Neuroplasticity III: Trusting Myself after Psychosis & Jail

In NAMI’s Fall 2020 issue of the Advocate, I told my story of experiencing delirium and psychosis for over a year and then finding myself incarcerated in a small county jail. While recovering from psychosis, I relied on the principles of neuroplasticity — my brain’s ability to adapt and change its neural wiring — to survive.

The following spring, I wrote a NAMI blog post detailing the realities I faced after I was released from jail and embarking on the early steps of psychosocial recovery. While the process of using neuroplasticity to fully recover from these events is not over, I am reaching one of the final stages: learning to trust myself.

My Situation

It was months after my release from jail on bail before I finally learned of the charges against me. I was horrified to discover that there were three pending misdemeanors and 14 pending felony charges. This meant I was looking at four to five years in the state prison for women — or at least the same time in the state forensic hospital.

Ironically, I had more than two decades of experience as a forensic psychiatrist, and I had worked in both places, doing research, giving lectures and providing consultations with the University of Washington’s Department of Psychiatry. I knew I shouldn’t be going back to either place as either an inmate or patient. But until some of my cognitive abilities returned, I couldn’t articulate my reasoning: our criminal justice system is based on the premise of individuals being able to form guilty intent when the alleged crime occurs.

I was so ill, as both my behavior and reasoning behind my behavior demonstrated, I could not have possibly formed intent to commit a crime. To plead guilty to even a misdemeanor, as I was being pressured to do, would undercut the foundations of the rights of everyone — regardless of their mental health status. But could I trust myself to make this argument? Could I trust the decisions I was making? This was a critical decision, and I had no room for error. Undoubtedly, my life going forward was going to be profoundly affected by what had happened. How could I trust that I was now able to make crucial decisions that were in my best interest?

Trusting Myself

I felt trapped in self-doubt; I was spending all my available time and resources questioning whether I could make sound decisions. I needed more information. What made it so easy to accept self-doubt? How could I counter self-doubt when I found myself paralyzed by it?

It helped to realize some factors that caused mistrust of myself:

1. My current social, religious and professional isolation. Historically, connection with people had been a source of validation and confidence in my abilities.
2. The looks of shock, disbelief and fear on the faces of my new psychiatrist and new Rabbi as I told them of my journey.
3. Family members expressing their concern by providing their own diagnosis, assessment and treatment plans that missed the underlying cause of my illness.
4. Bias from the criminal justice system that assumed I was resistant to care, despite never being offered care except in a jail setting. The people in the system could not see that I was profoundly grateful to be well again and actively wanted care so I could recover from all that had happened and remain well.
5. I lacked a model — a person I knew who had experienced psychosis and incarceration — that I could emulate.

I felt so battered by the actions and opinions of others, it became clear that trusting myself had to come from within. This was not something that someone else could give me. I would need to find my voice and, in time, learn to value it. It is true that parts of my story are shocking and sometimes evoke fear. It is also true that portions of my story are now over — people may be hearing about it for the first time and feel shocked, but I have moved on from these events. Someone’s reaction to a past event really ought not influence the decisions I make today.

Dealing with the Legal System

The ultimate test in self-trust was deciding what to do while experiencing inherent bias from those in the criminal justice system — from my private attorney to the prosecution to the judge. They believed I would lie if I became ill again. I hid my annoyance and pointed out that their hypothetical was a no-win scenario for me. Either I was sick and “admitted it” or I was sick and lied about it. I was not allowed to be well and telling the truth. I told the court that I was more interested in a health-based approach to my recovery rather than the presumption of illness and deceit.

The court’s conditions for dismissal of the pending charges were based on a punitive approach should I become ill again. My physician was required to agree to “report” me to the court if I became ill again, regardless of severity or treatment compliance. And the court reserved the right to immediately reincarcerate me if I became ill again — not to help me or allow me to seek care in a psychiatric facility.

I was incentivized to sign the conditions for dismissal: the prosecution would consider ending the agreement after only one year. I decided to trust myself; to trust that I was invested in my care and recovery and could face the challenges of meeting the conditions. I established care as soon as possible. At my 12-month review, despite meeting all conditions for dismissal and having established a Mental Health Advance Directive should I become ill again, the conditions continued for another 12 months. Eventually, though, all the charges were dismissed. &

Neuroplasticity helped me find calm in the decisions that I was making. It was profoundly helpful to learn about the pathways of self-trust in both general and specific terms. Replaying past sound, important decisions also helped — but only after I paused to consider how I could build new neural networking around the critical issue of self-trust.

Dr. Victoria Harris is now a retired forensic psychiatrist, with a background in family practice from Canada. She is honored to be the Washington State Representative to NAMI’s Peer Leadership Council and serves on the NAMI Washington Board. Dr. Harris was recently elected to the NAMI National Board of Directors and has been appointed Chair of the newly formed Justice Workgroup. Importantly, her young adult children have established their own orbits about the earth, and Victoria loves to walk the trails in eastern Washington with her dog.