Tag Archives: psychosis

Feb 11 2016

I’m Back: Psychotic vs Psychopathic

I’m back. I know it’s been a long time since I’ve posted anything, but often life intervenes in ways we don’t always anticipate.

I’d like to talk today about the difference between “psychotic” and “psychopathic.” Trust me, there’s a vast difference. In the media, however, the two are often used interchangeably. They’re not. Let’s take a look at the differences.

 

Psychotic

 

This is a term used that refers to someone who is suffering from a serious mental illness such as schizophrenia or other such disorders. It implies that the sufferer has lost touch with reality and is experiencing delusions and/or hallucinations. According to MedLine Plus: (https://www.nlm.nih.gov/medlineplus/psychoticdisorders.html)

            Psychotic disorders are severe mental disorders that cause abnormal thinking and  perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages.  Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there.

 

Psychopathic

 

This term refers to someone who has a serious personality disorder often referred to as Antisocial Personality Disorder. According to Psychology Today (https://www.psychologytoday.com/basics/psychopathy) , psychopaths often appear almost normal.

            Psychopathy is among the most difficult disorders to spot. The psychopath can appear normal, even charming. Underneath, they lack conscience and empathy, making them   manipulative, volatile and often (but by no means always) criminal. They are an object of  popular fascination and clinical anguish: adult psychopathy is largely impervious to treatment, though programs are in place to treat callous, unemotional youth in hopes of preventing them from maturing into psychopaths.

 

Psychotic vs Psychopathic

 

As you can see, they really are different. It is true that the psychopath will often display some disordered thinking, usually narcissistic. We can also see disordered thinking in the fantasies held by psychopathic serial killers. Most professionals would agree that these fantasies don’t quite reach the criteria to be called delusions. (I know, that sounds like hair splitting and it may just be so.)

One important distinction for you crime writers out there: psychotic killers are usually “disorganized” while the psychopathic is more often “organized.” Psychotic killers are going to have a much more difficult time planning out “the perfect crime.” Not to say they can’t do some pretty extensive planning. They can. The mass murder at the Aurora, CO, movie theater involved multiple weapons, tear gas, and tactical clothing, to say nothing of the explosives rigged in the shooter’s home. That all sounds pretty organized, doesn’t it? Still, Holmes was caught in the parking lot, waiting around and watching the chaos. That doesn’t sound very logical or organized.

 

On the other hand, let’s look at the Ted Bundy, the quintessential psychopathic serial killer. He operated during the 1970s and is often described as charming and manipulative. He cared nothing for his victims and totally lacked empathy or remorse. Towards the end, he did become less organized which led to his capture and trial. At no time, however, did Bundy evidence anything like delusions or hallucinations. From what I’ve read, he maintained his manipulative behavior right up to the end.

 

Takeaway

 

What’s the bottom line here?

*   A Psychotic and a Psychopath are NOT the same.

Yes, you can have a character making the error, but I ask you, please have another character correct the error. I don’t think any one of us wants to perpetuate false information. You can use the distinction to further your story’s search for a killer (assuming you’re writing a mystery or thriller).

 

Suggested Assignments

 

  1. Develop a dialog in which one character corrects another for believing psychotic and psychopathic are the same.

 

  1. Develop a character who is either psychotic or psychopathic. Show the character in a brief vignette.

 

Feel free to ask any questions you might have. I’d be happy to help.

May 29 2015

Insanity vs mentally ill: the case of James Holmes

Apparently James Holmes has pleaded not guilty by reason of insanity. This week, copies of his notebooks were released which seem to show that he carefully selected his target (the movie theater) and also seemed to be quite aware that what he was doing was wrong. This would argue against a finding of legal insanity. He knew what he was doing and knew it was wrong.

The writings also make it clear that he was (and probably is) very mentally ill. His illness seemed to torment him, from what I’ve heard on the news. This is something I’ve seen in many of my clients over the years. Very often they know something is wrong with them but they don’t know what to do about it. I find it almost heartbreaking that Holmes seems to have studied neuroscience in an attempt to figure out what was wrong with him. I can almost imagine the despair when his studies didn’t provide him with the answers he sought.

From what I’ve gathered in the news, it seems unlikely he will be found insane by the standards in Colorado. That’s not to say that this killer isn’t sick. He most definitely is. I suppose his illness will become important again when we get to sentencing.

As an example of the difference between the legal term “insanity” and the more medical term of “mentally ill” or even “schizophrenic”, this is about as perfect as you can get.

BTW: we are dealing here with a serious mental illness like schizophrenia. We are not talking about a personality disorder or psychopathy. Please, please do not confuse psychopathy with “psychotic” or insane. Personally I do think psychopaths are “sick”, but not like Holmes. Apples and oranges, folks. Apples and oranges.

JamesHolmesColoradoShootingAndyCrossColorado theater shooting suspect James Holmes

Mar 30 2015

Antipsychotic Medication and Flying

Okay, folks, let’s talk about antipsychotic meds. Remember, I’m a psychologist and not a psychiatrist. However, many of my clients over the years have taken these medications, so I think I have more than a passing knowledge of them.

Antipsychotic medications are primarily used to treat psychotic disorders. Makes sense, eh? Specifically, these medications help with the hallucinations and delusions experienced during many psychoses. I have sent patients to psychiatrists when it’s clear they’re suffering from a psychotic disorder. There are two basic types: the older “typical” antipsychotics and the newer “atypical” antipsychotics. The typical antipsychotic include Chlorpromazine (Thorazine) and Haloperidol (Haldol). The “atypicals” include:Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel),Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone (Invega), and Lurasidone (Latuda).

In recent years (say the past 10 or so), I’ve seen antipsychotics also being used as sleep aids and to help when patients are highly agitated. I’m not sure I really agree with this, particularly because of all the side effects. But I have seen it. BTW, the use of antipsychotics for agitation has been something I’ve seen in hospitals and is usually administered by injection (at least in my experience).

The side effects are numerous and can be very serious. Here’s what the NIMH (National Institute of Mental Health) has to say:

Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol.

In addition they note:

Typical antipsychotic medications can cause side effects related to physical movement, such as:

  • Rigidity
  • Persistent muscle spasms
  • Tremors
  • Restlessness.

Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can’t control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication.

These other side effects are not as common with the atypicals.

The next question is whether or not a person on any of these medications should be flying. Unequivocally I can say: NO! No matter what the reason for the use of the meds. My opinion. I don’t think a person on antipsychotics should be using heavy machinery either. Should they drive a car? Not at first, not until they know how it’s going to affect them. I can tell you, though, that most of those clients of mine in the past who were on antipsychotics *did* drive. To the best of my knowledge, psychiatrists are not required to contact the Department of Motor Vehicles (DMV) when they prescribe antipsychotics. They probably don’t contact the FAA either if the patient happens to be a pilot. Is this a loophole that should be plugged? I don’t know.

For you writers: consider having a character who is taking Seroquel for sleep (i.e. she’s not psychotic) and struggling with the side effects of that medication. A number of the soldiers I’ve worked with had been prescribed this med for sleep and they had a horrible time showing up on time for formation at zero-dark-thirty. So, now they were getting in trouble for that!