Understanding Psychosis: A Clear Guide to Symptoms and Common Myths

“Psychosis” is a term often heard but widely misunderstood, frequently associated with inaccurate and harmful stereotypes. To cut through the confusion, we’ve distilled the core insights of clinical and forensic psychologist Dr. Douglas E. Lewis, Jr., from his interview with Harsh Patel titled “Mental Health Support in Jail: Competency Restoration Explained.” This blog provides a clear, simple explanation of what psychosis is, what its symptoms are, and addresses one of the most damaging myths: the supposed link between severe mental illness and crime.

To begin, let's break down what experts mean when they talk about psychosis.

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The Three Anchors of Psychosis

According to Dr. Lewis, psychosis does not refer to a single condition but a set of symptoms. Experts like Dr. Lewis identify psychosis by observing one or more of three core symptom types, which he refers to as "anchors."

Hallucinations: Experiencing What Isn't There

A hallucination is an experience involving the senses that is not actually occurring in reality. A person might see, hear, or feel something that isn't there.

• Auditory (hearing) (Most common)

• Visual (seeing) (Most common)

• Olfactory (smelling)

• Tactile (touching)

Delusions: Firm Beliefs Contradicting Reality

Delusions are deeply and firmly held beliefs that are not based in reality. Crucially, a person experiencing a delusion truly believes it with complete conviction, even when presented with clear, logical evidence to the contrary. Common types include:

• Paranoid/Persecutory: The belief that people are out to get you, trying to poison you, or punishing you for no reason.

• Grandiose: The belief that you are exceptionally powerful or important, such as believing you are the "king of the world" or "the second coming of Jesus."

Disorganized Thought: Disrupted Speech and Thinking Patterns

We can also observe psychosis in disorganized communication and thought processes, making a person's speech difficult or impossible to follow.

Incoherence/Loose Associations: A person's response may be nonsensical and unrelated to the question asked. For example, if asked about the price of tea, they might start talking about walking their dog down the road.

"Word Salad": This term describes speech that is a jumbled mix of words and phrases that are not logically connected, making it completely incoherent.

Now that we have a clearer picture of the symptoms, it's crucial to address one of the most damaging misconceptions about psychosis and mental illness.

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The Myth: Is There a Link Between Severe Mental Illness and Crime?

There is no inherent connection between having a severe and persistent mental illness (like schizophrenia or bipolar disorder) and committing a crime. As Dr. Lewis states unequivocally in the interview:

"There's really no connection between an individual having a mental illness and them committing a crime... those are two very much mutually exclusive things."

In fact, individuals with these conditions are far more likely to be harmed by others than to be the perpetrators of harm. The critical factor is treatment. When a person with a diagnosis like schizophrenia is properly treated and follows their medication regimen, they can function just as well as those without the diagnosis.

Severe symptoms typically emerge only when a person stops their medication, which often happens due to a lack of social resources or a safety net. This is the critical juncture where the conversation shifts from mental health to public welfare. When a lack of social resources makes consistent treatment impossible, the subsequent emergence of severe symptoms can lead to a devastating spiral of events, as we will explore next.

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The Reality: How Social Factors Can Lead to Incarceration

The perceived link between mental illness and jail often stems from a lack of community resources and social safety nets, not from the illness causing criminal intent. Dr. Lewis describes a common sequence of events where a person with an untreated mental illness can be arrested for a low-level offense driven by basic survival needs.

• Lack of Support: A person may experience housing instability and food insecurity due to their illness and a lack of resources, forcing them to live on the streets.

• Survival Actions: To survive, they might search for food in a restaurant's dumpster. This is a biological drive to eat.

• Escalation to Crime: After being warned by the restaurant not to return, their biological need to eat drives them back. This time, they are charged with "Criminal Trespass." If a confrontation occurs with a worker trying to stop them, the situation could escalate to another charge, like assault.

In these situations, the individual is often a victim of a system that fails to provide for basic needs like food, shelter, and medical care. Their actions are driven by survival, not malice, which ultimately leads them into a justice system where, as Dr. Lewis notes, they can become victims all over again, forgotten for years over minor offenses for which they have long since served the equivalent time.

Understanding these points helps us form a more accurate and compassionate view of psychosis.

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Key Takeaways

• Psychosis is a set of symptoms, primarily hallucinations, delusions, and disorganized thinking, not a character flaw.

• Severe mental illness does not cause a person to become a criminal. This is a persistent and harmful myth.

• Individuals with severe mental illness are far more likely to be victims than perpetrators of harm.

• The criminalization of mental illness is frequently a direct result of systemic failures (a lack of housing, food security, and accessible medical care) that force individuals into survival situations, not a consequence of the illness itself.

By understanding psychosis as a set of treatable symptoms and recognizing that societal failings, not the illness itself, often lead to tragic outcomes, we can replace fear with facts and stigma with support. This shift in perspective is not just an intellectual exercise; it's a crucial step toward building a more compassionate and effective system of care.