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University Health Service
Office of the Provost

The Student in Poor Contact with Reality

These students have difficulty distinguishing fantasy from reality, the dream from the waking state. Their thinking is typically illogical, confused, or irrational; their emotional responses may be incongruent or inappropriate; and their behavior may be bizarre or disturbing. They may experience hallucinations, often auditory, and may report hearing voices. While this student may elicit alarm or fear from others, they are generally not dangerous and are more frightened and overwhelmed by you than you are by them. If you cannot make sense of their conversation, they may be in need of immediate assistance.

Bipolar disorder involved periods of serious depression combined with periods of extreme euphoria and frenzied thinking and behavior, the latter of which can reflect a poor reality. A person with bipolar disorder can become psychotic.

Psychological illnesses that involve psychotic features often have an onset between the late teens and early 30s.

What You Can Do:

  • Respond with warmth and kindness, as well as with firm reasoning.
  • Speak to the student in a direct and concrete manner regarding your plan for getting him/her to a safe environment.
  • Remove extra stimulation from the environment (turn off the radio, step outside of a noisy room).
  • Acknowledge your concerns and state that you can see they need help.
  • Acknowledge their feelings or fears without supporting the misperceptions, e.g., “I understand you think someone is following you, but I don’t see anyone and I believe you’re safe.”
  • Acknowledge your difficulty in understanding them and ask for clarification or restatement, e.g., “I’m not sure I understand what you’re trying to tell me, can you try to explain it more clearly?”
  • Focus on the “here and now.” Ask for specific information about the student’s awareness of time, place, and destination.
  • Speak to their healthy side, which they have. It’s okay to laugh and joke when appropriate.
  • Recognize that psychotic states can involve extreme emotion or lack of emotion and intense fear to the point of paranoia.
  • Recognize that a student in this state may be dangerous to self or others.
  • Consult with a professional at UCC (275-3113)
  • Accompany the student to UCC or call (911) if the student is highly impaired.

Don’t:

  • Argue or try to convince them of the irrationality of their thinking as this commonly produces a stronger defense of the false perceptions.
  • Play along with or encourage further discussion of the delusion processes, e.g., “Oh yes, I hear the voices (or see the devil).”
  • Demand, command, or order.
  • Expect customary emotional responses.
  • Assume the student will be able to care for him/herself.
  • Agitate the student with questions, pressure, etc.
  • Assume the student understands you.
  • Allow friends to care for that student without getting professional advice.
  • Get locked into one way of dealing with the student. Be flexible.
  • Assume the family knows about the student’s condition.

Guide Table of Content

Addendum