On Reality and Insight
Dr. Irene Hurford explains the concept of reality, the challenges of understanding reality for patients with psychosis, and some tools to help patients reality test on their own.
Dr. Hurford VO: So, reality is actually a very slippery concept. We all think we’ve got it nailed down, but the truth is we all struggle with reality from time to time. What usually happens is that we share a consensual enough reality that we’re able to have conversations, go to work, navigate the world around us. But reality is not something that any of us have a complete, clear hold on. So, one of the challenges I think people with psychosis often have is that they don’t necessarily agree with the way the rest of the world views how they’re doing. In medical terms, we’ll call that insight. People with psychosis often take exception to this term because it’s very pejorative. It implies that their experience of reality is wrong. And ours is right. When the truth is that we’re both struggling to understand each other when somebody has psychosis. Medications are really helpful to help establish or reestablish that foundational consensus reality. They essentially provide…like the foundation of a house. You can’t build a house on sand. The house will crumble and fall apart. You need a foundation, a concrete slab. And, and that’s what the meds do; they give you that steady surface of reality. But then we need to build the walls. It needs the roof. Like there needs to be the work. And that’s where the talk therapy comes in. That’s where the psychological work comes in because that’s what gives people the tools to reality test on their own. To figure out, you know what my voices are getting worse, but that’s because of the stress in my life right now. Or this vision that’s so scary, well, I can actually interrupt that vision. I can distract myself from it. I can reality test it so that every time somebody might have a small resurgence of symptoms, they’re not dependent on increasing a medication dose, for instance, as their only solution. They can turn to themselves and their toolbox and say, I’ve got this.