.Psychosis involves one or both of the following:

• Hallucinations. Hallucinations occur when you hear, see, or otherwise sense something that is not actually present. Auditory hallucinations occur when something is repeatedly heard that others do not hear, most commonly voices. Voices can be loud or quiet, aggressive or gentle, sudden or predictable.  Visual hallucinations involve seeing something that others do not see. These experiences may include seeing shadows, people, animals, or other figures. Less frequently, other types of hallucinations occur. These include tactile (feeling something on the skin or inside the body that isn't there), gustatory (tasting something foreign or inexplicable), or olfactory (smelling something with no known cause). 
• Delusions. Delusions are fixed, false beliefs to which you hold strongly and which interfere with your normal cognitive functioning. Examples could be believing that you are being followed, or that your phone is tapped. These are examples of persecutory delusions. They can be accompanied by hallucations, such as seeing someone following you or hearing someone tampering with your phone. Other types of delusions also exist. Delusions of grandeur involve believing you are special and different from others, have been chosen to perform special tasks, or are being given special sorts of information. Delusions of guilt or sin involve beliefs that you are unforgivable and/or should be punished.  Erotomanic delusions involve beliefs about others being in love with you. Delusions of reference involve placing unusual significance on specific objects, people, or events in your environment. 

Psychosis is not a mental health diagnosis, but rather a set of symptoms that accompany a diagnosis. Schizophrenia, schizophreniform disorder, and brief psychotic disorder are three diagnoses distinguished only by the duration of time symptoms have been present. They each include either hallucinations or delusions, may include disorganized speech and/or behavior, and may include what's called "negative symptoms" which manifest as lack of emotional or behavioral expression. Negative symptoms include decreased interest in activities, decreased speech, decreased social interaction, or decreased ability to experience pleasure.  Schizoaffective disorder involves the symptoms of schizophrenia listed above, with an accompanying mood disruption like depression or mania.  Delusional disorder involves delusional thinking without the symptoms listed above that indicate schizophrenia-related disorder. Depression and bipolar disorder in their most severe forms can include psychosis as well. 

Psychosis can be induced by substance use, and usually pass once intoxication passes. Most notably, methamphetamine, hallucinogens (particularly synthetics like K-2), and stimulants like cocaine can induce symptoms that look like psychosis. Acute alcohol withdrawal can also produce psychotic-like symptoms, and should be treated immediately.  

Some medical conditions may also induce psychosis. The most notable conditions in which this may occur are endocrine and metabolic disorders, autoimmune disorders like lupus, and temporal lobe epilepsy. 

Stay tuned for another post on treatments available for disorders that include psychosis. In the meantime, here is a helpful page from the National Institute of Mental Health on schizophrenia.

If you or someone you know if sad much of the time, is withdrawing from things they used to enjoy, seems hopeless or having thoughts about death, this poem may resonate with you. I wrote it sometime last year during a particularly long stretch of down days. I've struggled with depression on and off throughout my life, and writing about it has always helped. I encourage others experiencing depression to speak to someone you trust, and own that it happens. But don't let it define you. Being sad isn't all you are...you are a bright, blooming, vessel of energy beneath the veil of depression. 

Days Pass
by Kambria Kennedy-Dominguez


Nine days passed, or twenty nine, or ninety nine.

Breath keeps coming, oxygen flows in and out,

I am breathing above great wall of water.

Only to find I’m trapped again beneath

Clear white water turns to stale black confinement

Like quicksand.

A trick of the mind

Makes me believe I am sadness.

From under it I gasp, I must rise-- it is only water!

I command myself without compassion for illness or exhaustion

I must transcend this trick, expose the foolery of a sad mind

I grasp, I swim, I grasp

Upward toward air and daylight

As if there is leverage between finger and water

I slip down, giving way to downward pressure,

Moving fast to swallow me whole.

How scary is this darkness and the sinking--

What fear is provoked in the heart of a child to be swallowed up!

Fear leaves its image upon us, like a permanent tattoo,

Like a searing brand proving ownership.


Please share this with anyone you know. Forward to friends, share on Facebook, tweet and retweet. There are lots of organizations whose mission is to end the stigma around mental health issues. A particularly great page is http://notalone.nami.org. There are some courageous stories here of real people experiencing psychological pain.

I don't really like the term "mental illness" because it implies pathology or disease, and it's not always helpful to label our experience that way. One of the hallmarks of the counseling profession is our uniquely developmental and strengths-based perspective. Counseling grew from the need for career guidance in the early part of the 20th century when wartime in America shifted its workforce needs. The earliest counselors helped people find what they're really good and enjoyed, and encouraged them to follow that career path.  This emphasis on the clients' assets and how they can become productive members of society continues to inform our profession today. 


My own story reflects this. I've experienced depression, discouragement, ill health from lack of self-care, family issues, etc. Because others have helped me find encouragement and recognition of my strengths, I (most days) am lifted above depression to find my vessel of energy to bloom and Flourish...