13.1.1 The effects of psychosis
Psychoses are a group of severe mental illnesses characterised by loss of reality contact (where the patient cannot differentiate between reality and their imagination), delusions and/or hallucinations. This leaves affected people vulnerable to strange and potentially very distressing experiences, such as hearing voices or seeing things which others around them cannot. They may also express these delusions in a way that may disturb others. For instance, they may insist that they are God, or complain that there is someone else inside them giving them orders.
Often, as a consequence of their illness, people with a psychosis struggle to meet the ordinary demands of daily life, such as routine household responsibilities, work and social interaction with others. For example, they may lose the ability to look after themselves and their personal needs properly, appearing unconcerned about their appearance and neglecting personal grooming (Figure 13.1). They may also have an inadequate or mistaken understanding of their condition, blaming malevolent spirits or other community members for placing a curse on them. Challenging such views may prove difficult, as their impaired thinking often leads them to reject evidence that contradicts such traditional beliefs.
Psychotic illnesses make sufferers personally distressed and also cause distress to others in their family and neighbourhood. The level of distress (and the risk of permanent disability) is increased by the duration and severity of the symptoms.