"If you enter the psychiatric business as a patient, you run a high risk of being reduced to the mental disorder you came with, or to a disturbed object. Only what is significant for the diagnostic examination is seen and heard. Patients are examined but not really seen; listened to but not really heard.
A psychosis is far-reaching and overwhelming. It involves a severe distortion of meaning. It renders the world unfamiliar, unrecognizable and threatening. Psychosis can turn life into a living hell. Just “being“ can no longer be taken for granted, nor can anything else. A psychosis is also accompanied by a sense of estrangement. The disorder that you have is often closely allied with who you are. The manifestations of your illness sometimes dominate your entire personality. The distinction between the individual and the condition is soon lost, and is very difficult to regain. I have been my disorder for a very long time.
I was not yet 20 when I developed severe psychotic complaints, accompanied by a lot of powerful noises inside my head and unlimited fear. To control these symptoms, I became addicted to alcohol, drugs and self-harm. I was trying not to hear or feel, but the numbing effect was – although it sounds paradoxical – both a survival strategy and a destruction.
The intoxication drew me away from reality and allowed me to withdraw more and more into my own crazy world, isolating myself from the world around me. One of the things I remember from that time is my fear and the smell of devastation that surrounded me.
When I finally stopped eating and moving, I had literally become a living dead person. Twenty years have passed since then. Today I know that traumatic experiences from my past were haunting me, but at the time I was convinced that the inevitable was happening: I was the problem and the problem had to be solved.
I was admitted to a psychiatric hospital, where I stayed for three years, and then became a chronic non-clinical patient. I was treated for my disorder, but never witnessed the miracle of a cure. The first psychosis was not the last, and I did not get rid of my mental condition.
The psychiatric care gave my family and me an explanation of what was wrong with me: I was severely mentally ill and had a psychotic disorder, for which I was treated. For a long time this was the only official story of my life. I, too, saw myself as disturbed, with a disorder that I could not control.
In fact, I had become alienated from myself. I saw myself from a distance, as a sort of alien, who needed special treatment. When my symptoms got worse, I would need the hospital, the doctors and the medication. And I had to live by the rules: concentrate on the here and now, refrain from being ambitious, stay awake during the day and sleep at night. I mistrusted myself, because at any time my condition could get worse.
I had a dark side inside myself, however, a side I did not know and did not dare to explore. I avoided thinking about what had preceded my admission, and what might lie behind my suffering. The only thing I did was try to stay away from my dark side as much as possible. This was encouraged by the professionals I met in the course of my many years of contact with psychiatry. The general idea is still that talking about psychoses increases the risk of having another one, and you should therefore stay off the subject. So I covered it up, this disorder inside myself, and avoided looking at it.
In the years after my psychiatric admission, I managed to achieve stability in my life. I was free of psychoses for years, and managed to build an existence, develop a relationship and hold a job. My disorder disappeared into the background. To be honest, I thought I had conquered it and was convinced I would never experience a psychosis again. I had a husband, a job and a house, and everything was different.
But over a short period of time I experienced several shocking events, and became psychotic again. In the ensuing years, I had to make a choice. Would I see this as a revival of a deteriorating disorder, or would I really try to see what was going on in my life?
To accept my psychotic experiences as a disorder felt like surrendering, not least because of the nasty side effects of the antipsychotics. I couldn’t see how I could combine this surrender with all that I had achieved so far.
Instead, I wanted to learn to talk about my psychotic experiences and to learn to see their meaning. I found that this wish was not accepted as a legitimate need for care, however. A psychiatric history of psychosis is considered a contraindication for any kind of serious communication. It is my experience that professionals are reluctant to work with people like me, to go back into a dark history with people with psychotic responses. There are no guidelines for doing this. I think it takes a great deal of courage, from the patient as well as from the therapist.
Today, I no longer see my psychoses as isolated incidents of psychopathology. It is even hard to remember that I ever viewed them as such. My psychoses are my way of reacting to my life history. They are my response to the unpredictable abuse I had to face as a child.
I hit back at my father after years of submission, when I was finally angry enough. My father left the house and threatened to kill himself, after which the whole family turned against me. It was the last time for a very long time that I experienced anger. In the years that followed, I lost all my strength, exchanging it for guilt, fear and incomprehensible psychotic experiences. I became the problem that had to be solved.
I don’t think abuse is in itself a strong cause of psychosis. It hurts, but it is rather simple. In my view, it is the threats and betrayal that come with it that feed the psychosis: the betrayal of the family that says “You must have asked for it“ instead of standing up for you, and excuses the offender while accusing the victim. That distorts the reality for the child, forcing her to say that the air is green, when she clearly sees that it is blue. You are forced to betray yourself, which is what creates the twilight zone and makes you vulnerable to psychosis.
In psychiatry, my twilight zone was extended. A distortion of reality was forced on me once more. Nobody ever inquired what had happened to me, or asked: “What was it that drove you mad?“ I was observed, diagnosed and treated as a disturbed person, but no one ever looked at the association with my life history.
Victims of abuse who react with psychosis will not receive recognition as such from psychiatry – if that is what they seek. Many of us entertain huge guilt complexes and are convinced that we are to blame for the crimes of which we are, in fact, the victims. We punish ourselves in a multitude of ways. As psychiatric patients, we keep our destructive patterns alive and succeed in prolonging our roles as victims. Becoming a psychiatric patient could essentially be called a repetition of trauma.
Today, my psychotic experiences are no longer a mystery to me. I know what triggers them and what makes my memories turn into uncontrollable flashbacks and incomprehensible hallucinations.
I have learned to describe them and thereby make them less threatening. For me, it has been effective to discover the association between psychosis and life history. It diminishes my self-mistrust, because it makes my psychotic experiences understandable.
Here, I come to the end of my story. I didn’t mean to say that abuse always leads to psychosis in the victim, or that all people with psychotic experiences must be victims of abuse. What I wanted to illustrate was that psychosis could at times be an understandable response to trauma and a more likely response than is acknowledged today.
My story is not the only one of its kind. There is evidence that traumatic experiences such as child abuse are associated with psychotic experiences, yet this association is barely recognized in the psychiatric world. There is no routine inventory of traumatic experiences when you enter the world of psychiatry with a psychosis. People who respond psychotically to child abuse cannot count on recognition or adequate help.
I think it is about time we did something about that."