Fictional Tennis and Other Warning Signs of Manic Psychosis: A Retrospective

Even though it may feel as if you are absolutely lucid at one moment and in the midst of psychosis the next, there are warning signs in the vast majority of cases

This includes during my own experiences.

lone tennis ball

“Every normal person, in fact, is only normal on the average. His ego approximates to that of the psychotic in some part or other and to a greater or lesser extent.”—Sigmund Freud

Please: If you notice uncontrollable or challenging to control changes in your  thinking and/or behavior, or your allies show genuine concern for your mental stability and health viz-a-viz implore you to seek urgent medical assistance; or if you realize there have been behavioral health changes in one of your loved one, act immediately. There is simply no time to wait, as frightening as going to the psychiatric hospital can seem (though, in most instances, in reality it is more than fine: it is a medical facility that will aid you in returning to fuller health. Early intervention may not always prevent a psychotic episode from occurring, as the possible reasons for the condition vary quite significantly, but quick action ensures the individual will be closely monitored, and thus in a much more safe situation and environment.

At the advent of my first psychotic break, I was found in my room, packing a suitcase, convinced I was preparing for some class of travel. I had removed all of my clothing from my dresser. I do not remember this at all.

Every once in a while, when I think about this–try to imagine it, really–I still wonder where I thought I was going.

Or was going.

Fortunately, the ambulance arrived before I had the chance to leave.

The First Warning: A 15-part exchange that should have at least been a moderate indicator that something was sorely amiss (goes something like this):

  1. “I’ve been playing tennis all afternoon and my knees are really hurting because of those knee pads. You know, the maroon ones? Anyway, it was a great game of tennis, but I’m sweaty as hell right now and need to take a shower and get ready for your party tonight. Unfortunately, I remember hearing it’s going to rain, and be kinda cold, so maybe everyone will have to be inside. Do you think all of those people can fit in here? I mean, I don’t know how many people can fit in here comfortably, you know?
  2. My roommate didn’t say anything.
  3. “I didn’t mean to upset you. It might not even rain. We have a tarp. It could be fun.”
  4. “It’s six o’clock in the morning. “
  5. I didn’t say anything
  6. “What time did you play tennis?”
  7. I didn’t say anything.
  8. “And where? With who?”
  9. “I don’t know. I don’t know where.”
  10. “You did not play tennis.”
  11. “I just got back…”
  12. “You did not play tennis.”
  13. “All right.”
  14. “You have been here the whole time.”
  15. “Okay.”
  16. “You have been here the whole time!”
  17. “Have I done this before?”
  18. “…Yes.”

In fact, I had said/done something like this many times before, to several different people. When someone has delusions such as these, especially repeatedly, it is a warning sign of manic psychosis, which is generally accepted as having three stages: Prodrome, Acute, and Recovery. The most loving thing you can do if noticing the Prodrome phase is inform your friend that you are nervous—or if it you, admit that something is wrong—as the quicker the medical intervention, the better. The Acute phase will almost always require hospitalization in order to enable Recovery. Doctors can prevent the episode from reaching its frightening peak; the one I stood at, remembering nothing but its sharpness, for days on end.

The “tennis episodes”didn’t always involve tennis. Sometimes I’d paint something, like an entire piece of furniture, well into the night, even though I had to get up the next day.I spoke too much; the caliber of my flight of ideas was increasingly rapidly; the present tense seeming somewhat adrift, as if being observed rather than being a part of, and I wept for the loss of it, or truly, every single thing my life had been made of, and every single thing this was taking away from me. It got stranger. But I’ve already told that story.

Do not be ashamed. This happened/happens to you. It doesn’t make you “crazy.” Psychosis is a health issue, triggered by something psychiatrists often fully understand, and are frequently able to work with the patient in effective ways, including Cognitive Behavioral Therapy (CBT). This is dependent on what caused the break in the first place. For example, it can be caused by drug use (including withdrawal), an organic chronic illness (i.e., Psychotic Depression, Bipolar I, Schizoaffective disorder and, the most common and pervasive, Schizophrenia). While it is not always possible to prevent one from having a psychotic episode, early intervention has been proven to minimize the risk of severe relapses, resultant in long-term adverse effects. 

Don’t forget that people who are hin the midst of psychotic break, depending on the severity, may not have a hard and fast semblance of what is going on around them, and often report complete amnesia for the duration of the episode. Such has happened to me,ranging from exceedingly intense (no cognizance of “the outside world” to mild (for instance, I knew I was in Grand Central Station, but couldn’t remember why, or where, exactly, I was going. I knew where I was, but I was in a frightening, disoriented, and depersonalized state. I recall that I could hardly string words together, and sometimes even muttered world salad. Hearing the word salad. Trying again. Feeling ashamed. Thinking: do not feel ashamed. Do not. This too shall pass. You know that now.

So, whether you’re rhyming and speaking with manic energy; laying around, completely catatonic and wordless; or seemingly fine but then “suddenly” rambling about the neon lights scrawled across your halls: try to recall that the feelings accompanying the Prodrome state can be extremely scary because you are more aware of what is occurring than you are in more acute states of psychosis, but feel unable to stop it. And sometimes you are. And you may even, become angry and frustrated, in your unsound state, with those who love you, worried they are attempting to mock you as so many other have, or to play a tricks on you as others have as well. Paranoia, exaggerated denial of symptoms, and even fury, are hallmark traits of this stage. But the facts are plain: if you’re running around, telling your friends you’ve been playing tennis all day (and it’s 4am or so) and that the apartment is flashing with blue and yellow neon lights, something just isn’t right.

Get help. Now. There is ample scientific evidence that proves getting the correct diagnosis and treatment plan in place as soon as possible. the better the long-term outcome will be.

According to the National Health Service (NHS) in the United Kingdom, the three major stages of psychosis can be broken down as follows:

Prodrome state: During this early stage, there may be subtle changes in a person’s normal ways of thinking and feeling. They may feel that everyday experiences have changed or become confusing or overwhelming. They may begin to withdraw socially and have difficulty meeting educational/work needs. The nature and duration of the prodromal period varies, (and some people don’t experience a prodrome state at all) but it usually spans a few months and can last several years.

Acute Phase: This is when clear positive symptoms such as hallucinations and delusions appear. These symptoms can be very frightening and distressing, and can lead people to behave in ways that are uncharacteristic and unsafe.

Recovery Phase: Within a few weeks of starting treatment, recovery has begun for most people. Symptoms get less intense and people begin to feel more like their normal selves. Once treatment starts, 80% of people achieve remission of symptoms from their first episode of psychosis within 6 months and about 20% never experience another psychotic episode.

Further, psychotic conditions are split into two categories: positive and negative. “Positive symptoms” are experiences and behaviors that are not experienced by others (i.e., hallucinations), and “negative symptoms” indicate a reduction in common responses and actions. For example, positive signs of psychosis include hallucinations (including all senses), delusions (commonly the thought that one is being monitored with mal intent), thoughts of eternal control (such as broadcasting, which is present in nearly all cases of Schizophrenia as well), thought confusion, and changed behavior and feelings. “Negative symptoms” often include social withdrawal or completely isolation, loss of motivation, and changes in emotional responses (often revealing amplified depression).
 
But remember: there is therapy (psychotherapy, family therapy, CBT, DBT, etc.) and medications (antipsychotics, typically in conjunction with antidepressants, often treat the illnesses; they include Butyrophenomes, Phenthiazines, Thiozanthenes, and first, second, and third generation antipsychotics) that collectively treat psychosis. You can get better. I still have frightening moments sometimes. But I know who I am. And you so too.
 
You are not crazy, insane, nuts, a lunatic, out of your mind, a basket case, bananas, bonkers,  mad, mental, or cuckoo. You are simply you, fighting the good one, and braver than you may ever know.
 
Though I hope you do. Or come to find out.