I live with a diagnosis of Bipolar Affective Disorder. I was diagnosed at the age of 21 and will continue to live with this diagnosis for the rest of my life. It’s not pleasant, it’s not fun and it’s certainly not something I wish to be burdened with. It can be destructive, not just for me, but for those close to me. Despite this, it is well managed, and on average, affects me significantly once or twice a year. I am now 26.
It’s all too easy to look at the main aspect of this label, which is profound mood disturbances. In my experience, this is what people often focus on when discussing bipolar. Less commonly discussed is the psychosis that can accompany mania or depression.
To be clear, mental illnesses are incredibly complex and I am by no means an expert. I am still identifying my own triggers and how best to manage relapses. I can only speak from what I’ve been through. People’s mental struggles are unique to them, even those who share my diagnosis, so the way they’re managed must also be unique. All too often people are painted with the same brush, which doesn’t help. In this post, I will be talking about my own personal experience with psychosis and how it affects me. I hope this helps others to better understand my illness. I also hope that those who live with a diagnosis of bipolar or alike, and by extension to anyone who may experience similar symptoms, can relate to these stories.
I will not be talking about drug-induced psychosis, as I feel this is a separate topic. Although similar in character to true psychosis, the cause is organic in nature; so not the same. Ironically my first episode of psychosis was in fact drug induced. I was 19 and had been taking the antimalarial Lariam prior to my trip to Tanzania. I have dedicated a post to this experience already, which can be found here should you wish to read it.
Whenever I try to describe my psychosis, I find it really difficult to articulate what it’s really like. My psychosis isn’t just one ‘thing’; it’s a mixture of thought and perceptual impairments that negatively affect my behaviours and actions. It all starts with an idea. . This idea could come from something I’ve read, heard or seen someone or something do. This idea then develops into an obsession, which in turn spirals into a fixed, firm and unshakeable belief. This belief is almost always false. Once it’s taken hold it is really hard to change my point of view. Often medication is the only viable solution.
One of the main forms my psychosis takes is delusions of guilt, usually occurring during a depressive episode. I get very strong feelings of guilt during episodes of depression anyway, but these can often develop into powerful delusions. For example; I was watching a soap opera with my parents at home some years ago. I had needed to come home during a relapse in my mental health. Two of the characters were talking about their son, who was a lazy, good for nothing bum who needed to be more independent. Whilst watching the scene, I developed the idea and thought that perhaps I was also a lazy, good for nothing bum who needed to be more independent and stop relying on my parents whenever things became difficult. This quickly spiralled into overwhelming guilt. Guilt that I had come home; guilt that I was relying on my parents to look after me; guilt that I was even alive. I even began to think that the episode was aired specifically to target me, directed at me, to make me think this way. Maybe I wasn’t ill, and the world didn’t want me to be a part of it. And maybe that I should act on these thoughts. This led me down a terribly dark path, and one I never wish to revisit. Fortunately, with the help of my parents, I overcame these thoughts before they festered any longer.
When I’m unwell, my psychosis predominantly presents as delusions. However, another main form of psychosis is hallucinations. But I’ve never truly experienced an auditory or visual hallucination, or for a prolonged period of time at least. So I don’t feel I can talk about them as part of my experience with psychosis.
During a psychotic relapse, my thoughts become very muddled, which itself has a profound effect on my behaviours and actions. I can become very confused very quickly, often in response to the most insignificant stimuli. I will read into things far too much, often to the point where I’m analysing every fine detail and over-valuing their significance. This can turn into a serious obsession and usually takes someone or something to help ground my thoughts back in reality.
This can be provoked by my social anxiety. For example; someone might send me a text or an email checking in on me. I will read the message, and mid-way through a dog will bark outside. That’s it. I suddenly become profoundly paranoid that whoever sent the message somehow has a connection with the dog outside. Are they watching me? What if I don’t reply straight away? Do they know what I’m thinking? I have had moments where I have just stared at my phone for minutes on end, with thoughts racing through my head, too scared to say or do anything in the fear that I’m being watched, or even worse, controlled. I cannot even begin to explain how scary these moments are. Luckily in my most recent experiences with relapse, they have been merely fleeting thoughts, and I have been brought back into reality before anything came of it.
Not only do I become very delusional, I also get extremely anxious. This anxiety takes its toll both mentally and physically. There have been occasions when I’ve woken up half asleep in the middle of the night having a panic attack, my heart beating furiously through my chest. Pitch black, I can’t get my bearings and it feels as if someone is throttling me in my sleep and I can’t fight back. I feel like I’m suffocating and gasping for air and it’s petrifying. I can’t breathe. I try to scream for help but I have no energy or power to stop it. Sometimes I think ‘this is it, I’m going to die in my sleep’. My brain eventually settles, my heart beat slows, the grip around my throat steadily eases and my breathing returns to normal. I fall back to sleep.
All in all, my psychotic episodes vary in length and severity. They are dangerous psychological states for me to be in and I require almost constant observation by those close to me. If I were to summarise a psychotic episode, I’d say they’re like being in a living nightmare. All your worst fears and insecurities come out in all their forms. The difference between psychosis and nightmares, however, is that you can simply wake up from the latter. You may feel distressed, upset and traumatised by the dream, but at least you didn’t live it. Being psychotic – you don’t get the luxury of just snapping out of it. Recovery takes time. Much like a torn muscle, it requires support and self-care to help return to a normal functioning state. Instead of just avoiding cheese before bed, I take regular steps in my life to help avoid a relapse. I also take the necessary steps to help myself prepare to weather the storm, just in case I fall down the rabbit hole once more.