Blog Banners (6).png — What I want "psychosis" survivors to know

Undestanding psychosis

One of the most common harmful misconceptions is that there are some mental health conditions that are too serious for people to recover from. As a former crisis counselor in NYC, I've seen people in the most harrowing circumstances heal beyond their wildest dreams. Most commonly, the experience of "psychosis" or a "psychotic break", is especially feared. "Psychosis" has become what most people consider the quintessential form of "crazy," making those who experience it, highly discriminated against.

"Psychosis" itself is not a singular experience but a term that refers to a wide spectrum of experiences such as hearing voices, seeing things that others don't, holding strong beliefs that others don't, having intense suspicions, altered states of consciousness, catatonic states, extreme moods, and intense spiritual experiences, to name a few. People experience these to varying degrees and often have vastly different ways of understanding the experience. Some find it terrifying and others, helpful, blissful, or simply not as distressing.

I use the term "psychosis" here broadly and in a non-pathologizing way, using quotes to acknowledge that it's a concept that requires much more thought and nuance. Our language for these experiences is extraordinarily limited, yet I use it as a shorthand for a plethora of experiences deemed outside the norm.

The important part to remember is that mental health exists on a spectrum and there is no line between abnormal and normal behavior, moods, or ways of being, even though we might desperately want to draw that line. A diagnosis can be helpful to some, while others find it limiting or consider it to reduce their complex narrative into a category they may not feel comfortable with. Over the years, working with "psychosis" survivors, spiritual experiencers, and those who live on this spectrum of extreme and altered states, it is clear that there are always beautiful parts and challenging parts, and we can help each other heal without pathologizing or feeling as if we are broken, ill, or deficient. Some aspects of these experiences make life challenging and give us a signal of what needs to be healed, other aspects of the experience are immense gifts that when honed we can use to help each other and the world.

This is my love letter to fellow survivors, those who have lived through anything that could be labeled "psychosis" and the family members and friends who seek to understand.

What I want "psychosis" survivors to know:

1. "Psychosis" is not a life sentence

Contrary to popular belief, many people who experience extreme and altered states, or who have a "psychotic break" do not need to be hospitalized or medicated for the rest of their lives, if at all. Our cultural markers for "psychosis" are closely linked to the language of schizophrenia, of which the only movies, shows, and stories depict people who commit violence and are heavily institutionalized (e.g. A Beautiful Mind, One Flew Over the Cuckoo's Nest, etc.) The truth is that those who experience psychosis are much more likely to be survivors of violence, abuse, and trauma than perpetrators of it [1]. Those who experience "psychosis" are not fundamentally illogical, irrational, cognitively impaired, or even incapable of taking care of themselves, as pop culture may have us believe. Many experience a brief episode; as research suggests, about 75–90% of psychotic experiences aren't lasting and disappear with time [2]. With the right support, we can process and heal from it without institutionalization, restraint, or the loss of basic human agency.

Those who experience psychosis are much more likely to be survivors of violence, abuse, and trauma than perpetrators of it. — Those who experience psychosis are much more likely to be *survivors* of violence, abuse, and trauma than perpetrators of it.

The key here is having humanistic support. One of the best alternatives to institutionalization is a family/network-based approach called Open Dialogue which was founded in Finland and practically erased hospitalizations in the country for "psychosis". The approach brings together the person's social network along with multiple providers, often a peer-specialist and psychologist or social worker, to understand what's happening in the person's life and within the family context more broadly. Rather than pinpointing the individual as "the problem", Open Dialogue is rooted in the concept of "polyphony," with many voices sharing many perspectives and figuring out what to do next together. I've had the privilege of being a provider utilizing this approach and have seen the beauty of families and networks coming together to see that a crisis is never random, and it can be a huge opportunity for a shift in how we relate to one another.

2. "Psychosis" can be an opportunity for healing

Any kind of crisis is an opportunity for transformation. We have a popular misconception that a mental health crisis or psychotic break happens randomly, but this is almost never the case. Many of us spend years suffering in silence, all of the pent-up trauma, emotions, and experiences culminate when the body-mind can't hold anymore. There is always a reason someone is suffering, even if it's not readily apparent. And for those whose break is more of spiritual awakening and filled with intense but positive emotions, this too is an incredible time to shift.

We too often think about psychosis as a signal that we are broken, sick and beyond repair, but it can actually be a deep purging state of old trauma, emotional wounding, belief systems and ways of being. We can start seeing this as an opporunity to … — We too often think about psychosis as a signal that we are broken, sick and beyond repair, but it can actually be a deep purging state of old trauma, emotional wounding, belief systems and ways of being. We can start seeing this as an opporunity to heal, not as a point of no return.

Instead of thinking psychosis is a signal that we are broken and beyond repair, what if it meant the healing is already happening? The body-mind heals through altered states of consciousness, where we find meaning beyond cognitive awareness. There is only so much that can be addressed through language, and the body-mind knows this. In my experience, and from witnessing countless others go through this, altered states bring up all that is ready to heal, if we allow it. It can feel like a deep purging of old trauma, emotional wounding, belief systems, and ways of being. This is why deep meditation, some psychedelics in controlled therapeutic settings, breathwork, flow states, and, yes, even "psychosis" can have a profound impact on our healing. In traditional westernized mental health settings we only see "psychosis" as negative and a sign of illness. I constantly think about how many more of us would have the chance to heal if we knew what an incredible opportunity this was to let the pain pour out, and transform.

3. "Psychosis" occurs in a context

The humanistic ways of supporting people through "psychosis" or extreme and altered states work because they address the context someone is living in. If we think of "psychosis" solely as a brain disease, we miss fundamental reasons why someone may be experiencing it. Research shows that a history of any type of trauma or adverse experience makes someone significantly more likely to experience psychosis [3]. Adverse experiences can range from sexual abuse to poverty to other forms of structural injustice which play a huge role in someone's chances of experiencing "psychosis". When I was working in the mental health system I had young clients who were considered "paranoid" for hiding knives in their room, yet they were in physical danger from neighborhood and structural violence every day. Is it really paranoia if just because of the color of your skin you're more likely to be killed, imprisoned, or suspected of committing a crime?

Asking what it means to be ill in a sick society is the first step towards understanding how our behavior, which can be deemed as strange or abnormal, is actually a reaction to the absurd world we live in. In other words, "psychosis" is not the root problem, it's in part a reaction to the larger context of a society that often fails to meet our needs for connection, safety, belonging, and basic human rights.

“An individual having unusual difficulties in coping with his environment struggles and kicks up the dust, as it were. I have used the figure of a fish caught on a hook: his gyrations must look peculiar to other fish that don’t understand the circumstances; but his splashes are not his affliction, they are his effort to get rid of his affliction and as every fisherman knows these efforts may succeed.”

— Karl Menninger

4. "Psychosis" can be caused by other health concerns

When we think of any mental health condition, we often jump immediately to neurochemistry and chemical imbalance. However, in the last 30 years, we have not been able to prove the theory that mental health conditions are a result of a chemical imbalance, nor achieved any biomarkers to test for it. Emerging research actually indicates mental health concerns at large, may be rooted in the health of our immune system. While there are still many more questions than answers, research shows that someone with an autoimmune disease is 40% more likely to be diagnosed with a psychotic disorder [4]. People with psychosis have also been found to show higher levels of inflammatory markers in the blood than control groups [5]. Since inflammation is a key facet of autoimmune disorders, inflammation is likely to also be a root concern for psychosis [4]

There are fascinating new insights into how high levels of social stress can increase bodily inflammation. And there is growing evidence that people who have experienced adversity or abuse in childhood are more likely to be inflamed as children and adults.

In my own experience, and in working with those in extreme and altered states, many also struggle with chronic illness, auto-immune issues, viruses, and chronic inflammation that often get overlooked or treated as "psychosomatic". While not all kinds of "psychosis" or altered states are caused by underlying health concerns, it may be a piece of the puzzle, and it would be wise to test for autoimmunity and other conditions that are caused by inflammation.

5. "Psychosis" can provide meaningful information

Lastly, it's crucial to pay attention to the content and possible meaning of the extreme and altered states. Whether we consider it "paranoia" "delusions" or "hallucinations", many of these experiences are deeply meaningful and useful to uncover what is happening in our bodies and minds. In the same way that a trance meditation, a psychedelic experience, or a dream may give us information about our subconscious, so too does "psychosis".

Once, my own extreme and altered state led me to discover a latent autoimmune disease. This particular altered state centered around beings poking holes in my gut, only later to find out that I did indeed have an auto-immune condition that causes leaky gut and ulcers. If I had been told I was crazy or that my experiences had no meaning, I would never have found out the truth and very likely would've died an early death.

This is one example of many ways that our extreme states contain wisdom, even when it may be frightening or seemingly illogical. Listening to what people are seeing, hearing, feeling, and sensing is crucial for healing. In my experience, healing is never a result of pathologizing someone's experience.

Looking for More Alternative and Humanistic "Psychosis" Resources?

Understanding Psychosis & Schizophrenia [The most comprehensive guide on psychosis produced by the British Psychological Society]
The International Society for Psychological and Social Approaches to Psychosis [The U.S. chapter - Resources for clinicians, family members, and peers]
Hearing Voices Network [International and Local groups for voice hearers to get peer support]
Dialogic practice [Training for clinicians in the open dialogue approach]
American Center for The Integration of Spiritually Transformative Experiences [resources and community for spiritual experiencers and clinicians]
Institute for the Development of Human Arts [Training, events, and community co-founded by yours truly ;) for transformative ways of approaching mental health]

References:

What I want "psychosis" survivors to know - understanding psychosis