Psychotic Reality

On the subject of reality, I sent a question to my sister-in-law, who has a doctorate in psychology and treats psychotic patients every day. I asked her about the “sense of reality” in her schizophrenic patients. I still haven’t found any studies on that particular point, but then I haven’t been doing much of anything useful for three days as I fought off a cold. Commands, visualization, prayer – all those good things worked and made the cold very mild.

Here’s what my sister-in-law wrote:

“Hallucinations actually are real - depending on how you define real. The area of the brain which reflects listening actually lights up (on brain scans) when a mentally ill person is experiencing an auditory hallucination.

“As to the person with psychosis.... while he recognizes that the delusion sounds preposterous to the listener, it is more believable to the speaker than any other explanation of events.....Jack believes that he mustn't purchase the last 2-liter bottle of 7-Up on the shelf because it is likely contaminated. He knows that his mother and therapist don't believe it is contaminated, but, as far as he is concerned, his belief that it is contaminated overrides their beliefs about its safety.

“[I don’t] mean that he is more sure of his delusion than we are of our reality. (How many of us question our reality - don't most of us take it for granted?) He can intellectually comprehend that we believe differently than he does, but he holds a fervent belief in the authenticity of his perceptions/beliefs. It rings more true to him than other people's differing perceptions of the situation....This scenario is reflective of a person whose psychosis has partially remitted. When a person is deeper into a psychotic state, the ‘voices’ he hears, or his delusions, are unquestioned by him.

“A big issue in neurology now has to do with the sense of self...how I recognize me as me.”