Psychosis versus psychopathy.
The words sound similar.
Are they the same thing?
That's what I'm talking about today.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
This topic is based on a viewer question.
I think this is a common question that people have,
and I think it's a common misconception
that the two concepts are similar,
but they are completely unrelated.
Psychosis is a mental state
where your sense of reality is altered.
When you're in this state,
you have trouble knowing what's real and what's not real,
and there are different ways
that you can manifest psychosis.
One is in perceptual disturbances,
like seeing things that aren't real
or hearing things that aren't real.
These are called hallucinations.
You can also have delusions which are fixed false beliefs.
You believe things that are not true,
like aliens are inhabiting our bodies
and removing our organs at nighttime.
This sounds absurd to the non-psychotic person
because you know it's not possible
to live without your organs.
But, for the person who's in the throes
of delusional thinking,
it's very real to them.
Another psychotic symptom
is extremely disorganized thinking,
and this behavior is more
than getting confused about things
or not having all your ducks lined up in a row,
and therefore being disorganized.
With this thought disorganization,
also called a thought disorder,
you have disjointed thoughts
that are hard for people to understand.
What you're saying may make sense in your head,
but you lack the ability to put the thoughts together
in a way that makes sense to the listener.
Another thing you can do
is have your thoughts be completely derailed.
So you start talking about one thing
and then move on to something else
that may be only partially related
to what you started talking about.
This is called tangential thinking,
where you go off on a tangent.
In mathematics, a tangent is a line
that touches a circle at only one point.
Similarly, with tangential thinking,
what you're saying may be only indirectly related
to a minor point,
and the rest has nothing to do with the original subject.
That's psychosis.
Psychopathy, on the other hand,
is a set of personality traits
whereby people disregard the rights of others
and their behavior conflicts with social norms.
Some of the traits developed
by researchers Hervey Cleckley and Robert Hare
are extreme lack of empathy;
shallow emotional expression, also called shallow affect;
little capacity for remorse;
and superficial charm.
Hervey Cleckley authored the book "The Mask of Sanity,"
which referred to the way a psychopathic person
can appear normal and even charming,
but all the while,
their presentation is masking serious mental deficits.
When you lack empathy,
you can't see things from others' point of view.
The shallow affect make them unable
to experience real emotions.
By having little capacity for remorse,
they can hurt and exploit people and not feel bad about it.
So this person does not struggle
with being able to distinguish what's real
and what's not real.
Their tendency to exploit people
is not based on losing touch with reality.
In fact, they're very grounded in what they plan to do
to get what they want.
People high in psychopathy traits
can end up in the criminal justice system,
but they can also rise to the top of their fields
because their ability to manipulate
and exploit people works to their advantage
when it comes to being successful.
The superficial charm can turn them into pied pipers
who lead people astray.
You can see this in some cult leaders
who attract people to them and then take advantage of them.
It's like they have magical powers
that make people listen and follow.
The psychopath wouldn't be able
to establish this kind of control
if they had a thought disorder
that made you not be able to understand them,
or if they were delusional in saying absurd things
that were obviously not true.
So unlike the psychotic person,
the psychopath gives off an air of being well-put together.
Just to give you another view of psychopathy,
a relatively new model of psychopathy
is called the triarchic model.
It divides psychopathy into three domains:
boldness, meanness, and disinhibition.
Boldness refers to fearlessness,
toleration of danger, and high self-confidence.
The meanness domain includes lack of empathy,
disregard for close attachments,
and exploitative tendencies.
And then the disinhibition domain
refers to poor impulse control,
inability to delay gratification,
and possible frontal executive dysfunction.
So you can see these characteristics are very different
from symptoms of psychosis.
Psychosis can happen to anyone
in several different situations.
Some medications can make you hallucinate,
like high doses of steroids or morphine.
People can become so depressed
that they become delusional
and think people are wanting to harm them.
You can have a psychotic experience inside of mania.
You can believe the president has commissioned you
to create a new way to burn fuel using apples.
These psychotic experiences are usually temporary
and are a measure of the severity of the mood state.
Once your depression or mania improve,
so does your psychosis.
Then, there are the primary psychotic illnesses,
like schizophrenia,
where you have at least two of the psychotic symptoms,
like delusions and disorganized thinking as an example.
With delusional disorder,
you have compartmentalized delusions
where you believe something that's not true,
but you have high functioning in other areas.
An example of this is erotomanic delusions,
where you believe someone is in love with you,
and this is sometimes the motive behind people who stalk.
They are convinced that the person that they're stalking
is in love with them
and wants to be in their presence.
Not everyone who stalk is delusional,
but the ones who are can be very dangerous
because their behavior isn't modified
in response to logic and reason.
You can't just talk them out of it.
So there really isn't an intersection
between psychosis and psychopathy.
The two concepts are completely different.
Sadly, I think some people regard mental illness,
especially severe mental illness like psychosis,
as something deviant
that compares to the likes of psychopathy.
But, psychopathy refers to a set of deviant traits,
whereas psychosis is an impaired mental state
that is often temporary.
Can a person who is high in psychopathy traits
become psychotic?
Yes, but the psychosis would be the result of an illness,
like depression, mania, schizophrenia,
or even drug intoxication.
It wouldn't stem from the psychopathy itself
because the psychopathy doesn't affect your reality testing.
So the only two things these concepts have in common
is they both start with psych.
That's where the similarity ends.
If you haven't seen it already,
watch this video on what it means to be sadistic.
It's another concept
people will lump together with psychopathy,
but I explain how it's different.
Thanks for watching.
See you next time.