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A quarterly international literary journal

10 Things to Know About Living Through Psychosis

/ Nonfiction /

1. What It’s Like

About a month ago (or maybe six weeks ago, I’m not sure, time has been acting funny lately) I relapsed into a psychotic episode. Technically, when I called my therapist in hysterical tears for an emergency phone session the morning after it happened, he said it could have been psychosis but might have been hypo-mania, but I didn’t pay attention to that at the time, because I have been here before, and it didn’t matter to me what my mental state was called by my doctors because I knew I’d been dropped into the same deep waters that I found during the lengthy psychotic episode I experienced in 2014. I was once again insane, my greatest fear of the past eight years realized, hell reaching up to snatch at my petticoats and heels as I tried to scramble back from the edge.

In 2014, in the hospital in North Carolina that held me captive for nearly three weeks, that refused to release me no matter how hard I begged or fought, my mind cycled through delusions triggered by anything anyone said to me, any media I consumed, any view I glanced towards. Even though I remained aware I was crazy (difficult to be unaware of such a fact when you’re in the locked ward), each delusion gripped me with certainty until the next one hit. One of these delusions was triggered by looking at the single-serving packet of fake butter that went with the hospital breakfast, the top of which was labeled ‘TRANS’ in big letters. (Or did I only imagine the letters to be so big?) This plastic cup of butter seemed to be a message to me (from whom?), and the message was that I was secretly transgender, and had been this whole time. When I looked back at my life, this seemed like the last piece of a puzzle, a puzzle I had been torturing myself over for weeks (why was I like this, why was my brain like this, why had it gotten to be so bad that I couldn’t leave the hospital), the piece that could explain everything.

But this was in 2014, when I still thought of myself as a (staunchly feminist) woman, and to realize that I was so insane I was seeing proofs for my identity in butter cup lids sent waves of fresh horror through me. That delusion evaporated like toxic fog, to be replaced by the horror, to be replaced by a different delusional cycle triggered by something else innocuous, repeat ad nauseum for months. So many of my memories of that hospitalization experience are gone (or at least, I thought they were, until about a month ago), but the butter cup lid one stayed with me because it was so embarrassing. I never told anyone about it. It would be five long years before I began my tentative steps towards transitioning to male.

You can imagine (or maybe you can’t! I don’t really know what you can or can’t imagine; I only know what my frequently-hellish brain is capable of doing to me) the kind of ammunition such an experience gave to the voices of gender dysphoria in my brain. My dysphoria has always been rooted in self-doubt that tries to metastasize into self-abnegation, rather than any signals that I might have read as physical sensations. So when you have experienced your fevered brain warp reality to tell you that you’re transgender because of a butter cup lid, how do you ever know that you’re really trans, and not just (still? always?) crazy? You can’t know, you can’t ever know for sure. I’ve been on Testosterone for two and a half years, I’ve had surgery to remove my breasts, I’ve changed my name, and still I doubt myself. What if I find out in the future that my whole transition up till now has been one long delusion? What if the spell breaks and I learn that the whole world has been keeping a secret from me, the secret being that I was really a girl this whole time? What if that happens and then They decide to take my gender away from me, the one I’ve fought and clawed the world for, the one I’ve fought and clawed my self for, the one I’ve loved and nurtured and leaned into and built my life around, what if they take it from me, what if I turn into my own worst enemy and take it from myself, oh god oh god oh -

2. How it happened, as best I can recall

I watch a lot of leftist Youtube. And after Russia invaded Ukraine at the end of February, while I was doing my best to support my Polish wife who was enraged by the invasion and frantic with fear for her Ukrainian friends (not to mention the safety of her own family and friends in Warsaw), I started doing my own research into Putin, Ukraine, and the history of the region. All the media I was consuming had to do with Russia in some way; I was reading a book (the excellent The Future Is History by Masha Gessen, which I highly recommend even though I have not yet been able to finish it due to my mental state) that outlined the terrifying philosophy that helped Putin remain in power, and went into detail about how this philosophy explicitly called for genocide of Polish people, not to mention queer people. The more I read, the more viscerally disturbed I became. It did not feel like I was reading about events happening far away, unattached to me. It felt like it was happening inside my home, like my own life and my own family were being directly threatened.

My wife was worried about me, and I was worried about me. I could tell I was going past pissed off and into unhinged territory. I would find myself trembling after getting into arguments on Twitter, and I could tell that I needed to cool off, that I was in danger of burning out. One night, to relax, I turned on a YouTube video with a nice uplifting title, one that I thought might take me down from my rage cliff and into a calmer, peaceful state where I could still care about the world but wouldn’t take it all so personally.

Instead I fell down an online rabbit hole, found myself twitching in addition to the trembling, and barely slept that night. In the morning I woke up hours before my alarm, and when my wife got out of bed a few hours later, she was even more worried about me when she found that I had been sitting in the same spot on our couch, backreading the Twitter feed for the YouTuber that had led me down the rabbit hole, since just after dawn. I tried to reassure her that I was fine, I was just figuring out something that I couldn’t put into words because she hadn’t seen the video, but then I became worried by how worried she clearly was. I didn’t want to add to her stress. I followed her advice and called in sick to work, and tried to do the things I usually do to care for my mental health. I took our dog for a walk (but had another video from the same YouTuber on in the background while I did). I took our dog for a second walk in the afternoon, but the podcast I listened to seemed to be alluding to the same secret information that the YouTuber had also been alluding to. I was confused, I was upset, but I still didn’t think I was in the middle of a psychotic relapse.

In the evening, I walked to the Brooklyn Pride Center (while listening to further podcasts, which further confused and alarmed me) to attend a support group for the Trans and Gender-Nonconforming community. I didn’t think this was a bad idea. I thought support was exactly what I needed.

But by the time I arrived at the support group, my perception of reality had tilted. Instead of natural conversation flowing around me, instead it seemed like everyone in the room was following some secret script, talking in subtextual phrases around me (and about me) whose true meaning seemed buried beneath layers of implications and hints. My confusion turned into paranoia within minutes. When the subject of public health resources came up in group, I could not keep my body from going rigid. My heart was racing. I fought myself to stay in the room rather than bolting for the door. I did manage to stay for the length of the meeting, but suddenly everything was pulling me back to

3. Every bad thing that has ever happened to me

And some things that never have.

4. What happened in 2014

It’s none of your business really, and how I resent the pressure placed upon marginalized writers to display our traumas like shiny pebbles, but the key takeaway is that up until experiencing a PTSD flashback (which was no one’s fault, I wouldn’t have gone to that meeting if I’d realized I was already in an episode) at my support group, I didn’t think I had PTSD triggers around my hospitalization experience. I thought that because I could watch movie scenes that took place in mental hospitals without being triggered, that the trauma from being held against my will must not have been that deep. Then I got triggered for real, and realized that I’d never before experienced anything like that, nothing that made me have to fight so hard to remain in the present, to stay seated rather than fleeing for my life, because I was back in 2014 and terrified that the seemingly supportive people around me were going to escort me to the nearest emergency room for what (in my delusional state, in 2014) I had thought was going to be a quick check-up but turned into a weeks-long involuntary commitment.

In January 2022 if you’d asked me which I was more scared of: going psychotic again, or being held overnight in the hospital again? Like most sane people, I would have said the first. But now that I have lived through (and am still living through) the first of these options for a second time, it scares me less than it did at the beginning of the year. But my terror of hospitalization, the medical trauma inked into my skin, remains fully intact.

5. I do not believe in incarcerating human beings.

Why write about this now, and not several months (at least) from now, when I know I’ll be more stable and have more distance from the situation? The passage of time can be good for everyone but in particular for writers, giving us clarity on an event that we couldn’t have captured with the same perspective if we’d dashed something off on the day it happened. It’s entirely possible that six months, a year, two years from now, I will view this period of my mental health in an entirely different light. I have written about my experiences with psychosis before, and even though back then I waited months before putting pen to paper, in the years after the piece was published I often wished that I had waited even longer to write something so personal. Sometimes I wished that I had never published that essay at all.

So why now, why this? That old essay of mine hardly went viral, but a friend of a friend told me once that after they read it, they had a better sense of how to help someone in their life who went through a psychotic break. This was one of the most powerful pieces of feedback I’d ever received. Between the post-crisis urge to be understood by the world, and the possibility that anything I write might help anyone understand crazy people a little bit better, I have two powerful motivations to write about this here, now.

6. Brushing against the edge

One of my most vivid memories of 2014 (for most of my waking hours I am content to let that year remain a blur) happened a few months after I was released from the hospital. It was a summer day, sunny, warm. I was walking with a friend through downtown Chapel Hill, where the main street of eateries and bars that border the University meets the homeless shelter a block away. As typically happened on lovely weather days, unhoused people were hanging out around outside the shelter, sitting on walls, chatting with each other as my friend and I walked past them to get to our destination.

I spotted a woman I recognized sitting on one of those walls. She was skinny, with long blonde hair, clothes that gave off an odor. I recognized her from the therapy groups that I had attended within the psych ward. I remembered that while I, and some others, had been desperate to get out of the hospital and couldn’t wait to escape, she had been through the locked ward several times. The hospital staff seemed to know her, almost expecting that she would be back. We had been in there together, long enough for her face to imprint in my mind. Of course I didn’t remember her name, and she seemed to take no notice of me. My friend and I walked past, our day uninterrupted. I will never forget this.

7. I don’t believe in policing language around my own identity as the most effective form of activism because I still need words to describe the world

As I have returned to work and to the routines of my daily life, the war in Ukraine has continued. In my home state of Utah, one of the places where my wife and I are considering starting a family someday, the state legislature passed an outrageously broad ban on transgender youth playing in sports. The law that ended up passing was so egregious and hateful that the Republican governor vetoed it, writing a twitter thread and an emotional letter explaining why he had vetoed such a hateful bill (it will not only provoke hatred within the state against a specific group, but also, by virtue of being hastily written and shoved through undemocratically, will negatively impact high school organizations of all stripes throughout the state) and essentially begging the state legislature not to override it, which of course they did regardless. So many of the news items and think pieces and deluded commentary that I see around me every day are so personally upsetting.

When I start getting anxious and need reassurance, when I start slipping from rational grief over the state of the world and into egocentric paranoia, I often ask my wife, “It’s not just me, right? It’s the world that’s crazy now, isn’t it?” She firmly tells me that the world is indeed crazy right now.

8. The year is 2022, I have a wonderful support system in place, and I did not have to be hospitalized in order to survive this round of psychosis

I am very grateful, and lucky, and humbled by this.

9. The dub side of psychosis

Is feeling the interconnectedness of all people and all things, wherever you go. It has been a magical few weeks, filled with indescribable experiences and moments of beautiful connection between myself and nature, art, and other human beings. After the first bad few days of acute psychosis when I couldn’t leave our apartment, my new medication regimen kicked in, and I was walking around empowered and creative and smiling at everyone, even on rainy days. I felt the kind of wild love and invincibility that I always seek to embrace in the spring. (My hospitalization in 2014 took place in April.)

I have been discussing this aspect of my mental illness, the precious and psychedelic part, with my therapist and other mentor figures in my life. One of my mentors gave me the most beautiful metaphor to make sense of my mental illness, while also letting me know that it is likely I will experience PTSD-triggered psychosis again in my life. (Three out of ten people who experience a first episode of psychosis will experience a second episode within a year; eight out of ten people will relapse within five years.) My therapist told me that the Buddhist/mindfulness way of thinking (mindfulness has been an important component of my therapy) teaches us to notice and appreciate the interconnectedness of all life on our planet, and that it only begins to shift into psychosis when the ego gets involved, when that noticing shifts into the paranoia of ‘wait, is all this interconnectedness I’m noticing about me somehow?’

My moods have been evening out in the past two weeks. Life is starting to feel less magical, less intense, and even though a part of me will always yearn to feel that magic all the time, it’s better for my overall mental health to come down from it. But I am learning how to access that magical feeling when I need it, and I am also learning how to access it without taking any substances or messing up my medication schedule. For me, this is a victory.

10. German words

In the earliest phase of this latest round of psychosis, that week when I was always close to tears and could only focus on certain media (and playing puzzles and sometimes video games) because anything else triggered my anxiety to defcon levels, I was cuddled on the couch with my wife watching a sitcom. A thought occurred to me, and I perked up. When she asked me what I was smiling about, I said,

“I just realized, that if the world is crazy and not just me, that means that all the people I dislike are getting to experience a tiny slice of the hell I’ve gone through. All my enemies get a taste!” She laughed, a bit nervously I thought, and I immediately got worried. “Does that make me a bad person?”

“No,” she said, stroking my hair and pulling me closer. “It makes you human.”


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