February 16, 2022

By Max E. Guttman, LCSW

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Psychosis can be otherworldly — and it can also be completely disturbing when the symptom becomes too intense. This disruption of thoughts and perceptions can be all-consuming, and your new reality often outpaces your understanding of and connection to the world. As a result, it can leave a person seeing, hearing and believing things that aren’t real. This is often accompanied by strange and persistent thoughts, behaviors and emotions.

Those of us who have experienced psychosis (or cared for a loved one who has) know that this symptom of mental illness is difficult to navigate.

Ultimately, psychosis is best managed with medication, therapy, support and education. If you are looking to better understand or manage this symptom, here’s what you’ll want to keep in mind.


Identifying Psychosis and Seeking Help

People experiencing psychosis often deal with a group of interrelated symptoms. Many people dealing with psychosis, often those whose symptoms are rooted in schizophrenia, are unaware that they have disconnected from reality. This lack of insight and self-awareness is called anosognosia. Others who experience psychosis are aware of their distance to reality and the distortions that complicate their connection to the world. Regardless, it can be challenging to recognize when something is “wrong” with your thinking.

Delusions and other cognitive distortions can make it seem like these are natural changes in your mind’s perception. While there are rare cases in which psychosis stabilizes without professional help and medication, most people will find that their psychosis intensifies without medication and therapy. People generally need immediate psychiatric intervention to slow down and interrupt the cognitive distortions — so it is essential to talk to a professional if you notice this type of change.

If your medical professional determines that you are experiencing psychosis, it will be important for you self-evaluate the impact of psychosis on your life and ability to function. When psychosis activates, different thought processes are interrupted and derailed. With the help of mental health professionals, you and your treatment team will learn how to identify each of these blocked and broken aspects of your thinking and cognitive functioning.


Self-Monitoring Psychosis

There are methods you can practice to self-manage — or at least monitor — psychosis symptoms. After all, you won’t necessarily have constant access to a therapist or psychiatrist for counseling or support. Indeed, learning how to self-manage psychosis symptoms as best as possible without the help of a professional is vital to making gains in your recovery. Through ongoing mindfulness and self-reflection, you will be better prepared to self-manage active psychosis symptoms in your living environment.

You can begin by paying closer attention to your patterns of interactions and habits on a moment-by-moment basis. Take notice of even the most minor changes or interruptions to any of these behaviors. Shifts in your behavior can indicate changes to your thinking and sometimes worsening psychosis.

This kind of observation requires tapping into your external world. How do others evaluate your mental status? Checking in with friends, allies and peers is also an excellent litmus test for evaluating the quality of your thinking. If friends and family seem concerned or baffled by your speech or the quality of your thoughts, consider alerting your prescriber and therapist.

This self-reflective process is difficult and may require changing your thinking, so pace yourself. If every detail seems important, that can signal an issue called “referential thinking.” If you find yourself zeroing in on every behavior, try taking notice of your patterns of thinking across your day or week instead.

You’ll also want to ask yourself the following questions:

  • Am I communicating well?
  • Do people understand me when I speak?
  • How is the quality of my thinking?
  • Are my behaviors congruent with my goals and actions?

The answers to these questions will begin to determine how to track the meaningfulness and effectiveness of your interactions.


Understanding and Communicating Needs

Despite your efforts to self-manage psychosis, you may experience a complete “break” with reality. In this case, you will still need to effectively communicate your situation and needs to those who can help you. This could involve alerting your family and the appropriate medical professionals (or your treatment team if you have one in place).

In general, stress only further exacerbates symptoms, so the best time to communicate with your support network is when you can easily focus and articulate vital information related to your treatment.

However, some situations may require you to communicate while symptomatic. For example, you may have to take antipsychotic medication to reduce symptoms, and when obtaining a prescription, you will need to speak with a pharmacist.

Reflect on your experiences. Ask yourself questions about how you felt the task could have been completed differently or improved upon (or, perhaps, done with less distress). For example, when it was time to travel to the pharmacy, did you head there directly or make stops along the way? Given the distress you were experiencing, would it have been less risky to go directly to obtain your medication instead of putting it off until later in the day or month?

How was your interaction with the pharmacist? Was getting your prescription a smooth and seamless process, or did the pharmacist express concerns about your behavior? Did they feel the need to intervene in your care, make comments on your behavior or have you removed the premises? Being familiar with the success of your past behavior and interactions will allow you to accomplish tasks with the least risk of harm.

Ultimately, psychosis is a challenging symptom, one that you may have to manage throughout your life. Accordingly, those of us who experience it should always be practicing our “survival skills.” This begins with education and understanding how psychosis operates. It continues with determining how psychosis affects you — and what supports you’ll need in place.

By developing a regular connection to medical professionals and peer support, you’ll be better prepared for the unexpected. Keeping safety as a goal and knowing your weak points during illness will improve your possibilities for navigating a break with reality and ensuring your safety.


Max E. Guttman is a Licensed Clinical Social Worker, mental health therapist and disability rights advocate. He has worked in various systems of care in New York state, both as a clinician and as a peer. Max is also the editor-in-chief of Mental Health Affairs, a website for the mental health prosumer.

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