The classroom of law enforcement officers all donned headphones and pushed “play” on the attached MP3 player.
What they heard was a staticky background noise, overlaid with snatches of conversation, and punctuated with random bursts of words—“disGUSting!” “stop it! Stop it now!”—along with giddy giggles and eerie, guttural growls.
The exercise was part of a recent week-long Crisis Intervention Team training attended by over 20 officers from throughout the Gorge and was meant to mimic the experience of hearing voices, which is an auditory hallucination experienced by people in psychosis.
While officers listened to the voices, they were tasked with several memory challenges. It gave them a taste of what it’s like for people who are hearing voices but are simultaneously being interacted with by others, such as law officers.
Officers described the experience as annoying, distracting, and odd, though one joked it was like, “being married.”
“Can you imagine listening to that for a whole day?” asked Steve Bradley, a counselor with Mid-Columbia Center for Living, which hosted the training. “Can you imagine trying to sleep with that?”
One officer said the voices were depressing, because the listener would feel like they were under terrorist attack.
Bradley said hearing voices can come and go, but it can also last for weeks or years.
Hallucinations and delusions can be comforting or frightening. One officer said he was told by a person that using methamphetamine “made the voices a little nicer.”
The listening exercise was a tool to generate an understanding of, and empathy for, those who experience psychosis. The 40-hour class is meant to educate first responders on effectively working with people who are mentally ill to decrease injury and increase access to care. It also has a goal of fostering better communications between law enforcement and mental health personnel.
Before officers did the listening exercise, they were asked to list some terms used for the mentally ill. They suggested: disorganized, detached from reality, agitated, unreasonable, hallucinating.
They were asked again at the end of the session. That time, they added terms like resilient, vulnerable, and victim.
The section on psychosis described what it is, how it makes people act, and how officers can respond.
Center for Living Clinical Supervisor Terry Rogers said psychosis was a change in the brain that alters the way a person experiences the world. They lose touch with reality and feel “bombarded by sensations.”
A healthy brain filters things all the time, screening things out. When that screening stops working, strong sensations take over. Most people in psychosis hear and see things others don’t, which are called hallucinations. They can also taste, smell and feel things that aren’t present.
They also hold beliefs that are not true, and they become more meaningful and powerful than reality. Those are called delusions.
Delusions, which are often kept secret, are beliefs not based in reality and can include: paranoia and ideas of being followed; that you have special powers; that you have changes in your body; and that you are someone famous.
Delusions persist despite incontrovertible evidence to the contrary.
Psychosis can range from brief episodes lasting days, to constant and manageable psychosis, to constant and problematic psychosis.
Those in psychosis also have mixed up thoughts and speech. They can’t talk coherently, they go off on tangents, and may seem drunk. They may laugh at inappropriate times, like at a car wreck.
They may have unusual, obsessive behavior, such as wearing heavy clothes with a bra on the outside.
Psychosis is experienced by a range of people, including schizophrenics, who make up just 1 percent of the population. With roughly 80,000 people in the Gorge, about 800 people are schizophrenic, Rogers said, “So not a small number of people experience schizophrenia in this area.”
Schizophrenia hits both genders equally, but it has an earlier onset in males, generally in the late teens or early 20s.
Some people affected with psychosis may not believe the diagnosis, so they won’t take medications for it. The medications themselves have serious side effects: they can cause diabetes, weight gain, loss of sex drive, and a feeling of being muddled.
Psychosis can also be experienced by people with depression, anxiety and bi-polar disorder.
It can also come from trauma; medical conditions like having cancer and undergoing chemotherapy or being an elderly person with a bladder infection or pneumonia; drug use; extreme sleeplessness; or experiencing great loss.
A person experiencing psychosis is recognized by a lag time in response; guarded answers; a difficulty concentrating because of other stimulus going on; confused/disorganized behavior; bizarre thoughts and speech; and speech that’s hard to understand.
They can sound drunk, high, or scared, with poor eye contact or intense facial expressions.
Rogers said the vast majority of people experiencing delusions are not a danger to themselves or others. “There are exceptions, and that’s the ones you’re concerned about,” he said.
The challenge for law enforcement is to decide at what point to take bizarre and threatening statements literally.
Bradley said more benign auditory hallucinations are classed as commentary, while the rarer, but more concerning ones, are commands.
They might have voices that might be telling them not to trust the officer.
Rogers said the basics of interacting with someone experiencing psychosis is to have respect but be honest. “Say, ‘I don’t understand what you’re saying.’ Don’t be afraid to just put it out there.”
Officers should “approach as much as possible in a non-threatening manner,” Bradley said. Since the police uniform in itself is already a strike against the officer, the best option to appear non-threatening is to use a soft, slow tone of voice.
“How you approach things can get picked up by them,” he said.
Officers should avoid getting too close, avoid touching, and avoid shows of force when possible. They should state what they’re doing before they do it, express concern, have patience and allow people to tell them what’s going on with them.
Officers also shouldn’t argue or agree with a delusional person.Officers should validate the experience is real for the psychotic person. They can say things like, “This must be tough. This must be difficult for you.”
The empathy-building session seemed to be effective, with one officer saying at its conclusion: “They have a lot on their plate that we don’t give them credit for.”