I was sitting in my living room, opposite a jolly looking matronly psychiatric nurse. I had been talking pretty much non-stop for maybe ten minutes thanks to being at the height of mania. The subject of my ranting was rooted in delusions; I am the saviour of the world and I need to kill myself to make everything (war, famine, poverty) better. The nurse was giving no feedback or encouragement but I kept talking until I eventually lost my train of thought and had to pause.
She took her chance to talk. The words formed from her lips in an amused tone; “but you know you’re not superwoman.”
Well no. I didn’t know that. The thing about delusional beliefs is that the person having them lives in a kind of alternative reality where common sense ceases to exist. Her remark poked me right on the anger button. How dare she suggest I’m not telling the truth? How can she not see who and what I am?
Talking to people in a psychotic episode is something of a tightrope act. We can’t see the truth and wholeheartedly believe in our own reality that the mind creates for us. The main point is not to try to argue with the person or attempt to talk them out of their state of mind. Argument can make them suspicious of your motives and reduce their trust in you. Dismissive attitudes also sting hard; minimising the experience they have having can rile up tempers.
In a conversation with someone experiencing psychosis it is best to try to be sympathetic and listen attentively. You do not have to agree with their opinions, and making clear to them that what you experience is different to theirs is fine.
Your friend/colleague/co-worker may talk a lot, or they may be withdrawn and reluctant to share their thoughts with you. In cases of paranoia they can be distrustful of the people around them and so are far less inclined to talk about what they are thinking and feeling. Paranoia and delusion can mean that they interpret your actions and words in a way that fits with their beliefs at the time; they cannot see the innocent, alternative explanations.
Encouraging healthy coping strategies is a good idea. Soothing activities such as taking a bath or shower, or making a cup of tea, can divert attention away from the psychotic thoughts. Of course, if the person isn’t able to calm down or is posing a threat to them or you, it is best to contact medical services or emergency services in order to get help.