First Episode Psychosis: What is it Like, Why Don’t People Just Get Help?, and How to Help

I didn’t know I was becoming ill when psychosis took hold of me as a graduate student. The first time we become psychotic – or lose contact with reality, as it is more graciously referred to by professionals – is referred to as first-episode psychosis. It is usually a gradual process and people can die from this by suicide or recklessness or cause great harm to others. And since there is no mental health education in this country except for psychology courses that often treat mental illness as something that you only see in a museum, a psych ward, or jail, everyone is astonished when it turns out they too are capable of experiencing it.

Unfortunately the nature of psychosis is such that people by definition do not have insight into what is happening to them. Insight is a clinical term. It means that you can see that you are suffering. A person with OCD, for example, will often know that what they are doing is not “normal” or desirable. Not so for psychosis.

A story comes to mind just now to illustrate the point:

My grandfather, Ross, played polo competitively as a young man. One game he was struck by a mallet and lost his eye. Being in shock, he didn’t know this had happened to him initially, and he wondered why the men around him were fainting off of their horses when they looked at him. He felt fine. What was the big deal?!? Fast forward to me in graduate school: I’m doing fine!!! Why are people so suspicious of me and not willing to hang out with me? Why are they being compassionate?!? Why does it seem like they pity me?!?

People experience psychosis and have fully functioning families and careers all the time. No one talks about it! But the first time… – even if we do sense that something is amiss, no one wants to admit it might be happening to them. And the vast majority of people do not know that it is treatable. It took years for me to find the right medicine and mindset. But I never gave up and neither should you.

This denial about becoming ill is just natural human behavior. For example, some people also experience shock at a cancer diagnosis, or disbelief when they are in a serious car crash. This is a natural, universal aspect of getting a devastating diagnosis or of surviving horrific events. It is so natural and we must be compassionate with ourselves and with others when we are struck with bad news and know that it is natural to be taken aback and be incredulous that horrible things can happen to us.

It is natural human behavior to deny what is going on and, in the case of mental health, to not want to accept help, realize that you can, or trust that it will work out if you do. But in some ways it is harder with first episode psychosis.

Can you imagine how it would feel to grow up hating psychotic people and blaming them for their suicides and transgressions, to be a person who hears about a suicide and says, “that’s the most selfish thing a person could ever do” – only to realize that you are becoming psychotic or are experiencing suicidal thoughts in spite of being a good person? In spite of being a faithful person? A religious person? In spite of, maybe, even being a person who had a good childhood? What if you just had a baby? Nothing could be better, right? Know that there is such a thing as postpartum psychosis. And know that it is treatable and imperative to get help immediately.

Just think how different it would be if people had to learn mental health first aid as children. That’s what would help. And just think if that first aid wasn’t just showcasing a shop of horrors, but actually featured stories of recovery and talked about prevention… and had survivors like me?

Just a thought.

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