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What Is Psychosis, Really?

Hallucinations and delusions are the key.

Psychotic episodes can come and go, alternating with moments when you seem normal.

I had a friend I'll call Mike who suffered from bipolar disease. When he was 18, he came home from a trip and walked into his parents’ home on a hot summer day in New Jersey wearing a heavy jacket. He flew into a rage when he saw them. “We thought someone had slipped him” a drug, says his mother. She called the police, hoping he would be hospitalized.

By the time the police arrived, Mike convinced them that he was fine. Then he “ran away,” his mother says, without a plan.

I met him, by chance, in Cambridge and he rented a room in a group house I was sharing for the summer with another friend from our hometown and a few strangers. He was his old, sweet and fun, creative self. One day our friend baked a large lasagna, intending to freeze it and eat it over many days. Mike consumed half the tray, as well as someone else's marijuana he found in the house. Then he disappeared for days.

When his family found him, just a few blocks from our house, he told them that he was Jesus. This time he agreed to check into McLean Hospital, a famous psychiatric hospital affiliated with Harvard Medical School. At the hospital, “when he found that all the other young men thought they were Jesus he gave up the idea,” his mother says. Some rationality had come back.

The symptoms of psychosis are delusions, clearly false beliefs like “I’m Jesus,” or “You’re the devil,” and hallucinations, which can involve any of the senses. You might see, hear, taste, smell or have tactile sensations in a world all your own (Mike was cold on a hot day). You might speak nonsense, or walk outside naked. The vast majority of psychotic people are sad and confused rather than violent.

Mike had bi-polar disease. We tend to associate psychosis with schizophrenia, or bipolar, but the symptoms can arise for many reasons. Up to half of people with Parkinson’s, and about 20 percent of people with a type of dementia called “DLB,” have visual hallucinations.You can hallucinate and develop delusions from sleep disorders. One over-nighter can give you symptoms similar to those suffered by people with schizophrenia, some research found. People withdrawing from alcohol or cocaine or methamphetamines often hallucinate crawling insects.

Around three out of 100 Americans will experience psychosis at some time in their lives. Each year, about 100,000 adolescents and young adults experience their first psychotic episode. Many don’t get help for as long as a year.

To be diagnosed with schizophrenia, you must experience psychotic symptoms for at least six months. Some of the warning signs are lack of concentration, bad hygiene, feeling suspicious, spending more time alone, feeling emotionless or struck intensely by new ideas, and falling behind in school or at work. If you or someone you love matches several items on this checklist, consult a psychologist, psychiatrist, or trained social worker—especially if the symptoms intensify or persist. Early treatment of psychosis increases the chance of a successful recovery. Many people never have another psychotic episode. Some can live complete lives, although symptoms occasionally return.

Psychosis can accompany depression. If you ever suspect that someone you love is in danger of suicide or might have such poor judgment they would endanger others, act early. Avoid a confrontation, but secretly take away car keys, guns, alcohol, street drugs or prescription medications that could cause an overdose. Call “911” or the police and ask for a “mental health wellness check.”

Medication is standard care for someone with repeated episodes. Your loved one may have a choice between a daily pill or a monthly injection, and side-effects to manage. A number of programs can help coordinate care, which will include support.

A version of this piece appears on Your Care Everywhere.


Early Assessment & Support Alliance (EASA) offers an EASA Program Directory that lists early psychosis programs nationwide.

Prodrome and Early Psychosis Program Network (PEPPNET) offers the Early Intervention for Psychosis Directory

National Alliance on Mental Illness (NAMI) has a hotline (-800-950-NAMI (6264) Monday – Friday 10 am – 6 pm ET) and staff to answer emails at The NAMI Helpline web page can connect you with the NAMI office in your state to find local help.

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