Intruding on your life: experiencing psychosis.

Introduction

In the past two chapters we have provided information about psychosis. In this chapter, we want to emphasize the personal meaning of experiencing psychosis.

The personal meaning of psychosis

Experiencing psychosis can have a great impact on a person's life. The period of psychosis can take a lot of energy, and recovery afterwards also takes time. Sometimes it seems as if something is broken that cannot simply be repaired. Some psychotic experiences can be puzzling or, on the contrary, overwhelmingly beautiful.

At the same time, you may also have experienced horrible things during the psychotic period that you never thought such impressive events could ever happen to you. In all cases, it is important to give these experiences a place and process them.

Psychosis as an imbalance between burden and carrying capacity

In the previous chapter, we discussed that psychosis can be seen as an imbalance between carrying and carrying capacity. The very fact that someone has experienced psychosis can be extremely impressive, as can the experiences during the psychosis itself.

The process of acceptance and recovery

Once a person has experienced psychosis, it is a sign that that person has a certain vulnerability to the recurrence of psychosis. It is important to take this increased vulnerability into account as life goes on. The mere awareness of this can be unpleasant, as can the possible consequences of psychosis. It is therefore important to reflect on what has happened to you and make an assessment of how things may continue in the near future.

The future

The process of acceptance and recovery from psychosis can be challenging, but it also offers the opportunity for growth and resilience. It can be valuable to seek support from mental health professionals, as well as family and friends, to help you process the experience and find ways to reshape your life. By consciously reflecting on what happened and seeking appropriate support, you can draw hope from the possibility of recovery and give positive direction to your future.

It's important to note that psychosis can have a lasting impact on a person's life, both during and after the psychotic episode. The process of acceptance and recovery can be challenging but also offers opportunities for growth and resilience.

• Positive Symptoms of Psychosis
  

Positive symptoms of psychosis are intense and disruptive experiences that are often described as 'added on' to a person's usual way of thinking, feeling, and behaving. They are the most easily recognizable symptoms of psychosis and can be incredibly distressing for those who experience them.

• Here are some of the most common positive symptoms of psychosis, along with some examples:

• Hallucinations:

These are sensory experiences that are not real.

They can be:

• Auditory (hearing)
• Visual (sight)
• Tactile (feeling)
• Olfactory (smell)
• Gustatory (taste)

For example, we often hear voices when no one is around. Sometimes the voices are friendly and chatty, other times they are critical and hostile.

• Delusions:

These are false beliefs that are not based on reality. They can be bizarre and illogical, or they can be more plausible and believable. For instance, you can believe for a long time that you were being followed by the government and that the neighbours were plotting.

• Disorganized thinking:

This can manifest as difficulties with concentration, speaking in a way that is difficult to understand, or having thoughts that jump from one topic to another quickly. You often find it hard to focus on a task or follow a conversation, and your thoughts often feel jumbled and confusing.

• Disorganized behaviour:

This can include bizarre or unusual behaviour, such as talking to oneself in public, neglecting personal hygiene, or engaging in repetitive movements. You sometimes walk around the neighbourhood for hours on end without any clear purpose, and you can become agitated and restless very easily.

It is important to remember that not everyone with psychosis will experience all of these symptoms, and the severity of symptoms can vary greatly from person to person.

However, understanding the positive symptoms of psychosis is a crucial first step in recognizing the presence of this condition and seeking appropriate treatment.

Positive symptoms can be incredibly distressing and debilitating, but with the right treatment and support, it is possible to manage them and live a fulfilling life. If you or someone you know is experiencing any of these symptoms, please reach out for help. You are not alone.

• Causes of Psychosis:

While the exact causes of psychosis are not yet fully understood, research suggests that a combination of genetic, biological, psychological, and environmental factors may be involved.

• Psychotic Disorders:

Psychosis can occur in various mental health disorders, such as schizophrenia, bipolar disorder, severe depression with psychotic features, and psychotic disorders due to substance abuse or medical conditions. Each of these conditions has its own set of symptoms and treatment approaches.

Experiences during psychosis

In psychosis, thoughts and/or statements are expressed that would never normally occur to you. It can be a confusing and frightening experience.

• Some examples are:

• You may have felt that you had contact with a supernatural, spiritual world. You may have been able to receive messages that others could not understand.

• During psychosis, you may have accused your family and/or friends of acts they did not actually commit. You saw hidden meanings and conspiracies that others did not see.

• You may have tried to engage in activities with family and/or friends because you thought you were someone else, like John the Baptist who must convert others. Your identity and behavior were affected by the psychotic experience.

• You may have tried to touch others in the psychosis when they did not want you to. These are actions you would never normally do, and in retrospect you may feel ashamed about them and wonder how it was possible for you to do and/or say these things.

• During the psychosis, you may have endured extreme fears, feeling that you were being pursued and/or threatened.

• Things may have happened during the psychosis that caused you great pain and distress. For example, you suddenly found yourself in a police cell, forcibly committed or placed in solitary confinement, without fully understanding exactly what was going on.

• It can also happen that you yourself did not understand what was happening to you and could not explain it to others. It was logical that you did not know, nor did others understand. You simply could not know what was happening to you.

• The inability to logically tell exactly what happened to you can sometimes continue to reverberate long after the psychosis has ended. It takes time and effort to understand and give yourself a place. It is important to be patient with yourself and seek support from professionals and loved ones who can help you process these confusing experiences. The process of understanding and acceptance can happen gradually, which will eventually make you better able to understand and talk about your experiences.
  

Understanding the positive symptoms of psychosis is important for several reasons. Firstly, it helps individuals recognize when they may be experiencing psychosis and seek appropriate help. Early intervention is crucial in managing symptoms and preventing the condition from worsening.

After psychosis

Memories of experiences and events during psychosis can bring uncertainty and sadness. For many, psychosis is retrospectively considered a profound event in their lives. Sometimes people can discover meaning in it, but often it is experienced as a disaster or trauma.

• Logical questions to ask yourself include:

• What exactly happened during the psychosis?

• Why did it happen? What were the causes or triggers?

• How should I proceed with my life after the psychosis?

In addition to these uncertainties, doubts may also arise about the likelihood of recurrence of the psychosis. For some, the chance of recurrence is small, but there can never be 100% certainty. The future will have to tell how things will progress.

It can also happen that it seems like you are outside of everything. You may (temporarily) stop going to school or work. It may be difficult to get through the day. Activities that used to be natural now require more effort. You feel tired and want to do things, but don't have the energy for it. It seems like your battery is empty and it takes a long time to recharge it.

In addition to uncertainty and fatigue, symptoms may include difficulty holding attention for long periods of time, mood changes, fretting, frustration with help and caregivers, and sometimes having difficulty with the caution with which you are treated. You may consider yourself crazy or weird, not understand yourself, notice that acquaintances are seeking less contact with you, and experience misunderstanding for the temporary changes. You may also feel bad or guilty about yourself.

Emotions such as anger, sadness and fear may also occur after experiencing psychosis. These reactions are also normal. Processing the events before, during and after a psychosis is not a natural process. It takes time and energy to give these events a place. It is important to be patient with yourself and seek support from professionals and people around you who can help you process the psychosis.

It's important to note that negative symptoms can be challenging to manage, and it may require a combination of therapy and medication to address them effectively.

• Negative symptoms

It's important to note that negative symptoms, often referred to as residual symptoms, can persist even after successful treatment of positive symptoms. These residual symptoms can pose an additional challenge for recovery and reintegration into society.

These symptoms are indicative of a significant loss or diminishment of normal functioning, which can manifest in several ways, including a marked reduction in emotional expression, an increase in social withdrawal, and a noticeable flattening of affect. These features can severely impact an individual's daily life and interpersonal relationships, making it challenging for them to engage meaningfully with others or to experience the full spectrum of human emotions.

Following successful treatment of psychotic symptoms, also known as positive symptoms, it is not uncommon for residual symptoms to emerge. These residual symptoms, categorized as negative symptoms, relate to the diminishment of specific psychological functions. In the forthcoming section of this text, we will delve deeper into the nuances of these negative symptoms and their implications for those affected.

Negative symptoms signify not just the presence of new dysfunctional behaviors, as seen with positive symptoms, but rather point to the absence or significant reduction of essential functions that are crucial for everyday life. This can lead to challenges in various aspects of functioning, including one’s ability to maintain relationships, pursue interests, and handle daily tasks. It's essential to recognize that the intensity and range of these negative symptoms can differ widely among individuals, and not everyone grappling with psychosis will experience the same constellation of negative symptoms, further complicating the treatment and management of their condition.

This could include difficulties with social interactions, loss of interest in activities, and problems with communication and self-expression.

• Examples of negative symptoms include:

• Decreased expression of emotions: 

People may have difficulty expressing emotions or may exhibit a limited emotional response. For example, they may have a flat facial expression, monotone speech or show little body movement.

• Reduced speech and thinking activity: 

It may be difficult to put thoughts into words and communication may be slow or limited. This can lead to difficulty in conversations and expressing ideas.

• Reduced motivation and initiative: 

People may experience a lack of motivation or initiative to engage in activities, pursue goals or perform daily tasks. They may withdraw from social interactions and lose interest in activities they previously found enjoyable.

• Reduced ability to function socially: 

It may be difficult to maintain relationships and participate in social interactions. People may feel withdrawn and have difficulty understanding social cues or showing empathy.

• Blunt affect: Reduced emotional expression or flat affect, with little variation in emotional responses or facial expressions.

• Alogia: Impaired speech output, with a reduced amount of speech or speech that is empty or vague, devoid of content.

• Avolition: Impaired motivation, lack of initiative or reduced purposeful behaviour in social, occupational or self-care activities.

• Anhedonia: Inability to experience pleasure or reduced ability to feel pleasure in previously pleasurable activities.

• Asociality: Reduced social drive or desire for social interaction, often manifesting as social withdrawal or isolation.

• Attention disorders: Deficits in sustained attention and information processing, which may impair cognitive tasks and learning.

• Impaired executive functioning:

Difficulties in planning, organising and performing complex tasks, which can affect daily functioning and problem-solving abilities.

• Impaired memory:

Reduced ability to encode, retrieve and use information, leading to difficulties in learning new material and remembering previous experiences.

• Impaired insight:

Reduced awareness of one's mental state, symptoms, or the impact of the disorder on one's life, which can complicate therapy compliance and self-care.

• Poor grooming and personal hygiene:

Decreased interest in personal grooming, which may manifest as a dishevelled appearance, lack of basic cleanliness or neglect of personal grooming routines.

It is important to note that negative symptoms can have a significant impact on a person's recovery process and overall well-being. Understanding and acknowledging these symptoms is essential for appropriate treatment and support.

In the next section, we will take a closer look at the causes, consequences and possible treatment options for negative symptoms after psychosis. Identifying these symptoms and seeking professional help can help improve daily functioning and promote quality of life.

It's essential to understand their impact on the quality of life of individuals experiencing these symptoms. They can manifest in various forms, such as reduced emotional expression, social withdrawal, and flattened affect.

• General advice

• There are several general pieces of advice that are often given:

• Take adequate rest: 

It is important not to do too much in a day and to take enough time to recover after an activity. After all, your battery needs to be recharged.

• Use antipsychotic medication: 

These medications have proven effective in suppressing psychotic experiences. It is important to take your medication as prescribed and discuss any side effects with your practitioner.

• Avoid alcohol and drugs: 

Especially in the initial period after psychosis, it is wise to avoid alcohol and drugs. These substances can worsen symptoms and make the recovery process more difficult.

• Seek practical help: 

It can be helpful to seek practical support in getting things in order in terms of living, working, learning, leisure activities and social contacts. This way you can reduce the temporary burden you may be experiencing in these areas.

• Reflect on what has happened to you: 

Take time to reflect on your psychosis experience and try to understand exactly what happened. This can help you process the events and set goals for the future.

• Talk about it: 

It is important to talk about your experiences with family, friends and caregivers. Sharing your thoughts and feelings can provide emotional support and help process the psychosis.

• Seek home counseling: 

Consider seeking in-home counseling for yourself and/or your family. A counselor can provide support with daily activities and help build structure and stability.

• Seek contact with others who have experienced psychosis: 

Talking with people who have had similar experiences can offer recognition and understanding. It may be helpful to seek out support groups or peer contact.

• Identify and manage tension: 

Try to identify what causes tension in you and find ways to reduce, manage or, if possible, avoid it. This can range from relaxation techniques to modifying your living environment.

• Find distractions: 

Try to clear your mind and seek distractions by, for example, picking up your hobby again. This can help break through negative thoughts and gain positive experiences.

• Build reliable friendships: 

Try to reconnect with trusted friends and girlfriends. Having social support can have a positive impact on your well-being and recovery.

The remaining chapters of the blog will further discuss these different areas and how to deal with them during the recovery process after psychosis.

After psychosis, memories of experiences and events during psychosis can bring uncertainty and sadness. For many, a psychosis is retrospectively considered a profound event in their lives. Sometimes people can find meaning in it, but often it is experienced as a disaster or trauma.

The following questionnaire is designed to get an idea of what psychosis means to you now. When completing it, remember that it is a snapshot in time. It is about how you think and feel about certain things now.

Questionnaire

Questions about changes due to psychosis

• What is more difficult now compared to before psychosis?

• Are there any changes in your mood? If yes, which ones?

• Are there changes in the amount of activities you can handle?

• What positive or negative experiences have impressed you a lot during your psychosis?

• What things are you working on in your mind?

• What do you regret most now?

• What is it like for you to deal with psychiatry?

• Have there been any changes in your contact with family?

• Do you see your acquaintances less than before?

• Did your psychosis cause you financial problems?

• With whom do you talk about your psychotic symptoms?

• What things are you doing now to make things better for you?

• Did the experience of psychosis also have a positive effect?