Responding to Bipolar Psychotic Symptoms

A first experience with psychosis can be terrifying, exhilarating, disorienting or feel just plain ordinary. Sometimes it can seem ordinary because it was your reality for a while. Your senses and brain colluded to fabricate something that wasn’t actually there. It certainly felt real, though.

For example, during my first psychotic break, it felt as though my cognitive abilities had reduced to that of a toddler. I couldn’t understand what people said to me, and I couldn’t talk. It felt like I had lost my ability to process language. I locked myself in my bedroom for 48 hours and used a coloring book I had; I did this because it comforted me, and it was also the only thing I could focus on or understand. I had no sense of time—many hours would pass, and I thought it had only been a few minutes. I didn’t eat during this time, and it never occurred to me that I should eat or that I was even hungry.

Now that I have more experience managing my illness (bipolar disorder with a psychotic feature), I can look back on this experience and understand it. At the time, though, I didn’t understand anything was wrong, and even if I had, I lacked the language to communicate what I was experiencing. This was because I was not educated about psychosis—even if I understood the situation was odd, I would not have known exactly what it meant. 

Accepting a Complex Condition

The scary part of psychosis is usually the aftermath, when you realize what happened. When you first experience it, you may remember stigmatizing jokes about “crazy people” you’ve heard or news stories of violent, “psychotic” people. But the reality is more complex, and a little more painful than all that. The reality is that you are just a human being—a beautiful one, who also happens to have a mental illness.

This can be painful to accept, and there is a certain grief in admitting we don’t always have control of ourselves. However, effective treatment is available, and over time we may come to recognize the warning signs of an episode. During these signs, we may learn how to intervene for ourselves.

For example, I have many (now) predictable warning signs. I may become clumsy, lack spatial awareness and feel as though I don’t know where I am. I could become lost in a place I have been in hundreds, or even thousands, of times. I can become paranoid someone is in my house, when I know no one is. Even the sensation of sound seems to ebb and flow—seeming at first inaudible, then unbearably loud. It feels like I am drunk, when I am perfectly sober. 

As you learn how to manage your own illness, you might start noticing your set of symptoms. It can be scary to realize that you are headed for a psychotic break, but it is possible to do things that lessen the severity of, or even avert, psychosis. It’s like using an inhaler when your breath becomes heavy, rather than waiting to go to the ER with an asthma attack.

It’s not always that simple, but learning to respond effectively and without fear offers us some of the dignity we sometimes feel we lack. It empowers us to realize that we can confront this medical issue like any other—without shame. Here are some practical ways to incorporate safeguards into your own life: 

1. Notice your condition’s patterns. How does psychosis manifest in your life?
    
2. Tell somebody. Develop spaces in your close relationships for the ability to say you are slipping into a psychotic episode or that things don’t seem quite right. If it feels safer, develop a code for talking about it in public.
    
3. Take medication. Establish in advance with your doctor what medication you can take. You might be able to have an as-needed medication, or agree with your doctor to take a daily, maintenance medication.
    
4. Call your doctor. They are there to help. If you are afraid of hospitalization, realize that this is not always the outcome of telling your doctor about psychosis. I’ve experienced psychosis as an aspect of my illness for seven years and only been in the hospital once for it; and even then, it was my choice.
    
5. Absolutely avoid alcohol. This is generally wise with mental illness, but critical in regards to possible psychosis.
    
6. Know your potential hazards and act accordingly. If you experience “black outs” (dissociative amnesia), try not to drive. Ask a friend for a ride, instead. It is possible to lose total awareness of what you are doing while driving.
    
7. Get sleep. Sleep deprivation is a trigger for psychosis, and quality sleep can help abate active symptoms.
    
8. Develop routines around sleep, eating, medications and social time. It may seem overly strict, but it can go a long way towards preventing future episodes. For instance, I don’t answer the phone before nine in the morning, and I limit social time at night to get enough sleep.
    
9. Watch something that can keep you grounded. Like your favorite movie or television show—even if you watch it on repeat! Something about the familiarity can help if you are having trouble focusing.
    
10. Have a sense of humor. And finally, if you do hear voices or hide in a parking lot from the police or imagine yourself to be like Winnie the Pooh because you’ve just realized your head is made of fluff (all experiences I’ve had), learn to laugh at yourself! After all, you were Winnie the Pooh for a day.

Amy Willer is an advocate, writer, volunteer, friend and community member with bipolar I with psychotic feature and PTSD. She has survived suicide attempts twice and has overcome addictions to self-injury and anorexia. She lives in southern Arizona, and loves hiking and spending time with her friends.

Note: This piece was originally published in April 2017. 

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