What’s it like being psychotic?
Being psychotic is a lot like having an incredibly clever, manipulative person living inside your head, in the sense that, a lot like a very clever manipulator, your psychotic voices effectively blend truth with lies and distortions as a means of deceiving you and effectively making it almost impossible to figure out the truth of what’s actually going on.
Occasionally, your psychotic voices will trip themselves up and clearly contradict what an earlier voice said or they will try and communicate something so improbable that even a psychotic person will likely be able to see what they thought they heard makes no sense whatever and therefore must be an illusion.
Being psychotic is likely going to be scariest and most confusing thing you will ever likely experience and the cruellest thing about it is that it robs you of your trust in EVERYONE, including, most importantly yourself!
During a psychotic episode a person will likely become incredibly anxious, everything will become a potential source of paranoia and they will likely, at the very least consider confronting certain people because you believe that they have been saying horrible things about you or are hiding something from you etc.
Most of the hallucinations that a psychotic person experiences will be auditory, though visual hallucinations are still not uncommon as well.
What psychosis is not!
The word psychotic in particular tends to have incredibly negative connotations and is often used to describe a crazy, super-angry, violent person. In reality, while it is true some psychotic people do become violent, the majority do not and even those that do become violent usually do not become murderers or rapists etc.
Also, occasionally the term psychosis may be confused with psychopathy. The basic most definition of psychosis is ‘loss of contact with reality’ whereas, psychopathy is a condition were a person mostly lacks any real empathy with people and this disposition in some psychopaths may pave the way for violence, manipulation, deception, bullying and other highly anti-social behaviours.
The psychosis spectrum
Like with most problems in life, psychosis is very much a spectrum, and here, in my experience are the different zones which represent the varying degrees of psychosis and risk of developing full-blown psychosis.
Most people, most of the time will be in this zone. In this zone you will only have irrational beliefs and delusions which are mostly not distressing or damaging. You may when you are in this zone sometimes get a bit paranoid, angry, upset or down, but for the most part your experience of reality and how you deal with the stresses of life will be mostly healthy and sustainable.
This is what I would regard as the potential danger zone. A person in this zone may start having obsessive thoughts, depression, high levels of anxiety, substance abuse problems, paranoid beliefs, misperceptions of reality (like believing everyone is laughing at you etc). If a person stays in this zone for long enough their chances of developing psychosis or some other psychological problem is greatly elevated. People who are in this zone will probably not become psychotic, though they would still be best advised to talk to someone (preferably a mental health professional) about ways in which they can deal their problems.
This is what I regard as the danger zone! People in this zone are now mentally ill or in the process of becoming mentally ill (what’s known as prodromal phase of psychosis can last many months). A person in this zone will likely start to have many paranoid misinterpretations of reality, at least some hallucinations, high levels of anxiety and this is the stage at which they may start saying things to other people which don’t really make any sense or they may even become aggressive and confrontational (often because they believe that they have been spreading malicious gossip about or are attempting to conspire against them in some way).
People in this zone really need to get help, the problem is, however, many people in this zone have little to no idea that they are becoming psychotic and this lack of insight can be very dangerous (as it may lead to thoughts of suicide or harming others etc).
This is the zone that I found myself in a few years ago. In this zone a person will have many, many hallucinations, massively high levels of anxiety (when I was psychotic I would often get up to go to the toilet 5 or 6 times a night before I finally got to sleep). A person in this zone will quite likely come into conflict with people and may pose a threat themselves and others. A person in this zone needs urgent professional help and probably medication (anti-psychotics) will likely be prescribed. People who are in this zone may still act mostly rationally (if they are a generally rational, level-headed person) but, internally, to quote Full Metal Jacket they will be ‘in a whole world of shit’
A person who reaches this zone may end up being diagnosed as being schizophrenic (if they have multiple psychotic episode within a period of 12-18 months). Though, hopefully with good treatment they will either, after treatment have zero psychotic symptoms or only low level problems (like occasionally hearing voices when they are stressed etc) but they will still not become highly delusional and paranoid etc.
A person in this zone has, to be completely politically incorrect completely ‘lost the plot’ and may pose an immediate threat to both themselves and to others. A person in this zone will usually end up being heavily medicated and will likely be sectioned under the metal health act. A person who ends up in this zone may have to endure an entire lifetime of mental illness and in some cases managing the problem is as a much more realistic approach as opposed to trying finding a cure.
Probability vs refutation
One of the many problems that a psychotic person faces is that they often want 100% proof that what they are experiencing isn’t real, which unfortunately is not possible in many cases. From the point of view of a non-psychotic person, simply weighing up the odds of whether a belief true is usually sufficient, for a psychotic person however, this is usually not going to be enough.
What often happens when a person becomes psychotic is that an individual will have one or two central delusions (which are often highly improbable), part of the difficulty in assessing the veracity of these delusions is that these central delusions are often supported by a range of other, often far more plausible delusions.
Example: Patricia has become convinced (because of multiple hallucinations) that her mother wants to poison her. As much as this central delusion may seem highly improbable even to Patricia this delusion is supported by other delusions which are, perhaps based on at least a partial truth (Patricia believes that a girl that she went to school with who she was a bit mean towards on a few occasions has been going around telling everyone what a nasty bully she is). Patricia also believes that her mother has become aware of this rumour that her daughter is a bully that and that forms part of motive for Patricia’s mother wanting to poison her daughter.
Some paradoxical truths
The way in which psychosis manifests varies quite a bit from person to person but here are what I’ve found to be some things about things about psychosis that may surprise many people.
Being psychotic is not necessarily the same (although it is to some degree) as being totally irrational. A better way to really understand psychosis is to view it as like a difference of input (ie: a person who is psychotic believes that they have heard a knock at the door and therefore, since it usually makes sense to trust what your senses are telling you it makes sense to believe there is someone at the door).
The problem is, the more psychotic a person becomes the more hallucinations they’ll have and it generally becomes much, much harder to think clearly and rationally.
A psychotic person will likely go through many distressing episodes and they may even contemplate suicide, yet they will often not actually be depressed. A psychotic person, may actually be quite emotionally flat (when I was psychotic, I only broke down and cried once). One psychoanalytical explanation for this is that psychosis is basically a way of dodging depression (ie, instead of becoming depressed a person effectively, externalises that which they are not happy about, so instead of getting depressed and beating yourself about things that you don’t like about yourself your mind creates the illusion that people are saying nasty things about you and conspiring against you etc).
Most psychotic delusions are at the very least mildly unpleasant, yet, sometimes a person may have very nice, even fun delusions that, say, ‘all the girls fancy me’ or that they have special, magical powers or that they are smarter than everyone else etc.
One method for understanding this peculiar phenomenon is to consider that on a purely emotional level, we are all at least a bit bonkers and so, when a person becomes psychotic what they believe/ suspect about themselves and the world around them on a visceral level becomes something that they wholeheartedly believe in.
Parents in particular are often guilty of falsely believing that: ‘If there was anything ever seriously wrong with my child, I’d definitely know something was wrong’ in reality, unfortunately this is often not the case. Even a very well trained mental health professional could talk to a person who was in the process of becoming psychotic and have absolutely no idea there was anything was wrong with them.
Quite ironically, people who don’t actually know you are sometimes going to be the first people that notice that you are ‘not quite right’.
Example: John goes to work and (due to the fact that he finds work stressful) starts to exhibit early warning signs that he is becoming psychotic (John starts to become nervous around people and paranoid about people talking about him). As a consequence, people who work with John will quite possibly misread his behaviour as him being ‘a bit weird’ or think that he’s being he’s being a ‘bit of dick’/’drama queen’ etc if he starts confronting people who he honestly believes have been saying nasty things about him etc.
This is to be contrasted with when John goes home to his wife, he has much less stress, he relaxes and therefore exhibits far fewer psychotic symptoms, which means, even though John’s wife knows him best she likely will have no idea her husband is becoming mentally ill.
Methods of coping with psychosis
For me, the only thing that actually made any significant difference to my psychotic symptoms was anti-psychotics (I found after about two weeks of being on ap’s that my symptoms were downgraded, another two weeks wiped out about 90% of my symptoms and six months later I was virtually symptom free). That being said, there are certain strategies a person can use to manage their condition.
Distraction, finding ways to distract yourself from the voices etc can be very effective, this can be done through focussing on something creative, reading, listening to music, playing scrabble etc (wearing ear muffs is also a strategy many people may find to be effective).
Write a diary, logging your thoughts and experiencing in relation to your psychosis can serve two very important functions, function number 1 is that it can be highly cathartic to write down exactly what you think and feel, function number 2 is that sometimes writing about your delusions can enable you to see that do not actually make sense. I noticed, for example when I was psychotic that the voices I heard were incredibly repetitive (people who are psychotic often hear the same negative statement over and over again, which in one sense makes it very believable but in another way makes it highly implausible that the someone would say exactly the same thing about someone over and over again). I also noticed that my neighbours (who I was convinced were talking about me) would tend to refer to me using my whole name (over and over again), which certainly isn’t consistent with how people normally talk about people (people often start by saying person’s full name and then drop back to just using their first name).
Avoid substance abuse, avoiding getting very drunk while you are psychotic, avoiding illicit drugs and also avoiding taking large amounts of caffeine (caffeine is fine in small amounts, but caffeine in large amounts can make your mind race and increase symptoms of anxiety) can all be ways that you can reduce the risk of exacerbating psychotic symptoms.
Try talking back to the voices. Talking back (in your head if you are in a public place or even out loud if you are at home) can sometimes be a means of derailing the voices you believe you are hearing. I remember one night while lying in bed thinking that my neighbours had were talking me, I decided to talk back to the voices (the result of this approach was actually quite hilarious because the voices became offended by the fact that I’d stood up to them, which made it obvious to me that the voices were not real).
With people who know you who know that you are psychotic try and establish certain rules which will help manage your psychotic symptoms (certain topics of conversation and situations may often trigger psychotic symptoms). If a person can learn to be sensitive to these psychotic triggers this can help a person get through the worst of their psychosis and avoid freaking out too much.
Once a person has overcome all or most of their psychotic symptoms, gradual ‘exposure therapy’ (in relation to things they used to afraid of) may be useful in eliminating any residual paranoid beliefs a person still holds.
Life after psychosis
Even if a person completely overcomes their psychotic symptoms they will still likely have some residual issues in relation to their psychotic episode.
PROBLEM 1: What the hell do you tell people! When I was psychotic (as is the case for many people due to the extent of my paranoia) I only told my parents and my best friend that I was psychotic. After I overcame my psychosis I gradually became more and more comfortable with talking about the fact that I’d had a psychotic episode.
Of course, for many people they absolutely do not want anybody to know about their psychotic episode because they are worried (quite understandably) about being rejected and or discriminated against. The extent to which a person discloses details (if at all) about their history of psychosis is very much a personal decision. Some people, for example may feel that talking about their psychotic episode is therapeutic and really helps to reinforce that fact that it’s behind them and that they’ve overcome it or even that they have a duty to be open about their experiences in order to reduce the stigma associated with psychosis.
In many ways, this is one of those situations in which you are ‘damned if you do and damned if you don’t’. If a person chooses to keep the fact that they’ve had a had a psychotic episode this may lead to feelings of embarrassment and even shame, plus if you do not tell a person that you are dating (at some stage) that you’ve had a psychotic episode they may feel that you have deceived them.
People who have had a psychotic episode may have said and done some bad things while they were psychotic and this may cause a lot of friction. Explaining to a person the reasons why they did or said may in some cases be useful in healing wounds though, in other cases this may not be possible or be a good idea. Ultimately, a person will have to weigh up the pros and cons of trying to reconcile differences with a person that they came into conflict with while they were psychotic.
A person who has had a psychotic episode will often have extreme difficulty in identifying the exact point at which they started to become psychotic. As a consequence of this they may still feel very angry about things which they still believe people said about them etc.
In my experience, there are two practical ways of dealing with this problem.
Examine, as methodically as you can your experiences, write down everything you can in relation to a past experience which you believe may have actually been a psychotic hallucination. Sometimes, when you write things down you will notice certain things do not add up.
Example: I thought, one time when I was at work that some of my work colleagues had found my old Myspace page and were making fun of some of things I’d written etc. However, after careful consideration this probably did not happen because the user name I had on my Myspace account was not the same as my real name, therefore, my work colleagues almost certainly did not access my account.
If you still cannot figure out whether or not what you experienced was real or not mastering the fine art of forgiveness can be hugely beneficial. One of the barriers to achieving forgiveness is a lack of understanding, all too often when we are wronged in some horrible way we see our transgressor as a less than human monster who is completely devoid of humanity. In reality, even bad people have good qualities and often part of the reason why people do bad things is because they’ve had bad things done to them.
With all this in mind, a strategy I find which can be very effective for facilitating forgiveness is to consider the factors which have made the person or persons that have wronged you the way that they are. A good way of doing this is to find out (if possible) or imagine what kind of childhood the person had.
Mandy was bullied by a lady called Sally she worked with in a factor (lots of nasty malicious gossip and snide comments etc). Mandy, however found out that the lady who had bullied her had grown up with an emotionally abusive mother who always belittled her and made fun of her. As a consequence of this abuse Sally learned to deal with conflict by being very passive aggressive. Sally, unconsciously sees certain people as being like her abusive mother and lashes out them in the only way she knows how, by being bitchy etc.
This kind of new knowledge can change a person’s perspective quite radically and go a long way towards achieving forgiveness.
Safeguarding for the future
Unfortunately, people who have had a psychotic episode are much more likely to experience psychotic symptoms again at some stage and also have other related issues. I do not personally believe there is any one coping strategy or form of therapy which is guaranteed to work perfectly for everyone. What does work I believe is finding a range of healthy coping strategies to guard against the possibility of a future relapse or other mental health problems.
Methods which can be beneficial:
-Physical exercise: Exercise can often be as effective in dealing with low to moderate level anxiety issues and depression as talking therapy. Sometimes, even just going for a long walk or cranking out a few high-rep sets of push-ups or squats can make a huge difference to how you feel (especially with anxiety in my experience).
-Keep a diary: Keeping a diary or doing what like to call a ‘mind dump’, occasionally were I write down on a piece of paper exactly what’s bothering me can be useful. As discussed earlier this can be very cathartic plus you may also be able to refer back to what you previously wrote and use it to figure out trends in your thought processes which reveal where you are going wrong in how you deal with things.
-Meditation: Meditation can be a difficult skill to master, but the benefits of practicing daily meditation many people report as being highly beneficial (learning mindfulness can also be useful).
-Help others: Helping other people can be hugely beneficial for a person’s self-esteem and people who have been hurt the most by what life has thrown at them can often be the most understanding and empathic. A person who has had a psychotic episode may even find that working as a volunteer with people who have mental health issues is very rewarding.
-Find ways to feel, think and be positive: This can be achieved through a variety of methods, some methods which I find are extremely effective are: Listening to happy music, eating a mostly healthy diet, neuro-linguistic programming, visualisation techniques, reframing (a technique were you find a new way of looking at something), hypnotherapy, writing down a list of your best qualities and also things that you are proud of achieving. Anchoring, a process by which you learn to associate positive thoughts with touching your fingers together can also be an effective technique for getting you into a positive state of mind.
-Cognitive behavioural therapy: While it’s true I am not a huge fan of CBT myself I feel this form of therapy can be hugely beneficial for people who do not generally process things in a very rational way. CBT for many people can help them to realise the flaws in their thought processes and help them to see things differently and make less emotionally driven decisions etc.
-Try support groups: Many people feel that they are totally alone and that few people understand what they are or have gone through. Support groups (whether online and possibly even anonymous) can offer a very useful outlet for such people and you may even find that you can use your own experiences to help other people who are or have been psychotic and share tips on how to manage.
-Get a cat or dog: When I was psychotic the only individual in my life that I didn’t to some extent distrust was my cat! The wonderful simplicity of the relationship you have with a pet can be very reassuring and therapeutic. Plus, if you get dog this gives you a good reason to get out the house, possibly talk to some new people and walk, which is great exercise.
-Embrace humour: Being a bit silly, learning to see the funny side of things and having a jolly good old laugh can be great medicine.
-Identify the signs: Thinking back to time before you became psychotic (especially if some form of traumatic experience or depression preceded your psychotic episode) maybe a bit painful, but normally reflecting upon these experiences will give clues as to why you became psychotic and how you can avoid this in the future.
-Identify predisposing factors: Psychosis, like many other psychological problems is usually not a problem which manifests in isolation from other problems. People who get depressed, for example often become depressed at least in part because they’ve been suffering from anxiety. Another example of issues which are related but not always identified and addressed is the (sometimes) relationship between narcissism and anger (if a person who is narcissistic is ‘shown up’ or embarrassed they may suffer what’s known as a ‘narcissistic injury’ and lash out at the person who humiliated them).
Learning about different psychological problems and how they relate to one another can be very beneficial in arming a person with the skills and knowledge to avoid future problems.
Some closing thoughts
My experience of psychosis is probably best described as being like a battle between what I could logically surmise was happening to me and around me vs what the ‘voices’ were telling me. On a good day, logic would ‘win out’ and my head would be fairly clear, on a bad my mind was plagued by scary hallucinations and all of the delusional beliefs which tend to flow from that. For some people (like many people who I described as being in ‘ZONE 5’) they will have absolutely zero insight into their condition and they will be completely taken on a roller coaster ride of terrifying delusions. It’s important to realise that the severity and nuances of a person’s psychosis (or any other condition vary widely).
I would also like to say that I hope the future that the stigma surrounded serious mental illness like psychosis and bipolar disorder etc is greatly reduced (I believe the stigma in relation to depression and anxiety has really reduced, probably at least in part because so many people struggle with these problems).
My hope is also, through greater public and political awareness the disparity in funding between mental vs physical health care is closed (the biggest killer of young men is suicide, if we start to educate children in schools about mental health and how to manage risks we can hopefully reverse this appalling trend).
Hopefully, most people who read this will never have a psychotic episode, though I hope you if you do or know some that does some of what I have written here will be of some practical help and it will go some way to helping understand the true nature of psychosis and other related issues.