It is my impression that there can be discerned some commonalities in many people’s road to recovery from a psychotic episode. Phases, if you will, or sometimes moments, hence the title of this post. Clearly, there will be many differences among different people, but part of a common trajectory seems to me to proceed roughly like this:
(i) One suddenly or gradually slips into psychosis, up to the point that - (ii) one has lost most contact with reality, i.e. one is ‘properly’ delusional - (iii) then at some point, reality and delusion clash: typically other people, perhaps police or mental health professionals, or friends/family, notice something isn’t quite right. (iv) one gets hospitalized often without insight into the illness at that moment. (v) treatment commences, perhaps involuntarily at first. (vi) one will have to come to terms with the illness, to insight, maybe acceptance etc.
Perhaps I got it all wrong, but I think this is a recognizable path psychotic episodes can take. It seems to me that as long as we can’t prevent (i) and subsequent steps from happening, (iv) differs from the other steps I mentioned in that it is a goal in recovery most can agree on. The steps inbetween, are not necessarily desirable from any perspective I’d think. But perhaps they are necessary, or minimally, just the way things usually go.
Now, I’m interested in (iv), (v), (vi) mostly here. Personally I was never hospitalized and this may have had some benefits in my way to recovery, but may also have had some negative effects. In terms of the sketchy trajectory above, I was never in (iii), i.e., my delusions never really clashed with ordinary reality in the sense that I kept things to myself, was aware that others wouldn’t believe me and thus was careful not to talk about them- although at the time this certainly didn’t mean I was any less sure about these delusions myself.
As such I can relate a lot to psychotic experiences, but am less familiar with the impact of a hospitalization, and the, so I imagine, rather rude awakening to reality that comes with it. I can imagine that, from within a psychotic state, with some or more paranoia added to the mix, the very notion of other people telling you, or as it may feel, even imposing on you this rather radical idea of you being wrong on so many (seemingly) very important things to you - that this is very tough period to go through. And a period that may do some damage in the process of doing good. I am familiar with the pain of realizing I had gone mad, but it is something that was never imposed on me. I cannot help but think of this as a great luck, that has me dodge some bullets along the road to recovery. My treatment only commenced once I had insight, and although I am having some difficulties putting to words exactly why, but I think this has benefited my recovery, mostly in terms of self esteem.
I started to write this post, because I was thinking about the common advice of doing CBT only after medication has been administered. I do wonder whether this is always the optimal course of action. I am inclined to think, that perhaps only for some patients, it would be more beneficial if therapeutic dialogue could get them to insight such that medical treatment commences voluntarily. Perhaps this is tried during a hospitalization already, I am not sure. But maybe more can be done here. As I think involuntary treatment is sometimes necessary, but I feel like it can be such a blow to confidence and maybe trust in others etc.
Any thoughts? (and thanks for reading this far!)