My approach to first episode psychosis

After my first experience of psychosis, I did a lot of thinking and wondering about where it came from. I visited my psychologist and we talked about all these different ideas, and put together a strategy in the aftermath. We agreed that the idea in John Watkins book Unshrinking Psychosis that there can be many different reasons for psychosis, including positive ones such as personality reorganisation, or a spiritual awakening, was a good foundation. We drew no conclusions about why I’d had the episode, and made no assumptions about what it meant. Going forwards we decided the best approach was

• For me to work on accepting the idea that I am a person who sometimes experiences psychosis as quickly, gently, and positively as possible. It can be a huge shift in self-perception and identity, and if too large, or threatening to hope and self esteem, people stay mired in denial.
• To reduce my fear of the experiences and anticipation of possible new experiences. To be careful not to develop frightening personal narratives about the experience, or of being sold into anyone else’s ideas.
• To that end, to do my best to avoid mainstream mental health services.
• To develop my social support to meet this new challenge. At that time, my networks are very supportive when I’m physically unwell, or struggling emotionally, but many of my friends have no experience of psychosis except for a lot of fear based cultural ideas about schizophrenia. People don’t know what to do or say or how to be helpful. I can work on this by using times when I’m not psychotic to gently educate my networks about what it is and how it works. To also connect with other peers who experience psychosis (through the Hearing Voices Network)
• Welcome psychotic experiences into my life. To make room for the possibility that I will have more episodes, without being paranoid or fatalistic. So, make life, relationship, and career choices that will accommodate the occasional episode with a minimum of stress, and without having to be overly secretive or afraid of being outed.
• Approach the psychosis from a place of gentle curiosity rather than fear.
• Reduce shame, secrecy, and isolation. Stay connected to people. If I ever start to struggle with my reality testing, research suggests that close, trusted relationships with people who are not afraid of me or the psychosis will be the most helpful in supporting me to make sense of what is real and what is delusional.
• Learn. And accept not knowing things. Tolerate ambiguity, uncertainty, complexity.
• Grow. Use times that I’m not psychotic to explore ideas and needs that may underlie the psychosis, things that I’m drawn to or that feel significant during the episode. I may not be able to prevent another episode, but may instead be able to reduce how distressing the experience is for me. If I’m going fall into an inner world, maybe by taking good care of myself I can help the world to be one of dreams rather than nightmares.

I’ve since had a second episode and I’m working on making sense of that. But I’m still really happy with this approach. It makes a lot of sense to me, and it’s helped me navigate a second experience without shame or terror. It’s such a different way of looking at psychosis to that found in mainstream mental health services. I can’t help feeling deeply fortunate, and so sad and angry that my story and experience of psychosis is so unusual. I knew what was happening as soon as it started. I had experienced people to talk to about it who offered wisdom and support. No one panicked. No one made me feel I couldn’t handle what was going on, or that the safest approach would be to lock me up and tranquillise me. So, I didn’t have a load of shock, trauma, and fear to deal with on top of the psychosis. I was instead able to put together a plan with the support of people around me, which included options for outside support if managing at home became overwhelming. I don’t know what my future holds. Neither does anyone else. I’m free of dangerous, life limiting assumptions, free of a model of psychosis that speaks only of loss and limits, free of an enshrined cultural terror of madness. Don’t misunderstand me, this is not a polyanna, naïve approach, ‘mental illness’ of any kind can be terrifying and destructive. But as an approach, this has worked well for me. I hope it might be helpful for others too.