To help you gain new insights into serious mental illnesses, we invite individuals living with them to share their perspectives. This month, Celine Ruscher shares her experience with psychosis and cognitive impairments, and offers guidance on how best to support a loved one facing these challenges.
Psychosis refers to an altered perception of reality. People experiencing psychosis can either face delusions, hallucinations or disordered thinking and speaking. Delusions are beliefs that cannot be changed even in the presence of evidence proving the opposite. These beliefs encompass diverse themes like persecutory, religious, somatic, grandiose, etc. Hallucinations are perceptions without an external stimulus, such as hearing a voice without having someone speak. People experiencing hallucinations cannot control them and experience them with the same intensity as real perceptions. Disordered speaking and thinking reflect a state where the person’s thoughts and ideas are racing into their mind, confusing their speech.
As the nature of reality changes during psychosis, it is essential not to validate/invalidate the perception but rather acknowledge the feelings of the person experiencing psychosis. Hallucinations or delusions can be highly distressing and trigger anxiety. Focusing on grounding techniques can be extremely helpful in maintaining a link to the present moment. Behaviours can change during psychosis. Not taking too personally what your loved one says or does, can help you go through the episode with them in the best way possible. Listen and be present.
If your loved one experiences a crisis during which psychosis becomes a threat to their life, health or well-being, know where to get support: ER, psychiatrist, Nationwide Crisis Line 988 (English or French) or BC Crisis Line 310-6789 (140 languages available), 911 if in immediate danger. Ask for mental health car if available.
Cognitive impairments are frequently experienced by people living with mental illnesses, with psychosis exacerbating the intensity. I don’t remember having met someone living with a severe mental illness and not dealing with at least memory issues. They make daily life difficult and can manifest as a sensation of living in permanent brain fog, memory loss, problems with working memory, problems with attention, slow processing speed, difficulty following a conversation, problems with word retrieval, etc.
My journey with cognitive impairments has been full of ups and downs. I realized that something was going wrong when I could not recall events that happened during the day or the day before. Some months have never existed. This was highly unusual, as I always had an excellent memory. Work has rapidly become challenging. Starting a cognitively demanding task requires a lot of energy and focus. For example, reading has become a challenge. I struggle with a simple three-paragraph article online about a random topic. Even an email of more than a few lines can be challenging on my worst days. I don’t remember what I have just read and need to restart several times. I need time for a discussion. I heard what was said, but I don’t understand immediately. Frequently, I cannot retrieve the words when I want to respond. Every single aspect of my life suffers from cognitive impairments. I feel sick when working more than a few hours on a demanding task. I feel nauseous, and I am anxious as if I am going to have a panic attack.
I have been lucky enough to benefit from a program of cognitive remediation offered by VCH, during which I learnt strategies to deal with the issues I face daily.
If your loved one suffers from cognitive impairment, don’t diminish their experience. Maybe they seem to function normally to you, while they are struggling. Also, avoid sentences like “I also have memory loss” or “It’s also difficult for me to focus today.” Instead, try to see what would be helpful for your loved one—helping with their agenda? Setting reminders? Speaking slower? Listen and be patient.
Another important aspect is to avoid incriminating the medications, as some of them have side effects on cognition. Instead, support your loved one in taking them as prescribed, and encourage them to discuss cognition concerns with their psychiatrist during their next appointment. Working hand in hand with the healthcare provider is crucial to get the best possible options to tackle cognitive impairments.
In order to offer you additional support, we would like to hear back from you. We’re offering a Q & A section for caregivers. If you have specific questions or inquiries about living with mental illness, please send them to familysupport@pathwayssmi.org and we will do our best to address them in a future Notepad newsletter.