After Psychosis: What To Expect (Perhaps) & What You Can Do (Definitely!)

“Healing may not be so much about getting better, as about letting go of everything that isn’t you – all of the expectations, all of the beliefs – and becoming who you are.”—Rachel Naomi Remen, heralded medical doctor and pioneer in holistic medicine

Perhaps you’ve just come out of an acute psychotic break, or a loved one has, and you need to know, right now, just what you can expect after such a terrifying and traumatic episode; and how to work toward recovery, even with the intense fear and amnesia that often follows episodes psychosis.

Both your psychical body and mind have endured extreme shock. You’ve just spent a rather petrifying period of time—perhaps a week, maybe even a month—where you’ve not been able to identify what is real from false. You’ve existed, in part or sometimes in whole, in a type of reality which is only truly known by whose who have experienced it. Thus, in the way of empathy, things just don’t seem to be looking so hot.

Your folks and loved ones sympathize with your struggle, but they are afraid too. Just as victims of psychosis may develop PTSD, individuals in their support network may be traumatized as well, though clearly in a starkly different way. Nonetheless, it is still predicated on a similar sensation: tremendous fear. Try to remember that they saw you act in ways you may not be aware of. You might have been violent, screaming, rhyming, singing, dancing, or even without sound: catatonic and pallid. In time, you can and will make peace with the struggles entrenched in trying to uncover “lost” memories via therapy, solidarity, and self-love. As my psychiatrist advised me after me first and most extreme and horrifying psychotic break, try not to dig for those memories in ways that are ultimately injurious and prohibitive toward your recovery. Right now, your body may act as if it’s been exceedingly ill. And that’s only to be expected, for you have been. So be gentle with yourself. You deserve that, and so much more.

Respectively, it is highly probable you will experience physical symptoms that are similar to the flu. According to National Health Services (NHS) in the UK, post-psychotic patients may “sleep long hours every night (or even during the day); feel the need to be quiet and alone more often than other people; and be inactive and feel they cannot or do not want to do much; and may have unusual patterns of sleeping or eating (e.g., getting up for meals in the middle of the night).” As time goes on (remember, “withdrawal” can last up to six or even 12 months) it may become clear another medical issue is developing—a type of agoraphobia, really. It can be scary, but try to take comfort in the fact that this is largely your body and brain trying to recover. NHS stresses:

Putting too much pressure on the person to get up or go out and do things can make them worse during this time of recovery. This DOES NOT MEAN the person needs to lie down all day, have everything done for them, or never do any household chores, however. It is a good idea gently to encourage the individual to help with simple chores, chat with the family, or ask if they would like to go out on some outing they used to like. If the person says no at this stage, you should leave him or her alone, saying, ‘Okay, but you are welcome to come when you want to.’ […] It is important for your recovering relative to have a quiet place to go. his is usually a deep need and is often helpful.

Please note that this is all for mutual benefit and recovery. The more your allies understand, the more they can help, always remembering the essentially that leadership must come  from the person who experienced the psychotic break.

And then there’s the humiliation of it all. That word, psychotic, feels so extreme, and can be a deeply scary thing to admit to, especially because of years of societal stigmatization, and because of how afraid you are. Is this going to happen again? you may wonder. Is this how the rest of my life is going to be? Perhaps you’re frightened to sleep alone or in the dark. Maybe you fear the manner in which you’ll speak, so you opt for silence. You’re aware that you sometimes speak in strange or odd ways, in a manner that seems unfiltered, a flight of ideas. But here’s something else: this is not your fault, but due to a chemical imbalance in the brain which makes it exhausting for you to even try to have a “normal” conversation. This may be another reason why so may individuals who have suffered psychotic episodes are unusually quiet: because this illness can and has taken control of your very words. Because you know you may sometimes act in eccentric ways, misunderstanding basic social cues. Try to recall as often as you can that your true allies will always be there to support you, try understand, and most importantly, love you unconditionally.

You may also feel you need guidance that you do not have. Strangely, as those of us who have been in psychiatric institutions know, getting out of the hospital can be a much more harrowing than checking in. I am astounded by the number of people who just don’t know or care about this: doctors and nurses (and certainly hospital administration!) included. So while you are taking the time you require to recover, doing what you know you need to do to get well, you may want to engage in some healthy distraction tactics to fill that complex void (just be cautious they don’t turn into avoidance). A preliminary and critical step in your return to health is finding a safe place. This may be your home, or anywhere else. It’s your safe place, so it’s your choice! . Your home environment should be one that is relaxing and satisfying, but not overly stimulating. If you begin feeling trapped, frustrated, and/or agitated, try going for a walk or run (nothing that if you are feeling particularly disoriented that day, perhaps it’s better to stay at home. You can always take a soothing bath, listen to music, read a book, go on the Internet [there are so many support sites, such as depressionforums.org that have wonderful and supportive virtual communities). Additionally, try to resist watching or listening to anything excessively violent. And here’s another important one: resist complete self-isolation. The people who stood and are standing by you are true allies, and you have to trust them.

When I first came out of psychosis, I recall being critically confused very frequency (and naturally, frustrated with myself, which is why I suggest being gentle with ourselves). It is very useful to keep notes: about how you are feeling, what have are (or aren’t!) eating, and sleeping—and anything else you feel may help! Not only does this practice aid in ameliorating the confusion a bit, but it can be empowering and re-orienting too.

When you’re able, it will be very rewarding to get in touch with your loved ones again, and re-establish your connections, so remain as positive as you can, and attempt to gravitate toward happier and healthier environments and people. 

I know you’re afraid. But just think about how brave you are as well. What you went through and made it out of. That you’re a survivor, and can do this. And, without question, will.

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14 thoughts on “After Psychosis: What To Expect (Perhaps) & What You Can Do (Definitely!)

  1. A recently had an acute psychotic break last April. Now I came out after that cocktail shot of Ativan , Haldol and Bendril. It’s a couple months later, I feel different. The long term memory loss is to a point where I remember facts. Simple facts, of my past childhood. Its where I am not emotional attached to the past. It’s just a statement of what happened in my life. I use to relive the past in my mind. Now I couldn’t recall one story. I live for today just because I don’t remember yesterday. Also no attachment to any emotions of my past events to my life. A blessing or a curse? Solitude has been my friend as of late. That memory is my major effect of my break. It’s very dissassociative stance in my life that wasn’t there before. Your thoughts?

    • Hi there,

      I am so sorry for taking some time to reply to your important comment! As you can tell from my latest post, I have been traveling and therefore largely without Internet access (and certainly not in the proper frame of mind to be writing about or commenting on such serious issues!). As I am not a doctor (yet!), I can’t state what you should do regarding your present condition, but as a person with experience BEING in the place you are, I can certainly offer up my experience and opinion. The quantity of truly critical dissociation and even depersonalization I went through after coming out of acute psychosis for the first time—which the doctors said was the most intense they’ve ever seen, and were baffled, on the whole, as to what to do with me—was absolutely marked. In fact, due to the traumatic hallucinations I experienced, which were attached to all of my sense, and I had grave difficulty letting go of the fact that this happened to me but also DIDN’T happen to me, if that makes any sense, which made me feel even further away from the world, was part of the reason for my PTSD diagnosis. Sometimes I’d feel as if I was watching myself and I was this shell of whom I used to be just walking around. After psychosis, I wasn’t the same for MONTHS. I had more “little breaks” where I’d lose track of tremendous amounts of time, and sometimes wind up in places not knowing how I’d gotten there AT ALL. I had a severe set back in my SI addiction that required stitches for the first time ever. I felt the depression so heavily then, and yes, it was very much due to the fact that I felt as if I was this unfeeling person, yet I ALSO felt horrible. In short, nothing made much sense.

      With the assistance of excellent psychiatric care and A WEALTH of SERIOUS self care and commitment, I started to get better and have new, real relationships. I too was prone to isolation. VERY. This DID take about six months or more, so don’t look at the time frame and think you’re doomed. You’re not. What helped me most was concentrating on making new memories, of being mindful of the moment, of practicing DBT regularly, and of getting lots of exercise—I started to love hiking and camping and just being with nature. I found healthier “escapes.” It DOES take time because you’ve been through a lot—more than most might understand if they’ve not had a psychotic break—but it gets better. Try to find ways to GET OUT OF THE HOUSE. You HAVE TO for your own sake. Don’t push your safety zone too much, but take it slow and steady. You deserve it. You will get healthy again. Keep going. Honestly. If you want to contact me privately, please feel free to do so! Also, I really recommend depressionforums.org. You’ll find loads of support and information there!

      Thinking of you,
      in solidarity,
      Alex

      • My son has just had his 2nd break in 3 years. He is 22 years old. His last break was so psychotic that he made 5 out of 5 on the test at the hospital. The doctor said they usually only get 2. We witnessed it all. Every hour of 2 weeks, every minute, every second. We were and are still in hell. Our boy has been in two different hospital in the last 6 weeks and still is not close to being able to come home so we can help with his recovery. Where do we turn for support to try and understand what this awful thing keeps happening?

      • My daughter is a student, smart and beautiful, psychosis strike on her last Thursday, 6 days ago, fortunately her boyfriend and her brother were able to bring her to the hospital. She has hallucinations and completely lost her touch to reality. She is now in medications and we are completely in shock. What is the next? Will she get better? We love her so much and it is very painful to see a young girl suddenly not the same person anymore.

  2. I have experienced psychosis 2 months ago. I´m 17 years old and I feel terrible for this experience. In the early psychosis I cried a lot and I analyzed a lot of things. Later it went into such conditions that I thought I was Judas, who reproves God for treason, then I´m second Virgin Mary, I felt the same aroma that occurs in the church, then I´m Voldemort trapped in the body of 17 year old girl, then I thought about myself that I’m a vampire and I have to kill myself stab to the heart because it is the only way I can destroy myself. Normal or rather abnormal I pulled a knife and wanted to stab, but my mom stopped me. Later I wanted to hang myself, or drown, I just had suicidal thoughts, I’ve already had these thoughts before, but not too seriously. My family put me into facilities where I stabbed injection and and I then returned back to reality. After a month I embarked out and I´m not afraid of retuining to psychosis but that people find where I was and I will be considered me as fool.
    Sorry for English.

    • Hi there,

      What you experienced, especially so recently, is no doubt traumatic and upsetting–but please know if anyone considers you a fool, they are simply misinformed and ignorant to what psychosis feels like, is caused by, and even means. It doesn’t say anything about who you truly are; it is a condition, albeit a frightening and intense one, that you were afflicted with and treated for. You were at a hospital, which is something you should try not to be ashamed of. There is so much external stigma that we suffer from deep and painful internalized repression–and that’s in addition to managing our aftercare, recovery, and healing. I really think time helps heal that, or at least it did for me and I hope it will for you. I had suicidal thoughts and behaviors as well; I injured myself; I attempted to injure others. In short, I was NOT truly ME at my best and most kind, thoughtful, gentle (with myself and others) due to a malfunction that, thankfully, doctors understand a bit more about these days. A bit. :)

      Are you aware of the reason you had a psychotic episode? This is a helpful means of healing too, I think, because then you truly know how to manage it, or what the red flags are. It’s true that there is an onset that isn’t ANYTHING like what can ultimately happen (the worst nightmare! I understand the TERROR). Please know I was VERY frightened ALL the time afterwards in so many ways…but gradually I got better in just as many ways. I only hope the facility you were in treated you well and gave you good skills to use on the outside AND that you are receiving follow up care from behavioral health specialists. Don’t go it alone. You are too unique, special, and valuable. You are no fool. You are a survivor. Be gentle with yourself and remember who you really, really are.

      If you ever want to shoot me an email, please feel free. We are a community, and I am so grateful to you for sharing.

      In solidarity and with hope and faith,
      Alex

  3. Hi Alex,

    I experienced psychosis this past december around the time the end of the world happening was suppose to be happening. Little did I know that it was the end of my world. I thought I was somehow the center of the universe and was the chosen one because I felt god was talking to me through music and TV. I also believed I could astral project in daily activity, feel peoples energy and such. I thought I had these special powers along with believing I could see the future. I thought I was Jesus, the anit-christ, and even Santa Clause. I spent days in my room isolated reading the bible and listening to music. I even did a ritual on my bath water to make it holy and able for me to bathe in. I even remember thinking that my roommate was the devil and was trying to stop me from doing what I thought was necessary mediation. I was psychotic from the 15th till probably the 15th of January. I was put on meds on Christmas day as my parents were able to convince me to go to St. Joseph’s hospital, as it made sense to me at the time. Everything was unfolding as it should of.

    The problem I’ve been facing since coming out of it, is that I am still really quiet. I have poor attention, concentration, memory, and I have lack of thoughts/ things to say with groups of people. As a result it is very difficult to try and have a normal conversation. It is hard to have confidence when all my confidence came from my ability to speak fairly well. Now that has been taken away. I can’t communicate on the level I need to return to my job as a radio broadcaster. I’ve been at home helping my dad with the family business in the mean time. I do however want to get back to my job as a broadcaster as I know I could have a lot to off as far as experience to people. This is killing me inside and I desperately want to have normal, fluent, consistent ability to talk to people and not be scared out of my mind about what I might say and what I don’t have to say. I want to know how many people do you know that had or are going through what I’m going through after psychosis? Does this get better with time? It’s been 8 months, still not on the right medicine for me. I see my doctor on Monday and going to bring up these problems again and see if she has an answer. I interested to see what you know from your experiences with people who’ve had psychosis.

    Thanks
    JW

    • Hi there Joe,

      I am so sorry for taking far too long to respond to such a brave and important comment. I understand exactly how you feel. I worked in publishing, as an editor and writer, at the time that I was slowly descending into psychosis (I had a few brief “flashbacks” or brief psychotic experiences, but was also coming off medication and it was nothing like The Big Episode). The lack of cognitive functioning was devastating, as I’d always been able to communicate well; if not in person, I could count on writing, that’s for sure. But I just felt like this blank, dull thing that was in no way the relatively sharp person I’d once been. It hurt so much, as I knew I was far below how I was capable of functioning. And it did take longer than expected to fully come out of that. In toto, I think it took about a year. I know that’s not necessarily comforting, but think about the trauma and the fear, and maybe PTSD. That’s pretty damn FAST really. So, be gentle with yourself. I met a lot of other bright and really amazing people during my hospital stints who were suffering in the same ways: a vice president of a marketing firm who had to give up her apartment because she couldn’t work, a brilliant writer who wrote on neuroscience without the ability to access that part of his brain, several others who even had ECT to recover (one experienced a manic episode that involved religion much like you did). This is personal, so you do not have to rely (naturally), but do you know your diagnosis/cause of psychosis? The two people I know who dealt with what you did, or VERY closely, eventually were diagnosed with Bipolar 1. It is now managed with medication, but don’t forget, the stabilization process also takes a while and can have adverse effects before it gets better and you even out. I have Major Depression and comorbid anxiety disorders and brutal chronic insomnia, and it took 20 (what?!) tries of meds/cocktails before finding the right ones. During that time I was as dim as a 20 watt bulb, I feel. But IT GOT BETTER. Be gentle with yourself, research medication as much as you can, and make sure you are engaged in therapy (I found DBT to be paradigm-altering). It takes time. Allow yourself to heal. You’ll be back on the radio…and maybe with a story to tell or to research that can change not only your life, but that of others.

      In solidarity and with love,
      Alex

  4. Hi Judy,

    I re-read our comment after logging in here (I am trying to keep this site more updated; it’s just challenging with work and classes), and had some thoughts about my experience, which was nearly 3 years ago by now. I remember it as if it was yesterday, but the fear is not as present.

    I am so sorry for what you and your family are going through. Psychosis is a very distressing thing for everyone involved, and is such a complex, varied illness. During my major psychotic break that necessitated hospitalization (I have near complete amnesia of those days), I know my state was extreme and also surprised the doctors. I varied from extreme mania (including running around) to whispering/nigh catatonia. When I “woke up,” I recall having no idea, at all, that what I “experienced” (saw/felt/heard/smelled) was not real, and had a hard time finally understanding what had happened. All I knew was I was terrified and in a psychiatric institution. Once released, I relapsed, and if it hadn’t been for the support and trust of allies, would have certainly been hospitalized again (I was in three hospitals for a total of 14 weeks over the course of 7-8 months).

    When I got home, it was horrifying, and it took quite a while, perhaps a year, for me to really recover…but I DID recover, and have no psychotic symptoms since (they never did totally figure out why it was so extreme, but psychosis typically does have a rapid onset). Try not to think of this as something that has “kept happening” but something that is happening and takes time to get out of. Ask lots of questions about your son’s diagnosis AND the medications he was on before/during his psychotic break. It is likely my med-combo, which was supposed to help me out of depression, that pushed me into a psychotic state, and then my inability to speak/communicate that at the first hospital resulted in a dramatic med change/withdrawal and LOTS of benzos and Zyprexa and ultimately toxic blood. It was probably largely stimulant (and even overdose) induced.

    It is NOT unusual for psychosis to last a month or two, and according to NAMI, ~100,000 people in the US experience it every year. Here is there “support” page, which I find very helpful and hope you do too. I WILL get better: http://www.nami.org/Template.cfm?Section=First_Episode&Template=/ContentManagement/ContentDisplay.cfm&ContentID=127413

    I hope by now you and yours are on your way to recovery. Stay strong. You are not along.

    In solidarity,
    Alex

  5. I am trying to be a support person to my dearest friend who has recently experienced a psychotic break. The chain of events landed her in jail. Twice. She is far from a jail bird and her story is somewhat of a novel. I want to learn as much as I can about mental illness and her condition so that I can support her. It all started with some bad decisions and a consequential divorce. Some of it, in the beginning, was garden variety depression. But then the voices in her head started followed by her belief that she had telepathy and those closest to her did too. She started accusing people of having relationships with people in her head. She also started believing close immediate family members (including her children) were dead. As you can imagine, this has been extremely traumatic for herself and her immediate family and friends. She is in her mid-forties and it is to the point that her sister has no choice but to obtain guardianship. The places she has been admitted to have released her after a short time and the legal/jail system is of no help at all. Most people think a good lawyer could solve all her problems but then she would be free to cause more pain to herself. I sincerely feel it is to the point that others must protect her from herself if that makes sense.

    A few questions:
    1. Is there hope for recovery?
    2. At what point does electro/shock therapy come into play and is it effective?
    3. Is it standard to rule out other brain disorders via cat scans and MRI’s? (i.e. tumors, etc)

    I am hopeful because as of late, hope is all I have.

    Scared and desperately concerned, a dear friend

  6. I am so so happy to see your courageous website, alex, thank you for sharing your story with all of us. I have researched this a lot because a few teens close to me have gone thru breaks. I have two elder psychiatrist friends who have told me how they treated kids 40-50 years ago and it was kinder and gentler even though the hospitalizations were longer. This is what I know, and I’m not a doctor, but it’s what I believe. A psychotic break is as traumatic as a severe concussion, the chemicals in the brain have melted down, causing real confusion and disconnect. Anything you say or do in psychosis comes from disconnected thoughts. You are not bad for breaking, you withstood so much and were so strong but the brain needs to take a time out sometimes and psychotic breaks are one way they protect themselves. Kids used to have psychotic breaks and the lucky ones would be hospitalized for up to two years, the length of normal recovery period. The recovery period is between 2 and 5 years, which no one tells you, but it makes sense. It takes 6-12 months to come back to external normal but your internal work isn’t yet complete. You need meds, consistent counseling and a safe place to live and recuperate with out emotional traumas. At the 6 month point, kids would start taking college courses again, part time. They’d leave the hospital for class, come back and check in, do their homework, have dinner, do their homework and then get to sleep. A very family-sounding healing space. I so wish that was available today. Because psychotic breaks are recoverable. But you need to gift yourself with kindness and time. You can’t expect to be speaking normally in public in 8 weeks, it takes a long time to center yourself. The good news is that over a few years, you can become a 2.0 version of yourself, the false ways you presented yourself when you were younger and unstable fall away and you can claim your truest self and move forward. You have so many beautiful gifts to bring forth to your community, that taking a few years to come back to full speed is the best thing for your long term future. I wish we could provide free hospitalization until stabilization occurs, then provide safe living environments, educational and part time job support, and people could take the time they need to fully recover. When you are 60, you are not going to feel that 2 years was a long time, you are going to be happy you gave yourself that gift of slow and steady recovery. As a mother, I offer to all of you my deepest and sincerest love. You are adorable. You are loveable. This is what happened to you, it is NOT who you are. You are so much more than this. But this is serious and you deserve good, long term care. Don’t worry about what to tell others, don’t tell them much, protect your privacy. Smile and say you’re doing online learning, that you’re taking some me-time. You are worthy of the best recovery. You are also not alone, so many people are suffering as you are. It’s a cancer of our time, that our communities are under such terrible stress that our brains can’t cope. But you have good brains, they will restengthen and they will carry you thru long, happy lives, we hope! I care about you, many people do. Be your best friend and do for yourself what you’d do for your most loved family member or dearest friend. Give yourself time and gentleness and compassion!

  7. I suffered from multiple breaks of psychosis over a period of 4 months. I believed that I was specially singled out by some entity hiding in the walls, the sky, and in the form of other humans around me. I believed this entity could read my thoughts and was planning to kill me by the end of the year, and that I was being continuously thrown into alternate dimensions where nothing was real for punishment. I would spend a lot of time trying to decode messages from the TV, newspaper and even the crumbs on my desk to try to figure out the solution to ending the Entity.

    My last psychotic break was about a month ago now. I have a feeling the worst of my psychosis is over because I’m on medication and I’m feeling insight coming back to me, a sort of awareness which has been able to deal with the only fleeting moments of paranoia I get nowadays.

    However, I have descended into a deep depression after feeling that my cognition has since deteriorated. I can’t follow conversations properly, I’m not funny anymore, I can’t say anything interesting about myself and my self-esteem is at an all-time low. Even typing this message is a struggle for me.

    I’m only 17 years old and I feel like dying. This world has become more and more confusing and scary as time has passed on, and yes I’m aware that’s normal for the average human being, but for me it feels like I’m an alien on earth. The girl I used to be is gone. I don’t know what to do.

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