Psychotic thoughts and paranoid delusions are part of the bipolar psychosis experience. Read more on why bipolar psychosis is so scary to those who suffer from it.
I think it's easier to understand and accept euphoric psychosis than dysphoric psychosis. We all desire the feeling that we are perfect and invincible. A sense of profound well-being is craved by so many of us with bipolar disorder. But when it comes to dysphoric psychosis, the feelings are so uncomfortable and the thoughts and images so awful, it's just downright scary. Psychosis can make a person think the most awful, disgusting, shameful and embarrassing sexual, racial and violent thoughts. As terrible as this is, it's normal.
When I get psychotic, I see myself burning alive over a raging fire in a bottomless cave filled with bats.
My psychosis is so scary. I am sure people are following me so that they can kill me. I feel the world is out to get me- and I mean that literally. I am scared of everyone. I hear voices chattering in my head from people who are going to kill me. I feel like there is a gun on me at every location. I almost throw up with fear.
My body is so uncomfortable when I'm psychotic I feel like I'm literally going to explode from the inside.
I thought of raping every woman I saw. I visualized it. I was just well enough at first to be unbelievably ashamed and truly mortified by my thoughts. They were not me. I thought the people around me could hear them. When I got really sick, the thoughts were so much worse. I never acted on them, but I thought them and said them out loud- thank god I was alone when I did.
I said terribly racist things to the staff at the hospital depending on their ethnicity.
Paranoid Delusions: They Want to Kill Me
I spent quite a while talking with board certified neuropsychologist and co-author of my books, John Preston, Psy.D., about this topic. I think his words explain it the best:
"Paranoid delusions are a huge part of psychosis. With this delusion, the thoughts and experiences are all about feeling vulnerable and out-of-control. People, in this state, fear getting hurt to an unrealistic degree. They may think that people are spying on them in order to kill them. People with depression can suffer horribly, but it's an internal feeling of worthlessness and hopelessness. This is scary, but not to the point of truly feeling persecuted such as when a person says, 'Satan is going to poison me and everyone I know because I'm a horrible person.' So yes, bipolar psychosis can be mean and scary to many people and it's due to these feelings of persecution and fear of society."
Other psychotic episodes involve a complete change in the way a person thinks, talks and behaves. Such as being derogatory towards women when you have always been extremely respectful or saying something extremely hurtful to the person you love. This can also been seen when a person makes extremely suggestive sexual comments in front of their family members or coworkers.
As I mentioned at the beginning of the article, my partner Ivan went through a very long and serious manic psychotic episode in 1994. I wrote about his behavior and what he said every day when I got home from the psych ward. Now that you have quite a background in psychosis, you will probably be able to see all of the different symptoms present in the following examples from my journals.
April 30, 1994
He's worse today. Worse. I guess I prepared myself, but it's never enough. Ivan is in his hospital bed. He just looked at me and said, "Nice body!" We had this conversation:
"Julie, they need to stop the Nazi machine." I said, "There is no Nazi machine, Ivan." He winks at me and I wink back. He says, "Do you know what perjury means?" I say, "No. What does it mean." I want to see what he says. He replies, "Just wait a minute. Let me eat my salad." He leans over to shake my hand in a very serious way. He says, "No one needs to shake my hand behind my back. Perjury means when you swear something you do not believe."
Though it was 15 years ago, I remember being in the hospital when Ivan talked this way. The person I knew was basically gone and this person who said these crazy and amazing things was there for months. This is an example of the more euphoric mania side of his psychosis, as he was smiling and seemed pretty happy when he did all of this. When he had the dysphoric mania, he was very, very concerned for my health and believed that people were out to kill me:
I'm at the hospital in Ivan's room. When I got back from the bathroom, Ivan said, "Baby, did they torture you?" He's very, very suspicious. He said, "I feel scary." I said, "Do you mean scary or scared?" He said, "Both." He wants to read what I'm writing. He's about the same as yesterday. He is sitting cross-legged on the bed. His hair looks pretty and he looks handsome. He's very paranoid. He said," Did you see a man called Ross Perot?"
These days were harder as he was so incredibly suspicious and looked at me in a scary way. At one point, he took his pajama top and wrapped it around his head like a turban. He believed he was Jesus Christ. When he was better, I asked him what he was thinking at the time:
I remember that I was Jesus Christ. I did not want to see the misery inflicted on the world so I put my pajama top over my eyes. I thought that I was responsible for the death of many people. For the things I said. A lot of people shot themselves. I moved the fabric back on my head because I was tired of not being able to see.
Psychosis and Culture
Ivan was often very funny during euphoric phases in the hospital and the things he said were beyond anything I had ever experienced in my life- but he was truly distraught most of the time. If you or someone you care about has been in a full-blown manic psychotic state, this may sound quite familiar! This is why I always tell people that psychosis is an illness and nothing personal. In fact, all psychotic behavior is the same; it's simply the context that is different. This is almost always based on the culture of the person who is psychotic.
Dr. Preston puts it this way:
"Psychotic symptoms are the result of abnormal neurochemistry, but the content of hallucinations and delusions incorporate figures and themes such as Jesus or Chairman Mao that are understood in a cultural context. For example, a person in Saudi Arabia may have delusions about Mohammed. People often draw from images of power and authority whether they are euphoric or dysphoric. Euphoric visions of grandeur could be about Napoleon or the president or even a famous movie actor. I remember for awhile after Elvis died that for about five years people thought they were Elvis or that Elvis spoke to them, but then that ended. Jesus, of course, has been a constant. I guess how enduring a person is as a character in a delusion is a testament to the impact they had on the world."
Interestingly, when Ivan was psychotic, he constantly mentioned Freemasons. I had never heard him say the word before, much less obsess about it. When his psychosis was over, we were both fascinated. He was born in Scotland, the origination of the Freemasons. His culture was deeply ingrained and the psychosis brought it out in an odd way.
Hopefully, you now feel more confident about the topic of psychosis! The next section covers the origins of psychosis and the information you will need to understand the medications used to treat psychosis.