Returning From Psychosis

Life after brief psychotic episode

Brief reactive psychosis experience
The image Eve chose to represent herself. Felicia/DeviantArt

Eve was 20 when she crashed into a psychotic episode and was diagnosed with Brief Reactive Psychosis. Now, three years later, we discussed her experiences from then until now. In Part 1 of the interview, we discussed Eve's mental health history and her breakdown. In Part 2, we begin with her psychiatric hospitalization and treatment, her understanding now about what happened then, the many lifestyle changes that have been needed, and her feelings today.

These experiences are Eve's own, and don't necessarily represent the typical treatment and experience of brief reactive psychosis.

Marcia: What was it like coming back to reality in the hospital?

Eve: It was like waking up from a nightmare, confusing and overwhelming, so I didn't ask myself too many questions at first. I was too tired, I could only think about everything I felt and how badly I wanted it to end. It was like waking up into a hopeless world where your only desire is to fall asleep again.

I felt shattered and helpless. I was seeing everything crumbling and falling apart, and I didn't have the strength or the will to do anything about it.

I hardly talked. It was difficult to connect, to be able to see and give sense into anything that surrounded me because all of my structures broke in a simple snap. All of a sudden I was flooded by all of my dreads, clueless of what to do with them.

I just wanted silence.

I entered a deep stage of depression, swinging in between denial and numbness. I started questioning everything, my sanity, my reasoning, my lifestyle, whether anything was worth it at all. I became conscious that I wasn't as strong as I thought I was, or indestructible. I felt very vulnerable and fragile as if I could break at any given time.

But I couldn't care; I went through a sad melancholia, disapproval, disappointment, and began to shut myself to the world.

Keeping yourself grounded is the hardest struggle, because you don't want to be sick, but you feel you keep falling into it and can't do anything about it.

Marcia: How long were you hospitalized?

Eve: I was hospitalized for two and a half weeks. After that, I moved back with my family by my own decision.

Marcia: What was the initial treatment? How long did that last?

Eve: The initial stabilization treatment in the hospital was an antipsychotic (Risperdal), an antidepressant and a soft sleeping aid, plus counseling and seeing a psychiatrist. This treatment lasted for three months or so.

Marcia: What was the long-term treatment?

Eve: The long-term treatment for me lasted about two and a half years, with regular therapy and an antipsychotic (Zyprexa), because I slipped a couple of times. When you start to get better, when you feel you are fine, sometimes you mistakenly drop the medications thinking that you no longer need them, that you can control it and everything is going to be fine. That's a HUGE mistake that only makes the thing last longer.

Marcia: What do you think brought this on?

Do your doctors agree?

Eve: Primarily the high levels of stress that I was going through. I was very sleep deprived - hardly slept a wink some days, and when I did, it was for two or three hours. I was overly active, had to keep up with my jobs and careers that didn't leave any free time in my schedules to rest. I had eating disorders, so I was very underweight and fell sick very often.

I was trying to adjust, too, to a lot of life-changing events that happened in the fringe of two months and were just too much at the time for me to handle by myself. I felt very lonely and helpless, I was exhausted, but I knew that I couldn't leave anything because I didn't have anyone else to rely on.

The death of my best friend was the trigger, the last drop that overflowed me, and the fact that I didn't give myself the chance to grieve, the time to stop, pushed me down straight to it.

After that, I started having a lot of nightmares that only worsened my insomnia. I got into a deep depression that I tried to hide. I kept on with my life in spite of everything. I numbed myself and suffered yet another emotional detachment. I started having flashbacks of my past that I tried to block as I had before, but they got out of hand and became stronger. All the traumas I thought I'd overcome returned, with all the scarring they left. I began to feel panic and feel I couldn't leave my home. Noises, people, the street, gestures, just anything perturbed me. My thoughts started turning messy. I couldn't focus on anything I did. And the rest is history. Everything just blew up in my face.

My doctors agree with me, but in short, they believe the main cause was the stressful, unhealthy lifestyle I was leading and the untreated psychological traumas I had from my childhood and adolescence. Then from an extremely painful event I fell into post-traumatic disorder again, which ended in a psychotic episode.

Marcia: What do you expect to need in the way of treatment in the future? Have you been told anything about the usual course of the illness?

Eve: Thank goodness I've been attended to by a wonderful psychiatrist who made sure to explain to me absolutely everything and clarify each one of my doubts. I guess in the future, I only expect to need just regular counseling with a psychologist.

I've been told that the course of the illness always depends on the patient. For some people, recovery is easier and faster, and they return to their lives without a problem. But often complicated cases like mine, with a lot of background issues, tend to exceed the average recovery period. These patients may not so much return to their previous lives but literally have to start from scratch.

Suffering from delusions is normal, disorder in the thought process, unable to keep a clear mind or straight thought, focusing is terribly hard. I know that each case has its own particulars, but is very common for people that had suffered from brief psychotic episodes to fall into severe depressions in the periods of recovery, and that often makes us prone to experience relapses.

Having support and patience from your family and friends is a key in recovery, because all of a sudden you turn very dependent on others, you cannot answer for yourself because you are not well, so it's essential to have someone well-informed and armed with patience surveying you, the process, the progress, so they can prevent you from deteriorating again, and in case you start decaying, for them to be able to notice the subtle changes. We tend to sabotage ourselves, so having a healthy and understanding environment is probably the most important stepping stone.

Marcia: How are you doing today?

Eve: I am doing a lot better. It's a couple of months since I went off my medications (with doctor's permission), and everything seems to be fine. I retook my life naturally. Fresh starts are always complicated, but I am doing amazingly well trying to get out of the shell.

I still have the fear of relapsing and there's always this constant struggle against depression, against anxiety, against numbing and detachment, the psychological scars that I have, the things I fight against every day of my life to keep in line. I acknowledge that traumas are extremely difficult to work with -- that it will take me years of work to prevent them from affecting the way I view life, the way I react in situations, the way I unconsciously am towards myself, the way I relate with people. I find it extremely hard to connect with other people. There's still a lot of work for me to do in the years to come. It's like relearning how to live.

Marcia: What lifestyle changes have you had to make for the sake of your mental health?

Eve: I had to change everything, because when you go through something so abrupt like this, all your structures, everything as you used to know it, suddenly breaks along with you. It's something that affects your entire life and in order to regain your health, you are forced to stop, take some steps back, readjust yourself and slowly start again. I had to drop my careers, I had to quit my jobs, I had to return to live with my mom, so from being a terribly prideful and independent person who seemed to have everything sorted out, I saw myself being completely dependent and in absolute need of help.

I had a flip in my personality. You tend to thoroughly lose yourself, so returning to be the person you once were is awfully hard. In fact, if there's something I know for sure, is that you are not going to be what you once were -- not entirely.

I think this was the way that nature had of telling me -- hey, this isn't working, sweetheart, and since you can't see it by yourself, let's make you stop, make you look around, make you look inside, make you realize, and off you go to take a new and different path.

Marcia: Do you fear that the psychosis will return?

Eve: People that have been through this kind of situation are always scared of relapsing, although that's actually rare after full treatment. You become very aware of everything and you are attentive to that slim risk you have. In one session with my psychologist, I expressed my concerns, and he said, "The best way to prevent those things from happening is to learn how to stop stressing yourself, and to take your time to listen to your needs."

In case you missed it, read Part 1 of Eve's interview, Crashing Into Psychosis.

Information on Eve's conditions: