Chronically Disorganized

When No Other World Exists Besides Psychosis

There are many psychiatric patients who are chronically psychotic. They have been through the system numerous times, whether that is through temporary inpatient psychiatric stays or state hospitalizations for years at a time. But just because a patient is chronically psychotic does not mean that they cannot function in society, especially when room and board are given to them; in other words, supportive psychiatric housing.

The worst part about these chronic psychotic patients is that many refuse to believe that they have a mental illness. Try asking them a question and they often irritably reply, “No psych stuff! I’m not crazy! Get the fuck outta here.” They are either in denial or have a poor insight; the latter is oftentimes the case. Schizophrenia can impair a patient’s insight to the point of them not realizing that they are psychotic.

So what happens when a chronic psychotic patient has a poor insight? They oftentimes refuse medications, allowing their psychosis to flourish. So how are they not hospitalized you may ask? Well, just because someone is psychotic does not mean that they cannot function; they become used to their psychosis and live under its presence. And when shelter is provided . . . well, even better.

Shelter and support help a lot because it allows the psychotic patient to be relieved of their stress and worry of going homeless. When food and shelter are provided, who needs medications is the thought process. And to add to the mix, many of these patients continue to abuse substances such as K2, marijuana, cocaine, crack (the hardened form of cocaine), heroin, etc. Unfortunately, this is how the system works for some: shelter, food, drugs, psychosis but no medications.

The problem is not access to medications. They are hospitalized countless times during their life with many opportunities to better themselves and follow up with outpatient psychiatric services; but they refuse. They refuse because it’s either too difficult for them to follow up, are not motivated or simply do not care enough to improve their mental health. And when they also have a poor insight because of their mental illness, attending their psychiatric appointments becomes more difficult than teaching a dog how to urinate and defecate in the backyard and not in the house.

This is what chronic mental illness does to many who are noncompliant with medications, abuse drugs and do not care about their health. But we must not give up as psychiatrists and humanity as a whole. The DSM Ready Community will always keep fighting on because we are based on love, unity, peace and openness.

Are you Ready? (This is Defeating Stigma Mindfully)