What is a psychotic break? A psychotic break, more commonly called a psychotic episode, happens when a person loses touch with reality. Their thoughts and perceptions become disrupted to the point where they may struggle to tell what is real and what is not. The phrase “psychotic break” is informal, and although some episodes are brief, psychosis can also happen as part of longer-lasting mental illness. There are many reasons why it can happen.
Most of us have probably only heard about psychotic breaks because of crime dramas on TV. A psychotic break is sometimes given as the reason why a person has committed a murder. Many countries have laws that recognize some form of legal insanity, where a defendant may be found not guilty by reason of insanity if their mental state was severely disturbed at the time of the crime. That does not mean they are simply set free. They are usually sent to a psychiatric hospital or placed under strict psychiatric supervision for treatment and evaluation. This is different from diminished responsibility or diminished capacity, which can reduce a prison sentence because the defendant was in a situation where they cannot be held as responsible as a regular person. The exact rules depend on the country and the legal system.
A famous example of not guilty by reason of insanity is John Hinckley Jr. He attempted to assassinate Ronald Reagan in 1981. He wounded Reagan, a police officer, a Secret Service agent, and White House Press Secretary James Brady, who was left disabled and died 33 years later. Hinckley was found not guilty by reason of insanity and was committed to St. Elizabeths Hospital in Washington, D.C. He was granted conditional release in 2016 and later received unconditional release in 2022.
It can be difficult to assess whether someone is having a psychotic episode because there are many possible symptoms. The person may hallucinate and see or hear things that are not there. They may believe they have special powers or become very paranoid and suspicious. They may become anxious and withdrawn, spending a lot more time alone. They may become incoherent and have difficulty concentrating. They may have strong mood swings, stop looking after their personal hygiene, or have trouble sleeping. They may also struggle to think logically and have trouble separating reality from fantasy. These are only some of the symptoms, and because they can overlap with other illnesses, diagnosis can be difficult.
In John Hinckley Jr.’s case, he became intensely obsessed with the actress Jodie Foster and believed that if he could only make her notice him, she would fall in love with him. He sent her letters and poems, called her, stalked her, and when that did not work, he came to believe that assassinating the president would make her notice him. His case is often used as an example of how severe mental illness can distort thinking and judgment.
Scientists still do not fully understand exactly what happens during a psychotic episode, but they think signaling between neurons becomes dysregulated. The brain takes in information from the senses all day long and has to decide what to pay attention to and what to ignore. It constantly sorts what is important, what is threatening, and what can be safely dismissed. Depending on what it decides, different brain systems are activated. During psychosis, these processes appear to go wrong. Something harmless may suddenly feel deeply threatening, while something genuinely dangerous may not be understood properly. Wind in the trees could sound like a voice, or a car outside could trigger intense feelings of fear or significance.
Researchers think dopamine plays an important role in this process. Dopamine helps the brain decide what matters and what deserves attention. If that system becomes disrupted, ordinary things can start to feel loaded with special meaning. A passing comment may sound like a secret message. A stranger’s glance may seem full of threat. A coincidence may feel too important to be accidental. Researchers also think other chemical systems, such as glutamate and GABA, are involved, so it is not as simple as saying that psychosis is caused by too much dopamine. It is probably more accurate to say that the brain’s systems for judging meaning, threat, and reality stop working together properly.
There are many different things that can trigger a psychotic episode. One of the most commonly used explanations in crime dramas is an overload of stress. If a person experiences extreme stress for a long time, or is suddenly exposed to a huge amount of stress, the brain’s stress response can become overloaded. However, this usually does not happen in just anyone. Stress is more likely to trigger psychosis in someone who is already vulnerable because of genetics, trauma, substance use, sleep deprivation, or an underlying mental illness.
Stress causes the body to release hormones such as cortisol. Researchers think that when the brain’s stress system is overactivated, it can affect dopamine signaling and make the brain assign too much significance to ordinary things. That could help explain why severe stress can turn into paranoia or delusions in some people. Stress also often damages sleep, and lack of sleep can make thinking less stable and worsen any underlying condition. In that sense, stress may be less a direct cause than a trigger acting on an already vulnerable brain.
Psychosis can also be linked to trauma, drug or alcohol misuse, certain medications, severe sleep deprivation, and mental illnesses such as schizophrenia, bipolar disorder, or severe depression. In Hinckley’s case, later court records described him as having psychotic disorder and major depression. Psychosis, then, is not one single illness. It is a symptom that can arise from several different causes. And this is what I learned today.
Sources
https://en.wikipedia.org/wiki/Psychosis
https://www.verywellmind.com/what-is-a-psychotic-break-causes-symptoms-treatment-support-5270544
https://www.nimh.nih.gov/health/publications/understanding-psychosis
https://en.wikipedia.org/wiki/John_Hinckley_Jr.
https://www.famous-trials.com/johnhinckley/537-hom
https://en.wikipedia.org/wiki/John_Hinckley_Jr.
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