My approach to first episode psychosis

After my first experience of psychosis, I did a lot of thinking and wondering about where it came from. I visited my psychologist and we talked about all these different ideas, and put together a strategy in the aftermath. We agreed that the idea in John Watkins book Unshrinking Psychosis that there can be many different reasons for psychosis, including positive ones such as personality reorganisation, or a spiritual awakening, was a good foundation. We drew no conclusions about why I’d had the episode, and made no assumptions about what it meant. Going forwards we decided the best approach was

  • For me to work on accepting the idea that I am a person who sometimes experiences psychosis as quickly, gently, and positively as possible. It can be a huge shift in self-perception and identity, and if too large, or threatening to hope and self esteem, people stay mired in denial.
  • To reduce my fear of the experiences and anticipation of possible new experiences. To be careful not to develop frightening personal narratives about the experience, or of being sold into anyone else’s ideas.
  • To that end, to do my best to avoid mainstream mental health services.
  • To develop my social support to meet this new challenge. At that time, my networks are very supportive when I’m physically unwell, or struggling emotionally, but many of my friends have no experience of psychosis except for a lot of fear based cultural ideas about schizophrenia. People don’t know what to do or say or how to be helpful. I can work on this by using times when I’m not psychotic to gently educate my networks about what it is and how it works. To also connect with other peers who experience psychosis (through the Hearing Voices Network)
  • Welcome psychotic experiences into my life. To make room for the possibility that I will have more episodes, without being paranoid or fatalistic. So, make life, relationship, and career choices that will accommodate the occasional episode with a minimum of stress, and without having to be overly secretive or afraid of being outed.
  • Approach the psychosis from a place of gentle curiosity rather than fear.
  • Reduce shame, secrecy, and isolation. Stay connected to people. If I ever start to struggle with my reality testing, research suggests that close, trusted relationships with people who are not afraid of me or the psychosis will be the most helpful in supporting me to make sense of what is real and what is delusional.
  • Learn. And accept not knowing things. Tolerate ambiguity, uncertainty, complexity.
  • Grow. Use times that I’m not psychotic to explore ideas and needs that may underlie the psychosis, things that I’m drawn to or that feel significant during the episode. I may not be able to prevent another episode, but may instead be able to reduce how distressing the experience is for me. If I’m going fall into an inner world, maybe by taking good care of myself I can help the world to be one of dreams rather than nightmares.

I’ve since had a second episode and I’m working on making sense of that. But I’m still really happy with this approach. It makes a lot of sense to me, and it’s helped me navigate a second experience without shame or terror. It’s such a different way of looking at psychosis to that found in mainstream mental health services. I can’t help feeling deeply fortunate, and so sad and angry that my story and experience of psychosis is so unusual. I knew what was happening as soon as it started. I had experienced people to talk to about it who offered wisdom and support. No one panicked. No one made me feel I couldn’t handle what was going on, or that the safest approach would be to lock me up and tranquillise me. So, I didn’t have a load of shock, trauma, and fear to deal with on top of the psychosis. I was instead able to put together a plan with the support of people around me, which included options for outside support if managing at home became overwhelming. I don’t know what my future holds. Neither does anyone else. I’m free of dangerous, life limiting assumptions, free of a model of psychosis that speaks only of loss and limits, free of an enshrined cultural terror of madness. Don’t misunderstand me, this is not a polyanna, naïve approach, ‘mental illness’ of any kind can be terrifying and destructive. But as an approach, this has worked well for me. I hope it might be helpful for others too.

8 thoughts on “My approach to first episode psychosis

  1. Your approach to psychosis is very similar to mine.
    I figure its a useful measure of quality of life – spending least amount of time in company of lawyers and psychiatrists.

    A key thing I learned is to not expect very much from medicine – because it really has so little to offer me – either by way of understanding, insight, or “treatment”.

    We can learn to live with anything – part of that is learning to approach everything as something we can get through, and learn from – including “psychosis” whatever that is.
    Being told our experience it must be, must mean a certain thing is actually the kind of experience that causes us to have difficulty it in the first place.

    I was as asked a question in an interview the other day “what do you think causes “mental illness?”

    “living” was my reply.

    Your approach is also similar to most people who don’t work in “mental health services” and live in societies that have become dominated for decades by a certain way of thinking.
    Many societies have different approaches, different traditions that they have managed to maintain. I hop ethey continue to do so and that, one day, we will see that rather than export ours to them, we need to learn from them.

    Not even all psychiatrists think this way even though they may keep quiet for fear of losing their license [grow a pair, eh?] – so its kinda perverse to call it “psychiatry” but its certainly a tradition in psychiatry, and currently the most powerful and most common.
    But it is only one – and its a very, very, narrow – and disempowering – way of framing the world and human life..

    Personally I think the psychopharma tradition in psychiatry and “mental health services” is itself the very model of “lacks insight”, “not in touch with reality” – indeed it is itself the very model of “mental illness” epidemic- both a mass “delusion” and a collective “psychosis” .

    which is kinda ironic eh?.


    • Lol, very dry. I love your humour. For me, I think I’d have a problem with psychosis whatever I’d been told, it’s such a jarring experience. Certainly this approach has helped massively, but I don’t think I’d ever have just taken it in my stride without blinking. It’s interesting to look at different ways of explaining and understand psychotic experiences, some cultures frame them in pretty benign ways, as you say. On the other hand, other traditional cultures kill people as witches, or ostracise them as possessed by spirits. Not all the grass is greener on the other side. I hear you about the psychpharma tradition, I think it’s going to lose power as new paradigms are built, and that is a good thing. I’m fast coming to the conclusion that any model, when it becomes the dominant tradition, it dangerous to some people as much as it helps others. There’s a great deal of dissociation and delusion built into any framework that presumes one person can cure another person’s emotional pain. It’s a strange set up when you really start thinking about it hey. I’m fast coming to the conclusion that it costs everyone involved, the ‘sane’ and the ‘sick’ alike.


  2. The program I spent the last two and a half years in took a similar approach, a combination of the Finnish open dialogue approach and mindfulness in the Tibetan Buddhist tradition. I’ve only ever had one episode of psychosis, but I’ve found this type of approach helpful for other stuff too.


  3. I totally agree Sarah. I have grown and learn’ so much fro making room and gently exploring/walkining through Psychosis, for me to go by the MH systems veiw, would not be helpful and prevent my growth/learning from my experiences, not to place myself in danger or harm in anyway, but with the gentle and compasionate support from my health team , allowing me to be and explore within saftey and plans to assist if I am at risk at alll of any harm.


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