My intention here is to share the experiences that I went through with my son, starting with the first manifestation of his illness and our journey through numerous subsequent episodes. I also provide commentary as a parent and psychiatrist on issues that these experiences bring up, such as how the diagnostic process works in mental health, how to work with treatment providers, and medication issues. I hope this may be helpful for people with mental health issues and also their families and friends.
What Is Psychosis?
Understanding how Bill’s illness unfolded requires understanding psychosis, which developed into a core feature of his illness. Psychosis can be either a temporary state, commonly described as “temporary insanity,” or it can be part of a psychotic disorder, as described in the Diagnostic and Statistical Manual of Mental Health Disorders, the recognized cookbook of the psychiatric profession. Cookbook, because while it does a good job of categorizing and distinguishing different illnesses, it only provides a list of ingredients that make up a particular diagnosis, rather than a deeper understanding of the illness itself. To the person experiencing a psychotic episode, life takes on a different reality and often they have no appreciation for how bizarre some of their ideas are. This is what the mental health field calls failed reality testing.
Psychiatry is constructed around a taxonomy of more than 300 discrete diagnoses, delineated by criteria for the timing, co-occurrence, and severity of symptoms. A particular symptom may be part of multiple classes; for example, depressive symptoms can be part of several disorders, such as major depression, bipolar depression, or PTSD. Two patients with the same symptoms may receive different diagnoses—depending on co-occurrence and timing of other symptoms—and a patient’s primary diagnosis may change over time, as when someone who is first diagnosed with depression may later prove to be bipolar.
The diagnoses Bill received at different times included schizophrenia, schizoaffective disorder—bipolar type, and bipolar type I with psychosis. These bland labels can’t begin to convey what the patient is experiencing: the annihilating dissolution of self, merging with delusions and hallucinations; the havoc wreaked upon the sufferer and those connected to the sufferer.
The Feeling of Deja Vu
Here we go again, I thought. The sleep patterns were altered. The activity seemed much more focused on exercise and Buddhism but also more diffuse. He looked at me as though he was trying to read something from my expression—could I see into him and read his thoughts? The eyes again with that hard-to-describe difference. More intense, staring, frightened, and intimidating. The first psychotic break had some of the same elements.
The next day he didn’t eat dinner but went outside on the patio to exercise. He had cigarettes with him and was smoking one, something very explicitly forbidden. He smoked a cigarette dangling from his lips self-consciously James Dean-style.
I confronted him and he said: “Yes, herbs are cutting through the vessels and reestablishing the blood flow.” He flexed his neck muscles, and clasped his hands in front of him, rotating his shoulders forward. “I’m clocking my grip. It’s an ancient Eastern practice known to mystics.”
I asked what that meant he replied: “Through a redirection of chi flow I can direct the blood from the right side of my body to the left, which is weaker and needs to be re-channeled.” I told him I thought he had begun to get sick again.
He said: “You don’t understand. I’m a big T.”
“What’s that?”
“Big testosterone. Some men concentrate the testosterone in their necks, they think too much and it chokes them off. Black men know how to clock their grip in their abdomen. They don’t worry, they’re in tune with their muscles. I’m a Black Chink. I’m in balance.” He told me that through his new ability to “grow blood,” he had developed into a much faster runner.
“I can run Forest Park in 30 minutes, Mom. If you don’t believe me I’ll show you. Let’s go.”
The Emergency Room, or Not
I briefly contemplated the prospect of taking him to the emergency room that night, dealing with the whole emergency room scene, the long wait, the obligatory screening, then the evaluation by a resident, and then the possibility of being told that nothing was wrong, just like last time. Before, when I had taken him to the emergency room they stated that he was a sociopath.
Should I have taken him? I think the answer would have been yes if I wasn’t able to evaluate the situation to make sure that he was safe. In general, I would advocate for getting a family member to an emergency room evaluation if they discuss suicide or any wish to harm themselves; they need to be evaluated for potential hospital admission to keep them safe. If there is a suspicion that they may be hearing voices, are becoming more agitated, or other symptoms of worsening psychosis it is also wise to get an evaluation to determine the underlying cause and to make sure they get appropriate treatment.
Psychosis Essential Reads
For me, it was a fraught situation. It would have been great to have an independent, neutral evaluation and not to have to take upon myself the psychiatric task of deciding for my son to wait. However, given my psychiatric knowledge and training, it was evident that Bill was not in immediate danger and I didn’t want to put him and myself into an unnecessary ER evaluation. I decided to wait until morning.
