My Mind Through Psychosis

This story was written by Melissa who has shared her experience, in the hopes that it could help others who are going through similar experiences or supporting someone in a similar situation.

Trigger Warning: The following content may be distressing for some readers.

Today I’m going to talk through a mental health episode, from the onset of symptoms through to discharge from hospital, through states of depression, hypomania, mania and psychosis, the
transition between these states, the thought processes underlying them and their associated
stigma.

My aim is to give you an insight into what a mental health episode looks and feels like.

When living in London, I was seeing a GP to renew my prescriptions as prescribed by my psychiatrist in Australia. I thought as long as I kept taking my medication I would be ok. I now understand the importance of regular medication reviews.

When I started to feel depressed I kept telling myself I had no reason to be depressed. I was living and working in London and every few months I went on holiday to a different country. But depression crept in, each day I would feel depressed for an ever increasing amount of time.

I started to self-isolate. I stopped going out with friends as much and I hated myself for it. I didn’t plan on living in London forever, I wanted to do and see as much as possible. I felt like a failure. I blamed myself for being lazy and for being a bad friend.

My interest and pleasure in everything diminished. I had no appetite and I slowly lost track of what I was eating and when. I simply forgot to eat. I woke every morning with an overwhelming sense of dread. My internal stigmatisation was immense. I felt alone and worthless.

I was crying myself to sleep at night and having problems performing the admin part of my job as I couldn’t concentrate. I had to put on a happy-face for work.

I was surrounded by people having fun and was meeting new and interesting people from all over the world. But behind the scenes I was falling apart.

I was waking up depressed. Every morning I would wake up with brain fog. It felt like life was happening around me and I was just playing a part like a puppet. Everything was monotone. I felt completely disconnected from life, just walking around, going through the motions.

And then hypomania started to creep in. I woke up depressed but by late afternoon I was hypomanic. Over the course of the day I became motivated and full of adrenalin. I’d happily go about my routine. I started socialising again and interacting with my friends.

My daily state of depression was coming on less and less and I felt like I was getting better. My hypomanic symptoms were easy to hide and went relatively unnoticed, even to me. When hypomanic I was more talkative, productive, outgoing and friendly. It helped me to be successful in my job.

But just as the hypomania crept in, so too did mania. I had been manic before so I felt I knew my limits. This time my mania came with only a few grandiose ideas which, from experience, were easy to dismiss. I was experiencing a kind of reality-based-mania. I still had grandiose thoughts but I was able to stay in touch with reality. I told myself I wouldn’t go manic as long as I kept taking my medication, and I told myself I could control it.

The less sleep I had, the less I needed. I was unable to concentrate on doing only one thing at a time. I had to keep checking my phone to remember what day it was. I lost the ability to distinguish night from day and my circadian clock became completely dysfunctional.

I became more and more scared each day that maybe I couldn’t control this, and I didn’t want to go through a lengthy hospital admission as I had been through before. I needed early intervention.

I went to the ER. I’d previously been to this same ER for a matter not related to my mental health. My details and entitlement to healthcare under the NHS was already established. I explained my history of bipolar disorder and told the nurse I was in the throes of a manic episode. I begged them to give me something to help me sleep.

The nurse surmised I had a substance abuse problem and had taken something to make me behave like this. She refused to treat me. They labelled me just another street person with a substance abuse problem, looking for a safe and warm place to sleep for the night.

People in the waiting room moved away from me. I felt humiliated and embarrassed. I had gone there for help. I needed urgent medical help.

The stigma was so bad, and my judgement so impaired, I went back out onto the streets in the middle of the night.

I spent hours on the tube trying to get to a friends place despite it being three blocks over from the hospital. I’ve never been so mentally exhausted as I was that night. So many tube stations, so many platforms all with multiple exits – It felt like I was stuck in a maze and I was becoming increasingly desperate. Even though time had become irrelevant I knew eventually the trains would stop running for the night.

One moment I’d know exactly what I was doing. I was using a tube map to get to a chosen station, and the next I’d just be standing there on the platform wondering why I was holding a piece of paper, and trying to work out where I was and what I was doing.

I had a constant battle in my mind trying to work out what was real and what was not. Everything started to connect, the platform lift doors opened just as the train arrived, the escalators sped up and slowed down in line with my racing mind. I felt truly alive and connected with the world, like I was seeing it for the first time and it was magnificent.

To cope with this I created an imaginary world in my mind, a world that validated my emotions and behaviour. I started to believe someone was communicating and controlling me and watching me on the cameras to see how I reacted to their commands. I started to have auditory hallucinations. One moment I would hear someone whispering in my ear and the next I would hear someone shouting at me from the end of the platform.

There was a constant white noise in the background and what sounded like a radio playing softly. Sometimes the white noise was so loud I couldn’t hear the trains go past. I started to lose my peripheral vision, balance and co-ordination. Twice I tripped on the stairs. If I turned my head too quickly it felt like I was falling. I had moments where I thought I could feel the earth move beneath my feet.

I hadn’t eaten or slept for days but I couldn’t stop until I was somewhere safe.

It was like my mind and body were separate.

My mind was racing a million miles an hour but my body was screaming to stop as I was completely exhausted.

This is when I slipped into psychosis. The onset was rapid. My memory started to break down. I started losing control and the ability to take on information and use it to make decisions.

My perceptual processing was going haywire. My cognitive skills were fading and I was consistently unable to remember where I was and what I was doing, no matter how hard I tried to remember.

This was the point of no return. I knew then no matter what I did, or how much psychotropic medication I was given, it couldn’t stop me from developing full blown psychosis. I was in too deep and there was no way out. The best I could hope for was urgent medical help to lessen the severity of my episode.

By pure luck I found my friends flat. Bethany took me back to the ER. I don’t remember much of the admission process. I have broken memories. Snapshots of memory, but I can’t work out how they relate to each other, or which memory precedes the other.

I remember being placed in a locked room with cameras which only exacerbated my already delusional thoughts. The nurses kept asking my friends if I used amphetamines and I kept trying to tell them that I didn’t and I needed help. I kept asking them to do a blood test but they just ignored me. My next memory is of lying in the back of an ambulance being given a needle as Bethany held my hand and tried not to cry.

I woke up in a small room with bars on the window. For a moment I wondered if I was in hospital or in prison.

My strange grandiose thoughts persisted. Initially I thought someone might still be watching and controlling me. One minute I was in touch with reality, and the next I’d believe in the alternate world I created for myself in my mind.

I kept my strange thoughts to myself, I told no one about my secret thoughts of control. But it was clear from my behaviour that I was having times when I was not in touch with reality and I was placed under a treatment order.

I was in a foreign country, in a psychiatric hospital under a treatment order, with no cognitive ability to understand the country’s mental health act. I felt institutionalised. I wish I had the words to describe to you how this felt, but I don’t. Instead I will read some lyrics of a song in which I found commonality, written by an artist with bipolar disorder who has also been hospitalised for her health. This is what it felt like.

They send me away to find them a fortune a chest filled with diamonds and gold
The house was awake with shadows and monsters the hallways they echoed and groaned
I sat alone in bed til the morning I’m crying they’re coming for me
And I tried to hold these secrets inside me
My minds like a deadly disease
I paced around for hours on empty I jumped at the slightest of sounds
And I couldn’t stand the person inside me I turned all the mirrors around
I’m bigger than my body
I’m colder than this home
I’m meaner than my demons
I’m bigger than these bones
And all the kids cried out please stop you’re scaring me
I can’t help this awful energy
Goddam right you should be scared of me
Who is in Control?

I was finally receiving medical treatment, but my ordeal wasn’t over I still had to endure, and
recover from psychosis.

I have broken memories of the next two weeks of my full blown psychosis but after a few weeks of a psychotic episode I start to remember more and more about the experience.

I know of my behaviour from my discharge summary. To read about my behaviour during psychosis is quite confronting. Discharge summaries need to be written with great empathy and care and contain safe-language in order to allow the consumer to maintain a sense of dignity.

I slowly started to come out of psychosis. The next two weeks were the longest of my life. I became aware of my odd behaviour yet still I was compelled to keep doing it. Other than meal time and the one hour allowed outside per day, It was the only routine I had.

My cognitive skills had completely broken down and I had to rebuild them step-by-step using everyday challenges from the real world. It started with my memory, I started to remember my daily routine and follow it again the next day. Then my attention span increased and I tried to read again.

My perception of my surroundings started to align with reality. I was able to process external stimuli and my logic and reasoning skills returned.

I talked to myself out loud. I imagined situations in the real world and rehearsed conversations, trying to prepare myself for discharge. My strange thoughts slowly disappeared and I started to become aware of my surroundings. I developed situational depression.

Anxiety set in, I couldn’t sit still and my heart was racing. My life had fallen apart and I must learn all over again how to feel and act in the world outside a psychiatric hospital.

The release date of the treatment order was getting closer. I was excited but at the same time I was terrified it might be extended. I was allowed leave and my friends came to take me out. The outside world was terrifying and so fast paced. But I had to overcome my fears and get back to my life.

It is said that three quarters of the recovery journey happens after discharge from hospital.

I knew I would have to go home to Australia to fully recover. I wondered if I’d ever make it back to London to the memories of a life that I loved.

I realise now, just how much danger I was in that night. I was wandering around on train platforms with little balance and I walked through parts of London I would normally avoid for safety reasons.

But it didn’t need to be this way. If I had not been stigmatised at the hospital I would have been kept safe, and be on the road to recovery.

When I recovered from my episode I joined my local NHS Foundation Trust and shared my experience, in the hope that what happened to me, doesn’t happen to anyone else.

I’m not here to denigrate the NHS. Considering their funding and their number of service users there are bound to be flaws in their procedures and healthcare is subject to human error. What’s important is they continue to work towards improving their services, which is evident from the introduction of the Safe Haven Cafes UK on which I’m pleased to see Australia’s Crisis Support Spaces are modelled on.

I am pleased to see us reaching out to other countries to share expertise in mental health care. Providing quality mental health care is a challenge for many countries and we need to listen to those of us with a Lived experience. “The more that we recognise ourselves in the stories of others, the more compassion we will have for ourselves and others”.