The Unpredictability of Psychosis

Grayscale photo of psychotic woman holding belt around neck

0-60 In a Heartbeat

One thing to keep in mind with psychotic patients is that their behavior is very unpredictable. They can literally be having a pleasant conversation with you for 5-10 minutes, and 15 minutes later, they are yelling, cursing, agitated, banging on the walls and demanding medications! You scratch your head and wonder, “What in the world? I was just talking to them and everything seemed to be going well!” Psychosis could care less if everything was going well; when it wants its patient to terrorize, it will unleash all of hell’s dogs to get its fix. This does not mean that you should always expect psychotic patients to become dysregulated and violent; just be aware that the chances of that happening are higher than with other patients.

Are you Ready? (This is Defeating Stigma Mindfully)

Psych Patients Desire Authenticity

Two women and two men wearing blue face masks with Mona Lisa painting on wall

I Want To Learn More About You

It’s not so much the content of what you say but your approach and delivery. Anyone can walk in with pride and command a patient to do this or that, but the chances that the patient will listen to you or open up are not that high. An honest approach followed by consistent listening and the development of rapport and a strong therapeutic alliance will take the patient much farther into his or her treatment.

This is because like anyone in life, psychiatric patients desire authenticity. Patients are very good at sniffing doctors who are authentic from those who just go to work to make a living. The former are the ones who tend to be of the most help, regardless of the medical school or residency which they have attended. Patients want a doctor who can connect with them and put them before the doctor’s pride and image.

It’s very difficult for psychiatric patients to deal with their mental illness, especially when they are involuntarily locked into a psychiatric unit for up to 60 days at a time. Not only are they battling their internal demons, but their environment which is a closed unit with windows, some computers and a television displaying negative news from around the world. The last thing that they need is a doctor who is not authentic in their ways.

On the other hand, many physicians are struggling themselves with balancing work and their personal lives. Especially in the field of psychiatry, it’s not easy to listen and talk all day about other people’s problems and then go home and take care of yourself and your family. There is currently a high burnout rate among physicians around the world; the stress and pressure of the job is very demanding and adds up over time.

Many physicians don’t actually intend to mistreat a patient with disrespect; they are just so stressed out themselves that their encounter with the patient may come off as non-empathetic. But this is the difference between great physicians and mediocre ones; the former know how to keep their stress levels in check and maintain their professionalism at all times.

Overall, the field of psychiatry is not an easy one. Many believe that it’s not difficult to just sit around all day and talk, but talking everyday for 8-12 hours does become very tiring, especially if your life is not balanced. Whether patient or physician, everyone has a different struggle that they experience, but at the end of the day, we should all aim for authenticity and respect and nothing less.

Are you Ready? (This is Defeating Stigma Mindfully)

Psychiatric Patients Are Unpredictable

Angry man dressed in black sitting at table pointing finger

Expect Anything

If you don’t have patience talking and listening all day, then the field of psychiatry is not for you. Not anyone can become a psychiatrist and be good at it; it requires patience, determination, excellent listening skills and lots of empathy. Lots and lots of empathy! As any psychiatrist knows very well, the unpredictability of patients is something that they must be prepared for on a daily basis, even when you think that patients are doing well.

In the field of psychiatry, you must expect anything; anything less and you are in for a surprise. What many people don’t understand is that it’s not necessarily the patients’ fault when they become agitated, disruptive or physically assaultive; unless sociopathy is at play, mental illness is often the driver behind their madness. When mental illness takes control of you, you almost become a passenger wrestling to take back control of the wheel that the drunk driver is joyfully playing with.

But how do you help such patients when most of the time they cannot even help themselves? Patience and lots of it. And believe it or not, psychotropic medications work very well on mental pathologies; they just require the right dose and length of time in the patient’s system. Psychiatric medications aren’t something that you take for a month and discard with the hope of being “fixed.”

The stigma of psychiatric medications is still prevalent, but thankfully it’s decreasing. People are starting to realize that these medications work; they can fix your anxiety, depression and psychosis! People are also realizing that there should be no shame in taking them; there is nothing wrong with having a mental illness.

Sure it doesn’t feel good having one and no one enjoys suffering from depression or hallucinations, but the more that we normalize mental illness, the easier it will become for the world to be treated. People will no longer have to remain in hiding because they are too ashamed to get treated by a doctor.

As physicians, all we can do is continue treating our patients with empathy, professionalism and dignity. And as human beings, all we can do is continue to spread acceptance, love and hope into the world.

Are you Ready? (This is Defeating Stigma Mindfully)