Fantasies and Fears: Comparing Psychotic Experiences

I'm going to tell you about two psychotic episodes or experiences. The first happened when I was studying for my undergraduate degree in Creative Writing, at Falmouth University. The second happened last year, as I writing up my PhD thesis. The two experiences were very different, and it's my hope that in describing them (and the differences) young people who enter into their first psychosis can do so in a way that exposes them to less risk and more hope.

The first one:

My grandfather, with whom I was always quite close, ended up in hospital while I was in my second year of undergraduate study. I wanted to travel home to visit him, but I was also dealing with coursework deadlines and a deep fear of what may have been our final meeting. I ultimately didn't visit, and so I never got to say goodbye. I was also using cannabis in ever escalating quantities. As my time as university progressed, I developed both a physical dependance on and a psychological addiction to high-potency cannabis. This had been an issue for years prior, beginning when I was around 17, but its intensity and problem-potential peaked around the third year of my studies. I became anxious about attending the shops, lectures, socialising, and so on. I would smoke to manage this anxiety in the short-term, while the smoking would worsen the anxiety longer term. I found myself continually preoccupied with avoiding the unthinkable situation of having no cannabis. I also developed psychosomatic complaints, including a fear of urinary incontinence triggered by a comment from a lecturer. During a session on Freud, he explained that the Id was what prevented a person from urinating themselves in the street. I immediately became concerned that my Id may fail, and thus that I might become incontinent at any moment. This fear persisted to the point where I presented at the GP on more than one occassion, desperate for a physical explanation. This, looking back, was not the first but was one of the more evident signs of an emerging psychiatric problem. I was also in a turbulent long-term relationship that began some time during my A-levels. This relationship came to an end as we were finishing our degree, and I attempted to process this significant change with even more cannabis.

One evening, I experienced a transition from the more insidious prodromal phase into something closer to an acute psychosis. I experienced a combination of emotional extremes and a feeling that information of no direct relevance to me or my life was a personal, private commentary on my situation. Random social media posts seemed to reference my relationship, the breakup, my character. A loose narrative began to form as I made sense of these experiences. I saw patterns in images that seemed of personal significance, which I interpreted as coded taunts. I slowly pieced together an explanation for these events, implicating friends and strangers - some of whom I reached out to with accusations or cryptic messages intended to assess intentions and allegiances. I don't remember quite how the evening ended, but I remember becoming aware of something. I was very confused, and I could understand that my experiences were out of the ordinary. I didn't understand that I was becoming unwell, though, because I'd never experienced an illness of this sort in this way before.

I woke up the following day inexplicably and utterly convinced that I would be murdered, and that it would have something to do with having purchased so much cannabis. The evolving narrative was a fairly classic, persecutory one. People were (in my understanding) referencing me on social media, alluding to my nearing death, and the only explanation I could come up with was that something had happened to my ex girlfriend. There were some (delusional) indications on the social media posts that she may have committed suicide, and I wondered if I had been implicated as the cause. I also tied these fears to the criminal underworld, as in the course of spending so much time and money on procuring a large stock of cannabis I was eventually offered harder drugs and firearms. I'd heard stories of local gangs taking people out on boats and throwing them overboard.

The building manager of the student accommodation came to change a lightbulb in my flat, found me in a smoky mess, and after being accused of coming to kill me helped me see some people at the university. I spent some time, in tears, trying to explain who was after me, who might have died, and so on. Unable to really latch onto these threads of ideas, which were fragmented and not in any sense unified as a delusional whole, the support staff referred me to a GP who immediately diagnosed psychosis. I interpreted this is as the perfect method through which to orchestrate my disappearance, and so suddenly the GP was in on things. I was returned to my flat to wait for the crisis team. I had no idea what that meant, and I spent most of the afternoon hallucinating - believing myself to be talking to my parents through the flat intercom. I remember feeling an incredible itching sensation behind my eyes throughout the day. The doctor called and advised me to 'try and make it through the night', which I interpreted as a veiled threat on my life. I ended up being picked up by my parents and returning home. I then called the police for fear that the entire family would be killed, including the dog (which I considered to be particularly brutal). The police sent some officers out, who were satisfied that there was no threat to anyone. I somehow ended up in A&E, before being taken to an acute ward in Plymouth by private ambulance several hours later. I spent most of the time waiting accusing everyone who passed of being complicit in some protracted conspiracy against my life.

I ended up in the Plymouth acute ward late one evening. Confused and tired, I took myself off to bed. I was woken by someone shining a torch in my face, and they didn't answer me when I called out to them. The next day, I was shown around by another patient. I couldn't make any sense of what kind of place I was in. People seemed to speak in riddles, and everyone seeemed wary of me. I didn't like it. I wandered around, exploring the place, and found the chapel. The walls were covered in motivational quotes, in a font similar to one I'd used to print quotes on a canvas for one of my coursework pieces. I saw this as a sign of some kind, became very emotional, and prayed. I've never been particularly religious. I was very religious in that moment.

Then, rather suddenly, a more concrete delusional idea took hold. My experiences were, according to me at the time, best explained by an application to take part in a Derren Brown TV show, made some months earlier. I wasn't ill, or in a hospital. I was on TV. My reaction to this was to escape. I set the alarms off at one end of the building to draw the staff over before climbing a gate at the unattended other end. I was briefly advised against doing this by a nice psychiatrist or psychologist. I ended up running through Plymouth industrial estate to a travel lodge, where I began asking for my ex girlfriend. Everything made sense to me at the time, even though it makes very little sense now or to anyone reading. Long story short, I thought I'd ended up on some Derren Brown TV show where whatever I did was 'the right/planned thing' and so I just did whatever came to mind. The police arrived and put me in handcuffs. I explained that I thought I should leave the building naked. They obliged, and so I attended the police station and returned to the acute ward naked, much to the dismay of observers.

I then tried to escape again and had quite a bad reaction to a rapid tranquiliser. I had to be restrained after reverting to the original fear-of-life delusion. I threw furniture, destroyed another patient's room, and generally melted down. I reacted badly to the third-line rapid tranq, which I think was IM lorazepam and haloperidol. I ended up in the general hospital for monitoring before being taken to a PICU.

I won't tell you about the PICU stay because too much happened to fit into a single post. I ended up writing a book about the experience that will likely never be shared because it references real events, including the actions and words of other patients and staff. I will say that the Derren Brown delusion took over in the end, and so I spent several weeks believing myself to be in some Big Brother style house that was in fact a PICU. I believed many things, including that my purpose was to raise money for charity by pacing around a seclusion room naked for several hours a day and avoiding carbohydrates and sugar. I went from 13st to 9st in four weeks. They found a heart condition, Wolfe-Parkinson-White, on the admission ECG that made medicating me very difficult. I went through a series of unconnected delusions, including the belief that I'd died for a few days. I became obsessed with newspapers and national geographics, believing that they contained messages intended solely for me - that they were fakes, mocked up by the TV production team. I saw it as my job to decode these messages and take new courses of action, such as charity challenges and escape attempts, on the basis of what was written down.

The second one:

The second one was quite different from the first. There had been a long prodrome throughout the time that I was off medication. We discontinued on medical advice, partly due to the heart issue which was resolved through an ablation but also due to having had two bouts of neuroleptic malignant syndrome. The feeling was if I could do OK off meds that would be the better choice, as agreed by me and my consultant. In the intervening eight years, I never really got well. I managed to hold down a job in mental health services, but I learnt that you don't need to be particularly mentally well to do this. I then left to pursue a PhD. As I came to the end of that process, I was becoming suspicious of my wife, thinking she was poisoning my coffee and the like. I went to the GP and asked to restart an antipsychotic. We restarted, and I was seen by a community psychiatrist. The community psychiatrist thought that there was no evidence of psychosis, so I was advised to come off the antipsychotic. Several months passed and the ideas returned. When I finally articulated my beliefs out loud, I realised how paranoid and delusional they sounded. I took myself to A&E and explained the situation. I was sectioned again and admitted to a newly built hospital.

This time I had a lot more insight, and I was relieved to be sectioned. It allowed me to stop speculating about my beliefs so much. I didn't have to worry so much about whether people were out to get me or not, as I'd been sectioned. This was a pretty robust indicator that 'it was happening again'. I pledged to do as little as possible and avoid acting on or speaking about my thoughts. I shut the curtains to my room, took myself off to bed, and lay there as long as possible hoping to ride it out. I would occassionally call my wife and parents, telling them about my thoughts and beliefs, receiving reassurance that I was ill, and that really helped.

I also met a young man who was having his first episode. I instantly remembered a fellow patient from the PICU, who upon seeing me dash naked through the communal dining area, called out 'this is your first one, isn't it mate?' I decided to say the same thing to this young man, who was in the process of trying to steal keys from a support worker in the otherwise abandoned corridor. I ended up trying to distract him with games of football in the garden, but he was ultimately too unwell to respond favourably. He ended up in the seclusion area a lot, and was clearly somewhere else. He made reference to the ward potentially being a spaceship and the like. I felt a pang of sadness for him, and also a sense of helplessness. I think the first one is very hard to control, and you're very much at the mercy of the delusions you're dealt. I could have easily taken my own life back in Falmouth, terrified at the prospect of a brutal murder. I also experienced similar fears the second time around, and only with the support of my young family did I get through it.

I suppose I'm writing this to make the case that people need the most help during their first episode, and this is sadly the point in time where people are less likely to seek timely help. It's hard to protect yourself against something that creeps up on you and isn't easily detectable when it's in full swing. I think it's also worth saying that people experiencing their first episode might need more clinical input than those who have had several, at least in terms of management and containment. I know people won't like those terms, but I use them intentionally. Wards are safe spaces to enact the drama of a psychosis. It's dangerous to do this outside of such an environment.

Anyway, I hope that was of some use. I'd love to share the book I wrote about my time in PICU, but I need to look into the ethics of it in more detail first. Perhaps it can be released posthumously or something. I'm going to consider writing more on this topic over time. Do let me know on Twitter/X if that's something you'd like to see.

Cheers

Oli