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Does this sound delusional and/or psychotic?


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I hear a male voice in my head. It tells me bad things about me and tells me to do bad things. I can recognize it for what it is but it's hard to shake. The voice is also outside of my though process. It comes at random.

I hear constant music. It's simultaneously inside and outside my head.

I see shadows moving in the dark. I have for years. It used to really scare me but I've gotten used to it.

I often feel like I can read others thoughts and I feel then and/or hear them.

I can communicate with the dead and see them most of the time.

I feel so much malevolence from parts in the house and I can't go near them.

My therapist says I'm not psychotic but I wonder. i realize true psychosis happens when the person is not aware they are experiencing it. I just wondered what your thoughts are.

Also, I see flashes of the worst kind of violence. It happens right in front of me and it plays out like a horror movie. Sometimes this leads to very violent fantasies.

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It's really hard to tell, and I try to stay away from diagnosis on these boards.

It's possible to hear voices and not be psychotic, or even mentally ill, more and more these days the emphasis is on hearing voices as an experience and what that means to you, rather than pathologizing it. As I have talked about before on the boards, my 'voices' are always alien to me, I cannot predict what they will say and they have strange accents and a different gender to me. However I do accept on an intellectual level at least, that they are parts of me that are taboo or not integrated, and thus once I have started to find ways to interact with them, they have calmed down. I bargain with them about when I will put aside time to listen to them, if they do not stick to the bargain then it is a sign that they are unhappy about something, and I listen to them, and I try to figure out what is causing me to worry/feel insecure. They often take a bullying format too, and also used to command me to do things. I worked out that when I am taking a risk or moving forward, they crop up and bully me back into hiding, as a protection thing.

The rest that you describe sounds like intrusive thoughts. And I think some border on delusions. Although, to be honest, I have no way of proving that you cannot communicate with the dead, so to prove that is a delusion is hard. Were we in certain cultures where that skill is accepted as the norm, it would not be classed as a delusion. I am interested as to what effect this all has on you, does it interfere with your daily life? I found intrusive thoughts to be a reaction to stress, and they made concentration difficult. My pdoc says that I have a mild form of stress related psychosis (my experiences are very similar to yours) but I am not medicated, and I deal with it via therapy methods. Your therapist might not see it as psychotic persay, probably because you have insight, but if it is interfering with life, then do press for help. Medication might very well soothe it.

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Toeing the party line, this is not a dx, but observation.

What you have listed pretty much reads like a definition of auditory and visual hallucinations, delusions. The violent episodes are more complex and may involve delusions and intrusive/obsessive thoughts.

These can all be part of or types of psychosis. But why be afraid of a name? If you have symptoms of an illness, the name can't hurt you any further. The important thing is to recognize that your symptoms can and SHOULD be treated to control them and make them go away. The APA's stated goal of treatment is to completely control symptoms and allow us to lead the most normal life possible. Anything less than that is undertreatment.

You should be discussing this with your psychiatrist. He is the one who will make the diagnosis, and decide how to treat it, not your therapist.

Don't be afraid to talk with our doc. He can only treat what he knows about.

best, a.m.

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Ok, coming from a totally different view here.

And this is Not a DX:

Some of the things that you listed I can do to.

Like see shadows, talk and see the dead and feel what people are thinking. Do I think im psychotic? No.

And if my Pdoc or Tdoc asks if I have any auditory or visual hallucinations, I say no.

I think the most important thing to ask yourself is if any of these things bother you. If they do, then seek help for them, for there is help. I take Invega and my occurances have lessened. But I still see things walk by (or feel them, if they happen to be nasty) and I hear my name being called or parts of whole conversations.

I guess that could be psychotic. But ive done it my whole life and so its a normal thing for me.

Selene

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I see what you are guys are saying. I will talk to both my pdoc and tdoc about it. I've always grappled with whether these are bad or not. I've been told by more than one psychic that I'm a powerful medium. The only thing is I tend to encounter the negative. For a while I was deep into the occult. I studied all the systems I could find, even the black side of things. When I entered into black magic, that's when the shit really hit the fan. I quit it, but I feel I've opened doors I can never close.

It does interfere with my life. Being in public places is extremely difficult and often I avoid going. I just wish it would stop. Some nights I'm absolutely terrified.

I can't take atypical ADs because of the weight thing.Abilify and Geodon caused intolersble akathesia, I take haldol right now but it doesn't help much. My therspist is mediocre and won't help with the psychotic end of things. But it's the county. You take what you can get.

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sdjeff,

please understand that what you experience is a result of mental illness and problems in your brain. Properly medicated you will not experience any of these influences that seem so real at the moment. They are NOT real.

best, a.m.

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I hear a male voice in my head. It tells me bad things about me and tells me to do bad things. I can recognize it for what it is but it's hard to shake. The voice is also outside of my though process. It comes at random.

I often feel like I can read others thoughts and I feel then and/or hear them.

I can communicate with the dead and see them most of the time.

I feel so much malevolence from parts in the house and I can't go near them.

While all that sounds psychotic, there are still parts of your brain telling you this is all bullshit, which you maybe would not have if you were psychotic... So, that could leave these things in the categories of "things that someone who works Magick (in the OTO sense) had better learn to handle" or "things that even a county-supplied therapist had better help a person handle"

Given your list of conditions/prescriptions, there may not be an adequate medical intervention if the atypicals are completely out. I see you're already on Haldol, and an anticonvulsant or two, and an MAOI - that doesn't leave a lot of things to safely suggest for consideration.

I hear constant music. It's simultaneously inside and outside my head.

The important issue here is whether it's good music or crappy music. Maybe a guided meditation on getting the voices in your head to change the damned channel once in a while might be in order.

I see shadows moving in the dark. I have for years. It used to really scare me but I've gotten used to it.

I think you're supposed to.

Also, I see flashes of the worst kind of violence. It happens right in front of me and it plays out like a horror movie. Sometimes this leads to very violent fantasies.

Start writing them down! Add a little bit of plot and backstory; change up the names to avoid lawsuits. There's a legitimate market for that stuff, and it could even be therapeutic. Just don't post the stories to your MySpace or dating service profiles.

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Yeah, I have little choice over the music. Sometimes I can change the station, but usually I have to put up with whatevers on. Interesting idea to write the violence down. Come to think of it, maybe a whole books in order. Now if i could keep my attention span up long enough. :-B

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Some things could be psychotic in nature, but you seem to have a rational perspective on it. That's probably why your therapist isn't worried about it. Just because things aren't normal doesn't mean they're bad.. it all depends on how you interpret them & how it effects you. If they bother you, try and fix them. Perhaps the right meds could block these things even if they're not delusional or psychotic?

As for your list:

The voice bothers you and it's not kind.. getting control of that would be beneficial.

I think everyone has the ability to hear music - usually it's just a conscious thing. You just get it without meaning to and in stereo.

I've always seen those shadows. I've often heard they're normal.

A lot of people claim that they can pick up other's thoughts and communicate with the dead. If it doesn't bother you, I wouldn't worry too much about it.

I can relate to feeling bad things in the house. It was real to me and others. Unless it's just paranoia.. I'd take this one to be true.

Are your flashes just in your mind.. or do you lose where you're actually at? If you're losing yourself to it.. that's not too good.

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I found with voices, the best thing was to talk back to them. Sounds nuts, but when confronted, like bullies, often they would back down, or give me information. They hardly ever bother me, except for when I am very stressed and not taking care of myself. I found mindfulness techniques to help with intrusive thoughts, pm me if you want me to get into what worked for me. I'll try to find some good stuff online. As for the house and the occult stuff, is there a minister or a religious figure you trust who you could have to come bless the house? Or could you set up a small shrine to a spiritually safe foce that would help declare your intentions to be good and cleanse the house? Sometimes a little ritual like that can help. When I was suffering with that sort of thing, I saw a Hindu priest, and his advice helped a great deal.

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I agree with others' comments, but think there is a clearer answer to your original questions, that has to do with defining terms correctly and not conflating them with assumptions about those terms.

Hallucinations are the perception of things that are not actually there. Auditory or visual. This does not extend to distortions of things that are there, though many people use the term in this case as well. So for instance seeing movement among shadows sounds like more of a distortion of visual input than a full hallucination. This line can be a bit blurry though -- e.g. are audible voices true hallucinations or distortions in the sense that normally unconscious chatter present in everyone are "distorted" by coming through the auditory system and being perceived as originating externally? Regardless, hallucinations are some form of perceiving that which is not objectively there externally.

Delusions are false beliefs. This occasionally gets into problem areas where true/false are being defined by necessity based on others' beliefs, so for instance Copernicus was basically labeled delusional because everyone else was wrong. Or, say, many people would say I am delusional because I believe in evolution. Within any psychotherapy (including the fake kind practiced by pdocs), similar issues can arise where the therapist considers something delusional that the patient considers spiritual belief, a belief in other healing paradigms, or some other belief in the meaning of their experiences that doesn't reduce them all to symptoms and pathology. Again, regardless, delusions are *beliefs* (as opposed to sensory perceptions) that are not externally valid. If you believe you are a pink elephant, either you or everyone but you is delusional.

Psychosis is a diagnostic *label*. It is, like almost everything in the DSM, based entirely on observation of a set of symptoms. That is, there is no more intrinsic "real" state that is psychosis than the evaluation of observable symptoms, and the exact set or number of symptoms required for a given doctor to apply the label varies from doctor to doctor and has varied considerably over the years. The most prevalent "definition" of psychosis has been something along the lines of the very open to interpretation expression "out of touch with reality". Again, putting aside questions about a single absolute reality vs. the fact that everyone lives in their own reality and putting aside reality as an objective truth about the physical universe vs. consensual reality which reflects cultural mores and beliefs, in general someone having a lot of delusional thinking will be considered out of touch with reality and may be labeled some degree of psychotic. Someone only hallucinating will typically not be labeled psychotic (or, that used to be before pdocs began looking for every possible opportunity to add conditions requiring more prescribing) so long as they are not mired in false beliefs. And beyond this there are levels from acute to chronic and mild to severe. Certainly the average person believes many things that are not objectively true. We do not label the 50% of Americans who still believe Saddam Hussein was behind the 9/11 attacks as psychotic, because most of these people are still able to navigate the consensual reality of the social world and be productive members of society.

So, given your experiences, I would say that you are hallucinating, but not delusional because you are clearly articulating that you know these to be hallucinations, or at least not real external entities. Sounds like you realize they are in some ways manifesting from your brain, and you realize this is problematic because it affects how well you can function.

As for whether you are psychotic, this isn't a truly meaningful question. It would be more meaningful to ask, would a doctor group these observations into the label psychotic, and the answer is it depends on the doctor and in which decade you ask. If I were your doctor, I would say well diagnostic terms are for insurance companies, let's look at which problems are affecting your life the most. There is a large community of people dealing with hearing voices that offer each other support and have helped each other become more functional and accepting of these voices, sometimes even finding meaning in them (the voices are, after all, coming from your own brain and therefore do mean *something* about your unconscious life). On the other hand, there are possibly pills that will reduce the noise and reduce the symptoms. Many find these pills have side-effects worse than the hallucinations themselves, but this differs from person to person given the severity and intrusiveness of the hallucinations. Since you are not delusional, anything that would help you make sense of what you are experiencing may be valuable so that you do not succumb to delusional explanations of the hallucinations. Likewise, reflecting with a therapist or with others about the messages themselves may be important in identifying unconscious sources of angry or violent thoughts as well as self-hating thoughts, all of which ultimately should be dealt with to address the emotional roots of these experiences and do work to reduce or remove them for a healthier emotional self. And this work, pointedly, will never come in pill form. (You'll never in a million years find a pdoc who will point out all this.)

Just another opinion, hope it's worth something.

As an aside, I've had very limited experience with hallucinations. I've seen full sillouette people emerging from shadows and approaching me in a big circle, saw waves of rainbow color coming from an orchestra pit, and once saw houses breathing in and out, both while on LSD, and I've heard very limited audible voices talking directly to me with messages more neutral, while taking Ativan. Both seem akin to the broader term "cognitive slippage", but happening within primarily sensory regions of the brain rather than logic centers. As weird as they were when I saw them, I think of them as a failure in coordination of brain regions than is spilling over into other regions. And in my case I was fortunate in being able to say, okay, don't do LSD or Ativan. I've had delusions, always religious in nature, and always during the tail end of SSRI use, in a manicky state. As much as I know some of my thoughts during these times were invalid and truly delusional, there were so many meaningful insights in the same periods, and so much real (externally validated) creative thinking, that I don't entirely chalk up the experiences to psychosis. That is, I see them as slippery dangerous states where even while I wnet through them I was trying everything I could think of to come back down to Earth, but I don't dismiss everything I experienced as pathological and therefore invalid.

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Getting back to facts and all those who are too ready to tell people to ignore signs of treatable brain disorders....

"DELUSION

"A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person

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Other than some sort of grammar-nazi-like quibbling about using quoted sources as the most authoritative source of truth possible, I fail to see how those definitions differ from what I said. Yes, you did point out that some of sdjeff's post does indicate delusional thinking, which I missed because it sounded like he was overall saying he thinks these thoughts are not real. But those definitions are what I said about hallucinations, delusions, and psychosis, and perhaps you missed the point I made, also made in the definition you provided, that these terms have varied over time and are not universal for any doctor you ask, but that the general thinking is that if a patient is delusional, including having hallucinations which they attribute to some real external source, which is itself a delusion, than these criteria comprise the diagnosis of psychosis.

I also fail to see how anything in what you posted points to a treatable brain disorder, nor how anything I posted said one should ignore a possible treatable brain disorder. It seems rather that you just posted some more official source echoing every point I made and ignoring the very valid points I made, held by *other* professionals who do not treat the DSM as a bible, that there *are* other perspectives on things like hearing voices and that it *is* important to seek the root emotional causes of the *content* of such hallucinations, so I fail to see why *you* are discouraging someone from knowing of these other viewpoints and getting treatment for what is clear to me is not *only* a disorder of the brain.

In other words, if I don't tell you you're wrong and act like a complete prick about it, but simply offer another perspective, maybe you could extend the same courtesy?

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j,

you are assuming that my post was a reply only to your post, rather to the overall trend of the thread. And yes, you and I have echoed several points, including my first post.

- I have not seen anything to indicate that delusions and hallucinations are a lost cause and cannot be successfully treated with medication.

a.m.

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My sincere apology, AM. I have had so many experiences on these boards where I've felt I was doing by best to *add* a perspective but have been attacked by those pre-disposed to think of me as a crazy Scientologist or something. I can be a bit defensive about this.

Just to clarify, I was not saying delusions and hallucinations are a lost cause in any way, and as for "successfully" treated with medication, was pointing out that some people choose this route, some find this route problematic, and that with OR without meds, there are also other routes for treating or coping with hallucinations. I agree with what I believe is the mainstream thinking that if one is so disconnected from "reality" in terms of delusional beliefs that they are unable to function, meds can reduce the aberrant thinking enough to allow them to do other, talk-based therapy. However meds all bring their own problems and many people who have taken ADs feel they unreasonably slow or limit their thinking and hence the common "non-compliance" issue that is so prevalent among psychotics. My point here is not to get into whether meds are right or wrong, but to say there is no universally accepted "cure" and so it is wise to know of the options.

Beyond that I think it is always good to understand underlying causes, not just emotional ones, but for instance it can help people who have hallucinations to know that these *can* be somewhat explained, even when the precise triggers are still fuzzy. That for instance some types of hallucinations do stem from brain regions "spilling over" and cross-talking with regions they wouldn't normally, or more simply, that voices can be understood as processes that would normally be unconscious and inaudible becoming audible and therefore intruding in consciousness. Maybe it doesn't help everyone, but it helped me not freak out when I had experiences like this, and I believe that it helps one *not* need to come up with other explanations which can then feed delusions. It is truly hard to have hallucinatory experiences and not come up with some explanation. I guess the importance of defining terms like "psychosis" here is to separate them from more judgmental and less meaningful terms like "crazy". Which is what I meant about what I would say if I were the doctor. Essentially, lets spend less time on coming up with the label and more time addressing the symptoms that are most disturbing to the patient.

The original question sounded possibly like "To me, 'psychosis' means 'crazy'. Am I crazy for having these symptoms?" And so I was replying, and maybe this is what you too were saying, AM, that no, you're not crazy, you're having hallucinations, are maybe skirting with delusions, and these may or may not qualify you to have "psychotic" written down in some doctor's notes (more likely "psychotic features"). But there are all degrees of crazy, and all degrees of psychosis, and the fact that you are recognizing all these experiences as abnormal and problematic makes you far less "crazy" than someone who thinks they are all good. As I said about my own experience, I've been delusional, and even somewhat able to identify that I was delusional (though not entirely). I personally did not go on medication for this, and still managed to find more solid ground, which had a lot to do with getting out of the intensely stressful situation that was stressing me (and probably getting past some of the med withdrawal that was destabilizing). That is *not* me saying hey don't take meds. I'm just saying, psychotic symptoms are also not a lost cause *without* meds. Seeing the problem and taking some action is essential, but it is not the case that such experiences point to an inevitable descent into madness. They don't.

sdjeff -- How is all of this hitting you? Are you getting a lot of perspectives that help? I think it is in the end important to find someone to talk to, and that you are better off having an informed opinion before you just accept any single person's interpretation. AM is right that some things, like saying you can see and talk to the dead, will probably be interpreted by most as delusional and pointing to psychosis for that reason. On the other hand you might be able to talk about this as something that may or may not be valid thinking. And my points about reality being somewhat subjective are also relevant -- I've known others who have had basically spiritual beliefs labeled as delusional by doctors (let's not forget pdocs slant extremely towards materialism and atheism), and more broadly I think some beliefs are very susceptible to misinterpretation. Some people say they talk to their dead relatives. This is something I can believe and accept as a psychological reality, based in a less materialist concept of what a person is and a belief that memories of people have resonant patterns that continue to interact with us and in some sense are really "them". I do not need to believe in ghosts wandering the Earth in some other dimension from the living, but I can see how some could interpret the idea of talking to the dead as something outside their concept of "reality". In general, I would think that if you asserted things like you did about "special" abilities and did *not* realize that other people might interpret these as impossible, then yes you are delusional. In my own delusional beliefs, a general pattern was that there were aspects of logic that simply were not there, like I was incapable of seeing the holes until later, when not manic, and I would think Wow, that was some nutty stuff I was believing.

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Halucinations are a psychotic symptom but that doesn't mean you're psychotic.

the answers.com article is pretty good.

http://www.answers.com/psychosis?cat=health

J: I'm not trying to pick a fight, but you should know but that this was coming. I've proposed in the past that hallucination apologists should be banned from here. This is the reason why:

It is not possible to experience psychotic symptoms without simultaneously experiencing grey matter loss.

The days when psychosis was seen as a different but potentialy vailid way of experiencing the world are past. RD Laing's whole "I'm fine, reality is psychotic" trip doesn't really work because reality isn't the one suffering brain damage. Reality is quite likely broken in other ways, just not that one.

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I see what you are guys are saying. I will talk to both my pdoc and tdoc about it. I've always grappled with whether these are bad or not. I've been told by more than one psychic that I'm a powerful medium. The only thing is I tend to encounter the negative. For a while I was deep into the occult. I studied all the systems I could find, even the black side of things. When I entered into black magic, that's when the shit really hit the fan. I quit it, but I feel I've opened doors I can never close.

It does interfere with my life. Being in public places is extremely difficult and often I avoid going. I just wish it would stop. Some nights I'm absolutely terrified.

I can't take atypical ADs because of the weight thing.Abilify and Geodon caused intolersble akathesia, I take haldol right now but it doesn't help much. My therspist is mediocre and won't help with the psychotic end of things. But it's the county. You take what you can get.

I'm glad you're going to talk about it. I have delusions/hallucinations. I'm stable now, but I'm not sure what to believe of the strange thoughts I had. As you say, it is interfering with your life. You deserve to have that treated. I don't know what they would use since you have trouble with the AAPs. I know at one time when I was taking depakote they increased my depakote and the voices I was hearing and racing thoughts stopped.

Have you tried thought stopping? You say "no" inside your head or out loud when the voices come. Some people say it helps. It didn't work for me, but I thought I'd mention it.

Hope you feel better.

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It is not possible to experience psychotic symptoms without simultaneously experiencing grey matter loss.

I didn't know that. I wonder how much brain damage I have. What kind of effect does this have?

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The full text of that will be available for free in a few months:

http://www.ncbi.nlm.nih.gov/sites/entrez?c...p;dopt=Abstract

This is new:

http://www.sciencedaily.com/upi/index.php?...-us-bipolar.xml

Here are SPECT images before and after treatment:

http://www.brainplace.com/bp/atlas/ch8.php

That's blood flow, not just damage though.

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VE --

I am aware of the assertion that psychosis causes brain damage, as I am aware of alternate perspectives on this. And I am NOT advocating RD Laing-type relativism. Many things cause loss of grey matter, and I do not accept that all cases of hallucination or delusional thinking cause irriversible brain damage. Nor am I saying, as it seems I'm having to repeat several times here, that meds should never be used to treat psychosis. However I will point out that it was you who told me in the fall that my brain was burning out and I would obviously be insane and locked up soon if I didn't get on meds immediately, and I did not and I am not. In fact I'm back to work and suffering far less from panic attacks, having far less problem with moods, and generally feel like I'm recovering. What I know about you is what you accuse me of -- accepting only the research or facts out there which support what you assume to be true. The recent study showing long-term outcomes being much better for schizophrenics not medicated than those on APs, you dismissed without valid objection, despite the fact this study echoes results from 2 long-term international WHO studies. Such a study also seriously calls into question the fact that the most common measure of efficacy of drugs to treat schizophrenia is compliance -- ei, the drug is demonstrably more effective if the patient is more likely to keep taking it.

Does psychosis damage the brain? Sure, it can and does. I am not making a blanket assertion that those observed results are meaningless. Do ADs cause long-term debilitating brain damage? Yes. They can, have been known to do so, and recent research which you choose to dismiss shows that they do so more than the underlying psychosis.

Take it up with me in private. I've been trying to post things to help this person with their question. If you want to throw debate at me, I'll respond as I always have.

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