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Is there any way to tell what is and isn't real?


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I've read that some people have insight when they're delusional and hallucinating. How? I'm always so positive, so absolutely certain, that what I think is correct. When it gets bad you could throw all the evidence in the world at me and it wouldn't matter at all. How do I fix this? How do I fix myself?

My delusions are always paranoid. My hallucinations are almost always auditory. And I don't understand why these pills, the abilify and lithium and seroquel, work so well for balancing out my mood yet I'm left with residual paranoia that sometimes morphs into flat-out psychosis. And every time I get truly psychotic, I try to find a way to kill myself. It terrifies me, that I have no control over my mind.

Is there any way to reason with yourself once you're psychotic? Like, bad? Or is it just another ambulance ride to the emergency room and a few injections of haldol before you do something that will wind you up in jail?

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Keaton I don't know if it is appropriate for me to respond. I am very fortunate., I respond pretty well to medication and although I had a few years  in and out of psychosis I have been pretty stable for years.

I never could think my way through psychosis. I did have some periods of insight but it wasn't lasting. Enough for someone to convince me I was hallucinating, but then I would forget.

It is just so variable.

 

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I have unusually good insight when psychotic but a lot of it comes from training myself. I do things like regularly check in with people I love and run what I'm hearing/seeing/believing by them. I also look for patterns, things that happened in past experiences with psychosis. What's something I do a lot when I'm unwell and am I doing it again? Does this feel familiar? I write out whats going on out as best as I can and if something feels like it's a common symptom I've had previously, then I tell my pdoc/tdoc about it. I tell my husband first so he can call me out on any lie I tell the pdoc. If I'm psychotic, he comes to my appointments because it's too easy for me to lie when I'm on my own.

This isn't to say I don't still believe my symptoms to not be symptoms. It always goes against my isolating/hiding/lying instinct to actively "check" my thoughts and senses. When I'm psychotic, I start to lose trust in the people I should be trusting, but I fight that and force myself to trust anyway. It's their outside insight that can save me when my own is fractured.

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The only way I got insight about the hallucinations and delusions was when I went on medication.  Before that I believed everything I "heard" was real. The delusions were real.  I also turned off music because it was a trigger also to think to people within the delusions.  Saw my pdoc and a tdoc (tdoc only for a couple months).

When I was put on meds, it took years to finally get some insight, but I did.  When I hear stuff now, it is more of a nuisance than anything, and the delusions are mildly believable but they don't consume my life like they did before. 

And what helped was slowing my mind down with meds, turning off the music, as well as integrate more into real-life things ... not all at one time though.  I watched TV to catch up on current events, walked to the grocery store for a couple things to get real-life interaction, etc.

FWIW ... It was really scary for me when I had no more music and things were much more quieter than they had been, because I didn't know what to do with myself.  I didn't even know what to think or do next.  For me it was like waking up from a coma 5 or so years later, and had to catch up on things and learn what to do during the day, when to sleep.

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9 hours ago, confused said:

Keaton I don't know if it is appropriate for me to respond. I am very fortunate., I respond pretty well to medication and although I had a few years  in and out of psychosis I have been pretty stable for years.

I never could think my way through psychosis. I did have some periods of insight but it wasn't lasting. Enough for someone to convince me I was hallucinating, but then I would forget.

It is just so variable.

 

No, any response is a helpful one! I've actually noticed that as of late I've been responding better to my current regimen of medications (no more severe psychosis, mostly just mild psychosis--if there is such a thing-- now and then; sometimes just simple paranoia) but that if I stop taking my meds, the bad stuff sets back in pretty quick. I can think my way through the milder psychosis at times (or maybe it's not even psychosis; maybe it's just paranoia), but, like you, I cannot think my way through a full-on break. With my hallucinations, it's variable. Voices I can sometimes convince myself that they're not real, but other things, such as sirens, I always believe are real. And my delusions are all-consuming; I always, always believe they're real. I'm glad that you've been stable; I hope it continues.

 

7 hours ago, saintalto said:

I have unusually good insight when psychotic but a lot of it comes from training myself. I do things like regularly check in with people I love and run what I'm hearing/seeing/believing by them. I also look for patterns, things that happened in past experiences with psychosis. What's something I do a lot when I'm unwell and am I doing it again? Does this feel familiar? I write out whats going on out as best as I can and if something feels like it's a common symptom I've had previously, then I tell my pdoc/tdoc about it. I tell my husband first so he can call me out on any lie I tell the pdoc. If I'm psychotic, he comes to my appointments because it's too easy for me to lie when I'm on my own.

This isn't to say I don't still believe my symptoms to not be symptoms. It always goes against my isolating/hiding/lying instinct to actively "check" my thoughts and senses. When I'm psychotic, I start to lose trust in the people I should be trusting, but I fight that and force myself to trust anyway. It's their outside insight that can save me when my own is fractured.

My problem is that I have a tendency to lose trust in everyone around me when I'm really bad. I don't trust my brother, my parents, my friends, anyone. Probably I trust my brother the most. But I've even thought he was poisoning me; that my mother was poisoning him; that my dad committed terrible crimes. I simply don't trust them, no matter how much they reassure me, and I wish i could so badly.

Your amount of insight is impressive and I wish I could work my way towards that. Maybe I can. Looking for patterns is a good idea; my psychosis often follows similar patterns. I just don't understand why I can't listen to reason, any type of reason, when I'm psychotic, and it drives me almost to tears, honestly. It's just so frustrating. Especially because I have suicidal impulses when I'm really bad, and I'd have killed myself half a dozen times if not for my parents. :/

Thank you for your comment. I'll try to "train" myself as well, to gain just a little bit of insight. Maybe a little bit could go a long way.

46 minutes ago, melissaw72 said:

The only way I got insight about the hallucinations and delusions was when I went on medication.  Before that I believed everything I "heard" was real. The delusions were real.  I also turned off music because it was a trigger also to think to people within the delusions.  Saw my pdoc and a tdoc (tdoc only for a couple months).

When I was put on meds, it took years to finally get some insight, but I did.  When I hear stuff now, it is more of a nuisance than anything, and the delusions are mildly believable but they don't consume my life like they did before. 

And what helped was slowing my mind down with meds, turning off the music, as well as integrate more into real-life things ... not all at one time though.  I watched TV to catch up on current events, walked to the grocery store for a couple things to get real-life interaction, etc.

FWIW ... It was really scary for me when I had no more music and things were much more quieter than they had been, because I didn't know what to do with myself.  I didn't even know what to think or do next.  For me it was like waking up from a coma 5 or so years later, and had to catch up on things and learn what to do during the day, when to sleep.

Oh god, I can't listen to music when psychotic-- I always think the singers are talking to me. It's reassuring to hear that now you have some insight and that the delusions no longer consume you. I always hide in my house when I'm psychotic-- maybe walking somewhere would be a good idea, like you said. Thank you for your comment, and as I said, it's very reassuring to hear that you've gained insight into your psychosis, even if it was a struggle. I'm glad for you. And yes, the meds definitely do help, as much as I hate to take them.

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One more thing that came to mind in terms of getting insight into what was going on ... I had to make sure I got enough sleep and reduce the stress as much as I could.  Otherwise I don't think I could have gained insight.

Being tired and stressed out (at least for me) makes everything worse.  The delusions, hallucinations won't go away, and therefore impossible to get anywhere near insight.

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I've had insight on and off. Like I figured out that I was experiencing Cotard's Delusion at some point, but I didn't figure it out while I was experiencing it. When I had my major episode last year I didn't have a lot of insight, although I knew something was wrong.

I don't know enough to really give much advice on how to know or how to have insight while everything is happening.

Edited by Bellatrix
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7 hours ago, SchizoHH said:

When I am just starting to have an episode I have insight. But once I go head long down that tunnel I completely lose reality. And it takes forever to get it back. 

Exactly ... one memory that was ingrained and that I'd just forgotten about, that for some reason comes out, it is like a light switch.  and it takes me forever to get back to reality, get back insight, etc.

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I don't notice till I'm curled up in the fetal position on the couch and I've missed 2 days of school and 2 days of work. I can't recognize symptoms bein present for 2 days. 

I put on ear buds and play one song over and over again for 12 hrs and pull the blanket over my head and refrain from moving or breathing irregularly. Then I usually write my mom's phone number on my arm and test my yard. At first I stand in the hallway for 2 minutes. Sweating profusely, hyperventalating, bending over to keep from fainting. And those 2 minutes seem like an hr. All along I'm convinced that the neighbors who are spying on me will take me away.

Then after 20 min and regaining my composure I walk a lap around the house and get 5 days of mail. I keep pushing my boundaries till I'm able to walk a half mile and then I call my parents. Sometimes they come over and take me away for an hr. Currently listening to nsync Christmas music, since noon.

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If only to let you know that everyone is different, I'll comment. I've only been experiencing auditory hallucinations for about 7-8 months and haven't had a complete break from reality (yet). I've been seeing my shrinky-dink for years for depression/anxiety, so as soon as it started happening, he threw me on Abilify and started seeing me more. 

My auditory hallucinations are always very clearly unreal for me. I hear what seems to be called "word salad" along with sound effects, breathing, sounds from game shows... Random things. The breathing gets me sometimes, but I'm more afraid of the fact that I'm hearing things. Maybe because it's so strange, I haven't thought the voices/sounds were real. Who knows? 

I'm more likely to lose touch with reality when having a depression/anxiety attack. Then, I think everyone hates me, they'd be better off without me, etc. I think the fact that I have a deal with my mom makes a big difference for me, but I guess it's a little messed up? My mom has bad depression and anxiety as well, so we have a deal that if I don't off myself, she won't. It's thinking about there being a world without my mom that stops me. 

I hope something I've said here helps you. Keep on keeping on, okay?

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8 hours ago, heilmania said:

If only to let you know that everyone is different, I'll comment. I've only been experiencing auditory hallucinations for about 7-8 months and haven't had a complete break from reality (yet). I've been seeing my shrinky-dink for years for depression/anxiety, so as soon as it started happening, he threw me on Abilify and started seeing me more. 

My auditory hallucinations are always very clearly unreal for me. I hear what seems to be called "word salad" along with sound effects, breathing, sounds from game shows... Random things. The breathing gets me sometimes, but I'm more afraid of the fact that I'm hearing things. Maybe because it's so strange, I haven't thought the voices/sounds were real. Who knows? 

I'm more likely to lose touch with reality when having a depression/anxiety attack. Then, I think everyone hates me, they'd be better off without me, etc. I think the fact that I have a deal with my mom makes a big difference for me, but I guess it's a little messed up? My mom has bad depression and anxiety as well, so we have a deal that if I don't off myself, she won't. It's thinking about there being a world without my mom that stops me. 

I hope something I've said here helps you. Keep on keeping on, okay?

I just wanted to say that I am so glad you told your pdoc about hearing things etc right away and were put on medication, and that you still have insight.  I didn't do that and every thing became ingrained in my head, causing me to believe it all (the voices) over the years.

Quote

I've read that some people have insight when they're delusional and hallucinating. How?

Keaton ... I *think* what I wrote above (in this post) is why with some people the voices dont get ingrained and other do.  IME, it was because (I'm almost positive) I waited so long to get put on meds to reduce hearing the voices.  Had I gone on meds right away, I think I would have been in a totally different mind-set than I am now.

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I haven't seen any data on what melissa said, but FWIW I did get treatment when I first started hearing voices. I was in and out of lucidity for a few years but I have been pretty stable now. I wasn't very insightful during that time.

I still am not sure what was real with a lot of things. The way I experienced it, or what consensus reality tells me.

I had a late onset, too, though, so that probably helps. (I was 39 when I had my first psychotic break)

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14 hours ago, melissaw72 said:

I just wanted to say that I am so glad you told your pdoc about hearing things etc right away and were put on medication, and that you still have insight.  I didn't do that and every thing became ingrained in my head, causing me to believe it all (the voices) over the years.

I've read that catching and treating it early helps in the long run. I'm really glad I was able to tell my pdoc right away. He always asks at the end of each appointment, even way before the hallucinations started, "and, are we seeing little green men? Hearing anything we shouldn't be?" That man deserves an award. I know I got lucky with being able to tell him. It took a lot for me to admit to having these experiences, but it was harder with my family. 

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1 minute ago, melissaw72 said:

What I've said in this thread has been all anecdotal; I didn't say anything about factual things.

melissa I just meant that I was adding another anecdote that agreed with what you said. I phrased it poorly. I meant no offense.

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I have an example from this week. I am stable on meds. a  couple of people at work seemed to be complimenting me excessively. Then, I got home and I got a Christmas card from a friend that said something similar. I thought they were all planning something about me without involving me. It didn't matter to me if it was a good thing or a bad thing.

I still don't know. I calmed down over the weekend and people seemed more normal today.

But, I was distressed wondering if I was losing it, if they were doing something, that i didn't know where to go.

So, I know my thinking is off, but I don't know if they really were up to something.

Edited by confused
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Don't feel so bad.  Most people can't tell what is real and what is not.

For instance, I walked to the grocery store to pick up a few odds and ends, but while on the way there I notice a red winged blackbird protecting its nest that was in a hole located up near the top of a light pole. Anyhow, I kind of laughed to myself about keeping an eye on that bird when I would be heading home after being at the store, since some birds have a habit of dive bombing at you when it comes to protecting the nest. But by the time I was on my way home I had totally forgotten about the bird. That was a mistake. As I passed by the light pole, the damn bird took a nose dive at me and pecked me real hard on the back of my head. Some drivers by, who witnessed this, seemed to find it as being funny and were breaking up laughing. I reached back to the the back of my head and felt lots of blood. The blood was running suffice enough to also get blood on my shirt collar.

Anyhow, I eventually got home to my apartment building, a three story apartment building that is for both regular Joe/Jane Blows, and for the disabled. Here, if you have a problem such as schizophrenia, the word soon gets around. As I entered the building I spotted some neighbors. It was three ladies. Anyhow I felt that I had to tell them what had just happened. As I spoke to then about the incident, they just stared at the crazy "Schizo man" and soon said..."OK...that's very nice.....But we have to go now....Bye Bye."  In other words, they spoke down to me as though I was an insane moron and clearly did not believe a single word that I had spoken. Inside my head I basically was shaking my head while saying to myself how stupid people in general really are. So I turned around and headed to my apartment door. Then suddenly, while calling me to get my attention, one of the ladies came rushing over to me to tell me that there was bleeding at the back of my head.

Once again I was shaking my head.

"Bloody hell", I thought to myself, this woman thinks that a schizophrenic is so out to lunch that a schizophrenic has to be told about what he/she has told you, and do so such that the schizophrenic will now be able to know about what he/she has just told you. HOLY CRAP !!!!

Edited by YouThinkSo
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On 24/12/2015 at 8:48 PM, Keaton said:

I've read that some people have insight when they're delusional and hallucinating. How? I'm always so positive, so absolutely certain, that what I think is correct. When it gets bad you could throw all the evidence in the world at me and it wouldn't matter at all. How do I fix this? How do I fix myself?

My delusions are always paranoid. My hallucinations are almost always auditory. And I don't understand why these pills, the abilify and lithium and seroquel, work so well for balancing out my mood yet I'm left with residual paranoia that sometimes morphs into flat-out psychosis. And every time I get truly psychotic, I try to find a way to kill myself. It terrifies me, that I have no control over my mind.

Is there any way to reason with yourself once you're psychotic? Like, bad? Or is it just another ambulance ride to the emergency room and a few injections of haldol before you do something that will wind you up in jail?

Your right it is possible to have insight when your in psychosis. One thing I realized is that you have two things present with psychosis.  1 is that you have the ability not always a chance but the ability to say to yourself. I am sick. I need help. And another is the ability to set intents and follow them. Such as I am going to make toast. And then you do. 

 

Other then that I have noticed is that the nature of psychosis is to not be aware that your in it. Only when your coming out through medican do you realise how far you were in.

 

There are other factors of course. Such as auditory hallucinations. Or what I like to call the foreign installation or the internal dialogue to keep it simple. If you hear inside your own head a dialogue about the world and yourself that sounds like you describing things. Thats your internal dialogue and everybody has one. But if it somehow becomes corrupted and tells you to do bad things or if you hear voices that are not your own. You can do something about it. You can actually stop any dialogue from taking place and maintain inner silence. I personally have stopped mine and only speak to myself during math calculations.

 

 

But in terms of paranoia all I can say is that you have to see things as either useful or not useful and take it from there. Fear also plays a big part. Expect nothing ,accept the mystery and forget the self. And you will fear nothing.

Edited by Cherryarc
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