When Psychotic Doesn’t Mean Illogical

“The delusional theories she comes to do not hatch from nothing, but from a mind actively trying to figure out why solid objects suddenly seem less than fully tangible, why people appear distant and small, why time temporarily shifts and becomes disarticulated into unconnected moments. Her odd worldviews and theories about reality do not create the delusions but rather arise from an attempt to impose sense on the increasingly nonsensical.”
– From “Slipping into psychosis: living in the prodrome (part 1)” by Greg Downey in the PLOS blog Neuroanthropology.

I realize, and celebrate, the fact that mental illnesses of many stripes are far less stigmatized than in the past, but “less stigmatized” is a humble concept that certainly does not extend to all. For many of us who — how else to put this — struggle with reality, it’s all too easy to think of hallucinations and delusions and the many subtler shades of psychosis as symptoms of having mentally failed or being (simpler still) weak, weird, or stupid.

And unfortunately, it’s all too easy to bump into insular Internet thugs happy to agree.

The point the Neuroanthropology article makes is a tremendous one: that what’s true for mental illness broadly is true for psychosis as well — most people affected by it are reacting normally to abnormal circumstances. In this case, the abnormal circumstances just occur on the inside.

This is a better version of a thought I’ve attempted to articulate in the past, that being psychotic doesn’t necessarily imply deep-seated illogic; in fact, as this article points out, an effort to explain irregular sensory experiences that seem to come, sometimes literally, from outer space, can easily result in convincing delusions. In other words, delusions can be the brain’s frantic scramble to make something logical out of highly abnormal sensory input.

It bothers me to hear people insinuate that problems like this would vanish if the sufferer was stronger or had a more logical operating philosophy. Strength is a fishy notion to begin with, too often associated with grinning and bearing it — or pushing past a reasonable personal boundary. The more experienced I become, the more I think strength is an empty litmus for personal worth.

Philosophy is important. Clearly. Ideas may not make the world go ’round but they enable us to keep up with its revolutions.

But to elevate philosophy over psychology in areas of mental illness can lead to problems.

I’ve heard more than a few people in tight-knit philosophical circles expressing their confidence that mental illness would be fixed, or prevented, by correctly understanding reality and living by values that naturally proceed from that understanding. As somebody who genuinely believes my own condition was made worse by dogmatic religiosity, I can appreciate that view — to a point.

If bad logic can make a disorder worse, it stands to reason that good logic could heal it, right? To that, I would say “in some cases” with a HUGE caveat: that when it comes to mental illness, logic itself is a specialized field. Logic-ing your way through the chaff is what cognitive behavioral therapy is all about, but that doesn’t mean that getting better involves focusing hard on external, objective reality while ignoring your internal signals.

Image by Stefan Keller from Pixabay

At one point, in therapy with my excellent doctor, I became convinced that life was literally a dream. Yes, I had recently watched Inception. Yes, movies like that get to me. No, I’ll never ever rewatch The Matrix.

Though “convinced” may not be the right word. In fact, I was telling my doctor that I knew exactly how illogical it sounded. I knew it seemed like a belief my condition was capable of whipping up, but that knowledge could not compete with the overwhelming alienated sensation I kept feeling, the haziness that would descend on me as I considered parts of my life that had seemed ordinary days before. If you can imagine the feeling of deja vu lasting for hours, that’s approximately how I felt.

I was receiving treatment at the time for my schizoaffective disorder. This is a condition that has features of both schizophrenia and bipolar disorder, and in my case, the schizophrenic symptoms are much more evident. I once heard schizophrenia, its psychotic elements specifically, explained as a condition of being extremely “porous,” and it’s a description I strongly related to.

For me personally, psychosis has meant feeling that I had no protective barrier between me and my environment, and it registered at times in the very way I perceived my body. The feeling of metaphorically “having no skin” preceded the impression that my body was so malleable it might change forms — I might suddenly be an entirely different person, which on a few occasions, I believed I was.

If you take this at face value — if these strange sensations were the extreme endpoint of illogical thinking — then I should have been able to correct them when I accepted how illogical they were. However, for years I have known some of the ideas and sensations that got hold of me were fallacious and, in fact, never would have shared these experiences with others because I knew they would be heard as the rantings of a lunatic.

Wholeheartedly believing in every bad idea that scuttles through your mind is not step one of the path that leads to psychosis.

When I shared my feeling that the world was a dream with my therapist, I was afraid. I was afraid because I knew how persuasive that extended deja vu sensation could be, and I didn’t want it luring me into not simply bad but irreversible decisions.

My doctor initially tried combating it with a focus on objective reality, but she changed tactics when she hit a wall: to an extent, my logic was now subcontracting for the delusion, offering explanations for how the normal sleep-and-wake cycle fit within the larger dream of life, for the continuity experienced in waking life, etc. My “regular logic” was still in there — and begging a professional for help — but the delusion was just to powerful. Or, to put it in other words, the symptoms of my medical conditions were peaking; rolling my eyes at them wasn’t going to make them go away.

My doctor surprised me by not only changing her tactics but telling me to do the same. “Stop pushing against it,” she advised. “In a way, that’s only making it more defensive, and stronger.”

“But what can I do?”

“You can work with it. Let it have its way for now. If your life is a dream, can you accept that it’s still important? Is the fact that, whatever it is, it’s long and continuous enough for you to accept that what you do still matters?”

“ . . . I think so. Yes.”

“Then — for now — that’s our solution.”

By the next time I saw her, my symptoms were back to a lower tide, and the two of us could actually laugh about it.

In treating my symptoms themselves as elements of the reality I had to deal with — and in working with, rather than against, my brain’s attempt to provide a logical explanation for the weird sensations I was having — she helped me to relax, to subtract my anxiety from an already jumbled equation. This helped to disempower the delusion altogether, meaning that I could more quickly return to normal.

I’m fortunate that I’ve finally found the right combination of medicine to help bring my symptoms under control. Anymore, it’s hard to even fathom how some of the more intense delusions arose, but I can remember them vividly, and I have a great deal of sympathy for those still struggling with them.

Mental illness in its many varieties is a bear to contend with, and those affected by psychotic disorders have a very real struggle, against very real symptoms. We can be challenging, but we can also be creative and colorful. What we’re not is weak, weird, or stupid — or illogical.

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