Covert psychosis

Published on 5 February 2023 at 14:23


There are people who appear sane and relatively normal yet have a subtle but profound detachment from reality. They may be highly intelligent.

Most of us have a sense of truth - some degree of awareness of what is real and what is false. If we tell a lie, we have a knowledge of doing so. Our thought processes are anchored into key features of the physical and societal facts of our lives – our name, origin and lineage, formative experiences, significant relationships, educational achievements, etc. Those with a narcissistic psychosis do not have these anchors in reality. Instead, their ‘reality’ is whatever appears expedient in the moment – and specifically whatever is expedient for maintaining their positive (sometimes grandiose) self-image, an image that is also presented to the world. This ‘reality’ is not fixed, but will vary from situation to situation, from interaction to interaction. The crucial point to understand is that the person with this form of psychosis believes their ‘reality’ in that moment. This is what makes them so convincing.

At an early stage of their development, such a person has rejected reality, with all its unwelcome aspects, along with all its societal rules and laws. It is as if they have learned to live around reality rather than in it. As a result, the fundamental law of reality has not been installed. This is rather like a computer software that has some crucial components missing.

The narcissistic psychosis will not be immediately obvious to others precisely because the ‘reality’ presented by the person is appropriate to the social situation. Moreover, the person does not experience inner conflict because he or she believes their own false reality in the moment. However, extreme anxiety, and sometimes rage, may be evoked when he or she is confronted with their contradictory presentations of ‘reality’. In a process of rapid confabulation, others will be blamed for a mismatch between image and reality. Needless to add, those who are in a relationship with such a person, or have to work with them, may experience much confusion and anguish. The tormenting perplexity that can arise from dealings with such a person is a result of trying to understand them in terms of a normal mind – which they do not have.

This form of psychosis probably depends on a certain kind of high intelligence – not a useful intelligence, but one that is put in the service of evading reality. Unlike gross psychosis, this covert form does not involve major delusions. It rests upon a more subtle elision of aspects of reality that are unwelcome, whilst at the same time constructing a confabulatory narrative that ‘passes’ as normal. From that person’s subjective position, he or she does not believe they are lying – because that concept fundamentally does not exist in their mind.

The person with this kind of covert psychosis does not have a fixed view or opinion on any matter. If sufficiently clever, he or she can construct arguments to justify any position – and can shift fluidly from one to another according to the perceived requirements of the circumstances. Identity is similarly fluid.

Despite a superficial intelligence, closer consideration of what the person may say or write will indicate that language is not used as a tool for thinking and engaging with reality, but as a means of signalling, using words as if they were semiotic images. Thus, the person may have memorised a great many slogans and cliches that are then spewed out, with varying degrees of skill, to suit the moment. In another variant, words are used like coloured paint, to create arresting and novel images.

In addition to the severe but subtle pathology within the person’s own mind, there is usually an interpersonal component whereby others are manipulated or coerced into supporting or validating whatever ‘reality’ is presented. This can sometimes amount to coercive control, a pattern of behaviour that can be extremely damaging to others. Such people do not often seek psychotherapeutic help – but when they do, their energy will be devoted to trying to persuade the therapist of the correctness of their point of view. They are not able to engage in true introspection, inner exploration, or free-association. When their stance is challenged, or contradictions are pointed out, their reaction may be renewed attempts to coerce the therapist into agreeing with them.

How does covert psychosis come about? My impression is that the following factors may contribute during the formative years of childhood: overindulgence by parents who do not set appropriate boundaries and rules; insufficient presence of a fathering one who can function as a third party intervening in the mother-infant dyad; a lack of clear ethical, cultural, or religious rules; one or both parents who display a narcissistic or covert psychosis; a strong ADHD temperament that impedes submission to rules.

Covert psychosis seems to be becoming more prevalent – possibly as a result of changing cultural and societal conditions and norms.

Phil Mollon


Author of Pathologies of the Self (Confer, 2020)