Psychosis is often a legitimate and common driver of fear for those who experience it as well as those caring for them. For some, psychosis can appear suddenly; for others, it comes on over a longer duration. Regardless, it rarely fails to catch people by surprise, especially when you are not prepared or are still coming to terms with it. Thankfully, there are things that you can do as a caregiver that can make it a little less stressful. Bear in mind, psychosis is a very stressful experience for all involved, but the distress can typically be mitigated through certain actions and behaviours. So, what are the do’s and don’ts when you are handling a psychotic episode?
Firstly, remain as calm as possible – getting all flustered about what is going on will not help the situation and it can even exacerbate it. As I often tell myself “don’t lose your shit!”. No matter how intense or bizarre the situation may become, do not freak out. You know the saying that dogs can smell fear? I find people are the same in that we can pick up on each other’s emotional state through mediums like body language. Let me give an example. Say somebody walks into the room stomping their feet and clenching their fists with a look that could kill. They seem angry right? I can only speak for myself, but I would pick up on that, might even get uncomfortable. So, with that example in mind, how do you think somebody in psychosis would react when they pick up on your tension and stress? I have seen from my own experience that giving off the wrong emotional vibe can make a tense episode plummet into a tailspin. It can be extremely stressful, but don’t worry – there’s time once things are a little more calmed down, once the situation is under control, where you can let the stress out.
Secondly, you may find it helpful to focus on the task at hand. Try not to worry about all the concerns that may arise after your loved one is stabilized. In fact, I will make it even more simple, because I believe in the K.I.S.S. principle (keep it simple stupid). You have two jobs: keep the situation as under control as can be expected, and do the best you can. It would be folly to think that things won’t go wrong, or that you won’t make mistakes, because hey, we are only human, we can’t be perfect all the time. It’s okay to make mistakes and fudge up in a situation like psychosis, it happens, but we must learn from our mistakes so that we can be ready for the next episode. Anyway, back to the main topic, (can’t believe I just got off topic when the topic is to focus) when an episode strikes, the only time that matters is the moment you’re in. The past is not important, and the future is a long way off. Your focus should be on keeping the situation relatively under control and getting any necessary assistance such as an ambulance or crisis team. Alright, onto the next tip.
Third, eliminate any distractions. This could mean turning the tv off, turning down the radio, or politely asking anybody who does not need to be there to leave. When somebody is in psychosis, there is so much going on for them that they can have a really difficult time sifting through what is real and what is not. So, having a tv blaring or having somebody talking that shouldn’t be in the room, that only adds to the cacophony of sensory overload that the person is going through. In short, remember the K.I.S.S. principle.
Lastly, as a little tip that I have used extensively, this one is a life saver when done properly. Try to help the person in psychosis to remain anchored in reality. You can do this by talking to them, trying to keep them calm, and by showing through your emotion and body language that it will pass. When talking to a person in psychosis it is important to be clear and to the point, without raising your voice any more than necessary. While it may feel nearly impossible, it is critical that you try to remain confident and try to instill a sense of security for your loved one. You must be strong in this moment, because they are busy fighting their own struggles, so to say they are vulnerable would be an understatement. Keeping them anchored in reality is vital, as it can sometimes help them to know that there is somebody who loves them and is there with them.
One of the biggest no-no’s is ridiculing or being critical of what your loved one is experiencing. It is important to keep in mind, what they are perceiving as real, is not any less real than you or I. I have heard that it is like dreaming when you are awake. The point is that it feels real, and now is not the time to be condemning a loved one over something that they have as much control over as a person and their skin colour. This one may seem obvious, but many people make this mistake in the heat of the moment.
Similar to the first item in the “Do’s”, do not freak out. When somebody is in an episode it is important that somebody takes charge and tries to keep the situation from escalating, and that can’t happen if everybody is getting stressed out can it? I am not saying that you can’t feel fear, or concern, or any other emotion. What I am saying is that you have to try to keep your own emotions in check and not let them make the decisions for you. It sure as hell is not easy, but it is easier than trying to pick up the pieces after the situation has escalated.
Finally, do not lose hope. It is often in the aftermath of an episode that despair really comes into play. When you get a moment to think and process what has just happened, then all the emotions and fears tend to hit you like a ton of bricks. Try to remember though not to lose sight of hope. Hope is the torch that illuminates dark roads of mental illness. Being in the dark sucks, trust me. So, take hold of that torch and let it burn all the brighter in that night! I know this all sounds corny, but if it wasn’t for hope, I likely wouldn’t be able to manage my life too well. Hold onto hope, no matter what.
Psychosis, at least with regards to schizophrenia, is often when symptoms flare up to a level that is unmanageable in the moment. Psychotic episodes are typically dominated by hallucinations and delusions. In general, it is often described as losing touch with reality, not being able to tell what is real and what is not. As a caregiver it can be terrifying to witness a loved one go through this, only being able to imagine what they must be going through. Thankfully, psychosis usually is episodic in nature and as such is not always present. I hope that with this article I have been able to share some of the things I have learned the hard way with you.