Psychosis represents a spectrum of disorders with many different etiologies or origins. People are most familiar with the term schizophrenia, but schizophrenia is probably going to turn out to be an umbrella diagnosis for many different conditions. People can be psychotic for all kinds of reasons, in the wake of substance abuse, for example, or because of schizophrenia. People who are bipolar can become psychotic, and so can people with various degenerative disorders. The interaction between biological and genetic vulnerabilities with family and cultural factors is known to be complex. At the Austen Riggs Center we appreciate the complexity of the etiology and treatment of psychosis, providing an integrative treatment approach using psychotherapy, family therapy, and medication along with intensive social engagement through the Therapeutic Community Program.
I love working with these patients even though it’s heartbreaking sometimes. These are human beings at risk of becoming society’s throwaways. They’re often shuffled from one drug trial or one symptom management situation to another. And mental health professionals struggle to treat these people, because they can make you intensely uncomfortable. Patients with symptoms of psychosis can be oppositional and very negativistic. Imagine how painful it might feel to be isolated in a world of private belief without understanding others or feeling understood by them. In therapy, there may be long silences as patients struggle to put difficult thoughts and feelings into words. For most people there’s a longing for dignity and a wish to be respected. Patients want to find a place where they don’t feel exposed, ashamed, and humiliated. And often, patients are just grief stricken, asking, “Why me?” Often, on the surface, there may be delusions of grandeur, feelings of being omnipotent, of knowing better than everyone. But when that is stripped away, there’s a profound grief. We have many patients who are insightful and say ‘I would rather be crazy than face the sadness I have to face in my life,’ with so many relationships lost, so many opportunities lost, and people who think their future is lost. This is why it’s vital to get people into treatment as early as possible.
- Dr. Jane Tillman, psychologist and team leader