At Risk for Psychosis?

Nine years ago, uncompromising playwright Sarah Kane ended her own life. In an old Warsaw variety theatre, Mark Fisher is shaken by a mesmerising staging of her final work.

Scientific American/ By Carrie Arnold  

Mike (not his real name) had always been an unusual child. Even as a toddler, he had ­difficulties relating to others and making friends, and he seemed strikingly ­suspicious of other people. After he entered high school, Mike became increasingly angry, paranoid and detached. He worried that people were searching his room and his locker when he was not around. His grades plum­meted as he turned ­inward during class, sketch­ing outlandish scenes in his note­books and muttering to himself rather than listening to the instructor.

Paranoia and difficulties connecting with others are signs of psychosis, a mental illness in which people lose touch with reality. Psychotic individuals usually have problems forming rational, coherent thoughts. They also may hear voices or hallucinate while believing that what they perceive is real. Often such delusions result in bizarre behavior and, in severe cases, an inability to ­manage every­day life. But a psychiatrist deemed Mike’s symptoms too mild to qualify him as psychotic. Mike obviously needed some kind of professional intervention, so he bounced among psychiatrists who could not figure out how to help him.

Cases such as Mike’s have prompted some practitioners to propose the inclusion of a new psychosis risk diagnosis to the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the “bible” of mental health diagnoses. To receive this diagnosis, a patient would first need to report, for example, having delusions or hallucinations about once a week (as opposed to most of the time for at least one month for clinical psychosis). In addition, either the patient or a loved one must be significantly distressed by those symptoms. The idea of including such a diagnosis in the DSM is highly controversial, but supporters argue that patients such as Mike not only need immediate help, they are at increased risk for developing full-blown psychosis, an outcome doctors might be able to prevent with early intervention.

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