What Psychosis Actually Looks Like: Breaking Down the Myths

When most people hear the word "psychosis," they picture something extreme: a person talking to invisible people, completely disconnected from reality, possibly dangerous. Pop culture has done enormous damage to public understanding of what psychosis actually involves.

The reality is far more complex, more human, and more common than most people realize. Roughly one in three people with first-episode psychosis experiences visual hallucinations, and what they see is nothing like the Hollywood version.

What People Actually See

Aynsworth and colleagues (2025) conducted in-depth qualitative interviews with people experiencing visual hallucinations in psychosis, and their findings challenge nearly every popular assumption about the condition.

First, the visions are vivid. Participants consistently described seeing figures that were as clear and solid-looking as a real person sitting across the room. These were not vague shadows or fleeting impressions. They were detailed, persistent, and experienced with the full force of normal perception.

Second, the visions are deeply personal. People reported seeing deceased loved ones, strangers who watched them from corners of rooms, mannequin-like figures, and even figures that appeared burned or disfigured. One participant described seeing evil clowns pressed against their window. Another saw streams of famous people driving past. Each person's experience was unique and carried specific emotional weight.

The experience of psychosis is not a generic malfunction of the brain. It is an intensely individual phenomenon shaped by personal history, relationships, and emotional life.

Multimodal and Embodied

One of the most important findings from Aynsworth's research is that visual hallucinations in psychosis are rarely just visual. They are multimodal: the figures people see also speak, and sometimes they can be felt physically. A person might see a deceased friend sitting beside them, hear that friend's voice telling them to hurt themselves, and feel the friend's presence as though they were physically there.

This matters clinically because treatments that target only one sensory modality (such as auditory hallucinations alone) may miss the interconnected nature of the experience. The research suggests that visions function as coherent, multi-sensory experiences, not as isolated perceptual errors.

When the Label Becomes Part of the Problem

Wantoch (2025) offers a provocative philosophical argument that complements the clinical picture. Drawing on phenomenological philosophy, Wantoch suggests that the way psychiatry labels and responds to anomalous experiences can actually make those experiences worse.

The argument centers on something called "habitual trust," the basic, usually unconscious trust that the world is real and that other people share that reality with you. When someone has an anomalous experience and then encounters a system that frames that experience as a pathological brain malfunction, their trust in shared reality can be further disrupted rather than repaired.

In practical terms: when a clinician tells someone "what you are seeing is not real, it is a symptom of your illness," this may feel invalidating in a way that deepens the person's sense of disconnection from the shared world. The psychiatric framework, intended to help, can inadvertently reinforce the very isolation it aims to treat.

The Trauma Connection

Research increasingly shows a robust connection between childhood trauma and the development of psychosis. Odds ratios reach as high as 6.46 for individuals with five or more trauma exposures. Sexual and emotional abuse show the strongest associations, and dissociation serves as a significant mediator between childhood trauma and positive psychotic symptoms, particularly hallucinations.

Approximately 65% of patients with non-affective psychosis experience regular dissociative symptoms. This means that for a significant portion of people living with psychosis, the experiences they are having may be deeply connected to unprocessed trauma rather than being purely neurological events.

A Better Approach

These findings point toward a more nuanced clinical approach. Rather than immediately categorizing someone's experiences as symptoms to be eliminated, effective treatment can begin by genuinely understanding what the person is experiencing, what it means to them, and how it connects to their broader life story.

Culturally sensitive approaches that respect a person's own framework for understanding their experiences, whether spiritual, cultural, or psychological, show better outcomes than approaches that insist on a purely biomedical explanation. Shared decision-making, peer support, and trauma-informed care all demonstrate measurable benefits.

Some questions worth considering:

• How much of what you "know" about psychosis comes from media portrayals rather than actual research?
• If someone you care about described unusual perceptual experiences, would your first instinct be to validate or to pathologize?
• How might your own experiences of feeling disconnected from shared reality, even in mild forms, inform your empathy for those with more extreme experiences?

Learn More

Mental health literacy matters. Understanding conditions like psychosis with accuracy and nuance helps reduce stigma and improves outcomes for everyone. Explore our self-discovery tools for evidence-based assessments that help you understand your own psychological patterns, and visit our blog for more research-informed perspectives on mental health.

References

Aynsworth, C., Waite, F., Sargeant, S., Humpston, C., & Dudley, R. (2025). Visual hallucinations in psychosis: What do people actually see? Psychology and Psychotherapy: Theory, Research and Practice, 98, 58-73.

Wantoch, S. (2025). Can psychiatry hinder intersubjectivity? A phenomenological critique of the biomedical conceptualization of anomalous experience. Frontiers in Psychology.