Yalom thought that psychosis might arise when death anxiety overwhelms an individual. Similarly, May proposed that psychotic episodes could occur to cope with anxiety when it is unmanageable by any other method. The hypothesis proposed herein is similar to that of both Yalom and May, but it has nuanced differences. The proposed hypothesis is similar to Yalom’s in that it views existential issues as the underlying prompt of psychotic episodes. It is different, however, because it specifies how this overwhelming distress might prompt a psychotic break – namely, if existential distress becomes unavoidable but unmanageable and a psychotic episode can function as a dissociative mechanism for avoiding that distress. The proposed hypothesis is also similar to May’s because it views psychosis as a dissociative coping mechanism that arises in response to distress, but it differs in that it does not assert that a general type of distress could prompt these breaks – instead, it specifies existential distress in particular. The reason for this difference is that we do not anchor our lives around anxiety in general, whereas – as discussed in Section 1 – we do for existential issues, and overwhelming generalized anxiety therefore does not cause the same fragmentation of the self that existential distress does. The proposed hypothesis can thus be seen as a synthesis of elements from each of these historical perspectives. However, this hypothesis does not view these psychological processes as operating independently of biological factors; these psychological and existential factors work closely with the structural or functional integrity of the brain in producing psychotic episodes.