The idea that “madness” can be transformative and a catalyst for growth may seem absurd in the dominant biomedical-psychiatric paradigm which favours the language of pathology. Yet theorists such as R.D. Laing and John Weir Perry viewed psychosis as a crisis that has potential transformative value—as not only a meaningful and understandable response to life circumstances, but as a purposeful process that can disrupt and heal dysfunctional aspects of the self—given the right support.
As a researcher with lived experience of psychosis, I wanted to understand how the meaning-making process impacts the potential for positive transformation and growth, post-psychotic break. In other words, how do the narratives available to us, the way our distress is framed, whether we are allowed to find meaning in intense experiences dismissed as a misfiring brain, impact the outcomes of psychotic crisis?
Psychosis can be a terrifying and disabling condition, and by no means do I wish to romanticize this state. Yet, for some, myself included, the “psychosis” (or what some prefer to call “extreme distress,” “spiritual emergency,” or “altered state”) became a catalyst for greater connection to self, others, and a sense of purpose.
Such narratives are often written off as delusional or wishful thinking in favour of describing and monetizing psychosis as a burden on society; a path to chronic and disabling disease. Those with lived experience are deemed by psychiatry as “lacking insight” into their condition, echoing the paternalistic and discriminatory history of psychiatric treatment that is still used to justify human rights violations and coercive care. Yet psychiatry itself operates on a dangerous lack of insight, treating psychosis primarily with harsh medications despite no consistent evidence that psychosis is pathological.
By ignoring diverse conceptualizations of psychosis, we reduce hope and agency in those forced to accept a bleak diagnosis, and we obstruct the improvement of services.
To challenge mainstream assumptions about psychosis and understand how this state can be transformative for some, I conducted in-depth interviews with five people who experienced positive transformation and growth after psychosis: Megan from Canada, Darryl from the UK, Sofie from Denmark, Alke from the Netherlands, and Hannah from Finland.
The Harm of Removing Meaning from Madness
For most participants, the psychiatric care they received was coercive and harmful, and impeded their right to make sense of their experiences and make decisions about their own treatment. Being told their psychotic states, often deeply meaningful and spiritual, were merely symptoms of illness in need of suppressing often exacerbated the very distress being treated and hindered the opportunity for growth.
Sofie lives in Finland where she has been involved with peer support and advocated for more compassionate mental health services such as Open Dialogue. She works, parents, and studies holistic healing modalities. She believes coercive care “stole years” from her life, and experienced traumatic hospitalisations in Finland that included being handcuffed by police, forced into medical restraints, given forced injections, and placed in isolation cells.
She believes the trauma of the first hospitalisation at age 17 was so severe she went on to have ten subsequent episodes, saying “it took me six years and six hospitalisations to work through that trauma.” Besides experiencing harmful interventions, Sofie spoke about the impact of not being allowed to talk about her psychosis:
“It was so bad, you don’t get to talk about, I mean you should be able to talk about it, but it was like shut up we don’t want to encourage any hallucinations. Or then if you show too much emotion, they threaten you with injections, or they inject you, and then they put you in isolation. I completely every time broke down. I think that’s the worst torture you can do to a person when they’re completely disorientated and psychotic, you put them in isolation for eight hours.”
Hannah had similar experiences in Denmark of not being allowed to talk about her psychosis, or what she refers to as “altered states,” in early psychosis intervention family groups. “Either the subject was changed, or it was made very clear that us talking about our psychosis was not helpful.”
Originally from Denmark, Hannah currently lives in the UK. She writes poetry, facilitates Hearing Voices groups and trainings, works as a public speaker, and has published a book that beautifully illustrates her relationship with voices and altered states.
Hannah experienced “altered states of mind” for as long as she can remember, saying “what was distressing was not so much the altered states of mind as the awareness that I got that other people didn’t understand, so that was where the distress started, the sense of loneliness and the alienation.” Her sense of alienation contributed to emotional overwhelm and suicidal ideation, and these overwhelming states, not the “psychosis,” was what she sought help for. But she was often turned away by services until she revealed she heard voices. Treatment then became about fixing the voice hearing rather than addressing the suicidal ideation, and services told Hannah’s mother once the voices were silenced, “everything would be better.”
This narrative didn’t make any sense to Hannah, as the more she tried to suppress the voices, the angrier and more frightening they became. Hannah needed her own “wisdom to be recognised” and to “be given choice about what made sense.”
The Importance of Meaning-Making and Community Understanding
All participants described aspects of their psychosis as personally meaningful. Finding a community where they could openly share and formulate meaning in their experiences, without fear of coercive care or having their experiences written off as delusional, led to greater self-understanding and wellbeing.
Darryl lives in England and constantly takes courses and educates himself about mental health recovery, saying “you’re probably not going to learn and develop from any situation unless you have a little bit of belief and hope that things can get better.” Darryl doesn’t discount the biomedical model but found treatment in the NHS overly reductive and reliant on medication.
Through researching the correlation between psychosis and adverse childhood events, Darryl realized his psychosis was likely a response to severe bullying during his formative years, which led to a damaged sense of self. This insight led to greater self-compassion and a roadmap for working through issues around confidence and trust. He also found meaning in his experiences of psychosis through connecting with peers and by setting up a mental health blog with friends, including creating anthologies of poetry, artwork, and recovery resources.
Sofie was raised with a scientific upbringing and initially accepted her diagnosis of schizophrenia. She still finds “some truth in how psychiatry views it,” but also found value in alternative healing modalities, and now interprets what she went through as a “shamanic initiation crisis.” This framework provided Sofie with deeper self-understanding, a feeling of having control over her life, and the agency to “build [her] own happiness.” Shamanism helped her heal from traumatic and violent hospitalizations while addressing the spiritual layers to her wellbeing, which are frequently ignored.
Megan is currently writing a book to help others going through psycho-spiritual crisis or extreme states; a tool of navigation she feels would have helped her during the 17 years she spent in an “expanded state of consciousness.” She kept her altered states largely hidden due to negative encounters with medical professionals in Canada, until she began connecting with online communities that “had personal experience with different ways of being, seeing and knowing.”
For Megan, “reassurance” and knowing “you’re not going crazy, you’re not alone” were vital aspects of her healing process. Framing altered states of consciousness as fitting within the normal and valued spectrum of human experience helped Megan cope and grow from her distress. Finding people who “could meet you exactly where you’re at and just sit with you as it is for you” helped her feel like she could “breathe for the first time,” and was more beneficial than the medical system which surrounded her with “fear and scepticism.”
In the mental health system, there isn’t always time, resources, or a philosophy that enables an approach of holding space or sitting with someone through their discomfort. Rather, patients are dragged forward with harsh interventions, and in the process lose the ability to consent to, make sense of, and navigate their experiences in a way that is relevant and meaningful to them.
Psychosis as Purposeful Process
Participants rejected the claim that their experiences were only symptoms of illness disconnected from the web of their life circumstances and worldview. As they researched other frameworks for conceptualising distress, they began to understand psychosis as a type of “purposeful process” for working through trauma, enhancing insight and consciousness, undergoing a spiritual awakening, or even as a valued state of being. This conceptual shift allowed transformation and growth to occur, including a re-evaluation of selfhood, purpose, and worldview.
While Megan uses psychiatric medication and acknowledges the challenges extreme states can entail, and her fear of entering that state again in an uncontrolled way, she rejects the diagnosis of schizophrenia and feels there was a “purposeful process” taking place that needed to reach completion:
“I could see that processes were taking place with the dismantling, there was a purposeful process that was going on… it’s so important that when this ego dismantling process starts we… respect what’s going on, and we give space for it and support, because I can see, wow, the psyche is so masterfully putting things back together in way, you know with limited abilities, our mind is very limited, even our hearts are limited to the extent that psyche was just reorganising everything spontaneously.”
Megan and Sofie both spoke about their ego dissolving in altered states. They viewed the ego as a rigid identity structure that inhibited greater connection with others and their authentic self. While the lack of differentiation between self and the wider world could be terrifying and problematic, the disintegration of self-limiting beliefs and patterns provided an opportunity for a transformed sense of self.
Sofie shared that for the past five or six years she hasn’t been on medication, is working, and feels the psychosis and schizoaffective disorder are “a thing of the past.” While some might view this as wishful thinking, a key shift for Sofie is being able to think about her “trauma memory” without being triggered into another psychotic episode, as had always occurred in the past. She described her psychosis as “trying to solve something”—her psyche healed itself once she was allowed to complete the process in the altered state, in a supported way, and confront, express, and resolve her trauma so she could move forwards in life. She believes a person should:
“be allowed to go through a psychosis without it being interrupted, and have somebody support you through it and it can be a healing crisis, it can be that something in your psyche heals itself and you become stronger. And I think that’s where Western medicine fails, because if you treat it the right way, psychosis doesn’t become chronic. Schizophrenia is psychosis when it becomes chronic and it’s totally unnecessary that it would be chronic if you treat it the right way.”
Participants felt the psychotic content revealed useful insights or a path out of crisis, despite hallucinations and delusions being treated as meaningless symptoms in need of quashing. Sofie believes the fear brought up in psychosis can be so intense that the mind identifies with a “hero on a holy mission to conquer the dark forces, because that’s what you’re doing within your psyche, and you need something to block the fear.” This heightened, metaphorical narrative could be a protective strategy, helping the psyche overcome the fear and confusion and process what it needs to.
From the Netherlands, Alke is completing her PhD on the topic of psychosis while raising children and working as a lecturer in social work. Alke experienced a post-partum psychosis and was hospitalised shortly after the birth of her daughter. While she experienced support in the Netherlands’ mental health system, staff told her there was no meaning in her psychosis.
Alke feels that despite the intense fear, the psychotic content was a spiritual or psychological process occurring on a metaphorical level that needed to reach completion: “you can feel like you are in a labyrinth in psychosis, and it is not nice, but it is transforming you, and all the monsters are essentially there to help you in this transformation.”
Hannah considers her altered states to be more than transient processes, they are an integral and continuous part of what she values about herself and how she experiences life. After discontinuing her medication, she recovered her altered states. “I was like oh my god I’ve missed this, that was the initial response, oh I’ve so missed this sense of… I don’t know how to describe it, it’s life, other dimensions other levels to life.”
Hannah used to feel resentful and scared of her voices and visions before she learned how to work with them, benefiting from the Hearing Voices Movement, which views voice-hearing and other anomalous experiences as meaningful and existing within the spectrum of normal human experience. Now she describes her altered states as life-affirming as they are “rich and deep,” something she wouldn’t want to live without. She still struggles with societal pressure to suppress these states, yet it’s in these experiences that “being alive makes sense” to her, “it’s not in all this doing. It’s in feeling connected to something more than the superficial busyness of life.” While her experiences have been painful, there is a vast spectrum that includes beauty, creativity, and joy.
Whether participants felt their psychosis or altered states were a “purposeful process” or a valid way of being in the world, these perspectives allowed them to perceive value in their experiences, which was inextricably linked with how they valued themselves.
The Potential for Growth and Transformation
While negative changes occurred such as difficulties securing employment, struggles with cognitive challenges, and moments of despair, participants asserted the psychotic process also deepened their capacity to love and have compassion for self, others, and nature; fostered a greater alignment with authentic self and purpose; and had the potential to benefit the wider community.
Alke was raised in a religious home where she was taught to “love everyone,” but said it was still common to look down on certain people. After her psychosis, “it changes from selective love, from exclusive love to an inclusive love towards everyone—this universal love for everyone and everything.” She admits this shift could be a result of motherhood and not necessarily psychosis, but considers it likely due to the intense “transformation” within herself: “all systems of meaning can change through psychosis. And belief systems can come to an end, and new systems start and can begin.”
Megan’s altered states helped her become kinder. She sometimes feels a “divine grace” between herself and strangers, and can intentionally shift into an altered state to feel this deep level of connection and “grace” with another person. The difference between her 17-year state of psychosis and now is that she can “shift into other ways of seeing, but it’s not presented to [her] continually without choice.” The choice to oscillate between these “different ways of being” de-escalates the fear and trauma of losing control. While she recognizes she will always be at risk of becoming “stuck” in these states, she views her increased capacity to love and feel “divine grace” to be an immense value.
Megan says her altered states also led to “an improvement in wholeness” which she defines as “balance and connection to nature, soul, self, and others.” Megan adds, “in those states, that was for me the sanest I’ve ever been. I was seeing more of reality not less.” Megan acknowledges the paradox of this statement, as altered states can make day-to-day functioning incredibly difficult. Yet our culture focuses heavily on the limitations, so Megan feels we must acknowledge how these states can enrich our sense of self and understanding of consciousness.
In addition to experiencing the “intense love that you have, that your system has for yourself,” during her psychosis, Sofie believes the experience helped her gain a sense of purpose and greater authenticity. She shared that her first psychotic break at age 17 has “taken me on a path which has led me to find the things that are really me, and find the things I really want to do.” Emerging from difficulties strengthened her sense of self and “it’s a valuable experience to have for helping other people.”
Minimal attention is given to how neurodivergence and altered states may benefit society. Our limited understanding of altered states of consciousness and propensity to pathologize the abnormal is potentially disrupting opportunities for growth and insight that could not only be of value to the individual but to their wider communities.
Creativity is a gift Hannah shares with her community through poetry, art, and public speaking. Her altered states are “extremely creative,” and she views this enhanced creativity as “one of the gifts that is not being appreciated at all.”
Hannah has written and spoken publicly about the possibility that anomalous experiences don’t only reflect individual struggles, they can provide insights into the wider culture, as these states reflect: “something that either the person or the context they’re in have lost touch with. Whether it’s trauma or whether it’s cultural denial, whether it’s emotional disconnect. People who do get into altered states of mind seem to be connected into things that we are likely either individually or collectively suppressing.” For example, she has very “powerful” and “relational” interactions with nature, and can sense the land grieving the impacts of colonization, resource extraction, and human interference:
“Painful stuff is never individual, it may be part of an individual journey, but it’s likely to also be part of greater issues that the individual could never tackle on their own. And we all miss out when we don’t see, when we don’t face that issue or that complexity or that pain.”
As Hannah suggests, perhaps the wider community benefits when we value and incorporate diverse ways of knowing, sensing, and experiencing the world, the ones deemed abnormal and deviant in our cultural context and responded to with coercive and traumatizing treatment.
Part of Darryl’s healing process was “going on to help other people,” based on the wisdom he’s gleaned from being unwell. Darryl acknowledges he was out of touch with reality in that he had a dark worldview and harsh internal criticism. He says, “if I had continued meeting unpleasant people who were knocking me down all the time, then I quite possibly would continue having more and more psychotic episodes.” A pivotal shift for him was meeting others who’ve “been in a similar position” and developing “more trusting relationships over the years” that fostered self-compassion and a less distorted sense of self.
While he volunteers his time helping others and updating his mental health blog, Darryl explained the bind he is in: wanting to find paid employment and a meaningful career, but if he works over 16 hours per week he will lose his benefits, and there’s no guarantee he could regain them if he became unwell. This risk “prevents me from moving forwards” until there’s a more compassionate government in place that provides “grace of support for people to gain employment” without putting their health and financial wellbeing in jeopardy.
Darryl raises an important insight: that growth after psychosis is contingent on social support systems and economic circumstances.
While altered states can be a catalyst for growth and transformation, psychosis can also be devastating for individuals and their social networks—particularly in a society that misunderstands and mistreats the condition. The aim of this work is not to place additional expectations of recovery and growth on people who are suffering, but to question our current biomedical paradigm and the myths it propagates about chronicity, illness, and symptoms devoid of meaning, while ignoring the broader context of people’s lives and cultures. We must challenge narratives of what it means to be “mad,” “psychotic,” and “sane,” and shift from paternalistic treatment to care that values the insights and agency of those it claims to support.
As Sofie found alternative therapies to process her trauma, as Hannah accepts her way of experiencing the world through public speaking and poetry, as Alke marches onwards with her PhD, as Darryl helps others with his insight and compassion, as Megan writes her book so others don’t feel afraid and alone—those of us deemed mad take up space and refuse to disappear or submit to the idea that our way of being and making sense of our lives is a delusion to be cured. For if psychosis is indeed transformative, do we not have an obligation to support the potential growth available in this misunderstood and deeply human process?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.