Everything You Always Wanted To Know About Psychosis (But Were Afraid To Ask)

psychotic break

Psychosis is more common than typically assumed, affecting 3 in 100 people annually, with the first psychotic break commonly occurring between 15 and 30.

I have suffered four psychotic breaks in my life, ranging greatly in intensity, and caused by greatly adverse reactions to medications (in this case, the condition can also be called psychotic delirium). The reality of the condition is far different from the stereotype of the psychotic person: one who is gravely dangerous to those nearby; imagined as violent and even murderous. In reality, the person for whom psychosis is truly terrifying for is the person suffering from it, and their loved ones who have to witness their parent, child, friend, or lover in such a state. There is no such thing as “pleasant” psychosis. By nature, it is horrifying indeed.

According to the A.D.A.M. Medical Encyclopedia, psychosis is defined as “a loss of contact with reality, usually including false beliefs about what is taking place or who is (delusions) and seeing or hearing things that aren’t there (hallucinations). During psychotic breaks that are medically induced, a hallmark trait is picking at the floor, trying to grasp objects that are not there, and often hallucinations involving filth, danger, and notably, insects.

Other major symptoms of psychosis include disorganized speech (in its most severe form, speech and writing is semantically nonsensical, which is also known as “word-salad”; a famous example is heralded and revolutionary linguist Noam Chomsky’s phrase, “Colorless green ideas sleep furiously” or “Furiously sleep ideas green colorless.” Additionally, sometimes, the words are entirely false, and more akin to sounds than language); false beliefs that are not based in reality (delusions), especially unfounded fear or suspicion; hearing, seeing, or feeling things that are not there (hallucinations); thoughts that “jump” between unrelated topics (disordered thinking); flight of ideas; choosing words based on sound, such as rhyming or punning; making up words which mean something only to the speaker (neologism); echoing others’ words (echolalia); and extreme difficulty or complete inability to do ordinary things, which often includes critical problems with memory, attention, and rationally putting thoughts together. A person suffering from psychosis may also develop odd mannerisms and movements, or even become catatonic.

This condition is can also be a part of a number of psychiatric disorders, including Bipolar disorder; Delusional disorder (can include delusions of grandeur; belief that others are trying to hurt you; belief that you or others do not exist; belief that your thoughts can be read by others; belief that others are placing thoughts in your head; belief that one’s thoughts are being extracted from the mind; and belief that feelings, thoughts and actions are not one’s own, experienced as being imposed by an external source); Depression with psychotic features; Personality disorders (including schizotypal, shizoid, paranoid, and sometimes borderline); Schizoaffective disorder; and Schizophrenia. It can also be triggered by alcohol and certain illegal drugs, both during use and during withdrawal (causing psychotic delirium); brain tumors or cysts; degenerative brain diseases, such as Parkinson’s disease, Huntington’s disease, and certain chromosomal disorders; HIV; some prescription drugs, such as steroids and stimulants; some types of epilepsy; stroke. Psychosis is marked by an acutely rapid onset; it can quickly grow exponentially worse so that the person no longer knows they are having a psychotic break, and honestly view their terrifying unreality as truth.

I do not know what the hospital room looked like where I was first taken during my first and by far most intense psychotic break. I don’t recall being in an ambulance. I do not remember being transported, finally, to a psychiatric hospital once a bed was located. I was completely a prisoner of my own mind. Rather than have any idea that I was in a hospital suffering from psychosis, I had full hallucinations that included all five senses. The doctors said they had rarely seen a case like this. In retrospect, I experienced psychosis for weeks before reaching the point of complete unreality; when the onset of full psychosis fell upon me with all its weight.

Once, I woke up and did not know what time or day it was. To me, the events went like this: I got into bed around 2am, fell asleep, and woke up around 11am. Only…it was dark out. I couldn’t understand what was going on, as, at the time, it wasn’t a question to be that it was 11am. I went out on my wooden back porch and called a friend to ask what was going on. Now listen: I don’t have a wooden back porch; I have a metal fire escape, then a set of iron stairs that lead to my backyard. My friend told me it was 4am and became deeply concerned about me after she realized I wasn’t kidding: that I really thought it was 11am and that I was standing on my wooden back porch. I went inside and called another friend to see what was going on (“Why is it dark out at 11am?”), and couldn’t understand why she too was so panicked about my calling since it was a perfectly reasonable hour. She too told me it was 4am. I couldn’t really read time. It all seemed so confusing suddenly. When I went into my room, I thought I was in group home. No one was with me, but I could hear tons of people talking and talking, and I remember thinking, “Well, this is a shelter, what do you expect?” I went to sleep, and woke up late the next day, thinking it was all a dream until I looked at my phone and called my friends whom I’d phoned the night before. They were terrified.

Things seemed normal after that, but suddenly one night, after napping, I woke up with the same sensation, but much less confused. I was aware that I was wrong, and that it was the middle of the night but…it just seemed impossible. There were no voices and sounds this time, but the floor was full of bent and straight neon green and pink lines. I got up and explored the house, and the neon was in every, single room. This time it was I who was terrified, and went straight into my room, crying hysterically, sure I was losing my mind, until, I guess I fell asleep. Again, I woke, up, all systems seemed normal.

And suddenly, one day, everything changed. Really in my bedroom and ultimately the hospital, it seemed only my body was there (which I was wholly unaware of at the time). In my psychotic world, I was on a boat in Boston, restrained VERY hard, and we were all brought to this very frightening-looking building. All of my money had been stolen by a fellow passenger who was not restrained. I was screaming to be let go; that I was in a lot of pain and had been kidnapped and that they had the wrong person. I experienced extreme physical violence as the staff on the boat beat me within inches of my life. It was exceedingly violent; I will not get into detail lest I trigger someone. I was finally untied, and then I was handcuffed and brought into a large building with no windows, screaming the whole time for help. They threw me down a hole, and I fell to the bottom of the concrete floor hard.

There were many people down there, most with these critically evil expressions on their faces. Others were crying and trying to climb back to the small hole, which was now nothing but a circle of light about 30 feet up. Suddenly, it became pitch dark, and I heard humans howling like animals. I cannot describe the sheer terror. It was total, like nothing else I have ever experienced or could even begin to imagine. A black light was put on, revealing claw marks and hideous stains everywhere. I was being chased by four impossibly large men who chased me in large circles until I could no longer run and sexually assaulted me. The room changed shaped and the exit disappeared. I have no idea how I “got out of there” but was suddenly in an ambulance. I was thanking them, but when they turned around, their faces too had that sinister glow. And everything felt beyond horrifying; saturated with unspeakable violence and this feeling of deep and genuine evil. They drove 200 miles per hour in circles and laughed at me. I was in a straight jacked with duct tape over my mouth, and I rolled around the back of the ambulance. By this point, I was very near death. They stopped short and the back doors of the ambulance opened, and I flew off a bridge.

Hypnotic overdose

Psychotic episodes in the context of depression may cause the sufferer to experience self-blaming delusions or hallucinations. Conversely, those experiencing psychosis in the context of mania may form grandiose delusions.

I awoke up in a mental hospital, screaming. Noticing the person next to me (a nurse. I was on watch.Of course) I asked if I was in “the nut house.” I could barely walk “the first day back,” and still thought all of this actually happened to me. When they asked me where I was, I said Boston, and when they asked the year, I said 2009. One of the doctors told me I was in New York City, but I didn’t believe him, and thought he was just another person who was trying to mess with me. Then one of the doctors asked me, “How did you get all the way from Boston to New York in an ambulance?” And that’s when I knew. The doctors and my parents explained to me what had happened, and I gradually came to believe them.

I had told an entire short story as if on stage; rhymed like I was a hip hop star; screamed at the top of my lungs for hours; and actually was beaten and had my arm broken in five places in their attempt to restrain me at the ER, and was accidentally administered a very large overdose of Ativan (via IV from the hospital head psychiatrist(!), and I went into a completely psychotic state, alternating between trying to talk in a very, very low voice, though it was all word salad, and trying to run out the door and acting hysterically (shouting, crying, trying to bash the door in, etc.), all in absolute horror. My parents said it was the worst thing they have ever seen in their lives, but calmly described the events to me, though they too were traumatized and exhausted and could hardly remember anything. The doctors told them to start writing down all they remembered immediately, and they did (I have not seen it yet, as they are still remembering things, and I want to bring it to my psychiatrist to go over. I can’t do it alone). The blood test at the psych hospital showed that my blood was literally toxic from the quantity of benzos in it.

After spending over a week in the hospital, I was released, but too scared to go back to my apartment in Brooklyn. I did not feel safe alone, at all, as I had racing suicidal thoughts, and had even unconsciously started to gather things to enact the plan. My parents brought me to their house, and I was just not okay. I was always afraid. I was diagnosed with PTSD, and spent another month trying to recover, both at home and again at the hospital where I was enrolled in a Cognitive Behavioral Therapy program (which is a highly effective method for eradicating psychotic symptoms, though sometimes antipsychotic drugs are an imperative). Gradually, I came to terms with what happened to me and how to deal with the flashbacks.

My subsequent breaks were far less severe: for example, on one occasion, I checked into a motel in New York City (I live here), having taken the subway very far out in Brooklyn and winding up in a notably unsafe neighborhood. After hearing more than one gunshot (though one would surely have been enough), I just wanted to get off of the street and got a room in the first place I came across, the whole time thinking I was in the United Kingdom. The next morning, I asked a police offer where the green tube line was, and he looked baffled, and told me I was in the United States, and did I mean “subway.” It was beyond confusing, but that is when I realized I’d had another psychotic break—and that I was still in it. I did not recognize my own apartment, my dog, or know my address, and it took me ages to get home. Fortunately, as I knew what was happening and it was only a matter of time (as this was medically induced, it typically takes three days to come out of psychosis), I was terrified of yet another hospitalization; and am fortunate that my partner, who also suffers from Major Depressive Disorder and Generalized Anxiety Disorder, came over and stayed with me, understanding the fear and telling me it would be okay. We made a pact that I would not leave the house and I kept that promise. Ultimately, I regained my fully operational mind. The next day, I was myself again. My doctor found the cause of my repeated psychosis, and my medication was adjusted.

I finally feel like me again—and more so than I have in ages.