[Music]
[George] The Mind Deconstructed: Mental Health and Wellness with Dr. Kaz and George. [Dr. Kaz]  The
statements of Dr. Kaz and George are
not a substitute for medical care and
our opinions are our own.  If you are
experiencing the mental health emergency
please seek assistance from a
professional in your area. [George] You can
contact us via Twitter @minddeconstruct. I'm your host George,
with me is Dr. Kaz. Dr. Kaz Nelson is an
American Board of Psychiatry and
Neurology certified psychiatrist
licensed to practice medicine in the
state of Minnesota and an assistant
professor in the Department of
Psychiatry at the University of
Minnesota Medical School. On today's
episode: "Living with psychosis". What
episode is this, Dr. Kaz? [Dr. Kaz] We're on 14 now.
[George] 14 episodes of The Mind Deconstructed.
Thank you everyone out there who
supported us up to this point. And, for
everyone who's finding the podcast we
encourage you to go back and listen to
our prior shows. They've been getting
better... they've been getting better and
better, so take a listen. Please stick
with us and hopefully we'll just keep
getting better. [Dr. Kaz] Yeah, we are amateur
podcasters and going back and listening
to our earlier episodes we think, [embarrassed] "Oh,
that's a little rough here- a little
rough there-" and you're right.  So,
we've been working on editing and
working on structuring the show and
hopefully we can be learning and growing
in this process. [George] Our first segment is
always hot topics in mental health.
Where we try to tie in our topic for today
with things that are going on in the
world. Today, the "Austin City bomber"...
he was killed... (blew himself up, actually) when the police
were closing in on him, but he left some
sort of suicide note that mentioned that
he thought he might have been a
'psychopath'. [Dr. Kaz] mm-hmm
[George] And, today's episode is "living with
psychosis"... he was, I'm assuming, self-
diagnosing himself as potentially a
psychopath? [Dr. Kaz] Right, that's where this
terminology and definitions become very
important, because a lot of the words
that we use in psychiatry or mental
health have this prefix 'psycho' (like
psychology, psychopath, psychosis). All of
those things start with the same prefix,
but a lot of these words mean very
different things. So, that's
why we're doing this show today to talk
about what's the difference between
'psychosis' and this condition of
'psychopathy' (or as the Austin City bomber
put it- 'psychopath'). The point of today is
to define these things and help you
understand the difference so you can
navigate this nuance a little better. [George] So,
Dr. Kaz, what is the umbrella term that
we are looking for here for these sorts
of mental illnesses? [Dr. Kaz] What I mentioned before- the term 'psycho-' [spelling] P-S-Y-C-H-O, That's
simply part of a word meaning that it
relates to 'the mind' or 'psychology'. So,
that's a very general term. When we
drill down into this a little bit more
and talk about 'psychopathy', that's
actually something that's a broad term
'meaning disturbance of the mind
or psychology' and we use that mainly to
refer to a subset of people who
live without a conscience. [George] Is that what
the Austin City bomber is referring to
himself, as when he says he believes
himself to be a psychopath? [Dr. Kaz]
Yes, psychopath (or sociopath, these
terms are sometimes used interchangeably).
But, basically that's a type of a
condition (or a way of being) where you
can do something that's wrong, or do
something that hurts another person,
(maybe kick a puppy or something like
that) and feel no remorse about it... have
no sense of guilt or shame. [George] So, we're
looking at 'psychopaths' versus 'psychosis'. [Dr. Kaz] Right, very different. Psychosis is
actually a mental illness symptom.
Psychosis is a very general term. It's
sort of like saying "shortness of breath".
Well, you can have shortness of breath
because you have a lung disease, or a
heart disease, or because you haven't
worked out in a while and are havin'
shortness of breath after walking up the
stairs. So, in the same way that lots of
different things can ultimately cause
shortness of breath, lots of different
things can cause psychosis. So when
someone has this, we work very hard to
try to get to the bottom of what is
exactly going on, so we can best treat it.
[George] Because, psychosis is what again? [Dr. Kaz] That's a
symptom where somebody is becoming
detached from reality, so you can see how
that's very different from somebody who
doesn't have a conscience or doesn't
feel bad when something happens.
Psychosis is a symptom
where somebody's detached from reality
and that might mean that they have a
hallucination (that's a form of psychosis
where you hear things that other people
don't hear, or see things, or feel things,
smell things, taste things, that other
people don't experience) that's not
actually rooted in reality. Or, have a
belief that's not real (like that you're
being tracked, or chased, or pranked, or
harmed) and it's not actually happening.
[George] So, as a psychiatrist you're dealing more with
psychosis than with psychopathy. [Dr. Kaz] Yeah, I would say for me personally on a
day-to-day basis I'm constantly
screening for symptoms of psychosis as
part of my daily work and perhaps a
forensic psychiatrist (who's working more
in the legal system or people who have
been accused of committing crimes or
different things) maybe screening for
conditions like psychopathy. [George] What is
going to cause psychosis in an
individual? [Dr. Kaz] There are medical conditions
that can cause psychosis, so if you just
had a surgery and you're coming out of
anesthesia and you start to hallucinate
that there's a horse in the hospital
room with you- that's a form of psychosis
that we can easily see what the causes
that. You had anesthesia, and your brain's
kind of waking up from anesthesia, and
you have this hallucination. So,
that's one that we can easily say we
know what's causing it, treat it, and
hopefully get the brain functioning back
pretty quickly as the anesthesia wears
off, for example. But, there are other
cases where people have symptoms of
psychosis (or maybe have hallucinations
or delusions) and try as we might, we do
all sorts of lab testing, brain imaging...
all sorts of things, and we can't quite
come up with a medical cause for it
directly. Then, that means that it
might be due to a psychiatric condition
(like schizophrenia for example). [George] Okay, so you can have psychosis... can have symptoms...
that doesn't necessarily mean that
you're have schizophrenia, because it
could be based on a drug that you had
taken or other things like that.
[Dr. Kaz] Exactly. [George] And do you immediately jump to, like, [confidently] "Oh, this person has schizophrenia... or
something else... Yeah, it seems like that
would be my go-to if someone was saying
that they saw a horse in the room. [Dr. Kaz] No, that's actually the last thing we go to.
First, we go to, "Are their lab tests
normal? Are their electrolyte
healthy? Have they taken a drug in the
past few days that might cause these
symptoms?" So, we have to do a little
bit of detective work and sometimes even
talk to friends or family to get to the
bottom of it. But, if we rule out any kind
of substance, or medication, or ingestion,
or medical condition as the cause of it,
then we're left with considering
conditions like schizophrenia- which is a
usually chronic condition that shows up
in young adulthood or adulthood (very
rarely in children). It's really a
brain disorder that causes these
misperceptions. [George] I actually have a fear that someday I'll develop schizophrenia...
[Dr. Kaz] mm-hmm [George] ...and obviously (or maybe not obviously,
I don't know, but) I wouldn't realize I
have schizophrenia. I think perhaps
that's how it works, where all of a
sudden my perception of reality is just
different than actual reality and I'm
not privy to that information and
everything just starts getting really
weird. [Dr. Kaz] Oh, that's the cruelest aspect of this
disorder- we live our whole life, from
the second we're born, and all we can do
is make sense of our sensory information
coming in. So, if there's something
wrong with the brain that's impacting
that sensory information, it's very
common for people to not know that
there's a problem and to instead believe
their senses. I sort of compare it to:
if we were all meeting together as a
family, with the physician, looking at the
person with these symptoms and we were
looking at them and saying, [convincingly] "Well, you see this table here that you see, there's
actually no table here. I know you see
and feel a table, but it's not really
here. The rest of us don't see and feel
this table in this conference room."
To person who is seeing and feeling the
table, they might say, [suspiciously] "I'm gonna believe
my senses over the rest of you, and in
fact you all seem to be in some kind of
cahoots or conspiracy about this, because
there's clearly a table here.." And, so it's
natural for people to believe their
senses over the word of someone else [George] Is
it always like that, or to someone maybe
with drug-induced or other types of
psychosis too, are they like, [insightfully]
"I see a horse in the room. I know
there's not actually a horse in the room.
I think I'm having a psychotic or
psychosis-type episode." [Dr. Kaz] I've definitely seen that but I would say that's less
common. Sometimes, with a lot of
conversation people ultimately develop
insight into the fact that their
hallucinations or their delusions are
not, in fact, true but it takes a lot of
work to get there. [George] What are the impacts
to someone's well-being? I mean you kind
of touched on it, but like in dealing
with a reality that's different than
everyone else's on a daily basis, that's
got to really impact your well-being?
[Dr. Kaz] Yeah, it's stressful. This is a
disorder where... so, we're talking about
when you have chronic psychosis, the most
common cause for something like that is
a condition called schizophrenia, which
has this sort of old-fashioned name.
There's stigma associated with the term.
It's important to know that
schizophrenia does refer to this pattern
of long term or chronic psychosis.
it doesn't mean somebody changes their
mind often , which is how I kind of hear
it used popularly in the media: [casually] "Oh, this
person was schizophrenic because they
thought this on one day and then thought
something else the next day". That's sort
of a popular use of the term that is not
accurate. It is a medical-psychiatric
condition. It refers to this pattern of
brain thinking where the brain
misinterprets sensory information coming
in and actually processes information
differently than perhaps it should. And
it does impact life. Imagine walking down
the street and you make brief eye
contact with somebody. Normally, your
brain filters that information out
because it's not relevant, but in someone
with schizophrenia their brain puts off
a little alarm bell and says, [alarmingly] "This person is in on it, they're part of the scheme,
they're part of the conspiracy."
[George] Does someone with psychosis  need
treatment? hospitalization ? It would seem to me
that they may pose a danger to
themselves or others if they're you know
misinterpreting yeah if their reality
you know potentially is that they need
to go out and stab things or you know I
don't that would be extreme but but it
it seems possible
most people with psychosis are living in
the community managing their sin
on a day-to-day basis working with a
physician on the right combination of
medications to more effectively manage
the symptoms very rarely they maybe
require hospitalization if they're
having emergency level symptoms or there
are issues of safety related to their
misinterpretations so sometimes people
will think oh my loved one is inhabited
by an alien or a demon or some outside
force and very famous case of this was
Andrea Yates the woman who actually
drowned some of her children in the
bathtub because she felt that that was
the only way to save them and her
thinking was clearly influenced by this
psychotic process but that is less
common and more commonly people are
doing their best to function day to day
do their work be active members of the
community can you get someone to come to
terms with the fact that there is no
care in the room we work and work and
work on that and develop strategies to
try to communicate that clearly and try
to help people understand that sometimes
your brain for reasons that we don't
understand very well can play tricks on
you in terms of the sensory input and
the way you interpret it but it's not
always easy and it's heartbreaking for
families if they have a loved one with
this condition say it's not the level of
dangerousness where they need to be
hospitalized but it's impacting their
well-being their education or their
professional growth or their
relationships and if there's low insight
about the condition it's just
heartbreaking to see somebody go on and
not be in touch with reality and feel
like there's nothing you can do and we
touched on it a little bit but and I
guess I mentioned it but is there a
higher risk of violence for someone
who's suffering psychosis the opposite
is true it's actually higher risk for
somebody with a psychotic illness or
schizophrenia to be the victim of crime
than a perpetrator of crime so while
this does happen time to time for people
who have a psychotic illness or are
misinterpreting things it's the wrong
conclusion to assume that somebody who
commits violence is doing so because
they have a mental illness and I assume
that they're at a higher risk of crime
just because of the high level of
vulnerability that they're facing yeah
they may misinterpret something or not
be caring for themselves or put
themselves in a riskier vulnerable
situation due to judgment or choices
that are influenced by their psychotic
illness what we do have a listener
question a listener asked dr. Kaz
I know schizophrenia is often confused
with multiple personality disorder could
you further explain the difference yes
absolutely so this is very common that
when we talk about schizophrenia people
say wait a minute I don't have multiple
personality disorders or kind of like I
mentioned before there's this popular
understanding that's the term
schizophrenia means that you sort of
change your mind or your way of being
about things and the way you approach
the world and that's not true there is a
condition called dissociative identity
disorder di D for short which is the new
name for multiple personality disorder
yeah that's kind of a updated term and
this is a real condition and there are
some people particularly people who have
endured extreme trauma who have this
condition it's not necessarily a
condition that has psychosis as part of
it but it sometimes does so there can be
some overlap between dissociative
identity disorder and schizophrenia but
there are completely different
conditions and as I mentioned before
schizophrenia is a primarily a psychotic
disorder whereas D I D is something more
related to survival skills that the
brain needed to adopt to endure extreme
circumstances you mention it but most
people whose kids ofrenda aren't locked
away somewhere
no absolutely not they're living in the
community and functioning the best they
can
some have periods of wellness between
episodes of psychosis and some have
psychotic symptoms all the time that
influenced them day to day and this can
take the form of hallucinations they may
be just at the grocery store and there's
a voice in their head saying buy that
don't buy that you're worthless
that was stupid and sometimes it's easy
to think well can't you just ignore
those voices or if you know that they're
not real just live your life without
them but I bet if I followed you around
and
kind of talking in your ear this way and
making stream-of-consciousness remarks
about the things you were doing and the
choices you were making you would find
that very hard to ignore and suppress
that yeah
and medications sometimes move those
voices to the background of one's mind
and even that's a step forward but these
are strong medications that we use in
psychosis and they help to varying
degrees and oftentimes it takes trials
of different medications to see which
medication is going to be the right one
for you and managing some of the strong
side effects that can come along with
antipsychotics it's sometimes a very
tough conversation particularly for
people who are struggling with insight
about the illness to say here take this
very strong medication with side effects
every day and so we're trained in
psychiatry to have those heart-to-heart
conversations and try to meet in the
middle somewhere
sounds good dr. cast going back to the
Austin City bomber MJ needs a psychopath
that really then has nothing to do with
psychosis right I think that's important
for us to clear up on one of the reasons
why we're talking about this today that
just because he used this terminology
and made kind of this self diagnosis of
being a psychopath that doesn't
necessarily mean that he had a type of
mental illness that has the symptom of
psychosis or something like
schizophrenia we just cannot conflate
these things in that note he did use
that term and I want to clear up what
was meant by that so that we're not
jumping to the conclusion that perhaps
he had some kind of mental illness
thanks dr. Kaz I know a lot more about
psychosis now anyone out there with any
other topics that you want to hear us
discuss or any other questions or even
concerns feel free to check out our
website the mind deconstructed org send
us an email tweet at us whatever it
takes we're here listen
yeah thank you very much thank you for
joining us today this podcast was
produced by Kaiser George music by Paul
hees last contact us instead the few
questions on Twitter at Pine deconstruct
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