Author: Melissa Howard

 

A brief explanation of how the International Bipolar Foundation explains psychosis.

In periods of psychosis a person may show signs of being out of touch with reality, and may say, hear, see, or believe things that don’t match reality.

I was eighteen when the depressive episode I was experiencing evolved into psychosis. I cycled between hypomania and depression throughout my adolescent years. Unfortunately I was misdiagnosed and only being treated for major depressive disorder. After experiencing trauma and many surgeries throughout my youth, I would often dissociate and fall victim to the heavy, wet blanket of depression. It smothered and suffocated me. I was unable to get out of bed, lacked all motivation and could not stop the suicidal ideation taking up space within my vulnerable mind.

My hypomanic state was seen as productive, focused, and energetic— never problematic. My symptoms were viewed as my “normal” state, however, it came with many untoward symptoms that were viewed as teenage angst and rebellion, rather than symptoms of hypomania.

During hypomania I was impulsive, made poor choices, was unable to self regulate my emotions, was impatient, could spend my entire paycheque from my part-time job in one afternoon at the mall, and was easily irritated or angered causing me to lash out without a filter.

I rotated through the episodic nature of bipolar disorder, with depression being the only illness being addressed. I was prescribed an antidepressant which worsened the polarity between hypomania and depression.

My symptoms of hypomania controlled my final year of high school. Again, the way I managed my life was viewed as positive. I was able to work longer hours, save for a graduation trip, have an active social life, was accepted into all the universities I had applied to and was placed on the honour roll. I was riding high and felt invincible. The unsavoury symptoms of hypomania were noticeable but were overlooked and thought to be more of a character flaw than a serious disorder.

Shortly after graduating, my symptoms were drastically altered. Within weeks, my ambitious, focused and sociable behaviour faded, rendering me a useless and unrecognizable version of who everyone knew me to be.

I remained in bed all day and laid awake at night. I was unmotivated to shower, work and socialize. I was sensitive to noise — hearing the shrill of the phone ring made my skin crawl. Touch felt like torture and every space I entered brought me discomfort, even the familiarity of my home. My bedroom was my only refuge from the terrifying world I found myself in. I refused to speak, but when I did, I was curt, straight to the point and there was no filter to buffer my often hurtful words.

My perception of the world began to shift. I felt like I was the same person I had always been but the people around me were imposters. Everyone I knew was replaced with doppelgängers, they looked the same but did not behave the way I remembered them to be. It was terrifying. I was unable to recognize that I was the one who had changed. With my confusion and inability to make sense of my reality. I further isolated, only coming out of my room to drown my sorrows in food or the occasional shower.

My inner and outer space could only be described as silent chaos. My bedroom became unkempt and I disheveled. I had become a complete 180 of the young woman everyone had interacted with only weeks before. I had always prided myself on how organized, clean and meticulously put together I was. Now I was a hollow shell of a human who could not stand noise, light, touch or living. This depressive episode was different than all the others I had experienced. It had somehow evolved and taken on a life of its own, leaving me stuck between a reality that I could remember and the abyss of confusion I now found myself in.

My uncertainty only intensified when I tried desperately to find something to distract myself from the mind numbing pain I was experiencing. Reading no longer made sense. I could not focus on the tiny letters. The words on the page seemed all out of sorts and were impossible for me to follow. I experienced the same with newly released movies, music and television. The more I strained to understand, the more frustrated I became with my existence.

My only solace was watching reruns of films and sitcoms that I had watched prior to entering psychosis. They remained the same. The characters, content and endings were all as I remembered. I could follow along and comprehend the narrative. That brought me comfort during my dark time. I named the obtuse space I found myself in my “new world.”

As I witnessed my relationships deteriorate, renovations being done to my home and the odd way my family related to me, I began to realize I could lose the world I remembered forever. I desperately searched for pictures, past homework assignments and old pay stubs to validate that I had been in a space where I existed and the world made sense to me. I compartmentalized items from my “old world” from the items in my “new world.” I did not want to accumulate anything in this new place I found myself in out of fear of being stuck there. If the two worlds bound themselves together, I was terrified that I would be stuck in this horrific form of limbo and confusion forever. I required reassurance I would not forget the world that I had once lived in. I wanted desperately to preserve my sanity (which had slipped away weeks ago.)

My body constantly ached and my migraines intensified in frequency. It was during this time I began to experience an oratory and visible hallucination. I told myself repeatedly that the evil and sinister, floating, male head that was staring down on me and coaxing me to kill myself was not real. For nine months I survived in this desolate desert of despair—continuing to take an antidepressant that was not working for me. I continued to struggle with insomnia, hygiene, moving my body, and eating consistently. I did not speak of my hallucinations. They terrified me just to think about them. I was not going to share this with my family who would have had me committed to a mental health care facility. I struggled with this symptom in silence in fear that if I revealed it, it would validate my break with reality.

I withdrew from all of my university courses. I was enthusiastic about the next journey in my life—now all I felt was hopelessness. I began to write. Scribbling down any thoughts that came to my confused mind. It was the only way I could organize the perplexing rhetoric jockeying for space in my mind. The writing proved my existence, I could see and read it—as could my family because they questioned my insatiable need to record everything. My writing was tangible and it made what I was living through, real. What was happening within my mind could not be seen, explained or validated, therefore I questioned its very existence.

After enduring months in this psychotic state, without a proper explanation or diagnosis from my health care practitioners and emergency room doctors, I agreed to see a new psychiatrist who specialized in mood disorders. She recognized that my depression was much more than a depressive episode and that the comorbidities I had, exacerbated my symptoms. I agreed to have more sessions with her. She prompted me with questions as if she understood my confusing explanations of what I was experiencing. I did not feel judged and her office became a safe place that I could reveal all my shameful, terrifying and embarrassing symptoms without the threat of being hospitalized. As she followed me she witnessed my depressive psychosis evolve into my first official manic episode. I was immediately prescribed an antipsychotic in combination with a mood stabilizing medication and diagnosed with Bipolar 1. In less than six weeks she was able to properly assess, diagnose and medicate me— something my previous psychiatrist was unable to do for the five years I had been under his care.

I returned to a manageable state where I was able to accept treatment for bipolar 1 disorder. As I began to reflect back and sift through the events leading to and during my depressive psychosis, I experienced intense emotions of shame and guilt for my behaviour. I was unsure of how to accept myself knowing my mind was able to betray me in such a way that my entire sense of reality could be completely distorted. To try and make sense of something that was nonsensical was exhausting and painful to think about. Who was I after this acute episode and how could I accept myself after experiencing psychosis? I continued to question my sanity, often second guessing myself even as the medication worked to secure my reality.

As my prescription brought me closer to stability, I recognized how sick I had become. Only then was I able to start repairing my shattered sense of self. I held onto the belief that it was my fault I had developed bipolar disorder and that I should have been able to control my psychotic symptoms and behaviour. In reality I was never in control of the disorder. The way bipolar manifested itself within me was by way of genetics, trauma and my psychosocial dynamics. I had no say when and how it would be triggered. Through therapy and self education I learned that bipolar disorder could be managed through medication, therapy and a healthy lifestyle, however, even with all of these self care strategies implemented, I could still experience episodes. I felt defeated the more I understood that bipolar disorder was a permanent fixture in my life.

In order for me to flourish I would have to work with my diagnosis instead of fighting against it. I developed self-awareness with the help of my therapist, vigilance regarding any potential triggers and created boundaries to protect my peace. I was able to envision a future with me thriving with the disorder, instead of viewing it as a devastating life sentence.

I grew up fearing change and it was a major trigger for me. Though it continues to cause me a moderate amount of anxiety I’ve learned to take small steps towards a large change instead of all at once. This has enabled me to break down my life into manageable stages. I was able to understand it did not matter how long my road to stability was but that I should celebrate and embrace the small victories along the way. In fact, for me, the small victories are just as important, if not more, than the end result. I say this because acknowledging the small positives boosted my self confidence and validated my progress. This was something I was never able to do. My mind thought in absolutes. It was “all or nothing,” “black or white,” and “right or wrong.” I was raised interpreting the world this way. As we know, mental illness cannot be described in absolutes. Being able to break down change into smaller steps revealed that I could tolerate my evolving world. As my confidence strengthened, life’s challenges became inherently easier to manage. Even the unforeseen triggers did not evolve into major episodes. There is one thing that is static in life—change is inevitable and nothing can control or stop it.

At this point you are probably questioning how all of this connects to self-acceptance after experiencing depressive psychosis.

The way I perceive myself today may seem somewhat odd to others. I have learned to respect my mind and its limitations. It had the ability to turn my entire sense of reality on its axis. Causing months of excruciating, mind numbing pain, fear, confusion and debilitating self doubt. On the flipside, my mind was also capable of pulling me out of this break with reality. For years I viewed myself as weak and incapable of trusting my own thoughts. This is no longer my truth. It has not been for over a decade.

Everyone measures strength differently. It could be in the form of physical fitness, mental and emotional awareness, tangible productivity and achievements, the ability to remain calm during triggering situations or the positive way one navigates life challenges. For me, I found strength within my mind including all of its vulnerabilities. Self acceptance has meant embracing all aspects of myself, encompassing my bipolar experiences that I historically hid away because of shame, fear of judgment or being misunderstood. My self acceptance does wane at times causing me to question my abilities and how I live my life. This is where I remind myself of how far I have come from my first psychotic break. If I was told then that I would become a mother, wife, mental health advocate, writer and be able to maintain healthy relationships—I would have never believed you.

For me, self acceptance is my ability to share my story on my terms, without the worry of others’ negative discernments, opinions or their discomfort. Living with bipolar disorder requires management in order to remain stable. It does not define me as a person, it is one aspect of the complex human I am.

This is not a conduit for self diagnosis. This is my experience of depressive psychosis and others may experience it differently. Psychosis can be a medical emergency. If you or a loved one is displaying symptoms please consider contacting your health care practitioner immediately or 911, the crisis line at 9-8-8 or go to your nearest emergency room.

The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.