The Many Faces of Psychosis

My attempts at writing lately have not been particularly fruitful, but I have finally gotten some sleep. Unfortunately, the sleep was also accompanied by several intense conversations with my health care team pointing to ongoing psychosis the past few weeks (at least).

When it comes to psychosis I find myself in something of a pickle. I have not been able to tolerate taking an antipsychotic on a daily basis (because of intense side effects like ultra-rapid weight gain and feeling so fatigued and exhausted I can barely move) so my psychiatrist allows me to take it only in times I am experiencing psychosis. It definitely isn’t the sort of thing I would generally expect is a good idea, however my rapid cycling paired with my inability to tolerate the drugs for more than a few days at a time make it more useful than, say, nothing at all. Many times it seems like one or two days are enough to kick the legs out from under the psychosis before my mood cycles away from it.

The biggest hurdle in this method for me has been being able to identify when the psychosis is present on my own. With a good team looking out for me (my boyfriend included) it becomes easier… but even after meeting this “character” (psychosis) on and off for at least the last 50% of my life I have a hard time picking it out of a crowd.

Meeting psychosis when physically ill or on various medications has left memories that were already too fuzzy around the edges to be able to account for an accurate depiction.

Meeting psychosis when manic has been like stumbling upon a huge party where the music and lights are easily drowning out the words and the intentions of the faces I see around me.

Meeting psychosis when in a mixed episode has been like crawling into a crime novel where I don’t know who I can trust, and psychosis might look just as innocent or guilty as anyone else I stumble upon… leaving me with no distinguishing features.

Finally, meeting psychosis when I feel (or think I feel) stable has been the most confusing thing of all. The encounter is totally unexpected, and I find myself quickly trying to write the ensuing conversations and situations off as simple irrational fear or rapid mood swings happening too fast for me to put a defining stamp on them.

The best indicator I have of psychosis is when pieces of my life, pieces of stories don’t line up the way they ought to. When the memories I have don’t correspond with the half dozen other people who were there at the time. When my boyfriend seems to have me caught in a “lie” but as far as I know, I’ve only spoken the truth.

At any rate, I expect to spend the rest of the day on the couch due to the exhaustion I feel from the rispiridone today, but if that is what is necessary to aid in alleviating the confusion, I am ready to do it.


4 responses to “The Many Faces of Psychosis

  1. Just Plain Ol' Vic

    Has your therapist ever discussed utilizing ‘mindfulness’ as a way to better understand triggers and when you may be rapid cycling?

    • Unfortunately I rapid cycle almost constantly (or have been the last 3-4 years) and when I say “rapid cycle” I mean several mood swings in a day or week, not in a year (there just isn’t a good clinical name for that, last I checked). I have been working with therapists for well over five years and the best anyone has been able to do is suggest I avoid triggers at this point because I become triggered so quickly, even with coping skills. I can go from zero to sixty in a matter of seconds, and it can abate just as quickly. It is almost like playing one of those “cup and ball” games, because at any given time it is extremely difficult (even for my healthcare professionals) to know which cup is hiding the ball.

      At this point I am focusing on documentation of the swings, symptoms, and triggers to help identify patterns and allow me to be more insightful into my own symptoms. Having to reflect on my current state has helped me in negotiating identifying these states, however there are times when (like with psychosis) I cannot see it except in hindsight. I have found no shortcuts to know how to discern an experience that feels absolutely real from an experience that feels absolutely real… only the discomfort of conflicting information has left me any clues.

      • Just Plain Ol' Vic

        My wife is a rapid cycler too, so I really understand and empathize with what you are going through. It sounds like you are doing the best you can, which is all you can ever ask of anyone. Take care and if you ever need to chat I am just an email away.

  2. Thanks – that was enlightening to a mom of a teen with bipolar disorder. The only thing that works for him is rispiridone, but he hates it because it makes him tired. And he’s afraid of getting man-boobs!

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