Content warning: Discussion of ableist language and psychosis
When sitting in a lecture hall, chances are a handful of people around you have already, or will, experience psychosis. At family reunions, there are probably a few people who have been psychotic. If you have gone to see a movie or live theatre show, you’ve likely been near a handful of people who have experienced psychosis. I am one of these people, and maybe you or someone you know is.
Clinically, psychosis is characterized by a detachment from reality and may include elements like hallucinations, paranoia, delusions, incoherent speech, and unusual behaviour. In short, it becomes difficult for us to interpret what is real and what is not.
While causes of psychosis are not yet fully understood, it has been connected to factors like trauma, head injuries, substance use, some mental disorders, some medical conditions, and some nutritional deficiencies. Regardless of the cause, those of us who experience psychotic symptoms deserve to be treated with the same respect as anyone else.
I have been hesitant to share my experiences in detail, even with my loved ones. In writing this, I hesitate about how much to share, at the risk of being judged by people I may never meet. The word “psychotic” feels heavier on my shoulders than the alternatives of “having a bad day” or “feeling sick.” However, it takes open conversation about what these symptoms actually look like to dispel the idea that they always make us dangerous, violent, or difficult to be around. About 3% of people will experience psychosis, but it still remains a word loaded with stigma that can prevent us from getting help or talking about our experiences.
My first encounter with psychotic symptoms came with manic episodes. These episodes, for me, involve extreme levels of elevated energy, impulsivity, racing thoughts, a short attention span, and goal-oriented behaviour. In addition to these manic symptoms, I almost always have psychotic features too.
In my first manic episode, I thoughtlessly got two tattoos; went on a hike alone in the middle of the night without knowing the trails; painted a handful of things in my room, including some of my clothing; and believed I was the world’s best wood carver, even though I had never whittled a thing in my life before. Then, I thought I would write and publish an award-winning novel in under a week. I locked myself in my room for days at a time, believing I was being followed and tracked by people trying to harm me. I have since had other manic episodes, usually involving a lot more appointments with my medical team and sometimes requiring hospital emergency services.
These days, while I have not had a manic episode in over five months, I do encounter hallucinations nearly every day, which have involved all five of my senses. I also regularly face paranoia and delusions that may last hours at a time. I am often out of touch with reality, having to be corrected by people around me on things that are not really happening or possible.
Sometimes I feel someone grab my arm or foot, see a person or strange lights that do not exist, hear sounds like a loud alarm going off or a song that is not playing, smell strong odors like sulphur or cleaning supplies, or feel and taste food in my mouth that I never ate. Other times I believe that people I love are working against me to track my life and give away my information. I sometimes start believing that I am more talented at things than I am or on the road to fame, and my ambitions start ruling over my reality. It can be challenging, but I have made a lot of progress over the last year.
I say all of this not for pity or sympathy, but to be transparent. Being psychotic can include a wide array of experiences. It can be scary. It can interfere with sleep, hygiene, social involvement, motivation, and lead to anxiety or depression. Despite this, it is still a relatively common medical problem that could affect anyone. While it may change our thinking and behaviour, it does not inherently make us violent or unsafe to be around.
Even when psychotic, I still remain a nonviolent person. I still arrive early to (most of) my appointments, give my cat kisses, tip my servers, call my grandma, and wave at the people I pass on my walks. I once even held a door for a person I completely hallucinated! Like most others experiencing psychosis, I am no threat to the people around me. Sometimes we may act a little peculiar, but that only means we are engaging with a different view of reality, not that we want to hurt anyone.
People experiencing psychosis, or any mental illness, are more likely to be victims of violence than they are to be perpetrators. We also fall victim to stigma and stereotypes, and we may be treated differently because of this. The weight of the stigma around psychosis can lead us to be excluded socially and to internalize negative thoughts about ourselves. This continues to be perpetrated by a lack of accurate media representation, for we continue to be demonized and misrepresented.
Consider seeking out information from others who have known psychosis. This could be as simple as following activists like @acutepsychotic or @nathanshuherk on Instagram, or checking out narratives somewhere like The Mighty that describe real experiences of psychosis.
I encourage you to take a moment to consider the impact next time you hear the word “psychotic” when someone means “absurd” or “dangerous.” Consider shifting your language to reduce using words like “psychotic” or “crazy” as derogatory terms. Your language matters, and it can impact how comfortable people in your life are opening up about mental health.