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this post was submitted on 01 Jun 2026
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I've never found a good way to approach psychosis. Patients would snap whether I was trying to talk them out of a delusion, distract them from it, or indulge it enough to pacify them. It's as existentially real to them as thirst to someone dying in a desert so nothing rationalises them out of it. In this case it's concerning because Capgras delusions are tied to neuroanatomical abnormalities as much as they are disorders like schizophrenia. It could be a sign of a growth or dementia in addition to all the psychiatric etiologies.
This seems really relaxed for Capgrass. Plus they're including themselves in the mix of imposters, and no one's really an imposter?
This could just be a bit?
I'm not seeing relaxed at all. This immediately flagged for me because of the timeline which I see as anxious/desperate. There's that 29 minute interval where they're sending disjointed follow-up texts and going through multiple emotions about it. In general receiving a text like that is some kind of crisis.
If it is a bit, I don't see the punchline yet. Especially in the follow-up text they say it in a way that I see as casually stated. That's psychosis in my experience. Those patients are confused by their delusions and disoriented, but sometimes it's described in an extremely eerie way where they're just matter-of-factly telling you about an entire second reality you can't perceive. I'm very stereotypically male-presenting and I had a patient calmly tell me that I was their mother. There's a disconnect there where that's more real than reality and the hospital/ambulance itself is what drives their anxious and aggressive responses.
In the delusion there's body-switching between their family members, and also depersonalisation from their own body/identity. That latter is also a classic feature of psychosis. The way they phrase it with "We all confused bro" after a 7 minute pause is too ambiguous for me to make sense of it. I just know that if someone sent me these texts I'd be getting them to a hospital. The emergency medicine part of my brain immediately flagged it as concerning.
I'm deferring to your expertise on this for sure. I just saw the "We all confused bro" as hard to read and that's where I was getting the more "relaxed" part since they weren't upset with anyone.
As someone who has had psychotic symptoms, including delusions, there's not a good way to snap us out of it. The most helpful people to me in that situation were people close to me; I don't think I would have reacted well to any doctor in that state, so please don't take your experiences too personally. Reading your responses you sound really well-intentioned and knowledgeable, so I think you'd be a really good medical person to encounter. It's just when we're in that state, we can lash out at literally anybody.
I never held that against the patients. Those episodes seem scarier than any psychedelic I would ever take. In my role I wasn't any kind of psychiatric professional, just getting them to the hospital or seeing them in emergency before transferring to psychiatry or surgery. Ending the delusions or even diagnosing the illness was something we didn't try. In this case, snapping them out of it just meant trying to keep them calm even as it persists. Drugs, restraints, and especially cops are all such loaded options for management that we just tried to talk to them in ways that disengaged them from the negative emotions with the delusion. In the best of times I'm terrible with small-talk but it's especially ineffective when someone is living out the scariest moment of their life.
Yeah. I've not really ever had to help someone else who was having this issue. I'm glad you did your best to avoid the more extreme options. Most medical people I encountered were not so kind. Thank you for your patience, as hard as it is for us, I know it's really hard on you guys too.