5 Actions to help someone who has lost touch with reality

When someone has lost touch with reality the words to describe this experience, “psychosis” and “psychotic” often scares people. One automatic response to those words that many people have is “crazy”.

Reality is simply created by people agreeing on shared sensory experiences.

Psychosis simply refers to someone experiencing things with their five senses that other people are not able to perceive.

The five senses:

  • Sight

Some people see people or things that others do not see.

Some people see sounds or smells represented by shapes and colors.

  • Sound

Some people hear sounds or voices that others do not hear.

Some people feel sounds with their body or taste sounds that other people cannot.

  • Touch

Some people feel sensations in or on their body that other people cannot feel.

Some people can touch something that others do not perceive.

  • Taste

Some people taste flavors and textures that others do not taste.

  • Smell

Some people smell pleasing and displeasing scents that others do not smell.

What most people do not understand is that the EXPERIENCE of these sensations is very real.

When other people do not agree or share in these sensory experiences it does not make it any less real for the person who does.

These sensory experiences are taking place in a person’s brain.

What MAY be happening during these sensory experiences is:

  • There could be a communication problem in the sensory centers of the brain
  • Communication error between the sensory centers of the brain and the cerebral cortex (thinking part of the brain).
  • The messages coming from the five senses may get jumbled by the time they reach the sensory centers.

When someone is having these experiences, the goal is not to “snap them out of it”.

Instead, goals are to help loved one’s by:

  • assessing their safety in regards to harm to self and/or others.
  • meeting and supporting them wherever they are in their experience
  • helping them regulate if they are willing.

Five actions you can take to help someone who has lost touch with reality.

1. Do not challenge or try to disprove their experience

Instead, BE CURIOUS.

Some ways of being curious:

  • Ask them to tell you what they are hearing or seeing etc.
  • Ask how it affects them – behavior, thoughts, feelings etc
  • Ask how they feel about it
  • Ask them if they believe it is a problem or if there are ever times when it is problematic.
  • Ask them how it helps them.

This assesses for safety and prevents agitation.

If what they are experiencing is causing them to want to do harm to themselves or others, hospitalization is necessary immediately.

It is not helpful to tell someone who is experiencing psychosis that what they are experiencing is not happening.  Doing so often causes agitation for the person and isolation.

2. Bring their attention to their body

There are several activities you can do to help someone bring their attention into their body.  However, when someone is experiencing psychosis, you do not want those activities to be based on imagination.  The activities should be physically based:

  • Breathing: have them notice their lungs filling.  Some people may not respond well to listening to their heart beating it could cause some to become agitated.
  • Wiggle the toes, rotate the ankles, raise and lower the legs, or massage their own legs. You can do the same with fingers, wrists, and arms.
  • Put feet flat on the floor, sit with good posture and breathe
  • Rotate neck clockwise and counterclockwise.  This can be done with the chest as well.

What these activities do is engage the sensory organs and sensory centers in the brain to the present moment in the body.  This may help someone regulate their brain by focusing on the physical senses.

3. Focus on breathing

Breathing is consistently important in everything we do.

Ask them to take at least seven deep breaths, into their belly, and slowly release them.

Breathing deeply helps regulate the brain.  Its like pressing the restart button.

4.  Redirect them to thinking about a time & place where they felt good

If they are agitated, ask them to tell you about a time and place where they felt good (or whatever emotional state they are needing).

Ask them about sensory things like what they saw, heard, touched, tasted, smelled etc.  This may help regulate the sensory areas of the brain.

5.  Containment

If your loved one is a willing participant to be close to you, ask them if you may hug them.  Ask them if you may give them a long tight hug.

This type of hug is not one in which you pat them on their back or rub their back.  This type of hug is one in which you hold them tightly, without squeezing, and simply breathe deeply together.

This form of containment and breathing is very calming and may also be a “reboot button” for the brain.