The fear behind mental illness reflects the nature of fear itself: We fear what we don’t know. We can never truly know what is happening inside the mind of another person. We as people follow fixed rules most of the time. Drive through an intersection when the light is green. Wear some amount of clothing outdoors. Don’t cross the double yellow line. So many rules.
When rules are broken, it is jarring to us as bystanders. Perhaps that rule breaker is innovative. Perhaps that rule breaker is a genius. Or perhaps that rule breaker is sick. The more bizarre the behavior, as in something so unorthodox that we cannot construct a rationale to make the behavior make sense, the scarier it is. That person no longer fits the parameters of normal, and thus cannot be understood. Except they can be understood. Once the parameters are broadened, and we understand what is happening inside the mind of a “crazy” person, then they become just as human as anyone.
The typical example is a psychotic man. They may do “strange” or bizarre things. People are afraid of them. They may mumble to themselves all day long, or talk to people that aren’t there. They might run around naked. They might hide in unusual places. These activities don’t seem “rational” by traditional standards. We can’t understand it, and the easiest label is “crazy.” By categorizing these people as crazy, we know they’re not us. And yet with that comes stigma, because there is still no understanding in that label.
The way to destigmatize these conditions is not just to educate the public that these are people with illnesses, but to take it a step further and understand the process that led to them doing this.
An individual with psychosis (schizophrenia, for example) is having a break from reality. That is a definition for psychosis. This might involve hearing things that aren’t there (auditory hallucinations), having paranoia or bizarre thoughts (such as that aliens will be imbuing them with special powers). There are commonly occurring forms of psychosis, and people with psychotic symptoms often fit into one of these categories.
How does this happen? The short answer is it’s a brain malfunction, and they are thinking things that are fundamentally disconnected from reality. Some paranoid beliefs or delusions might pop into their heads. This is like what happens in a dream, when you know something without having any idea why you know it.
If you could imagine hearing a voice that no one else hears which whispers in your ear, making you question everyone and everything you trust, then you might start to understand the difficulties of someone with psychosis. I myself can only imagine, having never lived with it myself.
So this brain malfunction leads to this false information, until they don’t know what’s true and what isn’t. Within this world of misinformation, though, they’re acting as best they can. If the voice is telling them they are in danger, they might strike out at anyone approaching them. This is not because they’re evil, but to protect themselves. I once had a patient who stripped off his clothes because his voice told him it would help him outrun the devil. He believed it. It’s often hard, even if they know it’s not true, to completely discount this false information they are getting. Even worse than our attempts to filter mass media messages about what we should buy or think, the false information in someone with psychosis is coming from their own brains. It’s hard to learn to NOT trust yourself. That’s why they need our help and understanding. When we can understand what’s happening, then it’s easier to remember they are people.
Psychosis feels especially scary since there appears to be a level of unpredictability, and thus dangerousness. Research has never shown psychotic individuals to be more violent than the general population. But we’ll get to more on understanding the nature of violence in an upcoming post.