak in more “normal” and conversational terms, such as saying “stress” instead of “PTSD.” Generally, try to use the same language and terms that the person experiencing psychosis is using to describe his or her experience.
As for your body language, avoid touching the person without first getting his or her permission. A person experiencing psychosis may want a hug, a hand to hold, or a back rub, or he or she may not want to be touched at all. Always ask first, or wait to be asked, and always abide by the person’s wishes.
Make sure you aren’t expressing anxiety, stress, or discomfort in your body language during your conversation, such as hanging your head, tensing your muscles, or throwing your hands up in exasperation. Avoid nervous behaviors like fidgeting, biting your nails, pacing, or constantly avoiding eye contact or shifting your gaze. Avoid modeling the person’s own body language back to him or her with your own.
Notice how you and the person experiencing psychosis are situated in relation to one another. Are you both sitting or standing? Is one of you sitting and the other standing? Are you close up in each other’s faces or spread across opposite ends of the room?
Make sure, whatever your position, you aren’t making an imposing presence. Respond to the person’s changes in position by adjusting your own to continually give the person a supportive, non-threatening impression.
What to Avoid
Knowing what to avoid saying and doing can be just as helpful as knowing what to say and do when talking with someone experiencing psychosis.
Most importantly, avoid ignoring the signs and symptoms of a psychotic episode when you observe them. These signs may appear suddenly and all at once, but not always. Sometimes, they may appear gradually. It may not be completely clear to you whether what you’re noticing is indeed a signal the person is presently experiencing psychosis.
Regardless of your uncertainty, take your observations seriously, and treat the person the same as you would if you were more certain that they are experiencing psychosis.
Don’t simply dismiss your observations with rationalizations like that the person is just “being a typical teenager” or going through “a phase” or “life’s usual ups and downs.” Don’t assume that the person is behaving this way because they are under the influence of alcohol or drugs. Avoid assuming, as well, that the problem will just go away by itself.
Ultimately, despite all your efforts, you may find that someone experiencing psychosis doesn’t want to talk with you. In some cases, the person may not even consider it a problem. They might not be in crisis currently or feel that their life is negatively impacted by the psychotic experiences in any way. In such cases, don’t pressure the person to talk with you or seek help. Rather, tell the person that you’re there if they change their mind, and then, unless you’re concerned for their safety, leave the person be.
In Extreme Cases
Sometimes, a person with psychosis may experience hallucinations, delusions, or paranoia. In other cases, a person’s psychosis may affect their communication abilities. These symptoms can be particularly difficult to deal with properly though strategies do exist to help you best manage them. Sometimes, however, even with those strategies in place, a person’s symptoms may require enlisting the aid of a professional.
Hallucinations and Delusions
If the person is experiencing hallucinations, don’t pretend to see the same things in an effort to calm them. Don’t validate delusions. However, avoid the opposite approach, as well, of dismissing or minimizing the person’s experience or, worse, arguing against it. Avoid trying to make sense of the hallucinations or delusions, and ridiculing the person when they fail to make any sense.
Do not attempt to reason or rationalize with a hallucinating or delusional person. Don’t tell the person that they are just seeing things or having delusions. Don’t act surprised, embarrassed, or distressed by the person’s hallucinations or delusions, and don’t mock or tease them.
Similarly, the first step to dealing with a person experiencing paranoia is to avoid validating or dismissing the person’s fears or shaming the person for experiencing them.
You can, however, tell the person that you don’t notice the same threat but that you’ll stay with them if it makes them feel safer. If it is possible and safe to do so, try to gently steer the person away from the source of paranoia. For instance, if something outdoors is upsetting them, suggest that you go indoors together. If they are concerned about an elevator, suggest that you both take the stairs.
To keep from exacerbating the person’s paranoia, let them know everything that you’re going to do before you do it. Take no action that you haven’t first informed them that you’re going to take. If you want the person to take any actions, be sure to give calm, clear, and simple directions that are easy to understand and follow.
Avoid body language that could aggravate the person’s paranoia as well. Keep your hands where the person can see them, and avoid putting them in your pockets or behind your back. Make sure that you remain at a mutually comfortable distance from the person.
Psychosis could impair a person’s speech or other faculties of communication, such as the ability to reason or comprehend. They may meander among topics or drift off in thought or switch between shouting and muttering or give unrelated answers to questions. The person may not notice or be able to interpret common tools of communication, like your tone of voice or facial expressions.
If this is occurring with someone you don’t know well, seek out someone who is closer to the person if possible, to learn how best to communicate with them. In general, however, speak simply and clearly. Repeat yourself as needed. Avoid sarcasm or metaphor or other more complex forms of communication.
Give the person time to express what they need. Avoid interrupting. If you can’t understand what they are saying, try to gauge the person’s emotions. Then, you can at least empathize with their general feelings if not with the specific circumstances prompting them.
Above all, remember, even when communication is lacking, simply being there with the person can provide comfort and reassurance.
Seeking Professional Aid
Whether in the short term or long, it can be hard to provide a person experiencing psychosis with the right kind of support on your own. Fortunately, many resources exist to help you and that person to communicate more effectively and get the help that each of you need.
Don’t wait until you’re in the midst of a crisis to seek out these resources. Empower yourself in advance by learning what local services are available for treating psychosis and helping those managing a loved one’s psychosis.
To encourage someone experiencing psychosis to seek professional aid, express it as a hopeful message that they can get help and that things can improve.
If you need guidance speaking to someone you know with psychosis or have other mental health concerns for yourself or another, call the National Mental Health Hotline at 866-903-3787.