The Relationship Between Stigma And Psychosis

Psychosis: Symptoms, stigma, and compassionate care

Psychosis is not currently categorized as a mental illness in and of itself. Instead, it’s a set of symptoms commonly associated with several serious mental health disorders. It’s defined as a mental state characterized by a disconnection from reality that can significantly affect perceptions, emotions, and behavior. Due to the societal stigma around psychosis in many cultures, some people experiencing its symptoms may be hesitant to reach out for help or treatment, which can lead to additional negative health outcomes. Here, we’ll elaborate on the symptoms of psychosis, discuss the potential repercussions of psychosis-related stigma, and share recommendations for obtaining compassionate treatment.

Key symptoms, avoidance, and warning signs of psychosis

Avoidance behaviors, such as social withdrawal, often occur alongside key symptoms and early warning signs of psychosis. The primary symptoms of psychosis include the following:

• Hallucinations, or sensory perceptions that do not actually exist (e.g., hearing voices no one else can hear)
• Delusions, or belief systems that are not grounded in reality (e.g., believing other people can read one’s thoughts)
• Disorganized thinking, which can result in jumbled speech and an inability to navigate social interactions

Early warning signs of psychosis and mental illness

The National Institute of Mental Health (NIMH) notes that a person is likely to display certain early warning signs before developing clinical symptoms of psychosis. Learning to recognize them can help you know when to seek support if you or a loved one were to experience them. Some of the warning signs the NIMH lists include feelings of suspicion and paranoia, social withdrawal, a lack of feeling, unusual or intense ideas, a decrease in personal hygiene, sleep disturbances, and general difficulties with daily functioning, managing emotions, and separating fantasy from reality. 

The connection between psychosis and mental illness

There are various reasons a person may experience symptoms of psychosis. Genetics are thought to play a role in an individual’s risk of developing a symptom like this, as are differences in brain chemistry or structure. Past experiences of trauma can also increase the risk of psychosis. An individual could experience symptoms once as part of a single episode or more than once as part of a longer-term mental illness of which psychosis is a symptom. 

Signs associated with psychosis

A single psychotic episode or longer-term signs of psychosis as a symptom can be associated with a number of different illnesses. Some examples include:

• Schizophrenia, a relatively rare mental illness that commonly presents as psychosis, among other symptoms
• Major depressive disorder, which can present with psychosis in rarer cases
• Postpartum depression, which is thought to present with psychosis in one or two of every 1,000 cases
• Bipolar disorder, which is reported to include symptoms of psychosis in over half of cases
• Various medical conditions such as dementia, traumatic brain injuries, HIV/AIDS, multiple sclerosis, lupus, and Huntington’s disease, though not in every instance

Stress and substance-induced psychosis

Although it’s rare, symptoms of psychosis can also occur in isolation following a severely stressful event, such as the traumatic loss of a close loved one. Some substances can induce psychotic symptoms as well, including certain prescription medications and street drugs like methamphetamine. Note also that a psychotic episode could be triggered in someone who is at increased risk for psychosis or who has a history of psychosis as a result of stress, trauma, and even sleep deprivation. That’s why stress management and healthy lifestyle habits are typically components of long-term treatment for certain mental illnesses like schizophrenia.

Mental health, stigma and psychosis

The American Psychological Association (APA) defines stigma as “the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency” and which “implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual.” Stigma persists around mental health treatment, mental health services, and people with a mental illness—particularly more severe mental illnesses like those that can cause significant behavioral changes and symptoms, as with psychosis. People facing stigma due to negative attitudes about mental health conditions may experience effects such as:

Feeling ashamed or unwilling to talk about the condition

People may feel ashamed or avoid discussing their condition, thinking it isn’t real, it’s their fault, or it’s incurable, which can prevent them from seeking treatment.

Self-doubt and low self-esteem

Stigma can lead to self-doubt and low self-esteem as a result of bullying, harassment, and/or ostracism.

Increased risk of unemployment for those with mental illnesses

Those facing mental health stigma are at a higher risk of unemployment.

Difficulty finding insurance coverage

People may struggle to find insurance coverage for mental health care and psychiatric medications.

Negative interactions with mental health services due to stigma and psychosis

Experiencing negative interactions with healthcare providers, often due to stigma related to psychosis, may reduce the chances of recovery.

Disconnection from friends and family due to avoidance

Individuals may disconnect from friends and family members who may not understand the situation and/or may make insensitive comments

Exacerbated symptoms or development of new ones

Stigma can worsen existing mental health symptoms or lead to new conditions, such as anxiety and depression.

Engagement in self-sabotaging behaviors

Some individuals may engage in self-sabotaging behaviors, such as self-harm, as a way to cope or protect themselves.

How common language around psychosis may perpetuate stigma

Negative associations with the word “psychosis” can contribute to the stigma around this symptom. The term “psychosis,” and particularly the adjective form of the word, “psychotic,” can be associated and even confused with the words “psycho” and “psychopath.” The word “psycho” is a derogatory term often used to describe someone who behaves erratically or has difficulty controlling their emotions. Today, it is not considered a valid or appropriate term to use—especially in the context of mental illnesses or mental illness treatment. It can be offensive, harmful, and may further contribute to mental health stigma.

The word “psychopath,” like “psycho,” is colloquially used in a derogatory manner. It is important to note that the term “psychopath” does have a history of clinical use in mental health care, as it was once used to describe people with antisocial personality disorder who can lack empathy or regard for others as a symptom. However, the term’s use in that context is now considered outdated and offensive. 

Seeking support for mental illnesses, health services, and stigma

Seeking the support of a mental health professional immediately is recommended if you’re experiencing warning signs or symptoms of psychosis. While both in-person and online therapy are viable options for receiving mental health care in many cases, in-person care should be sought for symptoms like psychosis. 

While violent behavior is less common in individuals with serious mental illnesses than media and popular beliefs would indicate (and often more closely tied to their environment rather than their illness), it is possible for someone with psychosis to engage in violent or harmful behaviors toward themselves or others. That’s one reason why seeking in-person care right away for such symptoms is important, in addition to the fact that psychosis can simply be a distressing symptom to experience and that a professional can help.

That said, someone who is in regular contact with an established, in-person care team for a mental illness that has manifested as psychosis in the past may benefit from meeting with a therapist as well. They can allow you a safe space to express your emotions and help you continue working on tools for managing difficult feelings and symptoms. Online therapy may be particularly appealing to someone who is affected by stigma related to psychosis, other symptoms, or mental health care in general. You can engage in this type of treatment from home or anywhere else you have an internet connection, which makes many people feel more comfortable. Research suggests that this format can be associated with “a significant reduction in public stigmatization” of mental health care and can provide similar health outcomes to in-person therapy.

Seeking support for any mental illness, not just psychosis, is crucial. Addressing stigma and obtaining appropriate health services can help individuals get the care they need.