Psychotic experiences – what is reality anyway?

It may seem a bit strange, but we believe that it goes to the heart of what makes psychotic experiences so troubling for those who have them and for those who don't. We have had the same conversation many times with many patients. If patients come to see a clinical psy­chologist, they usually believe, in some sense, that they have a problem. Often they may go further and say that they have some sort of illness. However, asked about the reality of their experi­ences, for example the voices they hear or the strange ideas they have, they will reply, 'They're real.' Imagine for example a man who hears the voices of criminals threatening him, saying that they are going to kidnap him, torture him and finally kill him, and that perhaps they are going to do the same thing to his fam­ily. To have such experiences, and to believe the threat is real, must be terrifying. One might well think, 'Wouldn't a person prefer to believe that these voices are in his or her own head? After all, that would remove the threat.' But in our experience, most people with such experiences do not find such ideas either comforting or acceptable; their answer is, 'It's real.' Why might this be?

As you read these words, you are probably sitting on a chair in a room. Imagine that someone came to you and told you that you were not in a room at all, that you were really floating on an iceberg in the middle of the Arctic Ocean? You would undoubtedly think that this was a ridiculous idea. If a doctor, especially one you did not know very well, told you this, and told you further that you needed to take some medi­cation because you thought you were sitting in a chair, you would certainly believe him to be incompetent. Even if all your friends and family swore that this was the case, you would be bound to continue to doubt it. Most people who hear voices describe their experience of those voices as being as real as the chair you are sitting in.


But how can a voice be real if there is no one speaking?

This might seem to some people a watertight argument, but not everyone would agree. Many people believe that alien forces  talk to people. People from some parts of the world have been taught from their youth that some people have magical powers, pow­ers called, for example, voodoo or obeah (magical spell or a curse from God): perhaps these voices have a supernatural cause. We also know that modern science is advancing all the time, and that governments and secret services may have access to technologies of which the rest of us have not heard. Perhaps these ideas might seem far-fetched to you, but we also know that the idea of a powerful electronic computer that can sit in the palm of your hand and yet gather information from around the world would have seemed pretty far-fetched as little as twenty years ago.

The point of this discussion is that most of us are seldom, if ever, asked to question the reality of our own experiences. We may disagree about things like politics or current events, but we agree with others about what is real and what is not, and we do not usually have experiences that others find strange or unbeliev­able. Even if we might have had fleeting experiences which might have been strange or unusual, they will not have been sufficiently intense or frequent to impact on the routine of our daily lives.

Often groups of people with unusual beliefs gather into small groups so that they can reinforce one another’s beliefs. For example, unusual experiences, such as suddenly falling into a fit, are accepted as normal and viewed as evidence of powerful spiritual experience. Outsiders might find this ‘mad’, but for the members of the community, this is normal and acceptable. And indeed, they are enti­tled to say to outsiders, ‘You have never had these experiences, so you are not in a position to judge them. And you certainly can’t produce any evidence that they are not real. Some things cannot be tested or proved sci­entifically. In that sense, someone suffering from schizophrenia or another psychotic disorder is like a member of a group; he or she has unusual experiences of great personal signifi­cance but has no one to share them with.

One point about these experiences remains to be looked at: while most religious people find their beliefs comforting and encouraging, many psychotic experiences are deeply unpleasant, demoralizing and frightening. We will talk more about these experiences and the kind of suffering they can cause. Even though many of them are so unpleasant, many sufferers continue to believe that they are real, and some sufferers also find value in positive aspects of their experiences. In any event, they are often not helped by being told that what they experience is not real. As therapists, we tend to avoid arguing with patients: we cannot tell them what they are experiencing, and, whatever we think of the causes of these experiences, we have to accept that, at least to the sufferer, they are real. Instead, we try to focus on finding ways of reducing distress, as well as helping the sufferer to understand that the experiences may be real to them, but are not real to most people.  Perhaps the most helpful stance is to ‘agree to differ’.  It is also worth acknowledging at this point that for many people the key issue is not so much the experience of hearing voices or unusual beliefs: it is often the interpretation of these experiences and the fear or distress it can cause which has the most profound effects on people’s lives.


Help is available

The most important point is this: a great deal of help is available. Today a diagnosis of schizophrenia does not mean a lifetime of disability. There are now a wide variety of treatments, including medical, psychological and psy­chosocial approaches, and new treatments continue to be devel­oped. We also know that with almost, maintaining a positive attitude is very important, so a major goal is to reinforce a sense of hope and optimism in sufferers and their caregivers.

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