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Noah Curtis

11 May 2009

Your First Episode of Psychosis:

It’s Okay, It Happens

My first episode of psychosis was a horrific experience that I would not wish

upon my worst enemy. The whole experience, from going psychotic to the hospital

treatment and the experimental drugs to an excruciating long and depressed summer, took

something from me. When someone experiences their first episode of psychosis they

lose a piece of themselves and are left wondering what happened. To find something

within the experience is the most important thing when dealing with the first episode of

psychosis, as it not only gives meaning to the experience, but hope for the future.

In January of 2007, I thought the CIA was after me, that voices were speaking to

me through my headphones, and that I was communicating with a secret, elitist group

through MySpace; I was having my first episode of psychosis. I admitted myself to the

Crisis Rehabilitation Center at Central DuPage Hospital in February of 2007. I spent

roughly two months under hospital care through inpatient and outpatient treatment. I was

given nearly ten different medications, some without my consent or knowledge, that

attempted to stabilize my mood, fight my psychotic symptoms, relax me, and help put me

to sleep; some of the medications worked, while others amplified my symptoms. While I

was an inpatient for two weeks, I wasn’t allowed to go outside once, and the only choice

I was allowed to make for myself was picking out what I ate. As I was released as an

outpatient, I expected to get an answer of what I was going through, but no such answer

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was given to me during my time at the hospital. Outpatient was also the worst time for

my medications, as the side-effects got to be excruciating, both mentally and physically.

When I was released from hospital care, I spent the next few months visiting a

new doctor on a weekly basis to talk about my medication. I spent the rest of the summer

depressed and confused about what had happened earlier in the year. I had just started to

create my identity and thought I had a hold on everything, but before my mind could

catch itself I was sitting at home without a job, smoking a pack a day, wasting my time

with bad television programs and video games. I felt my friends had abandoned me and

put me out of their lives because I went crazy. Even my brother was reluctant to hang out

with me. Things progressed though as my doctor and I tinkered slightly with my

medications. By the end of the year, I had been back to school and passed every course,

and I started reconnecting with some friends. Since then I have done great in school,

rebuilt my social network, and have a steady part time job. My future is bright, but

many of my questions remained unanswered.

Mental illness affects roughly 22 percent of the United States population and

ranks as the second largest disease in the world only to cardiovascular disease

(Thompson 14-15). The National Alliance of Mental Illness (NAMI) estimates that one

in five families are affected by mental illness (NAMI). Mental disorders affect people in

numerous ways. NAMI’s website illustrates this point by saying, “Mental illnesses are

medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to

others, and daily functioning” (NAMI). Mental disorders have a long history that is

continually being updated and modified. The Diagnostic and Statistic Manual of Mental

Disorders was first published in 1952 by the American Psychiatric Association and is

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currently on its fourth edition in 50 years (Thompson 3). Mental illnesses are considered

more medical fact than fiction and Marie L. Thompson states in her book Mental Illness,

“The theory that mental illnesses are as real as physical illnesses is widely accepted” (4).

When attempting to understand mental disorders, one has to comprehend that the

physical and the mental, body and mind, need each other in order to operate (Thompson

5).

Psychosis is not an actual diagnosis rather it “is a syndrome, a cluster of

symptoms that affects thinking and perception in several different ways” (Hicks 268).

The Early Psychosis Prevention and Intervention Centre (EPPIC) emulates the same

attitude noting that the word “psychosis” describes conditions that affect the mind and

cause a person to lose touch with reality (EPPIC What). Dunkley et al. goes into detail

stating, “psychosis is an experience that can involve a significant distortion in the

perception of reality and impairment in the capacity to reason, speak, respond, and

behave appropriately” (Dunkley et al.). When a person becomes sick in such a way, it is

called a “psychotic episode” (EPPIC What). James Whitney Hicks author of, Fifty Signs

of Mental Illness, explains that the word “psychotic” is often misused and inaccurately

depicted when it is used under the connotation when referring to someone who is evil,

unpredictable, or beyond help (268). There are multiple types of psychosis, from drug-

induced psychosis to psychotic depression (EPPIC What), but any episode of psychosis is

considered to be one of the most traumatic events a person can be subjected to (Lundy

qtd. in Dunkley et al.).

First episode psychosis is exactly what it sounds like, it is “the first time someone

experiences psychotic symptoms or a psychotic episode” (EPPIC What). EPPIC also

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points out on their website that, “young people are the group most at risk for the

development for psychosis” (EPPIC Facts) and they back this up by sharing that the

average age for the onset of all mental illnesses is under 25 years (EPPIC Facts). When

the first episode of psychosis happens at such an age it impacts the person’s social life the

most. Thorup et al. illustrates this point very well saying,

Patients who have an early onset of psychosis (before the age of 35) are

often at a stage of life when social relations are being established or

stabilized, and with all its consequences, the psychosis may disrupt this

process….[influencing] the patients’ social skills, abilities to create and

maintain social contacts and to communicate with their closest

acquaintances. (761)

A psychotic episode occurs in three phases: prodrome, a time when feelings and actions

change, but there are no clear cut signs; acute, the peak of the episode where

hallucinations, delusions and disorganized thoughts occur; and recovery (EPPIC What).

As for the causes of psychosis, not much is known. Hicks outwardly says, “we do

not know what causes schizophrenia or other psychotic illnesses” (Hicks 273). EPPIC

also comments saying, “in first episode psychosis the cause is particularly unclear”

(EPPIC What). Destabilization in brain chemicals like dopamine, serotonin, and

glutamate are the forerunner in causes (Hicks 273). There are other articles like Crebbin

et al.’s that suggest that drug and alcohol abuse may be a factor in inducing psychosis

(417). Despite all the research that has been done on psychosis, causes for it are still

relatively unknown.

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Even though the causes for psychosis are almost non-existent, the syndrome of

psychosis is treatable like any other illness (EPPIC What) and many people make a good

recovery, while some never have an episode ever again (EPPIC Getting). The treatment

process though can be frustrating, stressful, and an all around painful experience. Perry,

Taylor, and Shaw conveyed this saying, “the language that [patients] used in describing

their experiences such as banged up, locked in, secure unit and released conveys this

sense of imprisonment, segregation and punishment” (786). The process of getting help

is not only traumatic to the patient, but also to family members (Corcoran et al. 8).

Corcoran et al. wrote,

Three family members described inpatient psychiatrists as insensitive or

unavailable, providing little information. Struggles with insurance

companies over coverage were also described. Overall, families saw

inpatient hospitalization and medications as problematic yet necessary. (7)

Perry, Taylor, and Shaw wrote a similar conclusion in their article from the view point of

the patient stating, “feelings of confusion and vulnerability appeared to be compounded

by the lack of information that [patients] were given before and during their time in

hospital” (787). Perry, Taylor, and Shaw also found that many of their interviewees had

a sense of injustice as they were denied basic human rights and isolated from their family

and friends (786). Most of those that were interviewed throughout the two articles felt

cheated, pushed aside and uncared for.

Medication is an essential part of treatment for the first episode of psychosis, but

at the same time it is a frustrating process. Medication generally reduces symptoms and

sometimes eliminates all symptoms (Hicks 274). EPPIC blatantly advocates medication

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by saying, “Medication is a crucial treatment for psychosis” (EPPIC Recovering). The

same article mentions, “There are a number of different types of medication which are

very effective in reducing the symptoms of psychosis…” (EPPIC Recovering).

Antipsychotic medication is the general class of medication used (Roberts 2) and is “a

necessary treatment for individuals with psychosis” (Addington, Mansley, and Addington

272). There is a downside to antipsychotic medication though as “All medications can

have unpleasant side effects, even if they are mild” (Hicks 275). The most frustrating

part of the medication process usually takes place during inpatient care, where nurses and

doctors usually try different medications in order to calm the psychosis. Participant one

in Perry, Taylor, and Shaw’s article vividly expressed this saying,

‘They kept giving me loads of different types of medication and I don’t

know what I was taking. Like one day it was these little blue pills, the next

day it was yellow pills, then it was injections, then it was like these red

pills.’ (Participant 1 qtd. in Perry, Taylor, and Shaw 787).

EPPIC advises that medication be monitored for side effects as the type of medication or

dosage should be changed (EPPIC Recovering). Unfortunately, doctors more often than

not pay little attention to the distressing side effects (Hicks 275). When a medication is

found to work for a patient, with little or no side effects, it is more likely that they will

continue to take their medication (McGorry, Killackey, and Yung 153). It is important

for a patient experiencing their first episode of psychosis to take medication and

continuing taking it after symptoms diminish, even though the process of finding the right

medication is a painful and frustrating process (Hicks 275).

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The recovery process after the acute stage of the first episode of psychosis is a

crucial time for the patient. Perry, Taylor, and Shaw illustrate this time saying, “The time

following a first episode has been identified as being critical and informative in the

adjustment to psychosis” (781). The recovery process does not happen over night and

usually takes a few months (EPPIC Recovering). Family is most important during the

recovery process. Macdonald et al.’s study suggests this stating, “[Patients] identified

close relationships with family members and valued family sticking by them through the

illness” (135). Social and interpersonal aspects of life are also important during the

recovery phase (Thorup et al. 761). Perry, Taylor, and Shaw shared the same view

stating, “the importance of belonging to social groups and more broadly to society was

central to the narratives of the participants” (790). Participants in Macdonald et al.’s

study expressed interest in resuming former relationships, but avoided contact because

they were concerned with the stigmatization of friends’ attitudes towards psychosis (136).

One participant in Macdonald et al.’s study expressed this intensely saying, “‘I am angry

about it, because I thought they were good friends’” (Jess qtd. in Macdonald et al. 136).

Although it is hard to find friends after experiencing a first episode, when they are

there it is a great thing, as a participant in Perry, Taylor, and Shaw’s study suggested

when they said, “‘When you’ve got your friends around (…) you feel a lot more

hopeful’” (Participant 4 qtd. in Perry, Taylor, and Shaw 788). Finding an activity, work,

or routine is the last piece to fit in during recovery in order to maintain hope (Perry,

Taylor, and Shaw 788). Overall, the process of recovery differs from patient to patient,

with some recovering quickly, while others recover over a long period of time (EPPIC,

Recovering 2).

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Both Dunkley et al and Perry, Taylor, and Shaw cite McGlashan et al.’s two

recovery styles as “sealing over and integration” (Dunkley et al.; 790). Sealing over is

the process in which a person puts their experiences behind them and do not investigate

their psychosis or explore the past (Perry, Taylor, and Shaw 790). Dunkley et al.

continues in saying, “These people isolate their psychotic experience because they view it

as incompatible with their life” (Dunkley et al.). The person who integrates tries to put

some coherent perspective upon their psychosis and their experiences (Dunkley et al.)

Perry, Taylor, and Shaw assert that “those who integrate tend to take responsibility for

their psychosis, and have an awareness of the pleasure and pain of their psychotic

experiences” (790). Essentially, the recovery style a person chooses in dealing with their

first episode of psychosis equates into the amount of hope they may or may not see

during recovery (Perry, Taylor, and Shaw 790).

Although the whole ordeal of a person’s first episode of psychosis is traumatizing

and may be linked to post traumatic stress disorder (Dunkley et al.), what a patient makes

of their experience has an important impact on their hope (Perry, Taylor, and Shaw 789).

Perry, Taylor, and Shaw note that there is high importance on maintaining hope through

the recovery process of psychosis (781). Hopelessness tends to be what most patients

focus on (Dunkley et al.; Perry, Taylor, and Shaw 781). Perry, Taylor, and Shaw suggest

that there is a high level of importance in an individual’s exploration of the meaning of

their experience (781). There is a rebuilding process that takes place in an individual

who has their world shattered by psychosis (Perry, Taylor, and Shaw 789). As a person

rebuilds after their experience they take into account the new information as they

reconstruct their identities and world views (Perry, Taylor, and Shaw 789).

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There is much hope underneath the dark shroud that surrounds a person’s first

episode of psychosis. When I was locked down in inpatient care, I thought that I would

never attend school again, never see my family or my friends again, or live a prosperous

life. Perry, Taylor, and Shaw identified that there is an “idiosyncratic nature of each

[patient’s] search for meaning in maintaining hope” (791). Long after a person has

recovered from their psychotic episode and has formed a life resembling their former one,

there is still a sense of wondering; it does not even matter if the person chose one of

McGlashen et al.’s recovery types over the other. When a young adult experiences their

first episode of psychosis it is important for that person to realize they are not alone as

three in a hundred young adults experience a psychotic episode (EPPIC Facts); whether it

is treated or not is a different statistic. There should also be much hope in the recovery

process as it is a treatable illness and most make a full recovery (EPPIC Facts). Leete

was quoted in Perry et al. as saying, “having some hope is crucial to recovery. None of us

would survive if we believed it a futile effort”(Leete qtd. in Perry, Taylor, and Shaw

791).

Although there is much hope for a person experiencing their first episode, there is

still much work and research to be done on young adults and their first episode of

psychosis (Dunkley et al.). Thompson states in her book, “these issues need to be

addressed as urgently as those of finding causes, improving treatment modalities, and

searching for possible preventive measures for mental illnesses” (22). Antipsychotic

medication has numerous side effects, many which go unnoticed and subsequently

untreated (Hicks 275). It is clear that the process in which medication, arguably the most

important factor in treatment (EPPIC Recovering), is given needs to be examined and

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regulated. Participant one in Perry, Taylor, and Shaw’s article illustrated this best saying,

“‘They kept giving me loads of different types of medication and I don’t know what I

was taking’” (Participant 1 qtd. in Perry, Taylor, and Shaw 787). Inpatient treatment is

another important facet of treatment that needs attention as one participant in Perry,

Taylor, and Shaw’s research said, “‘I just felt like an animal, being locked up all of the

time’” (Participant 2 qtd. in Perry, Taylor, and Shaw 786). Macdonald et al. sums up the

entire process best saying,

The findings suggest the need for psychosocial programs that provide

young people with environments that support them to cope with the direct

implications of psychosis and to engage in behaviors and activities typical

of young adults, thereby supporting the integrative processes following the

onset of psychosis. (129)

It is clear that more attention needs to be given to the first episode of psychosis in young

adults through public education, psychiatric improvement, hospitalization improvement,

medication improvement, and more research into the subject itself. It is time to end a

century reign of stigmatization, pessimism, fear, and neglect (McGorry, Killackey, and

Yung 148) on a subject that affects more people than society would like to admit.

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Works Cited

Addington, Jean, Chrystal Mansley, and Donald Addington. “Weight Gain in First

Episode Psychosis.” Canadian Journal of Psychiatry 48.4 (May 2003): 272-276.

EBSCOHost. Elgin Community College Library, Elgin, IL. 29 April 2009.

<http://search.epnet.com>

Corcoran, Cheryl et al. “Trajectory to a first episode of psychosis: a qualitative research

study with families.” Early Interv Psychiatry 1.4 (November 2007): 308-315.

PubMed. U.S. National Library of Medicine, Bethesda, Maryland. 29 April 2009.

<http://www.ncbi.nlm.nih.gov/pubmed/>

Crebbin, Kathleen, et al. “Drug and alcohol misuse in first episode psychosis: An

observational study.” Neuropsychiatric Disease and Treatment 4.2 (2008): 417-

423. PubMed. U.S. National Library of Medicine, Bethesda, Maryland. 29 April

2009. <http://www.ncbi.nlm.nih.gov/pubmed/>

Dunkley, Jane E., et al. “Understanding Adaptation to First-Episode Psychosis: The

Relevance of Trauma and Posttraumatic Growth.” The Australasian Journal of

Disaster and Trauma Studies 18 June 2007. Massey University, New Zealand. 27

April 2009. <http://trauma.massey.ac.nz/issues/2007-1/dunkley.htm>

EPPIC. Facts and Figures. 2 May 2009. Early Psychosis Prevention and Intervention

Centre. 2 May 2009. <http://www.eppic.org.au/

contentPage.asp?pageCode=FACTS>

EPPIC. Getting Help Early: Factsheet 2. EPPIC Statewide Services, 2006. Early

Psychosis Prevention and Intervention Centre. 2 May 2009.

<http://www.eppic.org.au/docs/Fact2gettinghelp.pdf>

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EPPIC. Recovering From Psychosis: Factsheet 3. EPPIC Statewide Services, 2006. Early

Prevention and Intervention Centre. 2 May 2009.

<http://www.eppic.org.au/docs/Fact3recovering.pdf>

EPPIC. What is Psychosis?: Factsheet 1. EPPIC Statewide Services, 2006. Early

Psychosis Prevention and Intervention Centre. 2 May 2009.

<http://www.eppic.org.au/docs/Fact1whatis.pdf>

Hicks, James Whitney. Fifty signs of Mental Illness: A Guide to Understanding Mental

Health. New Haven, Conn.: Yale University Press, 2005.

Macdonald, Elspeth, et al. “What happens to social relationships in early psychosis? A

phenomenological study of young people’s experiences.” Journal of Mental

Health 14.2 (April 2005): 129-143. EBSCOHost. Elgin Community College

Library, Elgin, IL. 27 April 2009. <http://search.epnet.com>

McGorry, Patrick D., Eóin Killackey, and Alison Yung. “Early intervention in psychosis:

concepts, evidence and future directions.” World Psychiatry 7.3 (October 2008):

148-156. PubMed. U.S. National Library of Medicine, Bethesda, Maryland. 29

April 2009. <http://www.ncbi.nlm.nih.gov/pubmed/>

NAMI. About Mental Illness. 1 May 2009. National Alliance of Mental Illness. 2 May

2009. <http://www.nami.org/Content/NavigationMenu/Inform_Yourself/

About_Mental_Illness/About_Mental_Illness.htm>

Perry, Beth M., Damian Taylor, and Samantha K. Shaw. “‘You’ve got to have a positive

state of mind’: An interpretative phenomenological analysis of hope and first

episode psychosis.” Journal of Mental Health 16.6 (December 2007): 781-793.

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EBSCOHost. Elgin Community College Library, Elgin, IL. 27 April 2009.

<http://search.epnet.com>

Roberts, Lynne. “Prescribing medication in first episode psychosis.” Nurse Prescribing

5.8 (September 2007): 335-343. EBSCOHost. Elgin Community College

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Thompson, Marie L.. Mental Illness: Health and Medical Issues Today Westport, Conn.:

Greenwood Press, 2007.

Thorup, Anne, et al. “Social network among young adults with first-episode

schizophrenia spectrum disorders.” Social Psychiatry and Psychiatric

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