When a person becomes psychotic, what happens to their personality?
It may sound like an odd question, but I would like to hear your response.
My son is not a violent person. He is loving, caring, thoughtful and kind. He is certainly not someone who would smash through a glass patio door and enter a stranger’s house to take a bubble bath. Yet that is exactly what he did when he became delusional.
Where “was” the person whom I love when this happened?
I asked my son this question when he was in the hospital recovering from being bitten by the police dog sent into the house to disable him. He told me that being psychotic was like having an outer body experience. He could see everything that was happening, but it was as if he were watching a Broadway play. He was one of the actors but had no control over the drama that was taking place.
When researching my book, I asked a man with major depression and bipolar disorder what it felt like when he was psychotic. He told me that it was like going from room-to-room in a huge mansion. In one room was a television. That was reality and every once in a while, he would pass through that room and see reality, but for most of the time, he was in other rooms.
Dr. Elyn Saks, whose book The Center Cannot Hold is well-worth reading, described her schizophrenic fueled breakdown as a “living nightmare.”
I’ve heard experts say that forty percent of persons who are in the midst of a psychotic breakdown do not believe there is anything wrong with them. That is why it is inhumane to not step-in and help them regain their sanity. Simply put, they are not responsible for their actions. I’ve heard others claim that although someone may be psychotic, they can still tell when another person is trying to help them or whether or not they are being respected by the people who wish to treat them. In other words, they may be acting strangely, but they still have some sense of what is happening around them.
Is that true? Has that been your experience?
As a rule of law, our society has decided that simply because a person is in the midst of a psychotic break and completely out-of-touch with reality, he/she can be held legally responsible for their actions. The only criteria is whether or not they know the difference between right or wrong — even if their mind is telling them that the police officer talking to them is actually an alien. I think that standard reflects a basic misunderstanding of mental disorders. Am I wrong?
Please tell me: Is a person’s personality simply pushed aside when they become psychotic or is his/her personality intact, just not in control? How much of a role does personality play during a breakdown?
One reason why I have been pondering this question is because I recently toured one of the laboratories at Eli Lilly where researchers are working on a new medication. One of the scientists told me that a person’s life experiences and personality could make a difference when it comes to how a medication may or may not work. I had never thought about how your personality might impact the effectiveness of a medication.
The question that I am posing in this blog might strike some as foolish, but I believe the answer could help us better understand how to best help someone when he/she becomes ill.
Please share your thoughts and experiences.
Thanks for reading!
About the author:
My son is autistic not bipolar or schizophrenic, but he has episodes of agitation and aggression. Most of the time, the episodes are tied to interruption of a compulsion-you are pulling him from a pursuit, a website goes down, or someone insists that he eat this or that or give back this or that. He is non-verbal, so I cannot ask him what occurs, but it is clear that his actions are based on impulsiveness,fixed ideas and fear. I think this is true of mentally ill people also. Right now, the episodes are relatively few and controlled because the enviroment here lends itself to that result.
I think the media doesn’t help with perceptions most of the time. They tend to make “monsters” out of illness because that is an easier sell. But, these conditions aren’t going away and we need so much more understanding as a society. I think you ask a very good question..
Great question. Am going to try to encourage some consumers to answer.
Hi Pete,
Good questions. My son lived with dopamine disorder for many years before taking his own life. His doctors would always comment that they had not experienced a patient that could “go that far out” of reality? his person? and come as far back to who he was prior to the break.
My son often spoke about how hopeless he felt over his inability to have little if any ability to influence his emotions that would affect who he would become – he talked about “personalities parrishing ” and becoming someone else.
He had no insight to his illness and certainly took on other personas when he became manic and psychotic. He would often travel to the city and buy an outfit a Brooks Brothers – This is what he wore to his Guardianship hearing that was held at the psychiatric hospital where he was being held but refusing treatment. He insisted that his millionairre father had hired an attorney to represent his rights to refuse treatment. The judge agreed that he had the right to representation and we would have to reconvene in 2 weeks. His attending physician was middle eastern – my son soon took on an Arab persona and refused to leave his room with out a towel drapped across his face with another wrapped atop his head in a turbin. He arrived in the brooks brothers outfit and the face veil and turbin to the next hearing . The lawyer he insisted was going to represent him did not appear – He brought a pad and paper to the hearing – took notes but never spoke a word. He did ask the judge to have me removed from the hearing.
The next day he had the nurses call me to see if I would bring him dinner from Burger King – which I did . We sat in his room and he insisted that President Bush had wire tapped the grounds keeper at the hospital and at night they would send people to take his sperm to clone people.
Yes, this is why it is inhumane to not step-in and help them regain their sanity. Simply put, they are not responsible for their actions.
He agreed to treatment after refusing for weeks once he was told that he had no choice because I had gained guardianship over his person. He and his doctor sat down discussed a plan and treatment began. 2 weeks after beginning treatment, he took his girlfriend to prom. After his death she and I talked – she was not aware of this hospitalization or the other 6. She had been on vacation with her family during his episode. And obviously he never spoke about these “experiences” where he would take on another personality with no or little insight.
He was there somewhere but did not have control over his person, thoughts, emotions,ect. He knew these delusions would keep him inpaitient so he would isolate and give yes/no answers to the Dr,s and nurses.
His delusions often had bits of reality weaved throughout but the reality existed in thoughts that we so distorted and he had no control over the extremes of his thoughts and personalities. He had no insight while sick but once he was no longer delusional , his insight to what was going on during with no control made him depressed, scared and anxious.
The only criteria is whether or not they know the difference between right or wrong — even if their mind is telling them that the police officer talking to them is actually an alien. I think that standard reflects a basic misunderstanding of mental disorders. Am I wrong? No , Mentally Ill continue to be misunderstood and mistreated .
I’ve heard others claim that although someone may be psychotic, they can still tell when another person is trying to help them or whether or not they are being respected by the people who wish to treat them. In other words, they may be acting strangely, but they still have some sense of what is happening around them.
Well yes my son knew when he was being treated with repect by his providers. He gained a wonderful relationship with a doctor – it was the respect and trust they developed that allowed him to continue and manage his treatment – functioning at a very high level.
Thanks for the invite to share!
My 55 yr. old brother, diagnosed paranoid schizophrenic, late onset age 38, multiple hospitalizations for last 17 yrs.; on Zyprexa — is an unusual case as he had a very successful, normal life until odd symptoms started out of the blue. I get the idea that he “disappears” into another dimension of time and space & somehow, sort of “time travels” i.e., his brain experiences past events as if they’re really happening in this current moment in time; not as we experience a “past memory” but just as if the even was happening for real. We believe this because when he spirals downward toward a psychotic break he often asks about events in his life and when they happened. It’s as if the brain somehow manages to distort the time/space dimension. I no longer tell him that whatever he sees or hears is “not real” because his brain is genuinely seeing/hearing things. I tell him I trust/believe him when he sees or hears something but that I cannot see or hear it and that if he focuses too much on these things he will end up in the hospital.
What I would like to know is: When a patient says that “a voice told them” to do (whatever anti-social act) that the patient has no free will to “resist” that voice inside their head. What is this inability to say “no” to the voice?
After seeing the movie “A Beautiful Mind” about Math-Game Theory Professor John Nash and his schizophrenia, I started to think about how John Nash managed to gain ground and “step outside” his hallucinations. One hallucination he had was of a little girl who followed him around. Nash used his logical brain to deduce that she wasn’t “real” because throughout many years of this hallucination, the little girl never “grew up” and stayed a little girl for many years. His logical part of his brain knew that it was impossible to have a child not grow up physically. Don’t know if this was just written into the Hollywood screenplay or if it really happened to him in real life — but it did get me to try this “technique” on my brother and get his “right brain” to “challenge” is “left brain.”