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Identifying Psychosis
Terence Watts
It is sometimes quite difficult to be certain exactly where the dividing line between neurosis and psychosis actually is, and some psychotically ill individuals can be very deceptive, often appearing to be quite intelligent and even superficially charming. It is as wrong to assume that you can recognise an individual with this illness by the appearance or demeanour as it is to believe that they are always dangerous.
The term 'Schizophrenia' - probably the most common form of psychosis - actually refers to not one, but a group of psychotic illnesses which often start in adolescence or young adulthood. There tends to be 'attacks' with gaps in between, typically starting at about 15 years old; between attacks the sufferer can seem quite normal, though the frequency of attacks will tend to increase - slowly if their environment is good (stable home, low excitation levels, low 'life-difficulties', supportive relatives, etc.) but faster if not (Homeless, frustration, angry/nagging relatives or companions, stress of any sort).
There can be an inherited predisposition with some individuals - the disorder definitely runs in families. Children who have one schizophrenic parent have TEN TIMES the chance of developing the disorder than if their parent had been 'normal'. During your information gathering, you should always enquire as to the emotional and psychological health of your client's parents. If they tell you that one of them was excessively anything that could be taken to indicate schizophrenia, then explore your client's psyche that much more carefully.
The advice to the GP about diagnosing Schizophrenia is that any one of the symptoms from the first group, below, or two from the second group should have been present most of the time for a period of no less than one month.
Group One
- Thought echo,
- withdrawal,
- insertion or broadcasting
- Delusions of control or passivity
- Delusional perception
- Third person hallucinatory voices
- Persistent bizarre delusions
Group Two
- Persistent hallucinations in any modality
- Thought blocking and disorder
- Neologisms Catatonia Apathy,
- poverty of speech or thought
- Blunting of affect and social withdrawal
The 1992 classification of schizophrenia lists five types: paranoid, hebephrenic, catatonic, residual and simple, with Paranoid Schizophrenia being the most common.
There are around 10,000 new cases of schizophrenia diagnosed every year; the risk of developing it during the course of a lifetime is reported to be in the region of 1 in 100. In its full form it is very obvious but there is a borderline 'grey' area into which many neurotics fit just as easily as potential psychotics, and this is where we have to be careful.
This bears repetition because it is so important: you simply cannot tell whether or not an individual is schizophrenic from the appearance alone; the psychotic often has a very high IQ and will not infrequently be a 'high-flier' of some sort in commerce or industry, or maybe running - or claiming to run - a hugely successful business or two. That, in itself, veers away from the norm and should prompt you to find out more. Obviously, not all successful people are psychotic, nor are all psychotic people successful, but the circumstance of a genuinely intelligent, successful, smartly presented and superficially charming psychotic is far from unknown.
© 2000 Terence Watts
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