In psychosis I often find myself obsessed with the truth of all kinds of issues. More so than in ‘ordinary life’ when I’m medicated and doing well. Obsession is really the appropriate term to capture this aspect of psychosis for me, for I cannot seem to let go of these concerns in such times.
One way of conceiving of psychotic phenomena is that we as patients have made mistakes in estimating the truth of various things, and accordingly, ought to engage in more thoughtful ‘reality-checking’. This may very well help for some, but it seems to me things may be a bit more complicated than this.
I think so for I have noticed in myself ways of thinking that kind of undermine this whole notion of reality checking in psychosis. You see, during episodes, I tend to ‘reason from exceptions’ - for lack of a better term. With this I mean that I might be confronted with some issue that is typically taken to be true, and now in psychosis I find myself unsure about this. What happens is that I reflect on the matter, try to establish whether it is true or false, and then the exceptions come to mind. So I would know that the issue is typically taken to be true, but conjure up some possible chain of events that could have it turn out to be false just now, and on the basis of this possible exception I take the issue to be false. Truth and falsity may be reversed in this description.
The thing is, given such a trend in my psychotic way of thinking, reality checking becomes a rather difficult and elaborate process. This is because the notion of any proof of anything, includes some premises that are assumed to be true. My obsession with truth in psychosis undermines such premises. For as I engage in reality checking, reflection would quickly turn on such premises as well, and lo, I conjure up exceptions to these too, and find myself rejecting these typical premises. Such quickly escalates into quasi-philosophical speculations about the accuracy of perception, the nature of reality and more things like that that are to be assumed in an ordinary check of the reality of things one is confronted with.
To me this is a large part of what psychosis consists of. Endless reality checking that gets me nowhere. I don’t know how common such a dynamic of thought is amongst other sz’s. But it does make me wonder… I am inclined to think that ordinary people do not end up considering such things. So someone may think they heard their name being called, and they would check the reality of this perception by having a look around to see if anyone is there. If no one is, that will be the end of the reality checking for them, it would be enough for them not to worry about the occurrence and confidently discard it as a false one. Such is to rely on assumptions that if one is to hear someone call your name, this other person is to be in the vicinity such that his presence can be confirmed by sight or something like that. This is perfectly fine, but it is not how it works for me in psychosis. I would question assumptions like this, and consider possibilities such as the person having disappeared quickly or telepathic communication and who knows what. And this in turn will have me end up checking the truth of such ideas - and this is already something ordinary people do not do, nor need to do. Checking such notions, I am inclined to say, could be seen itself as a symptom of pathological thought rather than a way of combatting it.
As said, checking such wild hypotheses, given the way I think in psychosis, takes so much time and attention that it becomes a nuisance to me, destroys peace of mind, and just hinders me in doing what I want to do. I cannot help thinking thus when psychotic though, for my obsession over the truth of things keeps me reflecting on such matters - and then there is a lot of unusual stuff going on in psychosis that needs scrutiny, or so it seems.
Such made me think that, at least for me personally, the problem is not so much a lack of reality checking, but rather an excess of it. I’m caught up in reality checking all the time when psychotic, and it gets me nowhere. You know, when I’m doing well there are many things I don’t have a clue about whether they are true or not. And that seems to be no problem for me in these periods. I can perfectly deal with things being uncertain, ambiguous, or taken to be true/false without having further proof for it.