Psychosis

Psychosis

What Is Psychosis?

Psychosis and the “Insanity Defense”

Resources

Psychosis (sy-KO-sis) is a broad term covering a range of mental illnesses associated with a loss of connection to reality. Illnesses that involve psychosis may severely impair a person’s ability to relate to other people and to perform basic tasks of daily life.

KEYWORDS

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Delusions

Dementia

Hallucinations

Schizophrenia

What Is Psychosis?

“Psychosis” is a medical term used to describe serious mental disorders that cause a person to lose touch with reality. People with psychosis may have delusions*, hallucinations*, or dementia*, they may lose the ability to speak coherently or to understand what others say to them; and their thoughts, feelings, and behaviors may be inappropriate and disconnected from the reality around them without their being aware of the disconnection.

* delusions

(duh-LOO-zhunz) are beliefs that are false and have no basis in reality. People may think, for example, that someone is trying to harm them or that they have great importance, power, wealth, intelligence, or ability.

* hallucinations

(huh-LOO-sinNAY-shunz) are sensory perceptions without a cause in the outside world. People may hear voices or see things that are not really there.

* dementia

(duh-MEN-shuh) is a gradually worsening loss of mental abilities, including memory, language, rational thinking, and judgment.

Disorders associated with psychotic symptoms

In some cases, psychosis lasts only for a few days or weeks (acute or brief psychosis), but sometimes it is a chronic* condition. Some of the disorders associated with psychosis include:

* chronic

(KRAH-nik) means lasting a long time or recurring frequently.

• Schizophrenia (SKIT-zo-free-nee-a) and related conditions, including brief psychotic disorder and schizophreniform (SKIT-zo-fre-ni-form) disorder, which are characterized by hallucinations or delusions and may lead to problems in daily functioning.
• Serious mood disorders, for example major depression or bipolar disorder with psychotic features.
• Alzheimer disease, a progressive disorder that affects the brain, most often in older adults, that usually causes dementia. Alcoholism, which causes many physical problems including liver disease and delirium tremens, a temporary condition involving hallucinations, delusions, fears, sweating, and discomfort, which typically occurs in the first few days after people with alcoholism stop drinking completely.
• Wernicke-Korsakoff syndrome (VER-ni-kee KOR-sa-kof SINdrome), sometimes called Korsakoff’s psychosis, which causes confusion, severe memory loss, and inability to control muscle activity, often resulting from advanced alcoholism or thiamine (a B vitamin) deficiency.
• Seizure disorders, which may temporarily disrupt the electrical patterns in the brain and the thought processes controlled by brain cell activity.
• Postpartum psychosis, a disorder that sometimes affects women who recently have given birth.
• Substance abuse, particularly relating to use of opiates, steroids, and hallucinogens like PCP and LSD.

Treatment

Psychosis is a sign of serious illness, and people with psychosis must be thoroughly evaluated and should receive appopriate medical treatment. Treatment often involves medication and psychotherapy and sometimes requires that a patient be hospitalized.

Medical treatment for people with psychosis has improved greatly in recent years. Safer and more effective medications have been developed. There also have been many reforms to the laws that safeguard the rights and freedoms of people with mental illnesses, so that they no longer can be hospitalized against their will without a fair hearing and legal representation.

Cultural Beliefs About Mental Illness

The fact that definitions of psychosis and mental illness have changed over the years has led to debate about whether mental illness really exists.

The astronomer Galileo Galilei (1564–1642), for example, was considered to be mentally ill because he believed that the earth revolved around the sun during an era in which everyone else in his culture believed the opposite. Galileo’s belief threatened the religious institutions of his day, and he was called before the Inquisition in 1633 and was asked to abandon his belief. When he refused to do so, he was condemned for heresy and held under house arrest for the last nine years of his life. Galileo was not mentally ill. Galileo understood that his culture did not accept his belief, but his personal commitment to scientific reality was more important to him than acceptance by his contemporaries.

British psychiatrist R. D. Laing (1927–1989) believed that mental illness was a form of withdrawal from reality that people chose when they no longer could tolerate situations that other members of their family or society found acceptable. He thought that “mental illness” was a sane response to an insane world. Laing believed that psychiatrists sometimes diagnosed mental illness when the true problems were in fact rebellion and a refusal to live in an unlivable situation. Laing’s publications include Sanity, Madness, and the Family; Self and Others; The Divided Self; and The Politics of Experience.

American psychologist Thomas Szasz (b. 1920) believes that mental illness is a metaphor for thoughts, feelings, and behaviors of which society disapproves. His well-known book The Myth of Mental Illness holds that society uses “mental illness” as a label to control people, forcing them to accept unwanted treatment and hospitalization. Dr. Szasz believes that all medical treatment must be voluntary.

While it is certainly true that medical diagnoses sometimes have been misused for social control, most mental health professionals today do not agree with Laing and Szasz that mental illness is a myth, metaphor, or chosen response. To believe this would be to deny a biological basis for many instances of mental illness and to deny the pain, disorientation, and fear that people with mental illnesses experience.

People with psychosis are seriously ill with medical conditions that affect their thoughts, feelings, and ability to understand reality, sometimes even the reality that they need medical treatment. In fact, many patients later thank those who insisted they receive treatment, because when they recover they recognize that their illness had been affecting their thinking.

Thomas Szasz, author of The Myth of Mental Illness, believes that people should not be hospitalized without consent and that “insanity” should not be used as a defense in courts of law. AP Laserphoto

Psychosis and the “Insanity Defense”

Our legal system rests on the notion of personal responsibility. To find a person guilty of a crime requires proof that the person committed the crime and that he or she can be found blameworthy. When might a person not be found at fault? One clear case where the law allows for a verdict of innocence, even when a crime has been committed, is when the crime was done in self-defense. The other extreme circumstance that might “excuse” a crime often is called the “insanity defense.”;

John Hinckley, Jr., tried to assassinate President Ronald Reagan in 1981. In 1982, a Washington, D.C., jury determined that he was “not guilty by reason of insanity.” Ted Streshinsky/Corbis

Psychosis is a medical term involving illnesses that cause people to lose touch with reality. Insanity is a legal term used to determine whether there are some mental states that limit people’s ability to understand their actions so severely that they cannot be held accountable for those actions. Legal tests for determining sanity during court trials using the insanity defense usually focus on whether the people on trial understood what they were doing when they committed crimes, understood the difference between right and wrong, and were able to control their own behavior.

At present, the legal test for insanity varies from location to location. Some states use the British “M’Naghten Rule,” named after Daniel M’Naghten, who attempted a political assassination in England in 1843. Other states use the American Law Institute (ALI) Test, also called the Model Penal Code. The ALI test was used during the 1982 trial of John Hinckley, Jr., who attempted to assassinate President Ronald Reagan in 1981. When Hinckley was found “not guilty by reason of insanity,” a political backlash occurred, and the U.S. Congress introduced the legal concept of “guilty, but mentally ill.”;

The American Psychiatric Association (APA), the medical group that publishes standards for classifying mental illnesses and supports research about their treatment, does not use the legal term insanity. The APA maintains that psychiatrists may testify in court to help trial participants understand mental illness and psychosis, but that questions of innocence, guilt, and moral responsibility need to be left to judges and juries.

See also

Alcoholism

Alzheimer Disease

Bipolar Disorder

Delusions

Depression

Hallucination

Schizophrenia

Substance Abuse

Resources

Organizations

U.S. National Institute of Mental Health, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. This division of the National Institutes of Health oversees research on mental disorders and provides information for professionals and the public. Telephone 301-443-4513 http://www.nimh.nih.gov

American Psychiatric Association, 1400 K Street NW, Washington, DC 20005. An organization of physicians that publishes the Diagnostic and Statistical Manual of Mental Disorders, a guide to the definitions of various disorders. This group also publishes the Let’s Talk Facts pamphlet series for the public. Telephone 888-357-7924 http://www.psych.org

American Academy of Psychiatry and the Law, P.O. Box 30, One Regency Drive, Bloomfield, CT, 06002-0030. This organization promotes scientific and educational research in how psychiatry is applied to legal issues (forensic psychiatry). Telephone 800-331-1389 http://www.aapl.org

National Alliance for the Mentally Ill, Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201-3042. An information, advocacy, and support organization for people with serious mental illnesses and their families and friends. Telephone 800-950-NAMI or 703-524-7600 http://www.nami.org