Psychosis is the contemporary equivalent of the term “madness” and serves as an umbrella term for a range of diagnosable conditions regarded by the medical profession and the American Psychiatric Association as severe mental health disorders. While psychiatry generally frames psychosis as an illness, some perspectives interpret it as a pathway to spiritual insight and personal growth, due to the emergence of chaotic subconscious forces. Regardless of interpretation, psychosis represents one of the most intense and potentially destabilizing conscious experiences a person can undergo. Therapy can play a crucial role in providing grounding, narrative, and context for individuals who feel overwhelmed, confused, or disorganized as a result.

The Oxford English Dictionary defines psychosis as “a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.” Psychiatry, particularly the Diagnostic and Statistical Manual of Mental Disorders (DSM), outlines specific criteria required for diagnosis and, in some cases, involuntary hospitalization. Among psychotic disorders, schizophrenia is often considered one of the most debilitating due to its profound and pervasive impact on cognition, emotion, and daily functioning.

 

The Five Criteria:

1) Delusions

Delusions occur when an individual believes things that are contrary to objective reality. While some argue that certain religious beliefs could resemble delusional thinking, clinically significant delusions are typically immediate and have explicit consequences for the individual—e.g., a paranoid delusion that MI5 is about to arrest you, or a delusion of grandeur in which you believe you have discovered the cure for cancer or have been reincarnated as a famous historical figure or celebrity.

2) Hallucinations

A hallucination is the conscious perception of something that is not present. Hallucinations can be auditory (hearing), visual (seeing), olfactory (smelling), gustatory (tasting), or tactile (touch). In mental health disorders, auditory and visual hallucinations are the most common, though other types also occur.

3) Disorganised Speech

Disorganised speech reflects an inability to coherently structure thoughts. It is identified through several criteria, including:

i) Tangentiality

Tangentiality is characterized by oblique, digressive, or irrelevant replies to questions, often linked by word association, e.g.:
How are you today, Tom?
I don’t know, Tom. Tom is the King. The King of England wants to come to my house.

ii) Derailment

Derailment involves persistent digression from the topic under discussion, often through word-based associations, e.g.:
I’m going to be out tomorrow, like the rest going to the beach. The beaches in Southern Greece have the most sandcastles. The biggest castles are in Scotland.

iii) Neologisms

Neologisms are newly created words used in unusual contexts. While common in children, they may indicate thought disorder in adults, e.g.:
I was so cross I jumped up and down on the ground in ‘pritulence’. Those people I saw this morning were so ‘sloozranuled’.

iv) Clanging

Clanging occurs when words are chosen for sound rather than meaning, e.g.:
How are you feeling today?
I’m feeling yes, reeling to be peeling.

4) Disorganised / Catatonic Behaviour

Disorganised behaviour can manifest in various ways, often requiring multiple signs for diagnosis. Individuals may appear unkempt or wear flamboyant and inappropriate clothing. Mood swings can be rapid and extreme, with sudden expressions of anger, joy, sadness, or grief. Bizarre, purposeless, or unusual movements may also occur.

Catatonic behaviour represents extreme physical manifestations. Individuals may show a lack of movement or responsiveness (catatonic stupor) or excessive movement and hyperactivity. Catatonic excitement may include mimicking sounds (echolalia) or movements (echopraxia).

5) Negative Symptoms

Negative symptoms reflect diminished affective expression and energy. Individuals may show minimal responsiveness, experience Alogia or poverty of speech (difficulty speaking fluidly or spontaneously), and display Avolition, a lack of motivation to engage in goal-directed activities, even basic tasks like dressing or preparing food.

 

Criteria

Diagnostic criteria for these symptoms have evolved across editions of the Diagnostic and Statistical Manual (DSM). DSM-IV required at least two of the five symptoms for diagnosis, although a single symptom—if sufficiently severe, such as bizarre delusions or hallucinations with commentary on thoughts or conversations between voices—could suffice. DSM-5 revised this to address ambiguity and cultural bias. Under current criteria, at least one symptom must be delusions, hallucinations, or disorganised speech, along with a second symptom from the five. The severity, duration, and history of symptoms determine the specific psychotic disorder diagnosed.

 

Opposition to the DSM – Medication vs Conscious Experience

Although the DSM has proven useful for many clinicians and patients, it should be approached with caution. The National Institute of Mental Health in the United States withdrew its support for the DSM, with Director Tom Insel stating:

‘Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.’

In other words, the DSM’s foundation rests on subjective agreement rather than empirical, scientific validation. This raises serious concerns about the consequences of prescribing psychiatric medications, particularly regarding whether their benefits have been rigorously demonstrated. The issue is compounded in the United States, where insurance coverage often hinges on an official DSM diagnosis, potentially incentivizing treatment based on categorization rather than evidence.

For a deeper look at the DSM’s history and its complex entanglement with the pharmaceutical industry, this insightful New Yorker article provides a compelling overview of the evolution of psychiatric diagnosis.

 
Beyond Diagnosis – Psychosis as Spiritual Emergence

While the DSM frames psychosis strictly as a pathological disorder, an alternative perspective views these experiences as potentially transformative rather than solely pathological. Stanislav Grof, a pioneering researcher in transpersonal psychology, argues that psychosis can represent a form of “spiritual emergence”—a process in which the conscious and unconscious merge to facilitate profound personal growth and reevaluation of one’s life and relationships.

During periods of intense emotional upheaval or inner transformation, what might clinically appear as psychotic symptoms—such as unusual perceptions, disorganized thinking, or emotional extremes—may actually reflect a natural, if overwhelming, process of psychological and spiritual development. From this viewpoint, psychotic experiences are not simply deficits or malfunctions to be suppressed, but signals of the psyche attempting to reorganize and integrate deeper levels of experience.

This perspective challenges the purely biomedical model emphasized by the DSM, suggesting that some individuals may benefit from therapeutic approaches that provide containment, guidance, and meaning, rather than immediate pathologization and pharmacological intervention.

See Stanislav Grof speak on Altered States, Psychiatry and Spiritual Emergence below:

 

 

International Schizophrenia & Psychosis Resources

United Kingdom – Schizophrenia & Psychosis Support

  • POPS UK – A UK-based support group for parents, family, and carers of people with psychosis or schizophrenia.
  • ISPS UK – The UK network of the International Society for Psychological and Social Approaches to Psychosis, supporting dialogue, events, and resources.
  • National Hearing Voices Network (England) – Provides information, advocacy, and networking for local Hearing Voices groups and peer support focused on voice hearing and related experiences.
  • Rethink Mental Illness – A major UK charity offering advice, community support services, and information for people affected by severe mental illness, including psychosis.
  • Hearing Voices Network Birmingham Support Group – Online peer support group for people who hear voices or experience psychosis/schizophrenia.
  • Mind Hearing Voices & Useful Contacts – Links and contacts for UK support services relating to hearing voices and associated experiences.