Do people under a state of psychosis often say things they don't
realize they are saying but could be really be the truth or their true
feelings about a person or subject

Hi kenricva-ga, 

Well, this is quite the interesting question! Very reminiscent of the
classic alcoholic question: Is the ranting drunk finally saying all
the things he/she has been keeping inside or is it just the “alcohol
talking?”  If you’ve ever been on the receiving end of that rant, you
sure want to believe it’s the alcohol.  The same holds true for a
person in a psychotic state. Some pretty horrible things can come out
during a psychotic episode and you have to wonder where it’s coming
from.

The very simple answer is: What they are saying is only true based on
their CURRENT PERCEPTIONS.  That is, it is their truth right now,
during the psychotic episode. That truth may any mix of reality and
psychotic perception. But it probably won’t accurately reflect their
real opinion or thoughts when they are not in the psychotic state.

A good (albeit simplistic) example would be suppose you were holding a
blue ball. If someone asked you to describe the ball, you would
describe it as blue. That’s true and we all agree on that truth. Now
suppose you went into a psychotic episode that caused you hallucinate
and see the ball as engulfed in flames. You would act based on your
perception and fling the ball away while yelling “fire!” and dousing
it with water. The flaming ball was true to you at that time. But that
truth doesn’t carry over into the “real world and it wasn’t some truth
that was “waiting to come out” during the psychotic episode. It was a
truth created entirely by your mind.

I’m going to base my further discussion here on three things: personal
experience, books I’ve read, and web research. At the end I’ll give
you some links and references so that you can do more reading on the
subject if you like.

First let’s examine what exactly is happening to a person during a
psychotic episode. What are they experiencing?  By definition, a
person experiencing psychosis has lost some or all touch with reality.
They are subject to auditory and visual hallucinations, delusions
(false beliefs held with absolute conviction) including persecutory
delusions, confusion of thought, disorganization of speech, and other
symptoms.

When a person experiences hallucinations and delusions, they then act,
feel, and speak based on those perceptions because they are REAL to
them. Anything they knew or felt before may be completely discarded.
People they have always trusted may become dreaded enemies. My own
experience with a bipolar person in a manic psychotic state
illustrates this point. She arrived at my house completely agitated
because she had (somehow, 50 miles away) overheard a private telephone
conversation between her sisters in which they discussed the “secret”
death of a relative who was leaving them a great sum of money. The
woman “knew” that the sisters were planning to cut her out of the will
and wanted me to do something about it immediately.

Now, had her sisters overheard the horrible things this woman said
about them, they might conclude that she had been harbouring this
hatred for year. But all of her ranting was based solely on her
psychotic perception that they had, for years, had a secret plot
against her. Something for which there was no basis in reality, and
something she didn’t even remember when she wasn’t in a psychotic
state.

Now one argument might be that this woman had always had some “issue”
with her sisters and that’s why her hallucination took this course.
This would be a Freudian interpretation; something that has been
largely discarded by the scientific community.

We now know that psychosis is not a “psychological” problem in the
sense of being rooted in emotional causes (though episodes may be
triggered by stressful events).  It is a physical / chemical problem--
an imbalance in the brain chemistry or structure that causes the
person to act or react in an inappropriate manner. A person cannot be
counselled out of their psychosis. They must be treated chemically.

What gets hallucinated may be completely random or may be triggered by
something immediate.  A neuron misfires and all of the sudden the
psychotic thinks that the man standing next to her on the train is a
Russian spy heading to Washington to kill the president. So she acts
on that belief.

For an excellent inside view of how a person thinks during psychosis,
read either of the following books, both written by people who suffer
from Type 1 bipolar disorder, which includes psychotic states. I have
read them both and found the insight incredibly revealing.  Both
authors discuss the thoughts, feelings and ideas they had during
psychotic states, and how those thoughts had no basis in any kind of
reality.


The Unquiet Mind
Kay Redfield Jamison
Paperback: 224 pages 
Publisher: Random House (Paper); 
ISBN: 0679763309; (January 1997)

http://www.amazon.com/exec/obidos/ASIN/0679763309/qid=1032283587/sr=2-1/ref=sr_2_1/002-6540126-5468012#product-details


A Brilliant Madness: Living With Manic-Depressive Illness
by Patty Duke, Mary Lou Pinckert, Gloria Hochman
Paperback: 338 pages 
Publisher: Bantam Books; 
ISBN: 0553560727; Reissue edition (June 1, 1993)

http://www.amazon.com/exec/obidos/tg/detail/-/0553560727/ref=pd_sim_books/002-6540126-5468012?v=glance&s=books


================================
USEFUL WEBSITES
================================


DEFINITION OF PSYCHOSIS
http://medmic02.wnmeds.ac.nz/groups/rmo/psychosis/psychosis1.html


PSYCHOSIS – LOSING TOUCH WITH REALITY

On this site, pay close attention to the different types of delusions
and imagine how a person suffering from one of those might act and
speak, and how that would have little bearing on how they feel in
“real” life.

http://www.hsu.edu/faculty/langlet/lectures/Abnormal/psychosis.html



MEDLINE MEDICAL ENCYLOPEDIA – PSYCHOSIS
http://www.nlm.nih.gov/medlineplus/ency/article/001553.htm


PSYCHOSIS IN LATE LIFE – NEUROCHEMISTRY
http://www.gcrweb.com/PsychosisDSS/clinical/neuro.html


==================================
RELATED GOOGLE ANSWERS
==================================

Other people have asked questions that have to do with psychosis
and/or related disorders (ie bipolar). You may want to read the
answers provided to these questions and peruse some of the related
links.

Schizophrenia
https://answers.google.com/answers/main?cmd=threadview&id=34675

Assistance for bipolar sufferer
https://answers.google.com/answers/main?cmd=threadview&id=60353

Mental health info on the web
https://answers.google.com/answers/main?cmd=threadview&id=3065

Bipolar disorder
https://answers.google.com/answers/main?cmd=threadview&id=63772



That should answer your question and the websites and books I’ve
recommended will provide further insight into the nature of the
psychotic’s thoughts and ideas.  Please feel free to ask for
clarification if anything I’ve said is not entirely clear.

Thank you for a great thought-provoking question. 

-K~

Search terms:
Psychosis definition

I cannot give a medical opinion, but here are some personal comments.
Someone in a psychotic state is likely to be very confused about their
own feelings. I would not take to heart anything said about yourself
other people that seems to be unkind or cruel during these episodes.

That said, there is a tendancy among health professionals to dismiss
everything said by a psychotic as untrue, or as part of the illness.
To give you a couple of examples from personal experience:

A young friend was hospitalised and occassionally delusional. He told
the staff he was to sing the lead role in a Pro-Am production of a
Mozart opera. This was dismissed as part of his delusional
structure.Imagine the surprise when we turned up to visit, and asked
if he was permitted to come to rehearsal!

In another case an elderly veteran told interesting stories of his
wartime experiences, no more coloured or embroidered than the average
old guy's "good yarn." The nurse, a quarter his age, commented "None
of that's true, you know." She cannot possibly have known what was
true and what was not in his stories from nearly sixty years ago.

Good luck.