The Great Pumpkin, according to Linus Van Pelt, brings gifts to good girls and boys at Halloween. You can even see the Great Pumpkin, if you are lucky: if you can find a pumpkin patch that is sincere enough, and if you are pure in heart. For this reason, Linus stakes out the most sincere pumpkin patch he can find, every year, and foregoing tricks and treats, waits to see if he can catch a glimpse of the great pumpkin.

The question I have is, is Linus crazy for thinking that there is a Great Pumpkin, and for behaving in this fashion? And can we do something about it? And if we could do something about it, should we?
A word of caution in what follows. I teach a course in mental disorders, and I can share some information with you based on what I think I know. However in Canada, marriage and family therapists (like me) are not qualified to diagnose people. Only doctors do that. Not me. And just because your partner looks crazy to you, not you, either. I’m writing this in an attempt to be helpful, but if you think you know someone with a mental illness who is suffering or causing you or others suffering, take them to see a medical doctor. Or go to the emergency department at St. Joseph’s Healthcare Hamilton (in Hamilton, this is where emergency psychiatric treatment resides). Or call COAST, the Crisis Outreach and Support Team, at 905-972-8338.
One of the more difficult issues to deal with in a relationship is psychosis. Psychosis is hard to define, let alone treat.
Broadly, mental disorders can be broken down into categories of thinking, feeling and behaving. A disorder of feeling would be a mood disorder, such as dysthymia, depression, or bipolar disorder. A disorder of behaving would be a personality disorder, such as borderline personality disorder or narcissistic personality disorder (by the way, narcissists are being dropped from the next rendition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5). A disorder of thinking would be schizophrenia, schizoaffective disorder, delusional disorder, brief psychotic disorder, etc.
But these categories are not clear cut, because the way we think affects the way we feel, and vice versa, and both affect the way we behave. A depressed person, for example, tends to exhibit what is called the cognitive triad of depression: they think funny. Depressed people tend to think that they are no good, that the world is mean to them, and that things will not get better. A manic person tends to think funny, possibly that they are able to do things that others cannot do. Mood affects thinking. Thinking affects mood, too: by changing the way you think you can treat depression. That is the basis of cognitive-behavioural therapy and other forms of psychotherapy. People with personality disorders also think funny and have mood problems: they may think, for instance, that they way they are behaving is normal, even though it may be causing them problems. and they may feel depressed because of their problems.
So psychosis, then, is a disorder in thinking, but you will also notice changes in feeling and behaviour.
A psychotic person usually has delusions, or hallucinations, or both. A delusion is a way of thinking that would not be considered normal by others in the same culture. A hallucination is a sensory experience – sight, sound, smell, touch, taste – that others don’t share. Linus has a delusion: he thinks there is a Great Pumpkin, while others around him do not think this is so. If the Great Pumpkin were then to appear to him, or speak to him, and not to others, he would be hallucinating.
Lots of people have delusions or hallucinations, and may not be considered psychotic, or at least not ill enough to require treatment. I may have the delusion that I am a pretty good therapist, for instance, while my clients think otherwise (even though they keep coming to see me). Am I psychotic? Good question. Probably only if my behaviour, based on my delusion, is causing me or others trouble – for instance, my business was failing or my clients were being harmed. Otherwise, you can be as delusional as you want, as long as no one gets hurt.
Same with hallucinations. Some individuals have religious experiences, for instance, which others may regard as hallucinations. Is that a problem? Again, not unless someone is being harmed.
Hallucinations and delusions seem to be related to abnormally high levels of dopamine, a neurotransmitter (chemical in the brain) that is involved with both thinking and movement. The first antipsychotics such as haloperidol can reduce abnormal thoughts and experiences, but may also cause a movement disorder: jerky movements, stiff limbs.
Another neurotransmitter called serotonin may also be involved in psychosis. Serotonin affects mood, and as we’ve said, mood affects thinking. Selective serotonin reuptake inhibitors – SSRI’s – such as Prozac help to elevate mood. Atypical antipsychotics – Risperdal, Zyprexa, and Seroquel – work on both dopamine and serotonin and seem to do a better job of treating the faulty thinking without causing the movement problems.
So Linus could be treated. He could be given a drug like Risperdal and quite possibly the Great Pumpkin would go away. Would that be a good thing? A lot of people would be disappointed if Linus stopped believing in the Great Pumpkin. But not Linus’s sister. She has to get up at three in the morning and go find him in the pumpkin patch, and guide him back to bed. And not Charlie Brown, who has to endure a lot of abuse from Linus for suggesting that his thinking is “stupid”.
And what about Linus’s wife?
“Psychotic individuals do marry,” says Michael P. Maniacci*. Linus will probably marry Sally, Charlie Brown’s little sister. She will forgive him for embarrassing her in front of her friends on Halloween. She thinks he’s cute if also a little eccentric: he looks like someone imaginative and not afraid to stand up (or stand out) for his beliefs. She believes he will go places, be successful, and be a good mate. And he might. But he might also get into great interpersonal difficulty because of his beliefs about the Great Pumpkin.
People who are predisposed to psychosis are frequently quite bright, sociable, and although a bit eccentric their “difference” may be appealing to a prospective partner. Later on trouble may start when the individual becomes stressed either because of normal developmental stresses – marriage, children, job changes, moves – or because of a tragedy.
The “psychotic” person doesn’t start out that way. Psychotically-prone individuals live relatively detached lives (Linus is pretty happy with his blanket most of the time). They know that the world has rules and expectations but they tend to step aside from such demands, perhaps daydreaming or seeming ambitious and hoping to attain some great goal. You marry someone like this, you have great plans for success, and what happens? The same thing that happens to the rest of us: reality sets in, some things are harder than they first appeared, and you adjust. Only psychotic people have more trouble adjusting. They have fairly rigid ways of thinking – by definition, a delusion is a rigid or fixed belief – and so they have trouble adjusting to life’s demands. They tend to retreat into their beliefs: the Great Pumpkin, the Great Pumpkin, the Great Pumpkin. When you’re trying to get your otherwise adorable Linus to come in from the pumpkin patch at three in the morning, only now you’re the wife with small children, not his sister, it’s not so much fun anymore.
Treatment can be tricky. If you have a floridly psychotic partner who is harming himself or someone else, call 911. The police can compel anyone they think is seriously emotionally disturbed to go to the hospital for a psychiatric examination. In Hamilton we have an additional option: the Crisis Outreach and Support Team, COAST, 905-972-8338.
And we also have a charter of rights and freedoms. So you can be delusional, or hallucinatory, and if you aren’t hurting anyone, you might not have to be treated. And if you’re in a relationship with such a person, and they will not seek treatment and aren’t sick enough to be forced into treatment, where does that leave you?
One thing you can do is seek treatment for yourself. Find a mental health professional who can educate you on your partner’s illness, and who can allow you to vent your stress. Maybe the two of you will come up with a way to help your partner. Maybe just it will help to have information, and some understanding.
Medication helps, and whenever possible the psychotic partner should be encouraged to see a doctor. If you can’t get a delusional person to see a doctor for the way they are thinking, you might be able to convince them to go because of the way they are feeling. For example, “Linus, you’re pretty upset because the Great Pumpkin didn’t show up again. Maybe you could see the doctor and get something for your depression” works better than “Linus, you’re crazy. You need to be on medication to change the way you are thinking.”
Another thing that helps is telling the truth to the psychotic partner. Speak from your own experience. “I have never seen the Great Pumpkin. I know that you believe in him but for my part I’m not sure that he exists, or that he is worth waiting all night in a pumpkin patch for.” You’re not forcing the other person to think differently: you can’t. But you can speak to your own truth, and just put it out there beside what he’s thinking.
Another thing that Maniacci points out is that hallucinations and delusions can be translated into commonsense language: meaning, purpose and response. He cites a woman, Jenny, who “believed the cups in her apartment were moving all by themselves. This hallucination had proven persistent, intractable, and unresponsive to medication.” By listening to Jenny, Maniacci learned that she had been greatly stressed by moving out on her own and the expectations that her parents had that she was doing well. He “determined, with Jenny’s help, the meaning of her symptom – that life was moving without human intervention. She was feeling out of control.” The purpose of Jenny’s hallucination was to alert her family to the fact that she needed help. The response from the therapist and the family was to tell her, “It’s okay to be frightened. How can we help?” The hallucinations ended soon afterward.**
If you find yourself in a relationship with a Linus, and his weird thoughts aren’t hurting anyone, you may just have to decide whether you can do 3am runs to the pumpkin patch or not. If you can, it helps to be honest, to try to understand the meaning behind the weird behaviour, and to get medical help for your partner, if you can. You may also need a safety plan: what to do to keep yourself, your children, and Linus safe, if and when the need arises. Talk to someone: family doctor, psychiatrist, therapist, COAST.
And go out and enjoy the beauty of the pumpkin patch, with or without the Great Pumpkin.
*Michael P. Maniacci (1998), The Psychotic Couple. In: Jon Carlson and Len Sperry, eds. The Disordered Couple (Bristol, Pennsylvania: Brunner/Mazel), pp. 57-81
** op. cit. p. 69