What is psychosis?
Psychotic disorders are among the most misunderstood and stigmatized mental health conditions. Media portrayals often sensationalize psychosis by associating it with unpredictable violence or moral deviance – as seen in films like Shutter Island and The Joker. However, the lived experiences of psychosis are far more nuanced and deserving of greater empathy.
Psychosis is more common than most people might think. Globally, approximately 3 in 100 people experience at least one psychotic episode in their lifetime (McGrath et al., 2015). In Singapore, about 2.3% of the adult population has been diagnosed with schizophrenia or other psychotic disorders at some point in their lives (Subramaniam et al., 2021).
Psychosis is a state of disconnection with reality, whereby an individual may struggle to differentiate actual experiences from their altered perceptions. It is not a standalone diagnosis, but a symptom which may stem from various underlying causes. These include primary mental health conditions (e.g., psychotic disorders, bipolar disorder, major depression), neurological or medical conditions (e.g., Alzheimer’s, brain tumours), substance use, psychological trauma, and even sleep deprivation (Arciniegas, 2015; National Health Service [NHS], 2023). People experiencing psychosis are not in control of their perceptions and may struggle to make sense of and cope with what they are going through.
Psychosis symptoms
The experience of psychosis can vary widely between individuals, depending on the type and number of symptoms, as well as their intensity, severity, and duration. But typically, psychosis impairs how an individual perceives reality, thinks, communicates, and behaves (American Psychiatric Association [APA], 2013).
- Hallucinations
- Perceiving things that are not present, often auditory or visual (i.e., hearing or seeing things that are not there), but can also involve taste, smell, or touch.
- Perceiving things that are not present, often auditory or visual (i.e., hearing or seeing things that are not there), but can also involve taste, smell, or touch.
- Delusions
- Strongly held false beliefs not shared by others which persist despite conflicting evidence (e.g., feeling persecuted or believing one has special powers)
- Strongly held false beliefs not shared by others which persist despite conflicting evidence (e.g., feeling persecuted or believing one has special powers)
- Disorganized thinking or speech
- Difficulty thinking logically and clearly, which also affects speaking coherently, staying on topic, and concentrating during conversations
- Difficulty thinking logically and clearly, which also affects speaking coherently, staying on topic, and concentrating during conversations
- Disorganized behaviour
- Unusual or inappropriate behaviour which does not match the context
- Unusual or inappropriate behaviour which does not match the context
- Negative symptoms
- A reduction in normal functioning, such as decreased activities, social interaction, and emotional expression
- A reduction in normal functioning, such as decreased activities, social interaction, and emotional expression
Cognitive models
It is often not just the psychosis symptoms themselves, but the individual’s interpretation of and response to them that contribute most to ongoing distress.
Cognitive models developed by researchers Garety et al. (2001) and Morrison (2001) suggest that when people try to make sense of unusual experiences, they may rely on existing beliefs, jump to quick conclusions, misattribute them to external threats, or perceive them as uncontrollable or threatening. These misattributions can contribute to fear and avoidance, reducing the chances of challenging or disproving these beliefs and reinforcing symptoms and distress over time.
Cultural factors
Given the surreal and disorienting nature of psychosis, cultural factors also play a significant role in shaping how these symptoms are understood and experienced. In many non-Western cultures, hallucinations and delusions may be perceived through spiritual or religious lens – for instance, communication with ancestors, possession by spirits, or divine messages.
Luhrmann’s (2015) interview-based study found that while many participants from India and Ghana endorsed positive or benign relationships with their voices (e.g., as elders offering guidance and spiritual voices serving to protect), all participants from the United States described their voices as violent and hostile.
At the same time, such spiritual or cultural beliefs may prompt individuals to turn to religious leaders or healers instead of seeking professional psychiatric care when needed. Societal stigma surrounding mental health conditions may also contribute to fear of being labeled and feelings of shame, which may discourage help seeking and delay intervention.
Treatment
The earlier psychosis is treated, the better the outcomes. Early treatment shortly following First-Episode Psychosis (FEP) is crucial to reduce the severity, duration, relapse risk and chronic impairment.
The main treatment approach involves:
- Antipsychotic medications – Typically recommended as the first line of treatment to reduce symptoms like delusions and hallucinations
- Therapy – Cognitive Behavioral Therapy for Psychosis (CBTp) helps manage distressing symptoms, develop coping strategies, and achieve personal goals. Family intervention Family interventions aim to enhance communication, strengthen relationships, and support caregivers.
- Case Management and Community Support – Providing personalized coordinated care, practical support, and reintegration into work, school, and social life.
To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.
Conclusion
While psychosis can be frightening, recovery is possible especially with early, compassionate, and person-centered treatment. Supportive communities and informed care can make a lasting difference.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Arciniegas, D. B. (2015). Psychosis. Continuum: Lifelong Learning in Neurology, 21(3, Behavioral Neurology and Neuropsychiatry), 715–736. https://doi.org/10.1212/01.CON.0000466662.89908.e7
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31(2), 189–195. https://doi.org/10.1017/s0033291701003312
Luhrmann, T. M., Padmavati, R., Tharoor, H., & Osei, A. (2015). Differences in voice-hearing experiences of people with psychosis in the U.S.A., India and Ghana: interview-based study. The British Journal of Psychiatry, 206(1), 41–44. https://doi.org/10.1192/bjp.bp.113.139048
McGrath, J. J., Saha, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., … & Kessler, R. C. (2015). Psychotic experiences in the general population: a cross-national analysis based on 31261 respondents from 18 countries. JAMA Psychiatry, 72(7), 697-705. https://doi.org/10.1001/jamapsychiatry.2015.0575
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: An integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(3), 257–276. https://doi.org/10.1017/S1352465801003010
National Health Service. (2023). Psychosis – Overview. https://www.nhs.uk/mental-health/conditions/psychosis/overview/
Subramaniam, M., Abdin, E., Vaingankar, J. A., Sambasivam, R., Zhang, Y. J., Shafie, S., … & Chong, S. A. (2021). Lifetime Prevalence and Correlates of Schizophrenia and Other Psychotic Disorders in Singapore. Frontiers in Psychiatry, 12, 650674. https://doi.org/10.3389/fpsyt.2021.650674