What is it Like to Experience a First Crisis in Psychosis?

Study explores the emotional and embodied experience of individuals undergoing a first crisis in psychosis.

Micah Ingle, MA
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A recent study in Qualitative Research in Psychology seeks to expand our understanding of what it is like to experience a first crisis in psychosis. The authors use qualitative interviewing methods to understand the experience in its embodied and emotional elements, moving away from a strictly neurobiological disease model. The data is also considered for how it can inform responsible, effective treatment for individuals in crisis.

“A survivor discourse has emerged and has begun to challenge the ‘psychopathology’ of breakdown and crisis. First-person accounts of psychosis as well as phenomenologically-oriented and survivor research continue to support this shift towards recovery-oriented and person-centred practice and research in the field, which is echoed in a renewed acknowledgment of the importance of emotional experience after a period of neglect, where symptom-oriented pharmacological and cognitive-behavioral approaches to treatment were favored,” write Sarah Bögle and co-author Dr. Zoë Boden.

Photo Credit: Pixabay

Coinciding with an increased interest in the psychological aspects of psychosis, as opposed to the merely biological, many researchers have turned to explore the phenomenon as it is experienced.

Although there is a long history of psychologists attempting to understand the experience of psychosis, modern researchers are still working on mapping its personal, thematic elements using in-depth descriptive interviewing methods. This can be linked to critical efforts in psychology and psychiatry to emphasize the whole human being, rather than focusing solely on the brain and neurochemical explanations.

“Over the past two decades and with the support of the service-user/survivor movement, social, emotional, and psychological recovery has also been recognized as important. New models of recovery have been developed, which define recovery as an individual and meaningful journey or process and take into account the complexities and many, subjective meanings of recovery,” write the authors.

The current study uses phenomenological interviewing methods to flesh out the lived experience of people undergoing first-time crises in psychosis. They aim to get at the “fullness” and “richness” of these “felt experiences.” They also seek to understand how these experiences might interact with issues of adaptation and recovery.

Peer support workers recruited seven participants through mental health charities, where they were involved in peer support groups. Semi-structured phenomenological interviewing methods are used, aiming to capture verbal, visual, and embodied aspects of the experience.

“Hermeneutic-phenomenological research aims to explore the ‘what is’ (noema) and ‘how it is experienced and understood’ (noesis), while embracing the intersubjective, embodied and embedded nature of human experience. Hermeneutic phenomenologists explicitly use interpretation to make sense of and situate their participants’ lived experiences within the context of their life situation, the broader cultural and historical context, as well the specifics of the research situation. Taking a hermeneutic-phenomenological approach, the researcher aims to ‘grasp at the meaning’ of the participants’ sense-making while remaining true to the participants’ experiences – as well as acknowledging and valuing the researcher’s involvement in the research process,” the authors explain.

The authors discovered three main themes in their data. The first theme they call feeling shattered, as expressed by the interviewee remark, “It was like a lightning bolt hitting my world.” This was defined by a shattered sense of self, a feeling of being trapped, and suicidal despair.

Several participants described this experience in terms of a sudden shock or attack and linked it to past experiences with traumatic abuse. A sense of “apocalypse” was common: pain, horror, being trapped, and a lack of power.

“ pushed about, bullied, emotionally, and physically abused […] It would stop, it would – it would stop all my normal functions. […] That’s when it [hearing voices] first started. It was a horrific experience,” one participant explains.

The second theme the authors call “an all-enveloping strangeness and lingering threat.” This theme was marked by “feelings of disorientation” and “a lingering sense of threat.” Confusion, being overwhelmed and feeling as though the world is alien or unreal were shared experiences. There was also a strong sense of being unable to distinguish what was “true” from what was “not true.”

This confusion coincided with fearful anticipation of danger. One participant described this as an “air of danger.” The experience of threat was often undefined and unknowable, more of a background feature of life than any nameable danger.

“Yes, it just felt like you’re being watched and perhaps people are following your every moves, so you have to be careful and very … I guess there’s also a feeling of … Like I was always a bit scared and frightened of everything that I encountered.”

The third theme was lacking a sense of belonging, expressed by one participant, “I was left stranded in the dark.” All seven participants reported this experience of loneliness and disconnection. The experience was often followed by a desire to avoid contact with other people, for the participants’ safety. Feelings of abandonment, such as by God, were also a reported experience. Participants longed for connection but struggled to feel safe enough to pursue it.

“I didn’t think I was part of it [the world], I didn’t think I was ever going to get better. I didn’t think anybody understood me, I felt alone, I wanted to achieve in the world, but didn’t think I ever would.”

Bögle and Boden note that trauma was a common feature in the experiences of their participants, confirming previous research linking trauma and psychosis. These historical traumatic experiences were present in the psychosis, often amplified as loss of sense of self, unreality, and sense of imminent danger. The authors suggest that trauma-informed perspectives can likely improve the wellbeing of individuals who have psychosis. They conclude:

“Services that consider the person holistically, taking account of how they view others, the world and themselves, which see ‘symptomatology’ as meaningful experience, and which consider the feelings and emotions of the service-user as something to be acknowledged and explored, rather than solely medicated, may also offer longer-term benefit by enabling people to feel safe enough to reconstruct their sense of self as a social being.”

 

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Bögle, S., & Boden, Z. (2019). ‘It was like a lightning bolt hitting my world’: Feeling shattered in a first crisis in psychosis. Qualitative Research in Psychology, 1-28. (Link)

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Micah Ingle, MA
MIA Research News Team: Micah Ingle is a doctoral student in Psychology: Consciousness and Society at the University of West Georgia. He has published on therapeutic approaches centering the person-in-context, as opposed to the individualizing medical model, and on the characteristics of people high in empathy. His current interests include the intersection of sociopolitical/economic structures and mental health, individualism in psychology, gender, liberation psychology, and mythopoetic perspectives inspired by Jungian thought.

4 COMMENTS

  1. My experience with “psychosis” was very different than your subjects. But I will say my first episode “psychosis” was brought on because the common symptoms of antidepressant discontinuation syndrome were misdiagnosed as “bipolar,” resulting in a prescription for a child’s dose (.5mg) of Risperdal. But millions of people have suffered from this type of malpractice, and no doubt millions more will, since this disclaimer was taken out of the DSM5, by highly unethical psychiatrists.

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    Two weeks later, just when the Risperdal was to “kick in,” I did suffer from my first “psychotic break,” and it was like “feeling shattered.” There is a self portrait I did in the art section of this website entitled ‘Psychiatric Drug Induced Hell” that depicts this chaotic, bloody, shattering of my brain. I learned from later research that the antipsychotics create “psychosis,” via anticholinergic toxidrome poisoning. But my psychologist, psychiatrists, and all my doctors denied this reality at the time, despite having learned this in med school.

    It was very strange and terrifying, but not really “an all-enveloping strangeness and lingering threat.” Since I’d been drugged up for belief in the Holy Spirit – a dream query was incorrectly called a “Holy Spirit voice” – I learned from later reading my child rape covering up ELCA “holistic Christian” psychologist’s medical records, and my child’s medical records. But since I was inappropriately drugged, due to a spiritual query, my first episode “psychosis” took the form of a struggle with God. And in as much as I’m just a person, and God is the Creator of the Universe, it was terrifying. But God had me think back on my life, at all the people who’d harmed me in my life, and pointed out that He’d always brought about justice, via sins of the father justice. I didn’t like that, since it didn’t seem just to me, but I do know it’s biblical. But then God reminded me of the many times in my life that He’d sent a “good Samaritan” to protect me, when I was in a potentially dangerous situation. God then wanted to know if I’d follow Him, even to hell. I decided I needed His protection, even if I didn’t always agree with His methods, so I agreed to continue to be a believer and follower of God. Thus there wasn’t a “lingering threat,” other than from the (unbeknownst to me at the time) child rape covering up, hypocritical psychologist and psychiatrists, who went on to attempt to murder me, via various egregious anticholinergic toxidrome poisonings. But this first episode “psychosis” lasted for three days, and it was terrifying.

    I didn’t, at the time, know the primary actual function of our “mental health” workers has, for over a century, been covering up child abuse, largely for the religions and the wealthy people who walk through their church doors, irregardless of the legality of their source of income or belief in God. And I was in denial of the abuse of my child, until the medical evidence of the abuse was finally handed over, at which point I could no longer be in denial.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    But all those subsequent, egregious anticholinergic toxidrome poisonings did result in three and a half years of “psychosis,” where I got the “voices” of the child rapists and their child rape covering up pastor in my head, incessantly bragging about abusing my child, and many other children. I was, however, gradually weaned from the drugs, and thankfully those evil “voices” went away as I was weaned off the drugs. Then my family’s medical records were handed over, by some decent and disgusted nurses in my PCP’s office. Who realized my PCP had been orchestrating these attempted murders of me to proactively prevent a non-existent malpractice suit, because her husband had been the “attending physician” at a “bad fix” on a broken bone of mine. And to cover up the medical evidence of the abuse of my child.

    My point being, my “psychosis” turned out to be true. And I was able to scare the school, where perhaps lots of abuse of children might have occurred, into closing forever, once the medical evidence of the abuse had been handed over. That PCP and her husband were subsequently kicked out of that medical practice. And a kind nurse followed my family, trying to protect us, to two subsequent PCPs. Neither of whom, would explain the prior “complex iatrogenesis,” thankfully I found the explanation.

    But since withdrawal from the psychiatric drugs does cause a drug withdrawal induced “super sensitivity manic psychosis,” I did experience this type of “psychosis” as well. It felt like I had “Godspeed.” I danced, biked, gardened, volunteered with the other “super moms” in my neighborhood, rehabbed my home, etc. This type of drug withdrawal induced “psychosis” functioned as an awakening to my dreams. It was a staggeringly serendipitous awakening to the concept that we are all “one in the Spirit, one in the Lord.” This connectivity of all occurs, supposedly, only within the “collective unconscious,” normally. And it did culminate in a born again type experience, where I was supposedly made “of the bride” of God. Thus, my drug withdrawal induced “super sensitivity manic psychosis” was rather the opposite of feeling like I was “lacking a sense of belonging” or “Feelings of abandonment, such as by God.” It was 100% the opposite of that.

    So I absolutely agree, “Services that consider the person holistically, taking account of how they view others, the world and themselves, which see ‘symptomatology’ as meaningful experience, and which consider the feelings and emotions of the service-user as something to be acknowledged and explored, rather than solely medicated,” is very important. And it’s the opposite of what my criminal, child abuse covering up, Holy Spirit blaspheming, “mental health” workers did.

    But I did need to leave my child rape covering religion, and I’m saddened that they have become a child rape covering up and profiteering religion. And according to them, apparently a DSM “bible” believing religion, instead of a Holy Bible believing religion. But I’m not the only one who sees that my former religion has lost it’s Way, and is behaving deplorably. I know over 200 people left my church, just after I left it in disgust, according to congregational trend reports. And an ethical ELCA synod offices insider did write a book touching on these ELCA bishops’ crimes.

    https://www.amazon.com/Jesus-Culture-Wars-Reclaiming-Prayer/dp/1598868330
    https://virtueonline.org/lutherans-elca-texas-catastrophe-coming-lesson-episcopalians
    https://www.firstthings.com/article/2018/10/elca-hits-bottom

    I do believe our “mental health” workers should start listening to, and believing their clients. Rather than acting like lunatics, who declare people’s real life concerns and entire life to be “a credible fictional story.” And it’s absurd that the psychiatrists think the best way to help a healing child abuse survivor, who’d been abused over four years prior, is to psychiatrically poison him. Thankfully, I was able to keep my child away from the multiple, lunatic “mental health” workers, who wanted to get their hands on him. He largely healed, and went on to graduate from high school as the valedictorian, and from university Phi Beta Kappa (highest honors), in addition to winning a psychology award. So much for our “mental health” workers’ deluded belief that no child abuse survivor can ever heal and thrive.

    But our “mental health” workers and religious leaders should get out of the child abuse covering up business, and our country should start arresting the pedophiles instead. Because I think I’m correct to believe that the majority of Americans don’t actually want to live in a “pedophile empire.”

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT

    But that’s what a country ends up being, when it has a multibillion dollar, primarily child abuse covering up, group of scientific fraud based “mental health” industries. Stop aiding, abetting, and empowering the pedophiles, “mental health” and religious lunatics. Your “dirty little secret of the two original educated professions” is destroying our country.

  2. What it is like is they have to protect themselves from the ~mental health~ and ~psychotherapy~ system. We all already live in a war zone. If we let them have a reason, we will be crushed.

    People have to allow time each day for feeling their feelings. The more they can promptly feel things when they happen, the better and the lower the risk of a crack up.

    We should have cards people can carry and lawyers always ready to respond.

  3. The danger of psychosis is that you could fall prey to the ~mental health~ system.

    At least as I see it, there usually will be no other significant danger. Can’t be afraid of feeling our feelings. Need to feel our feelings on a daily and on a continual basis. This is what I do. I know that any unnecessary repression of feelings only causes problems later on.