Inside Bipolar Podcast: Demons, Delusions, and Hallucinations

Inside Bipolar Podcast Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe Howard: Welcome to the podcast everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole Washington: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe Howard: I want to remind all of our listeners that if you email show at PsychCentral.com with your topic suggestions, we really do get those emails. In fact, today’s show came from multiple email suggestions, all asking us to cover things like hallucinations, delusions, and psychosis. And we’re really excited to cover those three things on today’s episode.

Dr. Nicole Washington: Yeah. I think a good place for us to start, Gabe, would be for us to talk about what is psychosis? Like, just what is it?

Gabe Howard: You’re going to say it’s delusions and hallucinations, aren’t you?

Dr. Nicole Washington: Well, that’s part of it. That’s part of it. So delusions are absolutely a part of psychosis. When we talk about delusions, remember we’re talking about that fixed false belief despite all evidence to the contrary, that that person just holds really tightly as being 100% gospel truth and then hallucinations. I think we all have a good feel for what hallucinations are. You know, you’re the seeing things, the hearing things that other people aren’t seeing and hearing. Sometimes the feeling things on your body, tactile hallucinations. We it’s all those things that you think are there, but nobody else can see or feel or hear but you. But hallucinations and delusions aren’t the only symptoms of psychosis, so.

Gabe Howard: Hang on, hang on, I want to I want to interrupt you real quick. I want to make sure that I understand delusions versus hallucinations,

Dr. Nicole Washington: Okay.

Gabe Howard: Because this trips a lot of people up

Dr. Nicole Washington: Yes.

Gabe Howard: From my understanding, delusions are when you know something is there but you don’t see it, and a hallucination is when you know something is there because you’re staring right at it. But of course, it’s not actually there. Is that a good layman’s definition for delusions versus hallucinations?

Dr. Nicole Washington: I mean loosely. I guess that for a visual, hallucinations for sure, but absolutely. I think that if you break that down, yes, that that that is a good explanation of the difference between the delusion and the hallucination.

Gabe Howard: Perfect. Now, you started to explain that psychosis covers more than just delusions and hallucinations. It turns

Dr. Nicole Washington: Yes.

Gabe Howard: Out there’s this whole big definition that you probably have to go to medical school to understand.

Dr. Nicole Washington: You know, it helps, it helps, it helps. But for some people, their psychosis comes out in disorganized thoughts and behaviors. So that is also something that we might see. A disorganized thought is, for lack of a better term, kind of speaking incoherently. So the person is talking to you and maybe the words are just not making sense. The you ask them one question, they answer a different question. The thoughts that they’re generating and kind of sharing with other people just are not making sense to the situation. So that could also be.

Gabe Howard: Is this where word salad comes from?

Dr. Nicole Washington: It could.

Gabe Howard: We hear about that phrase a lot, where the person is speaking in gibberish, or putting together words or sentences that don’t fit together. And we hear a lot. Well, they were speaking in word salad. Is that psychosis?

Dr. Nicole Washington: Word salad can be psychosis, but it can be sentences that make sense grammatically but just aren’t in line with what we’re talking about. They just don’t go with the conversation. If I ask you, how are you feeling today? And then you start talking to me about aliens or something that is completely not related to what we’re talking about, and sometimes it can be disorganized behaviors. You know, an example that I can use from real life, I’ve seen patients with psychosis stand in front of a door and almost stand there knowing like this is a knob and not really knowing what to do with it, to be able to enter the room. So they’re looking at this knob and just can’t figure out how to use it. I’ve seen people hold a comb in their hand in the hospital and not really be able to figure out what is this for, what am I supposed to do with this? So just a complete disorganization of their behavior. And so those are also symptoms of psychosis, not ones we tend to think about as commonly as we think about the delusions and the hallucinations, but still symptoms that we look for.

Gabe Howard: Dr. Nicole, as you were talking, one of the things that I was thinking about is racing thoughts. Racing thoughts is a very common symptom of bipolar disorder. Almost everybody is familiar with it. Is racing thoughts a part of psychosis or is it something different entirely?

Dr. Nicole Washington: Racing thoughts can be a part of mania, but I do often see people who are actively psychotic, so they’re right smack dab in the middle of their psychosis. If they have a diagnosis like schizophrenia, for example. Sometimes people who are psychotic are just very passionate about what they’re talking about, because I have these thoughts and things that I believe are true and nobody believes me. You know how maddening. You know, you know how maddening that can be. Or I am hearing something and I hear people saying negative things about me, and everybody in the room is pretending like they didn’t say it, but it sounds so real. How could I be making it up? Right? People always say, well, I’m not making this up. I heard you say that I was a jackass. You’re like, but I didn’t say that. And if those things happen for you repeatedly, it’s easy to get so passionate about it that you’re talking really fast and it can come across to somebody like, oh, I wonder if that person is having racing thoughts. Maybe you are, maybe you aren’t. So racing thoughts is a symptom for sure. In mania we can see it in anxiety, right? People with anxiety say, oh, I have racing thoughts. My thoughts are racing. People with psychosis can have racing thoughts about all of these things that they’re so passionate about. So racing thoughts can be a symptom of a few different things.

Gabe Howard: Now, every single person with bipolar disorder has psychosis, right? That’s just the number one thing that gets them the diagnosis. I’m positive of this. This is correct. Right.

Dr. Nicole Washington: Well, you are absolutely 100% wrong.

Gabe Howard: Wah wah wahhhhhhh.

Dr. Nicole Washington: [Laughter] Wah wah wahhhhhhh. You are wrong, Gabe. Not everybody with bipolar disorder will experience psychosis. Some people with bipolar disorder might experience psychosis with severe depression episodes, but never experience it with mania. Some people with bipolar disorder may only experience psychosis with mania and never experience it with depression, regardless of how severe their depressive episodes are. And then there are some people who might experience psychosis with both, and there are some who may never experience it at all.

Gabe Howard: Okay, so if not everybody with bipolar disorder experiences psychosis, what’s the percentages? How many people will is it rare? Is it common?

Dr. Nicole Washington: It’s pretty common. We know that over half of people who have bipolar disorder will experience psychosis at some point in their lifetime during an episode. It may not be every time, it may be once, it may be multiple times. But over half of folks with bipolar disorder are going to experience psychosis during an episode.

Gabe Howard: Now, I was in the half and you’re probably thinking, Gabe. Which half? Dun dun duuun!

Dr. Nicole Washington: [Laughter]

Gabe Howard: I was in the psychosis half. I experienced delusions. I never had hallucinations. I never saw things that weren’t there. I never had, like, tactile hallucinations. I never felt anything. I never smelled anything. I never heard anything. But I was positive that demons were chasing me for years. So I want the audience to understand that I was a grown man and believed that there were these things under my bed, in the closet, or just outside of my eyesight that was trying to hurt me. It’s it sounds very, very childish. But after I was diagnosed with bipolar disorder, you know, people came to me and they’re like, okay, this is a delusion. I started to get treatment and the demons went away. And for a while I was really happy. I was really happy. The demons went away because they had caused me so much pain. But I’m curious about this. This is what happened to me. I then believed that the demons went after the people that I loved. I knew they were gone from me, but that I thought they were attacking my friends and my family. I thought they went after my mom. So for a moment I started to consider to stop taking my medicine so that they would come back. And then if they would come back, I would have that comfort of knowing that they weren’t hurting anybody else. Is

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: This common either in delusions, hallucinations, psychosis for when you finally get it treated and it goes away, which is what everybody wants, there becomes this secondary problem.

Dr. Nicole Washington: Well, I would argue that it didn’t go away,

Gabe Howard: Okay.

Dr. Nicole Washington: So I would argue that the delusion really didn’t go away. It just shifted.

Gabe Howard: Hmm. Okay.

Dr. Nicole Washington: Because the fact that you thought that this thing was still happening, just not to you, means that it’s still a problem. It hasn’t gone away. So I would argue that, oh, well, that delusion is still present. It just has shifted flavor a little bit. The theme has shifted, but I would say that it did not go away.

Gabe Howard: See, that’s the difference between medical school and lived experience. Right from my perspective, it

Dr. Nicole Washington: Yeah.

Gabe Howard: Went away, it was over, and I was

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: Just making this very reasonable determination that I needed to protect my family. And from

Dr. Nicole Washington: Yes.

Gabe Howard: Your perspective, you’re like, oh, yeah, that’s all kinds of abnormal. That’s stinkin’ thinkin’ there, Gabe.

Dr. Nicole Washington: Yeah. I, I would say that it did not go away. It just shifted a little bit. And you know, I’m glad you brought up delusions though, because I think it’s really important for the loved ones, the caregivers, the, the, the actual support system out there to know that delusions are not made up. So one of the things I hear loved ones say a lot is, oh, he’s making all this stuff up and he’s saying all this stuff and he’s just making it up. He’s not making it up. It’s very, very real to him or to her, to the person who’s experiencing it. It feels very, very real. It’s why they’re so passionate and upset about it. So it’s not made up for them. It is their reality. It may not be anybody else’s but theirs, but it is their reality. And they’re not just making things up.

Gabe Howard: I can tell you, I 100% believed that the demons were real. And I believed that the things that happened to me were caused by the demons. And here’s what made it very difficult for me, some of the things that happened to me, and in fact, all of the things that happened to me legitimately happened. You know, I really did lose my job. I really did get in a fight with my mother. I really did have all of the problems that the demons were causing.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: The reason just wasn’t demons, right there were there were other external factors that were easy to explain that I just could not see

Dr. Nicole Washington: Absolutely.

Gabe Howard: When it comes to what you’re saying, Dr. Nicole, that people would think I was lying. I never really expressed that I thought that demons were chasing me or causing me

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: Any problems. I, I kept that I, I knew that the demons were real, but I also knew not to tell people. So

Dr. Nicole Washington: Okay.

Gabe Howard: I did not have to deal with any of the social stigma of saying, hey, I’m having this delusion. But I got to tell you, if somebody would have told me, Gabe, those demons aren’t real, I would have stopped trusting them immediately because I would have been like, well, what do you know? I’m telling you, they’re real. I they’ve done this to me, this to me, this to me. You’re clearly a moron.

Dr. Nicole Washington: Yeah.

Gabe Howard: Is this another problem that you have in treating people with delusions? You can’t just tell them that they’re not real, right? Whether

Dr. Nicole Washington: Absolutely.

Gabe Howard: It’s delusion, hallucinations, or etc. you just can’t just say, no, Gabe, that’s not true. And then suddenly they’re well.

Dr. Nicole Washington: I mean, if that worked, I wouldn’t need the medication. I would just say, oh, that’s not true, don’t worry about that. And they would say, you know what, Dr. Nicole? Thank you. I was so concerned that someone was after me and going to take my life. But now I’m reassured. Have a great day. That is not how this happens. It just doesn’t work that way. And then people become so passionate about it that that’s where the conflicts with the loved ones happen. That’s where it happens. And I think family members and support systems get confused, because sometimes the delusional content can be things that they know. The person knows when they’re well aren’t true. So if during your psychosis and your delusion was that you were adopted, or that your parents stole you from a family and that your real family lives in Idaho, if that’s what you believe to be true. But your parents know, like, hey, knows that I’m his mom and that Gabe knows all these things. Like he’s seen the baby pictures, he knows he’s heard the stories. And then all of a sudden, when you’re not well, you’re saying these things, you’re like, why are you lying? Why are you making this up? This isn’t true. You know, this isn’t true. And yes, stable mood. Gabe does know it’s not true.

Dr. Nicole Washington: Manic Gabe doesn’t know it’s not true. Not this time anyway. Just doesn’t know it. So it gets people really worked up. And family members have a really hard time understanding how people can get so worked up about something. And I always give the example. I tell them, we all know how much money we have in our bank account. We can look at it online. You can look and see how much money you have. If I walk into the bank right now and I say, I’d like to make a withdrawal, and I decide I want to change banks and I want to move my money to a different bank. And I go and I say, hey, I have this number of dollars in my account. I’d like for you to give me that. I’m going to change banks. If the bank told you I’m sorry you don’t have any money here. I have no idea what you’re talking about. And then you are going to get more and more escalated because, you know, you have money at the bank. Like I checked my account. I know how much money I have in the bank. And you’re there and you’re getting escalated. The bank people are like, I don’t know what to tell you. You don’t, you know, sorry, I can’t find any record of you. Do you have an account number? Do you have any information? And you are getting more and more worked up.

Dr. Nicole Washington: If it’s me, I’m turning the bank out. I’m just going to tell you, if I show up to the bank to get my money and the bank is telling me that my money is not there, I am turning the bank out. So then what’s going to happen? Police getting called, everybody’s like, oh my gosh. Like she oh my goodness, this is what it’s like to have a delusion. Like you firmly believe something with all your heart and soul to be true. And then you have people saying, well, no, I mean, absolutely not. And just as much as I know how much money I have in the bank, that person with that delusion, they fully believe that with that level of certainty. So when you start poo pooing them and start saying, no, it’s not true, and you start disagreeing with them, it can cause a lot of problems. So if a loved one has delusional thoughts and they’re sharing them, I don’t recommend saying, well, that’s not true or don’t be silly, you know that’s not true or don’t be crazy. That’s just crazy talk. You know that’s not true. Those are not the words and not the way I would choose to deal with that.

Gabe Howard: One of the things that you mentioned in your story, Dr. Nicole, is that the police were called and that the police show up. I do crisis intervention training. So law enforcement training to help police officers work with people who are in a mental health crisis. And one of the things that I tell them immediately is if you show up to somebody who’s actively hallucinating, having a, you know, psychosis, delusion, etc., do not under any circumstances disagree with them or you have lost. And the exact example that I use is if they say there’s a dragon there and you say there is not a dragon there, it’s over, go get another officer. You have lost all credibility because they’re staring at a dragon. Now,

Dr. Nicole Washington: Right.

Gabe Howard: In your example you said, you know how much money you have. So the police officer walking in and saying, you don’t have that kind of money, it’s over. A better way to handle it for all of our family members and friends who are listening is to say, what’s the dragon doing? Or how much money did you think that you have? Or which bank did you have it, and ask open ended questions. Don’t confirm that the dragon and or money is there, but also don’t deny that it’s there. De-escalate. Keep the conversation going and see if you can figure out. Am I hitting the nail on the head here? Is this what you would do if you were called to deal with you pre turning out the bank?

Dr. Nicole Washington: Before I turned the back out. Yes, I you don’t deny it, but you also don’t agree with it and buy into the delusion if it’s not accurate. You don’t want to do that either. I’d like to ask questions. I’m usually pretty honest with my patients when they say, well, don’t you see that? Don’t you hear that? And I tell them, I don’t. I believe that you do, but I do not. And that’s a place of like, I believe that you hear it. I believe that you see it. I believe that for you right now, that feels very real. But I just I don’t have that same experience right now. It’s okay to say that in a non-judgmental way, but when you come in going, well, you don’t have any money here or there’s no way you have that kind of money here. It’s over. It’s over.

Gabe Howard: Yeah, yeah, it’s gas on a fire.

Dr. Nicole Washington: It’s over.

Sponsor Break

Dr. Nicole Washington: And we’re back discussing psychosis and bipolar disorder.

Gabe Howard: Now, you brought up as a doctor, in your office working with patients, you can say, I believe that you do, but I do not see them. You said that you were very, very honest. I believe that’s an advanced skill. I don’t think that’s something that, like family members, law enforcement can, can probably easily do, especially if they’re responding to a mental health crisis. How do you move your patients to be able to hear that? I just I want to make sure that the audience hears that anybody who is in the midst of a mental health crisis is probably not going to respond too well to, well, I believe that you believe that, but I don’t believe that. But I also know that it’s important to get people there. I, I work with people, including myself all the time where I’ll say, did you hear that? Or do you feel that? Or what do you think? And I’ve become very receptive to getting that feedback to help inform my own decisions about what I may or may not experiencing. But again, it’s an advanced move. It’s not something that people are doing on day one, and certainly not in the midst of a mental health crisis?

Dr. Nicole Washington: No, no, no, not in the middle of. But if in the middle of a crisis, somebody says, did you hear that? And I say, I did not hear that. Like I’m very honest. Nope. I did not hear that. And I mean, that’s just that’s the answer. That is the honest to God truth. If they asked me directly, did you hear that? And I say, I did not hear that, or if they are, you know, responding to something, I say, it sounds like you’re hearing something that is really bothering you, and I am not hearing that thing. Can you tell me what it is? What are they saying? What kind of things are they saying? You look pretty upset by it. So I’d like to know what you’re hearing or what you’re going through right now. Those are. Those are the ways I kind of manage that. But like you said, I mean, I’ve been doing this for more than a day and it takes time, especially in the beginning, sometimes as a loved one, being there when it’s really going down, the best you can do is just I can tell you’re very upset. I am so sorry that you’re going through this right now. And if they ask you specifically, do you hear that? And you say, I’m sorry, I don’t, I don’t you want to tell me about it because it sounds pretty crappy and let them tell you about it. Let them share with you what’s going on. But it takes some time to get to that, to that place.

Gabe Howard: In preparation for this episode, Dr. Nicole, I went into a sub thread and I said, hey, anybody who’s experiencing hallucinations described them to me and almost all of them, you know, out of the dozens of responses I got, were a glimpse out of the eye. Somebody running away just they thought they saw him out of the corner. They were far down in the crowd. Nobody ever described anything like the Star Wars glowing Jedi returning from the dead kind of hallucination. It was. It always seemed to be in in glimpses or side I never like dead On. I’m absolutely talking to my dead father kind of vibe. It always seemed to be they saw it, but not perfectly. Whereas

Dr. Nicole Washington: Eh.

Gabe Howard: On television it’s always they see it perfectly. It really does kind of feel like the, you know, the Jedi returning from, you know, the force ghost concept, this, this glowing being.

Dr. Nicole Washington: Visual hallucinations are not as common as auditory hallucinations, so voices are much more common. Visuals aren’t that common. I do have people who tell me they see fully formed figures, and then I have ones who tell me what you said. They saw something. They saw a shadow pass by. They saw someone in a red shirt, you know, walk by the doorway. But nobody was there. I hear both, I hear all kinds of scenarios of what people are hearing related to their psychosis. People aren’t always sure that what they’re experiencing is a hallucination that comes with that whole level of, do they have insight into what’s going on with them? And oh, this probably isn’t really happening. That may come with time for a lot of people. So yes, people think like, oh, this is happening. So when I hear someone call me an ugly name, it has to be somebody who’s in the house with me. Forget that these are my loved ones and the people that support me. Sometimes they think that it is for real and it has to be somebody there, because how could it be somebody else? Sometimes that improves with time, but it may never improve, especially if the person just doesn’t have really great insight into their particular illness and their symptoms.

Gabe Howard: Not to put too fine a point on this, but it it’s real to them. Right. There’s no question that it’s real to them. It’s I suppose as they get gain more you know like me, I started to question the delusions. I started to learn. I had the medication assistance, therapy assistance, coping skills. I got wiser, but go back to before I was diagnosed, I was 100% positive, zero doubt. And nobody needed to challenge it because I wouldn’t have accepted any challenge, I was positive. I’m also positive that there’s a microphone sticking in front of my mouth, and I’m podcasting with Dr. Nicole. There’s no message that you could send me to convince me that this wasn’t happening. Is that what a hallucination is like? You’re positive that it’s happening? Or is it is it even more on a spectrum? And again, I know that if the person is in treatment or if they’re learning about their illness or they’re moving towards improvement, that’s going to change. But what about before intervention?

Dr. Nicole Washington: It can change, but it also cannot change, right? That that person may never get to the space where they say, you know, I have asked everyone who lives in my house if they said anything and they all said they didn’t. And I have enough equity in these people to believe that nobody called me a bad name. This might be part of my illness. They may get to that point. They may never get to that point, but especially early on when you’re first experiencing psychosis. Yes, you absolutely believe that that is what you heard and that it had to come from somewhere. Because, I mean, why would you be hallucinating? You absolutely believe that that thing is crawling on you because you feel it just as much as you would feel an actual thing crawling on you. So those things feel so real in the moment. It is very difficult to kind of crack that that wall to get through and get past that early on. It can improve, but then it cannot improve.

Gabe Howard: One of the big things that I’ve noticed about psychosis is that it turns it sick people into liars. We sort of alluded to this a little earlier, but you use it for why are you being crazy? Why is that crazy talk? Why are you lying about that? You know that’s not true. And people with bipolar disorder are constantly getting pegged as being manipulators or liars, or causing problems where no problem needs to exist. And I’ve always tried to give pushback on that by saying, I understand that can be incredibly frustrating. You know, the whole time I was screaming that I hated my mother and that she was ruining my life, that that had to be very difficult for her to hear. And of course, she wasn’t a bad mom and she wasn’t ruining my life. She was doing everything that she could, and the more she defended herself well, the angrier I got. But after I was diagnosed, and after a lot of time, we learned that I wasn’t lying. That is what I believed. That is what I perceived. That is what I saw. How do families even begin to to address that? Because I, I there’s a small part of me Dr. Nicole I want to I want to be very careful how I phrase this, but there’s this very small part of me that wishes that my mom could have fixed it before I spent years declaring my, you know, hatred of this woman. I mean, that’s like a lot for me to now that I’m well, just knowing that I was angry at her for so long for no reason, is an awfully big burden. And there’s this little piece of me that still blames her for that. Why couldn’t you convince me that you weren’t a bad mom? Now that that’s my delusion, I’m using an example from my own life. But we can also use the analogy that you used earlier, which is, you know, you’re not adopted. You know you’re not from. Where’d you say Utah?

Dr. Nicole Washington: Idaho.

Gabe Howard: Idaho. They have potatoes there.

Dr. Nicole Washington: Idaho. Yes, yes I know. No. It’s hurtful. And it it can be very hurtful to someone who’s on the receiving end of the delusional thoughts. And whatever that content is, it can be very hurtful. And the reality is, it may just hurt and there is not a whole lot you can do about it. You can get support for your own stuff in in dealing with your loved one and their illness, and probably in talking to other family members who’ve been where you are, which another plug for NAMI and their Family-to-Family meetings and that whole program. I think the value in that is you have that community so that you can vent this out to other people, random people who don’t have a loved one who’s ever had severe mania and psychosis are going to have a very difficult time giving you support and advice in how to manage those emotions and feelings that that brings up because they’ve never been there. They don’t know what that’s like. But another person who is in close proximity to someone who said similar hurtful things and who’s had these kind of thoughts. They can they can give you that that. Yes, I’ve been there. It hurts. It’s terrible. You know, just to give you a sense of, okay, well, okay, I get it. Okay. This is not them talking. This is the psychosis. This is the mania. This is whatever that is. Sometimes you need just the right people around you. We’re always telling our people with bipolar disorder, you need the right people. You need the right team. You need the right. You also need the right people around you, because you also have to figure out how not to let the hurtful things that were said. Linger on once that person stable.

Gabe Howard: Is it possible when you’re experiencing psychosis for somebody to break through? I mean, is that even a reasonable thing? Just I’m talk to all of our, our people living with bipolar disorder right now that are thinking, look, I don’t want to be this way. They’re listening to this show for a reason. And they’re

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: Like, okay, what can my friends and family tell me that will make me not believe in this delusion? Hallucination? What will push through the psychosis and save me from myself? What’s the magic phrase, Dr. Nicole?

Dr. Nicole Washington: I wish there was a magic phrase. There’s not a magic phrase. I mean, if a person is in a severe mania, severe depression, and they’re psychotic, and sometimes medication is just what we need to do to deal with the psychosis specifically. And then once you get to that point where we see it shift a little bit or we see it not be as intense. So you talked about having the delusion that the demons were after you and then it’s shifting. So it sounds like it lightened up on you a little bit so you didn’t feel as personally attacked, but now you were worried about people you care about. That might be a time where I can talk to you about, okay, Gabe, I know you really feel this way, and honestly, it’s just really hard for me to wrap my hands around the theory or the concept of demons being after your family. I’m struggling with that. So I have a question for you. Can I ask you some questions about it? Gabe says, yeah, I guess, and I am asking you things like if indeed demons were after your family, what would that look like? What do you think would be happening to your family if that were true? And just trying to tease out as much reality as possible? Reality testing is very, very difficult and sometimes takes a lot of time, oftentimes takes a lot of time to be able to get a person to that point where you can get through. It’s not easy, and I don’t recommend you when they’re just right in the thick of it, intense, severe delusion, psychosis. And you’re like, so what if it was something else? Like, that’s just not the time

Gabe Howard: Here’s an example where you have blown my mind. Dr. Nicole, as everybody just heard earlier in the show. I thought the delusions completely went away, but that the demons were now chasing my family members. And Dr. Nicole said, well, I don’t believe the delusions went completely away. So there’s a disconnect here. But here’s why I felt the delusions went away because I was on medication. When the delusions went away, I started to get medications. I started to get treatment, and I started to get better. Therefore, I perceived that the medication was controlling the delusions. But I still believed this other thing. But they didn’t up my medication. My Dr. Nicole didn’t give me more meds or anything like that. My Dr. Nicole started asking me questions. What are they doing? What do they want with your mother? How does your mother feel? How does your friend feel? And I started having these conversations. I would go to them and say, hey, have you seen anything? And they would they would answer me, well, no, I haven’t seen that or well, but this bad thing happened to you, right? Well, this happened to me because of XYZ, not because of this. Interesting. And before you knew it, I was I was convinced. I was convinced that the demons were not, in fact, going after my loved ones. So

Dr. Nicole Washington: Right.

Gabe Howard: That’s how come I didn’t see that second part as part of the delusion? Because I was able to use my rational and logical brain

Dr. Nicole Washington: Yeah,

Gabe Howard: To convince myself that it wasn’t there.

Dr. Nicole Washington: But it was improved. Like your

Gabe Howard: Yes.

Dr. Nicole Washington: Your delusional thoughts were improved because

Gabe Howard: Correct.

Dr. Nicole Washington: You weren’t feeling as much personal distress from them. They were still there. They were milder. They were less intense. Didn’t mean that medication necessarily needed to be increased. Maybe it just needed time for you to get out of that manic episode. And it doesn’t always mean that. And delusions, we’re not always saying, oh, you’re delusional. Let me put you on something. I gotta up your meds because you’re delusional. That’s not really how it works or it’s not how it should work.

Gabe Howard: It’s so interesting to find the nuances of this, because everybody wants the black and white answer, right?

Dr. Nicole Washington: Yes.

Gabe Howard: We want zero psychosis and 100% perfection, and

Dr. Nicole Washington: Yes.

Gabe Howard: You seem to be indicating that it’s just not that simple.

Dr. Nicole Washington: It’s not even in your demon example. I don’t know that I would have increased your meds because you thought that the demons were now after your family. If I said to you, hey, Gabe. So if I thought that something was after my family, I’d be pretty upset about it. And I would be trying to figure out what I could do to save my family. What are your thoughts on what you need to do to fix that situation? If you said to me, well, I feel like I should camp outside of my mom’s house with a gun and I should, you know, shoot the demons when I see them on site so that I protect my mom. That’s a whole different answer than if you said, well, I mean, I don’t think there’s anything I can do. I mean, they’re demons. I mean, I’ll let the religious folks deal with that. I’m just not going to deal with that. I’m going to just, you know, I’ll keep calling my mom and kind of checking on her and making sure she’s okay. Different answer, different reaction from me based on kind of your response to the delusion. So it’s not always like, oh, they have psychosis. I have to jump to increase meds or change things. A lot of it really might depend on.

Dr. Nicole Washington: What’s your response? What’s your what’s your plan of action to deal with this? What’s your history? If you have a history of doing things that are aggressive, that get you in trouble. Then I may be a little more apt to jump to increase the meds or make changes. But if that’s your M.O. is that you kind of have these delusional thoughts and you just kind of have them and you don’t really do outlandish or dangerous things in response to them. I may not jump, so it’s not as simple. It’s not as black and white as people would like to think. But sometimes family members are very ticked off with me because they’re like he’s catching two busses to go to McDonald’s because he thinks the one around the corner is poisoning him. That’s insane. But is it hurting anybody? Like, let’s keep our plan of action. We’re going to keep adjusting the meds as we do. We’re going to. Yes, I agree, not the most efficient use of time, but not dangerous. Not a big deal in the grand scheme of life. And so we figure that out. But if you’re bipolar and you’re having psychosis, it’s in one of those episodes. We’re going to focus on getting that episode closer to center than on either one of those ends.

Gabe Howard: Dr. Nicole, I have really learned a lot. I’ve learned a lot about myself, but there’s just a couple of nagging questions that I’m afraid the listeners are going to have that, that I just want to touch on real quick. And the first one is what causes this? And don’t say bipolar disorder. What causes psychosis?

Dr. Nicole Washington: I mean, I mean, in a I mean, as I have said in a person with bipolar disorder, yes, it is the result of being in one of those other mood episodes. But to be honest with you, we don’t know why a person can have severe depression for decades and never have an episode of psychosis, but another person can have severe episodes and they’re psychotic every time. We don’t. We don’t know why that is. We don’t know why some people are psychotic during their manic episodes, and some people never experience psychosis with their manic episodes. We don’t have the answers to that. And psychosis in general. We have theories. We have a dopamine hypothesis when it comes to psychosis in general, which is why a lot of the antipsychotic medications affect dopamine receptors, because we do think that having, you know, too much dopamine can be a problem for those people who have schizophrenia or who have those, those illnesses. Some people think it’s a glutamate as another chemical in the brain. It might be glutamate, right. We have all these theories. But you know, glutamate is affected by dopamine levels. And so maybe that’s where the disconnect is. There’s so many theories. There’s theories. There’s all kinds of maybe it’s your brain function. Maybe genetically you’re predisposed to having psychosis for whatever reason. We don’t know the specifics of these things.

Gabe Howard: I never miss an opportunity to point out that bipolar disorder works just like many other illnesses that we have that have nothing to do with mental health. There really is that that. I know it’s a cliche at this point, but the person who smokes two packs a day and does not get lung cancer versus the person who never smoked a day in their life and does get lung cancer.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: We don’t know the answers to the things we know, that certain things raise the odds of it happening,

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: And certain behaviors lower odds of things happening. But ultimately, when it comes to our mental and physical health, sometimes it’s just simply bad luck or good luck, as the case may be. I only point that out because I don’t want people to think that bipolar disorder is somehow different from other illnesses that we’re currently learning about and researching. I mean, last I checked, we don’t know as much about cancer as we really wish that we knew about cancer, and there is no cure for it. Sounds a lot like bipolar disorder, right?

Dr. Nicole Washington: Yeah, I mean, I agree with you. We are we are lacking in information about a lot of things. But I completely understand that when this is your thing, it’s the only thing you care about. And I get that for sure. And I get the frustration. But yes, there are a lot of places in medicine where we still need answers. But I do know, you know, the brain is just very different. It’s a different the playing ground is just very different.

Gabe Howard: Well, Dr. Nicole, it is up to you to get those answers. One of the great

Dr. Nicole Washington: [Laughter]

Gabe Howard: Parts about being me is my job is podcaster. If you are listening to this show, I am 100% succeeding in my chosen profession. If you have questions about bipolar disorder research, that means Dr. Nicole has got some work to do.

Dr. Nicole Washington: It means I have failed. I am not doing my job. Let me go get my super friends and solve the bipolar disorder question. Yes, on my way.

Gabe Howard: All right, all right, everybody, thank you so much for listening. We have a few favors that we need us to do. Wherever you downloaded this episode, please follow or subscribe. It is absolutely free and you don’t want to miss a thing. And do us another favor. Recommend the show. Put us on social media. Share us in a support group. Send somebody an email. Send somebody a text message. Mention it casually at the mall if you still go to the mall. Because sharing the show with the people you know is how we’re going to grow. My name is Gabe Howard, and I’m an award-winning public speaker, and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon because everything’s there. But listen, you want to be super cool and get a signed copy with free swag by heading over to my website, gabehoward.com.

Dr. Nicole Washington: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or on my website, DrNicolePsych.com.

Gabe Howard: And we will see everybody next time on Inside Bipolar.

Announcer: You’ve been listening to Inside Bipolar from Healthline Media and psychcentral.com. Have feedback for the show? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/ibp or on your favorite podcast player. Thank you for listening.