Psychosis isn’t always pathological

Unusual, psychotic-like symptoms, such as hearing voices, are not as rare among the general population as you might think. For example, it’s estimated that ten per cent of us hear voices that aren’t there, with only a small minority of hearers likely to ever receive a clinical diagnosis. According to a new study, this means that the factors that cause psychotic-like symptoms are likely different from those that lead to a diagnosis of pathological psychosis. Charles Heriot-Maitland and his colleagues argue that this distinction has been missed by the majority of past studies that hunted the causes of psychosis by focusing only on patients, neglecting those who live happily with their psychotic-like experiences.

To make a start rectifying this situation, Heriot-Maitland’s team interviewed six patients with psychosis (recruited via psychosis teams in SE England) and six “healthy” non-patients, who reported similar unusual experiences (recruited via UK networks involved with spiritual or psychic phenomena). Across both groups, these experiences included: receiving visions from God, hearing voices, and feeling that their body had been taken over. Based on their symptoms alone, you couldn’t tell which group a participant belonged to – clinical or non-clinical. The researchers asked all the participants open-ended questions about the circumstances that led to the onset of their unusual experiences, how they felt about them, and how their friends, relatives and other people had responded.

Using a qualitative method called Interpretative Phenomenological Analysis, the researchers looked for emerging themes in the participants’ answers. Both similarities and differences emerged. In both groups, their unusual psychotic experiences had started after a period of negative emotion, most often accompanied by feelings of isolation and deep contemplation about the meaning of life. However, the groups differed in how they responded to and perceived their odd experiences. Members of the non-clinical group had been more aware of non-medical interpretations of their symptoms; they viewed them as transient and desirable; and people close to them shared this non-pathologising perspective. By contrast, the patients encountered invalidating, medical interpretations of their experiences and were themselves less able to accept their experiences and to incorporate them into their personal and social worlds.

From a theoretical point of view, Heriot-Maitland and his colleagues said there was a need for a more precise approach to the study of psychosis, which distinguishes risk factors for psychotic experiences from risk factors for actual clinical vulnerability. “It would seem that the more out-of-the-ordinary experiences are associated with clinical psychosis, the less chance people have of recognising their desirability, transiency, and psychological benefits, and the more chance they have of detrimental clinical consequences.”

The researchers added that this has important clinical implications: “psychotic experiences should be normalised,” they said, “and people with psychosis should be helped to re-connect the meaning of their out-of-the-ordinary experiences with the genuine emotional and existential concerns that preceded them.” They also acknowledged that more studies, including quantitative investigations, are needed to build on this initial work.

ResearchBlogging.orgHeriot-Maitland, C., Knight, M., and Peters, E. (2011). A qualitative comparison of psychotic-like phenomena in clinical and non-clinical populations. British Journal of Clinical Psychology DOI: 10.1111/j.2044-8260.2011.02011.x

Further reading: The British Psychological Society’s response to the planned changes to the DSM – psychiatry’s diagnostic code. In its response the BPS airs its concerns about the over-medicalisation of people’s experiences.

Post written by Christian Jarrett for the BPS Research Digest.

6 thoughts on “Psychosis isn’t always pathological”

  1. Finally someone noticed that. There is a simple problem of human physiology capable of causing these psychotic-like events. ICU Psychosis in hospitals is a similar problem that causes a limited time psychotic episode.

    My wife had a psychotic break when her office was change eliminating Cubicle Level Protection. That's when I discovered this problem I had known most of my life is unknown in mental health services.

    Investigators of temporary psychotic episodes are unaware that designers and engineers found the cause of these psychotic events but did not understand what they discovered.

    They designed the office cubicle to stop the mental breaks they discovered in business offices in 1964. They believe this episode can only happen in an incorrectly designed business office.

    Researchers are struggling to find out why these episodes happen unaware that the problem was solved forty years ago.


  2. I was thinking the same thing myself – however – I would suggest that the problem of psychosis started with the onset of orthodox diagnosis. If you consult psychology literature archives before bedlum came about most people believed ESP to be natural. It only become problematic where the individual is being scapegoated or socially stigmatised for something; or as with the office cubicals, people become psychologically self-conscious and start displaying 'displacement behaviour'.

  3. I slipped into a psychosis in April this year and because I refused medication I was put under a section 2 and hospitalised. Not only did this situation increase my feelings of dread and fear, but also the out-of-the-ordinary experiences hightened. I now carry the stigma of being hospitalised under the mental health act and feel like a social misfit due to the lack of understanding from general joe bloggs. The quatiapine that I was forced to take and still take has numbed most of my positive feelings.I am very self conscious. Before this happened I quite happily listened to what my dead relatives voiced to me and enjoyed the feelings of grandeur that i quite often experienced. Now I am just numb and hear nothing but my own thoughts and have lost an elliment of my faith. I agree with the idea of normalising these experiences, as the stigma can be more damaging than the illness itself in my experience.

  4. Part one—–Don't forget there are two psychosis a real one and a drug induced one, And psychiatry treat them both the same. And have zero success, rehabs and drug clinics gave a 70% success rate in treating drug induced psychosis,enough said on that, Bad heart, bad feelings, equals bad thoughts, I believe, or should i say feel,all thoughts come from feelings in your heart,or did i think that, no one knows that's why there are two schools of thought, but i can tell you either way, in my thinking and my feeling the trouble starts in your heart and goes to you head, if you don't fix your heart you cant fix your head, most people with a bit of insight know this, psychiatry thinks if i throw a bomb in the brain and tell em to sit in the corner, it will fix it all up, sorry boys and girls, your actually making things worse. Anonymous your exactly right but unfortunately the compliant outweigh the non compliant, not in actual numbers per victim, but the industry who feeds off sick that they will always find, its the old what you see is what you get principle,and they the vested sick seeing section have got all the dollars and the numbers at the moment, but don't worry the wheels are turning big time now, society has evolved and peoples awareness is starting to stand up to these tyrants, and really question what constitutes proper care,keep your faith mate, we all end up on the scales don't worry about that,so will they,hearing voices is a lot of different things to a lot of different people, Ive got my own theories on that, a disk jockey with a hand on the volume button, dreams in your wake interfering audibly, driven by unresolved issues or feelings, in images and voices,the standard self voice of reason and encouragement running riot because of unresolved issues,questions,a desperate need to find a peace, who knows really what causes this to happen, but i still believe its feeling based, by people who have higher imaginations than.

  5. part two— the average person, more vivid or realistic, these are moderation and information and practice procedure problems, that may need some temporary medication to ease, whilst the real issues are investigated, and understood to a point at least where the troubled person is able to understand a procedure of thinking and feeling on how to deal with and cope in a better way, where the hearing voice person can turn up or down the volume from a thought or feeling process,feeling thinking acting tools that allow the person to control what they allow to effect them, and how it effects them, knowledge and comfort and belief in the knowledge that they will be OK, and that things are going to be OK,information that helps you cope in healthy helping ways,when the rolercoaster of life is in the down position,I haven't got all the clues or answers either, like the most of us, but i do believe that what psychiatry is doing is wrong, and that what we were doing in the seventies and sixties was psychology based,and was where we were supposed to stay, the love and finding out who we are era,introspection, which has now been stolen by psychiatry, turned into mental illness and used to torture the majority of their victims with the drugs they deal. and the sick they see wherever they look. To me that's whats making society sick. that were all sick.And its the unevolved unaware vulnerable people in society who will be the next victim, and who will swallow whatever these professional con artist sick see errs tell them, including the poison, some of them will even let themselves be plugged in for psychiatric electricity. But between you and me, we know that its these people in particular psychiatry loves, and these people who to some degree help them poison the non compliant. When these people are the same as the victims once were, people who let their concerns build up in their hearts, without seeking to investigate, or find real answers, to help them resolve their concerns, until they fester and become real mind problems the mind cant deal with, because they are feeling based,the answers not in your head its in your heart,not being aware or too scared to look turned what was manageable with proper care into what inst manageable,not until you address the source of the problem, sometimes that can take a poison to settle the thinking down enough for you to access clearly or comfortably enough, the feeling healing process of elimination and addition of knowledge, to be able to change the thinking feeling and behaving that causes concern and trouble in the heart, which messes the thinking ,poison wont fix that, but you, and seeking to find out, learn and change, will.

  6. I had no idea the percentage of people (10%) that hear voices was so high. By that evaluation, that means at least one of the people in my class room here's voices, and strangely they have never said anything about it. Fear of being considered crazy I suspect. Great study.

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