Introduction

“Reality, for the individual. Is the world as that person perceives it, not
necessarily as it exists.”

Mary Almore (Almoire, 1976)

With the possible exception of the sociopathic personality, the

psychoses constitute the most serious psychiatric disorders with which the
nurse has to deal.

A psychosis is traditionally defined as a subtotal disorganization of

personality, in which the individual loses contact with reality. However, the
latter part of this definition frequently leads to misinterpretations and sets off
spectres in the layman’s perception of psychosis, which are themselves
unrealistic. Perhaps it would be most accurate to say that in a psychosis, the
individual moves in and out of reality for, characteristically, the “loss” of reality
does not involve the totality of the individual’s life, at least not for protracted
periods. In fact, sometimes the psychotic is sufficiently in contact, that he can
maintain himself in society without hospitalization or even without treatment.
In such cases, of course, the effectiveness of that person’s overall adjustment
is minimal. His personality is disorganized, and his behaviour tends to be
psychologically, if not physically, damaging to those close to him. In any
event, no matter how bizarre the behaviour of the psychotic may be at times,
psychoses may also be seen as an attempt to adapt. What one calls the
psychotic’s ‘loss” of contact with reality may be seen as a restructuring of that
reality on his own terms, as it were. In effect, these are the best, or only,
terms he sees as available and reinforcing to him at the time.

An example of the latter would be the schizophrenic who cuts himself

for the reassurance that he is still real because he bleeds and, possibly, hurts.
This should not be interpreted as an indication that he is attempting to
structure a less “crazy” world.

Professional treatment, then, ideally becomes a matter of permitting

and encouraging the person’s redefining of his terms in a more realistic and
effective way. In another way, one opens up new options, enabling and
reinforcing the person’s behaving in a more normal way. This is not a simple
process, however, and tool often the helping profession settles for no
treatment at all beyond custodial care or for removal of symptomatology
classified as “sick”-with-out going on to deal with behaviour and without really
attempting to encourage growth orientation.