Why It's Important to Distinguish Between Psychotic States

This is the second part of a four-part interview between the author and psychologist Lisa Dahlgren. You can read Part 1 here.

The more we learn about the brain, the more the need for neurodivergence sets in.

Not everyone who hallucinates is having an episode of psychosis. And not everyone who has psychosis necessarily hallucinates. Psychosis is marked by a reduction of well-being, while altered states of consciousness might enhance one’s life overall.

There’s a reason why the famous neurologist Oliver Sacks wrote a book about hallucinations and specifically didn’t discuss hallucinations of the psychotic breed. Neurological hallucinations can appear whimsical and friendly, while psychotic hallucinations are often stressful and frightening. Similarly, the same can be said between altered states of consciousness and psychosis.

In this part of the interview with Lisa Dahlgren, we discussed what it means to define consciousness states that are different from psychotic states. Through her nature-based practice, Dahlgren sheds light on what that looks like in a clinical setting.

SM: Why do you think it is important that we have a definition of alternative realities that is not the definition of psychosis or the illness model?

LD: First, I am not sure that non-ordinary reality states, altered states, experiences during the use of therapeutic psychedelics, and psychosis are the same experience. Anecdotally and through my own observation, even the perceptual differences (like hallucinations) that occur in each of these states appear to have different qualities.

These states also appear to differ in what they produce. When we practice techniques that lead to altered states, such as mindfulness, hypnosis, breath work, yoga, and prayer, our stress level lowers. This is shown through both subjective report and neurobiological indices. Anecdotal report of the benefits of therapeutic use of psychedelics is similar to my experience of non-ordinary states.

It appears to be different from a psychotic disorder. Listening to those who have a diagnosis of psychotic disorder, I would say 100 percent of the time, the disorder does not lower stress. Additionally, again as I listen to those explain their experience, I would say what I learn is that the experience of having a psychotic disorder appears to contract or destroy one's experience of self on a non-temporary basis.

My experience of non-ordinary reality states are closer to that of an altered state but have some other components. Initially, when I began to experience non-ordinary reality states, they happened spontaneously, and when they were occurring, I did not have complete control over my behavior. It was as if I had jumped from the far end of the awareness continuum to the far end of the other side of the continuum in one breath and without attempting to or wanting to do so.

The episodes were short (minutes, not hours), and during those times, my experience was both that I had to try hard to retain my sense of who I was while simultaneously there was a tremendous amount of self-expansion. My stress level was low prior to these occurrences, but it went through the roof when they first began to happen.

When I started to practice mindfulness, meditation work, my experiences came more gradually and were much, much easier to incorporate.

I would like to add two other components to the non-ordinary reality states I have experienced: that the majority of them have not been self-referent, and for the small number of times they have felt they were about me or that I was being spoken to personally, it has been a positive, warm, extremely loving experience. I believe my experience of those two components is vastly different than psychosis and may also be different from altered states as well as therapeutic or non-therapeutic use of psychedelics.

In fact, once I got past the stress of spontaneously going into those states, they have been the most profound and amazing of my life, and I wish everyone could experience them.

SM: That’s an important distinction to make, that the loss of control is central to the experience of having an altered state of consciousness or psychosis. With my psychosis, I don’t control the onset of hallucinations; they just kind of happen to me. Usually, however, I can tell when an episode is coming on when I start to feel a break from reality, usually by dissociation, which is usually brought on by significant stress. I have coping mechanisms to draw me back to reality, but it is essentially a very traumatic experience to have a psychotic episode.

In the middle of a severe episode, I often feel tortured by voices saying things that I do not want to hear. Verbal abuse and mental images of torture and criminal acts are common in my experiences, and I feel that my own brain has turned against me.

I will say that when I do yoga, meditation, and rhythmic breathing or related activities that I can feel calm and centered, but I don’t view the two as related experiences. If I have a higher stamina to withstand my hallucinatory verbal abuse, it’s from the skills I developed in therapy and meditation, but I wouldn’t say that the two are affected by one another or even caused by the other.