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Psychosis

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Trigger Warning

This article goes in depth on my experience with having a secondary psychosis. My psychosis lasted roughly two months from October 2020 to December 2020.

I would like to advise that I am not a licensed psychiatrist nor a medical professional. I am simply writing about my point of view as someone who went through a psychosis.

This article may be triggering for people who have gone through similar conditions.

Why am I writing about this?

Having a psychosis was the most defining and life altering moment for me. It not only affected myself, but a lot of people around me as well. My closest friends, parents (especially my mom), practically saved my life through outpatient care, and the amount of knowledge I've gained about mental health, understanding my limits, and the dangers of personal neglect have been substantial.

I've been open with so many people about my psychosis ever since I regained confidence and clarity, and I want to enlighten others with knowledge about psychosis. Psychosis was the scariest thing that I've ever went through, and I want to provide a story that people can empathize with so they don't have to endure what I or my close friends and family went through as a result.

Defining Psychosis

A psychosis is when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions).

Secondary Psychosis

A secondary psychosis is a psychosis that stems from something else other than having a primary psychotic illness such as schizophrenia or bipolar disorder. Secondary psychosis' primarily stem from things like drug abuse, stress, lack of sleep, or other medical conditions. This is the type of psychosis that I had, and was a culmination of numerous factors.

Phases of Psychosis

Prodromal Phase

The prodromal phase is the period during which the individual is experiencing changes in feelings, thought, perceptions and behavior although they have not yet started experiencing clear psychotic symptoms such as hallucinations, delusions or thought disorder. Depending on the type of psychotic condition, the prodrome may or may not be apparent.

Changes in this phase vary from person to person and some people may not experience a prodromal phase. The duration of this phase is also quite variable, although it is usually over several months. In general, the prodrome is fluctuating and fluid, with symptoms gradually appearing and shifting over time. Some prodromal signs and symptoms include:

Changes in Affect: Feelings of vague suspiciousness, depression, anxiety, tension, irritability, anger or mood swings.

Changes in Cognition (Thinking): Difficulty in concentration and memory, thoughts feel slowed down or sped up, odd ideas, vague speech.

Changes in Sense of Self, Others or the World: Feeling somehow different from others or that things in the environment may seem changed.

Physical and Perceptual Changes: Sleep disturbances, appetite changes, bodily complaints, loss of energy or motivation and perceptual aberrations.

Family and friends may notice when: A person's behaviour changes, their studies or work deteriorate, they become more withdrawn or isolated, they are no longer interested in socializing or they become less active.

Clearly, these changes are non-specific and can result from a number of psychosocial difficulties, physical disorders and psychiatric disorders

Acute Phase

During this period, which will usually continue until appropriate treatment is initiated, the typical psychotic symptoms occur. This includes positive symptoms such as thought disorder, delusions and hallucinations. Hallucinations are sensory perceptions in the absence of an external stimulus. The most common type is auditory hallucinations or hearing voices. Other types of hallucinations include visual, tactile, gustatory and olfactory. These are less common and an organic cause may be evident in these situations. Delusions are fixed, false beliefs out of keeping with the person's cultural environment. They may be sustained despite proof to the contrary. These beliefs are often idiosyncratic and very significant to the individual but hard for other people to understand. Delusions often gradually build up in intensity, being more open to challenge in the initial stages, before becoming more entrenched. They can take many forms.

Common types of delusions include:

  • persecutory delusions,
  • religious delusions,
  • grandiose delusions,
  • delusions of reference or that certain comments or other are cues are specifically directed towards oneself,
  • bodily or somatic delusions, and
  • passivity experiences such as thought insertion/broadcasting/withdrawal.

Thought disorder refers to a pattern of vague or disorganised thinking which may appear illogical. The person with thought disorder may find it hard to express themselves. Their speech seems disjointed and hard to follow. The person's information processing is impaired. Changes in cognition may impair insight and judgement. The individual experiencing psychosis may not be able to recognize that something is seriously wrong.

While these symptoms are definitive of psychosis, disturbances of mood, behaviour, sleep pattern and activity also occur.

Many individuals with an underlying psychological/psychiatric disorder will initially present with physical symptoms that concern them, such as tiredness, repeated headaches or insomnia.

An underlying psychological disturbance should always be considered in an individual presenting with persistent or ill-defined somatic complaints in the absence of demonstrable physical pathology on examination or investigation.

The way an individual may present in this 'active' phase is quite variable. The commonly described scenario of the disturbed psychotic individual is only one possible mode of (usually late) presentation. Just as common is the more 'quietly' psychotic individual who is gradually slipping backwards, losing their place in society and dismissed as being just odd. In fact, negative symptoms such as decreased motivation, energy and interest, blunted affect and a decrease in the richness of inner mental life are common in the acute phase. These symptoms may simply be regarded as indicative of depression thereby increasing the duration of improperly treated psychoses.

Recovery Phase

With available treatments, the great majority of people recover well or fully from their initial episode of psychosis.

The recovery process is dynamic, affected by a number of interacting factors. These include the treatment environment, medication and psychological therapies, factors within the person and factors within the person's family and social environment. The recovery process will vary from person to person and take different lengths of time for each person.

Specific issues to be dealt with in the recovery phase include helping the person and family make sense of the illness experience and see the need for treatment and helping the person to re-establish a confident sense of themselves, which will allow them to return to their premorbid level of functioning. Problems such as post-psychotic depression, anxiety disorders, altered sense of self, loss of confidence and social withdrawal need to be addressed directly in a preventive manner. Assistance with housing, employment and study may also be required.

To achieve maximum recovery, a supportive and collaborative approach to the person and their family, use of a range of specialist treatments and a comprehensive biopsychosocial approach is essential. All interventions should commence from the time of initial presentation and diagnosis. Medication is usually continued for at least twelve months after a first episode and then slowly discontinued while the individual continues to be monitored.

Following recovery from a first episode, a significant number of people will never experience a recurrence of psychosis. Others will develop recurring episodes of psychosis, but be relatively well in between and continue a productive life especially if they continue on maintenance medication. During the recovery phase, a discussion of these possibilities needs to occur and the person and their family should be provided with information about the risk of relapse. Guidelines for recognizing and seeking treatment for relapses at the earliest possible stage should also be provided as part of the general focus on individual and family psychoeducation. Definitive prognosis is not possible. The number of people who develop significant disability from a first episode is small

My experience

My prodromal phase

I don't necessarily know when the first phase of my psychosis started. Looking back, I remember during the summer of 2020 as a time period where I was having thoughts and ideas that seemed to be legitimate and valid at the time, but in retrospect weren't at all. I assume that was my Prodromal phase.

In the summer of 2020 I was working as a pizza delivery driver for Nino's Pizza in Hamburg, NY, and doing a Technical Program Management Internship at ACV Auctions. Due to the coronavirus pandemic and other struggles with my mental health, I had failed two classes during the spring semester. This would cause me to have to take 20 credits in the Fall 2020 semester and 16 in the Spring 2021 semester if I wanted to graduate on time.

I was super stressed out over the fact that there was a possibility I wouldn't graduate on time, and that I had to work two jobs just to make ends meet again. In retrospect what I should have done was just taken the summer off and collected unemployment as soon as possible. I had friends that were sitting at home doing nothing and make 2-3 times as much as I was. There would be times that I'd be on pizza delivery and I'd believe that black SUVs are following me. Looking back I don't even know if this was something I actually saw, or I just had an extremely irrational fear of black SUVs and saw them more often because I was driving around a lot.

I felt like I wasn't doing much at my internship during the summer of 2020, because I really struggled as a Technical Program Manager (TPM). I was having a hard time adjusting from a software engineer who is strictly in the lower level and technical aspects of a problem, as opposed to seeing things from a high level. The project I was leading felt like it had good direction, and I had built an amazing relationship with my mentor and manager Wesley Csendom but I became frustrated because I couldn't get things off the ground on my own. I was striving to be a guy that could do everything at once, as opposed to just being a good TPM.

This attitude of trying to do everything concurrently is an unhealthy habit I had developed since an adolescent. I've always wanted to hustle and get things done as soon as possible and make as much money as possible. My father worked anywhere from 60-80 hours a week at his job, and my mom worked 2 jobs herself. I saw them work really hard, so inevitably I wanted to work hard. It wasn't because they pressured me to, I just loved working, making money, making an impact, and building things. All of those things remain true today.

It got to a point where I would start to lash out at people at my pizza delivery job, argue with customers, get angry with my family members, skip meals, and stay up late. My solution was to drink 2 Bang energy drinks every day (600mg of caffeine total) in order to get up to speed each day. I felt like shit constantly, and that's ultimately what started the first onset of my psychosis, and transitioned me out of the prodromal phase and into the acute phase.

My acute phase

I started showing symptoms of a first onset secondary psychosis when I started to really get stressed out during the fall 2020 semester. I was taking 20 credits, trying to start my own company, Open Beats, and was also doing consulting work for a few small businesses in website design so I wouldn't have to work a regular job.

The courses I were taking are as follows:

  • MTH 411 - Probability Theory, 4 credits
  • MTH 309 - Linear Algebra, 4 credits
  • CSE 442 - Software Engineering, 4 credits
  • CSE 421 - Operating Systems, 3 credits
  • CSE 368 - Artificial Intelligence, 4 credits
  • UBC 399 - Capstone, 1 credit

All of this while trying to figure out how to write code for a software startup, consulting, and having a social life was just too much for me. It became another vicious cycle of staying up late, acute stress (to the point that I would get headaches), mixed with a lot of depressive episodes that brought me back down. My brain couldn't keep up with the up and down cycle that it was going through and eventually decided to shut off. The final straw was when I stayed up for over 100 hours straight. I don't know why I did that. In retrospect, I would have been more efficient if I had just went to bed. I felt like I was racing someone--like I was constantly trying to be the best and fastest at whatever it was that I was doing at the time. That's not a healthy balance, it's not the way things are done efficiently.

Proper sleep and nutrition are required for optimal performance whether you're an athlete, programmer, musician, whoever.

The way I see it is that your ability to tackle the day is completely determined by how hard you plan for it, and how well you establish your "baseline."

Your baseline is a collection of things to do on a check list that we sometimes forget about, but are so important to making us feel better every day. Sleep, nutrition, hygiene, exercise, spending time with family and friends, taking time for yourself, etc. Whatever your "baseline" is, it's important to hit those milestones everyday so you can feel good about yourself and continue on with the rest of the day. The baseline can be seen as the foundation of a house. If you want to build a mansion, or some other large structure, you have to build that solid foundation so you can whether storms, and other challenges that might be thrown your way like maintenance, and intruders (negative thoughts). Plus, what sense does it make to start doing renovations on a house with a moldy and unstable foundation?

As time went on I had less of a desire to work on school, and more of a desire to work on Open Beats. Although that still maintains true today, I've decided to take an extra semester

I won't dive super deep into the hallucinations and delusions that I had, mainly because I think that's a little too personal, and there were a lot of them. The biggest thing I remember from being in the acute phase of psychosis was an extreme and irrational fear of people talking about me, looking, at me, recording me, and ironically technology. I partly blame that on the fact that I watched a documentary called The Social Dilemma which really freaked me out and convinced me that technology was bad. This made me cut off all communication with people and nobody really knew I was going through something because of it.

My recovery phase

My recovery started with my mother, Annette. She quit her two jobs during a pandemic to live with me, listen to me, schedule my doctors appointments, and feed me when I was at my lowest point. Without her, I don't know how long it would have taken for me to regain clarity.

I would say I started to regain clarity in late December 2020, but with that came an extreme depression and sometimes even suicidal thoughts. There were a lot of things that contributed to my depression.

Due to the fact that I wasn't going to graduate "on time" with some of my friends, I viewed myself as a failure. Taking into account everything that happened to me, I felt so foolish for letting it get to the point of psychosis. I thought to myself "how could I be so negligent." All of my confidence had shattered, and I had gained a lot of weight in a short time, and I wasn't able to go to the gym because of the pandemic.

I'm blessed to have close friends and family who helped me get through it and were there for me when I needed them most. Those people know who they are, and some of them even work on Open Beats with me.

My recovery wouldn't have been possible or nearly as quick without the help from the Prentice Family Foundation. Without their support, who knows if I'd even be in school again. I wasn't expecting to have to take courses over the breaks and even in the fall and spring again, so I was blessed to not have to worry about the cost of attendance and my status with the WNY Prosperity Fellowship.

Beyond psychosis

When I got furloughed from my job as a result of the pandemic, my father helped me file for unemployment during my psychosis. I was able to collect 500 dollars a month which I later rolled into NVDA stock options (calls), and helped pay off some of my tuition. I also got a new lease, and upgraded my laptop.

I've also started a company called Emerald LLC where we engage on software consulting contracts with businesses and other organizations. I've decided to pick up Open Beats again, and we're planning to launch our Minimum Viable Product (MVP) in late January.

On top of that I took summer courses to catch up, worked at Walmart Labs as a Software Engineer Intern, and am currently doing the same for a company called Verivend.

I started going on dates again, and found an amazing girlfriend who supports me, Rachel.

Things have been going well for the most part, and I try not to let my psychosis define me, even though it was the most life defining moment for me.

I wouldn't change anything that happened to me, because I've been blessed in more ways than I can count since then, but let this just be a reminder to take care of yourself because the world is already harsh enough as it is. As I go through my day to day life I make sure to take more breaks and I've found a healthy outlet to relieve stress in DJing.

-Ryan