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.

On Involuntary Hospitalization: Taking Back the Narrative of Serious Mental Illness

Ethnic studies is taking off in some parts of the US. Groups of people who have been historically discriminated against are defending their right to tell their stories their way. I see the value of people who are marginalized – and those of us with mental health challenges are certainly marginalized – controlling their own narrative. My starting this blog is liberating, and this is so largely because I’m controlling my own narrative and sharing it with others to help others. I’m saying what has worked for me.

How can people with serious mental illness take back their narratives? By admitting we need help. And if we have been involuntarily hospitalized, this means that we have lost the dignity of being able to control our own narratives without help.

But guess what? Once we’re stable it never needs to happen again.

We cannot hope to control our narrative and become full and respected members of society if we do not commit to treatment.

Taking back the narrative on serious mental illness means admitting we need help. Taking back the narrative on serious mental illness means that we are taking the appropriate steps to stay stable. Like sleeping regularly, eating well, and exercising. Like avoiding workaholism. You know – things that everyone, and not just the ill, should do.

Question: Why should we do this as Christians? Won’t God cure us??? And aren’t we lacking faith if we rely on medication? 

Answer: Is a diabetic lacking faith that they take insulin?

If we are eating all the junk food we want and have developed late-onset diabetes due to lifestyle issues, we should not just take insulin. We should make healthier life choices. But we cannot forget that God works in human history through advances in medical science. Why wouldn’t we take care of ourselves so that we can help others and serve the way we were meant to as Christians?

A lot of us don’t take medicine because we feel like it means we’re weak or defective and that by taking medicine we are admitting our own failure. But consider this: if we are worried about why God isn’t working in a certain way in our life – why isn’t he curing me? – then perhaps, just maybe, we are focusing on the wrong thing. In Luke 6:42, Jesus criticizes followers who are judging others without taking care of themselves first by reminding them that they must tend to their own well-being before setting about transforming the world in the image of Christ. Jesus says,

“How can you say to your brother, ‘Brother, let me take the speck out of your eye,’ when you yourself fail to see the plank in your own eye? You hypocrite, first take the plank out of your eye, and then you will see clearly to remove the speck from your brother’s eye.”

This is so apt in the case of mental health. When we are really struggling, we can’t see straight. Our mission as Christians is to help people. Helping people is more important than feeling like we’ve been cured or healed, and the healing that can come from medicine and therapy allow us to take the focus off of ourselves and put it back on the kingdom of God where it belongs. We must help ourselves so we can get over ourselves and get back into the game of living. And help comes from community, not just professionals. This is a picture of my husband and myself taken the year I was hospitalized twice.

How to Listen to Me When I’m Hurting: Communication Skills For Working With Loved Ones in Crisis

A friend of mine has been distressed and so we’ve been talking more than usual lately. They asked me if I could talk to their family about how to treat them when they’re having a hard time because I’m such a good listener and their family only freaks them out or makes them angry. To which I said: “First of all please tell my husband that you think I’m a good listener! He’ll be amazed!”

In all seriousness though, what I learned about being a good listener actually came from my husband Todd and how he had to learn to listen to me when I was distressed. So really I just try to act like Todd when I’m talking to my friend. I’m not hurting anymore, so I’ve picked a picture of myself for this post from a time when I was hurting very much so you can see the anxiety that was there, and yet also my humanity. There was a lot of love for humanity in me then, and I think it comes through in this picture.

I will share two things from Todd that I channel when talking to my struggling friend on the phone:

First, to use an expression from teaching, I show them unconditional positive regard. This means that no matter what the friend says I continue to view them as fully human and worthy of love and respect and I don’t take what they say personally if they get triggered by my reaction. I treat this, instead, as something to learn from about how to interact with them in the future. (Obviously there are some things that need reporting, like any ideas of causing harm to people or self – never keep this kind of thing confidential and never leave a person who is suicidal unattended. Obviously if they are violent or dangerous, leave).

And second, I never push them to give me more information than they’re sharing. I just repeat back with some variation what they’ve already said with genuine feeling and interest to show that I’m listening, that I care, and that I want to hear more if they want to share. This is so important, especially if the person is experiencing paranoia, that you are not pushing them to share more than they want, which will just make them more anxious, paranoid and isolated.

Honestly, I recommend taking classes or talking to a therapist about how you can help your loved one since every person with mental illness is mentally ill in their own way. I’m just sharing my experience here.

And know that things may not be this hard forever! The brain changes! Especially with medical help and therapy! And if you take some therapy to help yourself cope then it will greatly help your family unit.

“You’re Crazy!” How to Invalidate Someone Permanently and the Christian Imperative to Accept the Ill

There is perhaps no better way to invalidate someone in terms of career, familial status and worthiness of social investment than legitimately calling into question their sanity. This is why people attain stability or recover rarely share.

What is really going on when we invalidate people with mental illness? We are taking away their wholeness as a breathing creature of God who matters just as much as the rest of them. And we are certainly not following any Christian mandate to serve the least of these.

Hear the words of St. Paul in 1 Corinthians 12:

 The eye cannot say to the hand, “I don’t need you!” And the head cannot say to the feet, “I don’t need you!” 22 On the contrary, those parts of the body that seem to be weaker are indispensable, 23 and the parts that we think are less honorable we treat with special honor. And the parts that are unpresentable are treated with special modesty,24 while our presentable parts need no special treatment. But God has put the body together, giving greater honor to the parts that lacked it,25 so that there should be no division in the body, but that its parts should have equal concern for each other. 26 If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.

When we reduce someone to their pathology, in other words, how their illness is showing up in their lives, we are taking away their personhood. And this is un-Christian, as St. Paul teaches us above. When people are struggling with serious mental health issues, they need professional help and medication and it is often, though not always, dangerous to proceed without professional intervention. But if we had mental health education in high schools in this country, people would not judge people with mental illness as harshly. It would be normal to go into treatment. And then people would not deteriorate. Life would be more meaningfully lived.

Every case is different, but I would err on the side of caution regarding going off of medication. I always encourage people to continue to take at least some medication if they have serious mental health issues. If they go on medication, it doesn’t mean they have to stay on the same amount forever. Community and love are needed and not just professional help. Some doctors’ worldviews can hinder a person’s ability to heal. It is imperative to find the right community if one cannot find a supportive doctor.

My Story: An Academic Career Ruined, a Reputation Tarnished… and yet…

This post holds a combination of how I viewed my life at the end of my twenties (I was a “failure”) and how I view it now.

I remember when my academic career was ruined as a result of my experience of mental illness while in graduate school. No one would recommend me. No one wanted to work with me. Looking back I can’t say I blame them. But the isolation and the despair I experienced was nothing like I had ever known. And because no one shares about their recovery until they’re in their 60’s or tenured, I had no one to look toward with hope. Which is why writing this blog is my calling…

I went to graduate school at UC Davis. Straight A’s. Fulbright scholar. Highest honors at Berkeley as an undergraduate. Departmental citation for excellence in research…

…And it all disintegrated over the course of two years as I lost touch with reality. Since there is no mental health education in this country, I did not know what was happening to me as I became progressively worse. And since I lacked insight into what was happening to me, in other words, since I had not the faintest idea that I was becoming ill, there was no reasonable way that anyone could intervene meaningfully.

I couldn’t have held my life together nearly as well without my husband. So I don’t blame people who don’t power through. Even people who really fall hard can make a great recovery.

I often ask myself: What would have happened if I had received mental health education when in high school or before entering the university? In that case I would have seen the warning signs, or believed other people when they shared them with me. And people who were worried about me would have been able to come up to me and use common language with me to explain that I needed medication and to take a break. Which no one did.

I powered through and got two MA degrees and then went on to work full time for 6 years… Many people do this, and then they don’t share how hard they had it for a while in the 20’s. They move on, have great resumes and get good jobs like I have. But if I had just taken a break for a year to resume my studies the following year, people would have forgotten about my struggles, I would have continued to be brilliant, and I would not have alienated myself from my departments.

My calling happens to be writing and sharing my story, studying literature and making connections between life, literature, faith, health and wellness, and helping others like me. It is a joy to be more open than most. And my illness makes it so that I know that academia would never be a good environment for me. And I am empowered to choose wellness.

Each of us has our own distinctive fingerprint as a creature of God. And it changes over time. In this season I am doing the right thing for myself: sharing my recovery and staying out of hierarchical things like graduate school, which are triggering for me if I’m not on loads of medication.

There is still a lot of stigma, job discrimination and misunderstanding around the topic of serious mental illness. So be careful who you share with and what you share…know that you can make a full recovery just like me. And know that, unlike me, you don’t have to share just how bad it got. If I wasn’t called to share, no one would know any of this about me. And just imagine how many people there are like me who don’t feel that call toward health advocacy?

Always remember this: that from our suffering comes great growth. I often think about how committed I would have been to material wealth, career success and Facebook bragging expeditions if my life hadn’t gotten real with a serious health challenge in my early years. Now I am creating and living the life I want.