Psychosis Or Personality?
When it comes to understanding psychiatric patients, many times it can prove to be quite a challenge; their behaviors leave you scratching your head, “is it their psychosis or are they just being oppositional?” Sometimes it’s fairly obvious that a patient is so psychotic that their behavior suffers as a consequence. But then there are times when it’s hard to tell whether their improved psychotic symptoms are still contributing to their behavior, or they are being oppositional.
Patients have many reasons for being oppositional:
- They don’t like the psychiatrist or the treatment team
- They don’t believe that they have a mental illness
- They don’t like taking medications
- It’s simply their personality
- They’re angry at the world and are taking it out on the treatment team
. . . and the list goes on. Sometimes you’ll never understand a psychiatric patient’s behavior. And many times, you will never be able to discern between psychosis and personality, because they’re often intermixed. This is when the field of psychiatry becomes challenging and even frustrating for many clinicians.
It’s like a child or significant other who starts changing their behavior in a negative manner; they leave you wondering at what point did something go wrong! And you continue to gently probe and offer your assistance and guidance, only to be shut down with resistance and oppositional behavior.
Becoming frustrated in the field of psychiatry comes with the job, but the frustration must always be concealed from the patient and dealt with privately. Showing a patient that you are frustrated will influence the therapeutic alliance, almost always in a negative, counterproductive and potentially destructive way.
The solution is patience, dedication and professionalism. You will not always understand the behavior of a patient and that’s okay! As long as you continue working with them in a safe, professional, caring and compassionate fashion, then that’s what matters most! Psychiatric patients have a very good eye for being able to tell which clinicians are kind, honest and caring, and which are in it for other reasons.
The stigma that revolves around “he’s crazy” or “she has lost it” is something that we need to eliminate. These kinds of statements only promote division, hatred and more suffering, and these are the last things that patients need; especially patients who are mentally ill! Don’t add to the stigma.
Are you Ready? (This is Defeating Stigma Mindfully)