Bipolar with Psychotic Features

By Daniel J. Tomasulo, PhD, TEP, MFA, MAPP

I feel rather silly for even asking this. I worked as a psych nurse for several years. I was always under the impression that when people had hallucinations or delusions they did not know that it was not real. Over the past year everything I’ve ever thought I knew has been challenged. I suffer from both auditory and visual hallucinations. I realize through logic that it is not real. That’s one thing that confuses me. When I was first diagnosed with a psychotic episode, I realized there was a problem with my thinking. I was paranoid. I was delusional. Is there a reasonable explanation to why I am able to know these symptoms are not reality?

A. Thank your for your honesty and courage in asking this question. The popular movie from the book A Beautiful Mind showed the capacity of the mind to separate itself from the hallucinations. You can call it an observing ego, a true self, or the breakdown of the bicameral mind, but whatever the definition it seems as though your experience matches others’.

For a scientific underpinning of this process you may want to read the classic 1976 book The Origin of Consciousness in the Breakdown of the Bicameral Mind, by Julian Jaynes. He gives the history of brain development that squarely brings your question, and a possible explanation, into focus.

Wishing you patience and peace,
Dr. Dan
Proof Positive Blog @ PsychCentral

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Last reviewed: By John M. Grohol, Psy.D. on 21 May 2011

APA Reference
Tomasulo, D. (2011). Bipolar with Psychotic Features. Psych Central. Retrieved on July 30, 2014, from http://psychcentral.com/ask-the-therapist/2011/05/21/bipolar-with-psychotic-features/

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