Recently on Twitter, someone who has struggled with psychosis apologized to her family for past behaviors, hoping for forgiveness. Given what we have been through, that tweet stuck with me.
Why would she have to apologize?
Psychosis is a symptom of disease, let’s be clear about that. It is not in someone’s head; it is not caused by demon possession.
It’s triggered by a disruption in the chemicals that control thought. Psychosis can accompany many mental illnesses and some organic ones, or it can result from lack of sleep, extreme stress, or chronic pain. I’ve never experienced psychosis myself, but I supported my wife through several bouts of it. Aside from a terminal illness, I can’t imagine anything more challenging or harrowing.
If you want a better understanding of psychosis, read actress Sarah Wynter’s compelling narrative in Vanity Fair. Anyone who has witnessed it in a loved one immediately identifies with her retelling. Sarah’s paranoia begins with legitimate concerns about the health of her newborn twins in the NICU. She needs to keep them healthy; she needs to keep their environment pristine. But over time, the fears overpower rationale thought, leaving her unable to decipher fantasy from reality. Ultimately, she winds up in a psychiatric ward, blunted and tired from the antipsychotic medication. It takes years for her to achieve full recovery.
Reading her account, everything feels so familiar. Watching a loved one descend into psychosis is gut-wrenchingly sad and upsetting. At times, their behavior can become offensive—loud and aggressive. But I would never blame Ms. Wynter for her behavior, just like I would never blame my wife for hers. And I wouldn’t expect either of them to apologize. We wouldn’t expect a person suffering heart disease to apologize for their chest pains. We’d never ask a friend suffering asthma to excuse themselves for wheezing.
When someone experiences psychosis, they suffer thought disorder, misinterpreting what they hear and read. Usually, this is accompanied by delusions or hallucinations. A delusion is a thought or belief that isn’t grounded in reality, and a hallucination is hearing or seeing things that aren’t actually there. What makes these profoundly difficult is that the person can’t recognize that these are fabrications. As far as they know, their brain is working correctly, just like it always has. The devil really is hiding in the shadows of the room; that voice really is speaking to them.
Stop and think about how frightening this must be. We’ve all relied on our brains since before we can remember. But what if you couldn’t trust it? What if you had to question everything you thought or heard or saw, and you couldn’t tell what was real? Watching my wife—the most grounded person I know—suffer with delusions was terrifying. What’s more, you can’t explain to a psychotic what is transpiring; it’s nearly impossible to communicate with them in an effective way. They’re gone, and all you can do is try to keep them safe and protected.
But that’s not easy. Even though psychosis builds gradually, the final break with reality can be sudden and jarring. In these cases, the sick can quickly become unpredictable. We’ve all read articles about celebrities whose behavior becomes suddenly bizarre, unable to hide their illness with all the cameras around. Back in 2012, a relatively unknown film maker named Jason Russell found himself an overnight celebrity when his documentary went viral. Along with the fame came an incredible amount of criticism, and Jason became overwhelmed by stress and a lack of sleep. Ultimately, he broke from reality, with acute psychosis overtaking all rationale thought.
“This is a black out." -- Foo Fighters
Oprah interviewed Jason and his wife, Danica, after his recovery. His testimony is disturbing; he doesn’t remember much, only snippets and vague memories. He was found on a busy intersection in L.A., completely naked and pounding the cement so violently that he permanently damaged his wedding ring. But Danica’s answers hit just as hard. She was caught completely off guard, scared and in shock. Her first reaction was to protect their young kids, which left Jason free to rage publicly. And with smart phones everywhere, it wasn’t long before videos of his troubled behavior began spreading across the internet. The juxtaposition of the eloquent, personable father in the interview and the screaming, raving lunatic from the YouTube clip is startling.
But that doesn’t mean that Jason should have to say he’s sorry. A psychiatrist once told me that a psychotic break is alike a “heart attack of the brain.” No one that sick should have to apologize, especially when they have no control over their thoughts or behavior. On the contrary, anyone who has lived through psychosis should be shown support and compassion; we should applaud their strength and fortitude.
Journalist Carole Cadwalladr, who interviewed Jason for The Guardian a year after his psychotic break, captured it perfectly when she wrote: