What Does Psychosis Feel and Look Like?

Rachel Star Withers is an entertainer, speaker, video producer, and co-host of Psych Central’s “Inside Schizophrenia” podcast. She also lives with schizophrenia. Here, she shares an in-depth look into what psychosis feels like.

Visual hallucinations

“I grew up seeing monsters and scary things, and I thought that was normal.”

Rachel has experienced hallucinations since childhood, for as long as she can remember.

“I grew up seeing monsters and scary things, and I thought that was normal,” she says.

Rachel explains that since everyone would talk about the “monsters under your bed” and the “monsters in your closet,” she naturally assumed that everyone else saw these things, too. Why else would people talk about them?

“I also grew up in the church and you heard the preacher on Sunday talking about demons and angels and Satan. So, when I got older, that’s what I assumed I was seeing — that I saw the spiritual realm.”

Again, Rachel didn’t think this was so unusual. “Because why else would people talk this much about demons and angels and the spiritual realm unless everyone was seeing it?” she says.

“It wasn’t until I was in high school that I said something about seeing monsters. And one of my friends was like, ‘Rachel, what are you talking about?’

“And that was literally the moment I realized not everybody saw these things. And I learned very quickly to keep my mouth shut, because nobody wants to [have] another reason to stand out in high school.”

For Rachel, these hallucinations are fairly constant and her most persistent feature. She estimates they happen about 90% of the time.

“It’s always happening. I have to be careful because I can trigger it. If I look in the mirror for more than a second, my features start to change and become distorted and weird, and I have to get away from it.

“It’s pretty much across the board for any kind of reflection — even if it’s a store window or something. I’ve gotten really good at glancing,” she says.

If Rachel looks at the carpet for long enough, she will start to see faces. “They’re not happy faces. It’s not like an emoji,” she says with a chuckle. “They’re distortions.”

“I would look at trees and the leaves would turn into faces.

“Sometimes I’ll look at another human and they’ll be distorted, and I know something is off. I can’t quite place what it is. It’s like my brain is glitching and can’t fully understand what’s in front of it,” she says.

Voices and other auditory hallucinations

“I’ve never had the voice telling me to do bad things. Since I was little, I’ve heard the far-away voices talking.”

Voices vary considerably for people with psychosis. Some people may hear one particular voice while others hear several. Some people feel like the voices are talking directly to them or about them.

For Rachel, it’s a bit different.

“Mine was never a straight-up voice talking to me. It was more of a radio being left on that’s caught between channels in another room of the house,” she says.

“So, I could make out voices that were talking, but I couldn’t quite figure out what they were saying. I’d catch a word or two, but it was never like a full-on conversation. I never thought they were talking about me.

“I’ve never had the voice telling me to do bad things. Since I was little, I’ve heard the far-away voices talking.

“Most of the time [people with schizophrenia] don’t hear voices in our heads. It’s not an inner voice talking. It sounds like somebody who’s around you,” Rachel says.

These voices might sound like they’re coming from inside the wall or from another room, for example.

For Rachel, voices can also be triggered by white noise, such as the sound of vacuuming or drilling. When this happens, she may hear what sounds like someone talking behind her, but she can’t quite make out what they’re saying.

Rachel also hears ticking sounds. She says it’s like someone is holding a wristwatch to her ear, like a constant “tick tick tick.”

The ticking sound might get louder and softer or faster and slower. It sounds like it’s coming from the walls or another room. Or behind her to the left. It plays into the confusion of psychosis.

“Schizophrenia is like wires crossed,” she says.

Complete episodes of psychosis

“If I’m in a fully psychotic episode… I’m still here, I’m just far away.”

Rachel distinguishes these “everyday” symptoms of psychosis — in which she can still function in reality — from complete episodes of psychosis. These episodes are when symptoms totally take over.

“They can last like a few minutes to days. For some people with schizophrenia, they can last much longer. The longest one I’ve had was only a few days.

“If I’m in a fully psychotic episode… I’m still here, I’m just far away.

“I know something is wrong. It’s not like I’m in an alternate reality. I know something is very wrong, and there’s nothing I can do about it. And in those moments I’ve even had the ability to think, ‘Oh no, what if I don’t come out of this?’”

Nowadays, Rachel is able to recognize the early signs of an episode. One of these signs is when she starts thinking in third person.

“So, once I realize I’m having one of those warning signs, that means I need to get home and pretty much get into bed. I just need to get safe.

“A lot of times when I have a psychotic episode, I lose body parts,” Rachel says.

She recalls one time when her arm kept running away from her. It was “slithering away like a snake” in her bed.

Even when her mom tried to explain to her that her arm was still attached to her body, Rachel kept trying to find it.

“There is no rational talking to me about it,” she says.

People have asked Rachel if having schizophrenia is like a horror movie.

“Not really,” she says. “It’s more just very confusing and distorted. Like I don’t get what’s happening here. It can be intense.”

She explains how one’s thought processes can become completely confused. She might suddenly think, “How do zippers work? Do I need this? Do I have wings? Should I put something over the wings?”

“That’s what it is. That’s what psychosis is like.”

“It’s nothing like the movies.”

Entertainment and news media give a dramatic and distorted picture of psychosis that tends to emphasize criminal activity and unpredictability. Rachel notes that movies and popular culture tend to portray psychosis as if you’re a danger to others.

“It’s nothing like the movies,” Rachel says.

“It’s really just confusion. What’s scary about it is [that] it’s very confusing. Nothing makes sense, and the entire time you’re trying to make sense of everything going on around you,” she says.

Still, it can certainly seem scary if you’re watching someone you care about disconnect from reality. They may appear to be talking to themselves, acting erratically, talking about unusual subjects, or just looking completely bewildered.

In these situations, it may be good to remember that they’re probably even more scared than you are.

“If you have someone in your life who is experiencing psychosis, don’t be afraid. This person is going through something very confusing. It’s hard for them to process anything that’s going on in the real world.

“Their own body isn’t making sense. Things that have always made sense just don’t make sense anymore,” Rachel says.

During psychosis, there’s often dysfunction in the brain circuits that use dopamine. Dopamine is a neurotransmitter that plays a significant role in thinking, attention, and mood.

Dopamine dysfunction as a cause of psychosis is supported by various types of research, including PET scans, animal studies, cadaver research, and in clinical studies that show how certain drugs affect dopamine receptors.

In particular, hallucinations and delusions appear to be linked to overactive dopamine receptors (D2 receptors) in certain parts of the brain.

Another important brain chemical called glutamate may also play a role in psychosis. For instance, research shows that symptoms of psychosis can occur when a particular glutamate receptor — called the NMDA (N‐methyl‐D‐aspartate) receptor — is blocked.

If you think you have psychosis, it’s highly advisable to seek professional help right away so you can begin appropriate treatment.

Some early signs of psychosis may include:

• new difficulties with concentration or thinking
• social withdrawal
• odd and intense thoughts
• strange emotions or feeling emotionless
• poor personal hygiene
• suspiciousness, paranoia, or feeling uneasy with others
• difficulty distinguishing reality from fantasy
• confused speech or difficulties communicating
• poor school or job performance

You may also want to consider checking out this article with tips on dealing with psychosis in the moment.

Psychosis can occur in a variety of conditions, but it’s most commonly seen in schizophrenia.

In most cases, antipsychotic medications, such as Abilify or Risperdal, can help manage symptoms of psychosis in schizophrenia or mood disorders.

Try to keep in mind that if you or a loved one have psychosis, you’re not alone. There’s plenty of information and support you can take advantage of.