Proponents of enforced treatment often point to horrific but rare events, like mass shootings, committed by people with mental illness. But psychosis alone is only a modest risk factor for violence. A 2009 study of more than 8,000 people with schizophrenia found that those who did not abuse drugs or alcohol were only slightly more likely than the general population to be violent.

There are several studies that demonstrate that assisted outpatient treatment can reduce the risk of hospitalization, arrest, crime, victimization and violence. Few, however, are based on high-quality randomized controlled trials. A 2014 meta-analysis of three randomized-controlled studies of more than 700 people found no statistically significant benefit of enforced outpatient care in reducing hospitalizations, arrests, homelessness or improving quality of life.

It can be devastating for families and doctors alike to watch psychosis seemingly claim the lives of those we love or care for. And in some situations, brief episodes of enforced inpatient or outpatient treatment may be necessary. But in my experience, weeklong inpatient stays, or yearlong outpatient treatment regimens, can do more harm than good when they engender distrust. Perhaps we must accept a new reality — to truly engage people in treatment we need to understand their own experience of psychosis and its treatment.

Many people describe their experience of psychosis as enriching or even ecstatic. One of my patients is promised a seat at God’s side in heaven. Another cries quietly while she describes how Jesus’ love keeps away the demons that infest her world. One describes his ability to take the pain from others; another has the power to see the future. Sometimes psychotic ideas are engrossing — a patient spent the summer contemplating the nature of substance and sound, and found them ultimately to be indistinguishable.

It’s hard to persuade someone who finds psychosis rewarding to adopt an alternate reality. In fact, studies demonstrate that positive experiences of psychosis are one reason people stop taking medication, in addition to side effects like weight gain, mental dulling and painful muscle spasms.

When the medications take full effect people sometimes emerge from a psychotic episode only to realize that they have alienated loved ones or damaged their lives as they knew them. We take the psychosis away, and then fail to acknowledge the loss.

Finally, the public and even many mental health providers are unaware of how often people with psychosis experience meaningful recovery, without necessarily being cured. Berta Britz, a friend, spent decades in and out of hospitals, on high anti-psychotic doses. Now off medications, she is a leader in mental health delivery services, and married last year.