The 101 On How To Talk To Someone Experiencing Psychosis

Do you know someone struggling with psychosis?

I doubt anyone thinks they or someone they know will experience psychosis in their lifetime. After all, the lifetime prevalence of all psychotic disorders is only roughly 3.06%. Families and friends often have no idea how to help or what to do when their loved one shows the signs. When people ask for my advice, this is what I tell them:

1.  Know the signs that a psychosis is developing:

  • anxiety, depression or irritability;
  • suspicion, hostility or fearfulness;
  • difficulty sleeping, or unusual waking hours;
  • appetite changes;
  • loss of energy, motivation and interest, or hyperactivity, or alternating between the two;
  • concentration or memory problems;
  • preoccupation with certain ideas (about, say, religion, angels, God);
  • social withdrawal – not wanting to spend time with friends and family members;
  • cognitive problems such as racing thoughts or slowed-down thoughts;
  • difficulty meeting responsibilities such as work or study;
  • deterioration in self-care and personal hygiene;
  • appearing perplexed;
  • changes in personality.
  • **A loved one shows several of these signs without them going away fairly soon, or these symptoms become more pronounced over time

2. Seek clarity and assistance from a mental healthcare specialist regarding these symptoms.

3. Remember that what the person is experiencing is real to them. Many times when someone experiences a break from reality, they may be unaware that anything is wrong. It won’t help to insist to them that the voices, sounds, or situations are all in their head. Arguing with them will only discourage them from confiding in you.

4. Do not criticize, shame, or blame them for their illness. This disease happened to them. They are a victim. You can help them recover and survive it.

5. Express curiosity about their experience and validate their feelings of fear, worry, and discomfort.

6. Express empathy. Consider how helpless and confused they are, especially if everything they have tried has failed to reduce the hallucinations, worries, and troubling perceptions.

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7. If possible, try and minimize the stress in their lives. Stress can exacerbate their psychosis.

8. Recognize that persons experiencing psychosis are at higher risk of depression and death by suicide– nearly 12 times that of the general population! Suicidal thoughts and gestures should be taken very, very seriously. Consider their level of frustration, anger, self-blame, and discouragement. Even if your loved one would feel betrayed or upset, your duty is to keep them safe above all. Talk to a medical/mental health professional about your concern immediately. **Here is a critical resource to help you make sure you ask your loved ones the important questions.

8. Things that you might want to say when finding out about suicidal plans include:  

It sounds like you’re really suffering and trying to get some relief. I care about you and I think it might be a good idea to talk things over with your doctor.”

“I would like to help you, however, you need to tell me how I can best go about this.”

“I can’t keep your suicide plan to myself. I would like to arrange for us to go and see a doctor together.”

9. Recognize you may be the only friend they have. Invite them to small gatherings and help them stay active rather than isolated. But do not force them to do so.

10. Most experts say to avoid encouraging the person’s misbeliefs, but they also advise against directly confronting them. One alternative is to focus your response on their emotions and say, ‘I can understand how you’d feel misunderstood and confused about why people don’t believe you.’

11. Focus your communication with the person on consulting a doctor and getting treatment, whether that be medication, connecting with a social worker, attending a support group, or all of the above. Prioritize helping them cope with their stress, hallucinations, sleeplessness, anxiety, isolation, suicidal thoughts, and depression. And always prioritize their safety over them joining your reality.

12. Don’t forget to take care of yourself! Talk to someone who can help you deal with the stress of caring for someone will a severe mental illness.

Friends, I hope you never need this advice! But if you do, I’m sending extra love, compassion, and much hope for experiences of healing in your lives!
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