Understanding psychoses

How do persons afflicted experience psychotic phases?

bild„“Psychosis” is a generic term of highly different disorders. This becomes clear from the different experience and is conveyed by various verbal images.

A psychosis is for me (like)...

  • “Submersion into another world and reality, very similar to the world of dreams, fairy tales and myths and borderline situations – with all of the beauty and horror that affect me greatly and to which I have no distance.”
  • “An imaginative space of associative connections with incorrect conclusions. Marginal issues are accorded more significance. Language in metaphors, strong feelings of ambivalence. No differentiation between fantasy and reality.”
  • “Sinking into chaotic and intensive colours and movements: psychosis is the drifting on a stormy see without a compass and with incomprehensible ringing sounds from the radio set.”
  • “A breakup of inner impulses. A feeling of being driven. I then have a much greater self-confidence, an increased feeling of being alive. I then have always written a lot. I sensed a close connection to the whole world than in the normal state. I am now trying to maintain the inner impulse. Perhaps I have neglected that."
  • “A withdrawal from the environment. I then did not trust anyone anymore. I perceive rumours and noises increasingly. I become increasingly anxious. Sometimes for many days and nights. Some day it will be less; probably some day I can no longer have any anxiety.”
  • “No longer having to cope with perceptions, being overwhelmed – also of earlier impressions. At the same time, the psychosis has also helped me further; I then live very quickly and at a high energy level, want to do something very soon and tumble over.”
  • “A flight of thoughts into another reality: the knowledge or ignorance of this flight, the sense of an unwanted change can be frightening but also full of colours and forms that were previously unknown.”
  • “In psychosis I feel like a mobile that moves in the wind. Already small impressions somewhere at the periphery lead to great tremors of the entire human being, and states of relative calm are rare.”
  • “A surge that comes out of me and I have the impression that I understand a large part of my life.”

(Source: T. Bock, StimmenReich 2007, Psychatrieverlag, Germany)

Pias story

A small boy, well-mannered and unobtrusive, tied to his big sister’s apron strings. The parents have little time. The sister becomes psychotic, is admitted to a psychiatric clinic. The small boy witnesses firsthand what is happening there has great anxiety for his sister but also for himself. He rescues himself on the side of order, struggles for distance to his sister, does not want to be like her. He goes through school and puberty without attracting attention, joins the national defence forces for a long stint, becomes a company commander, completes specialized training, marries early, soon becomes a father. And yet the order cannot be maintained for long.

After the end of his time in the defence forces, despite having qualifications he cannot be taken on in the long-run. Despite considerable efforts, he finds it difficult to gain a foothold in another profession in the long-run. It makes him even more unsettled that his daughter will grow up, grow away from him. He cannot explain this development other than delusional, believes that it is manipulated by drugs, until finally he sees little white packets and puts his daughter and wife to flight. He has debts, loses his apartment. All he has left is a rabbit. When he gets ill he withdraws into the forest of Ludwigslust, from which he believes that the mafia has not yet reached him. He lives there for months, without seeing a human soul, lives only on the fruits of the forest.

Since then Mr K. - he sometimes also calls himself "Pias” – has lived for almost seven years on the street, has depots / dumps in the forests around Hamburg. His credo: “Man is the only living being that by itself is not able to live in a way appropriate to its species” He tries nonetheless, lives close to nature, without alcohol and cigarettes. In a permanent struggle for survival he benefits from his training at the national defence forces. Specific psychic anxieties do not allow him to stay a long time in closed spaces, impose on him many restrictions also otherwise. However, he does not come into the outpatient department in which I worked in order to change something or even receive treatment, but only to warm up sometimes, be among people, also to eat and to drink coffee.

Around two years ago, this harmless man living a very withdrawn existence was the victim of a mugging shortly before Christmas. A fanatic for order from a better neighbourhood beats him up, gives him a good kicking and sets his dog on him. With a serious leg injury Mr K. wants to drag himself to one of his depots, but breaks down beforehand. He only survives the ice cold night due to his special constitution and the many layers of clothing. The next morning he is found and brought to hospital. There, for the first time for a long time, he endures being in a closed space and lying in a normal bed. Unfortunately, only for a few days: owing to the upcoming New Year’s Eve celebrations, surgical beds must be kept free for burn injuries. Mr K. is admitted to psychiatry – for the first time in his life. And yet, there are surveillance cameras installed there in order to be able to observe acute patients without being nearby them. Moreover, a somewhat invasive fellow patient comes to close to him. He flees, is completely beside himself. I cannot even keep him in the outpatient department, find out further that “the current is passing through him” Mr K. not (only) means the electronic surveillance but – what I am finding out only now - the electric shocks of his sister.

Only a few weeks later, I see him again. His leg has fortunately also healed. Only much later do I trust myself to ask him whether he agrees to the creation of main character of a story for young people being based on his example. He agrees surprisingly quickly, appears to sense that his story has a lot to say particularly to young people and that it is a matter of encountering prejudices at the right time.

The joint work resulted in the book for young people “Pias lives … dangerously“ (balance – buch- und medienverlag, Germany). Gerd Kemmen becomes a consultant as “Irre menschlich”, Hamburg, Germany.

The question remains whether the psychiatry that Mr K. encounters satisfies his criterion of “living in a way that is appropriate to the species” whether it is humane. Moreover, it becomes clear that all efforts for treatment – whether motivated biologically or from social psychiatry perspectives must be taken into account that particularly people with experience in psychiatry go their way obstinately and that particularly this obstinacy can be a meaningful coping strategy compared with the (psychotic) heteronomy. In the figurative sense, this then also means that all considerations regarding new treatment methods can only be attempts at approximation. We must at the same time recognise and support self-will and individual coping strategies, we must leave them social and cultural space, indeed under circumstances first create this space by confronting the current prejudices.

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