Depressive psychosis explained

My waking nightmare

Photo by James Lee on Unsplash

Trigger Warning: The following is a graphic description of some very vivid hallucinations suffered during a major ‘depressive psychotic episode’ which lasted for several weeks.

Pyschosis is a scary word I know. It is loaded with negative connotations from its depiction in the media, both in fiction and the news.

What is the first thing that comes into your mind when you hear the words psychosis or psychotic?

I’ll tell you what it used to mean for me. It made me think of the film Psycho, actually one of my favourite films. Axe murderers, serial killers, people with no basic compassion or care for human life. Psychopaths in other words.

That was before I had several profound experiences of a psychotic state myself, of course.

But the words psychosis and psychotic need to be used and without judgement if we are to fully tackle mental health stigma.

So what is psychosis anyway?

Simply put, psychosis just means losing touch with reality in some way. As I’ve explained before, a psychotic episode can creep up on you, especially off the back of a manic episode.

That doesn’t necessarily mean you can nip it in the bud. That’s doubly the case if you’re not medicated and living with a condition like bipolar.

And what about depressive psychosis?

This is basically a psychotic episode on steroids. The best way I can describe a depressive psychotic episode is like an extremely vivid waking nightmare or bad psychedelic trip that rather than ends just seems to last forever and get more intense.

Worse still, it’s like one of those nightmares that occasionally incorporates flashes of physical reality.

You know the ones where your alarm sounds like a police siren in your nightmare or the chatter of people on the radio blends in with the conversations you’re having in your dream state?

For example I was told that I was punched and knocked out for a while while waiting in A and E. I fully felt that visceral blow but I have no idea of the wider real context behind it.

Apparently another rather disturbed person waiting there had seriously encroached on my personal space, so I had thrown my hot chocolate over them in frustration, being unable to communicate about this infraction. (Or perhaps I was simply too scared to say anything to him so lashed out bizarrely with my cocoa in desperation.)

That was what prompted him to punch me in the head. In a weird kinda way I was grateful for feeling that punch, as it almost reassured me that I was still alive. Almost.

So what does this mean?

Simply put, someone in a psychotic state basically loses touch with reality in a major way. That’s what the word psychosis means in a clinical sense.

It’s all to do with my perception of reality and it is a very frightening experience indeed.

This is my memory of finally ‘waking up’ in a secure mental health hospital after the most severe experience of mental ill health and impaired physical health of my 49 years of life.

I am relatively lucky after all, since I have never even been admitted to any kind of hospital before. Never even broke a bone in my body. I also have a great support network, including a loving and patient live-in partner and many friends, near and far.

Not everyone has that I know. I will soon meet some people in a worse situation than me. Fellow service users of the unit, some of whom have been sectioned and hospitalised before. Some of whom don’t have this support network or whose symptoms are just more ingrained and advanced. People of all ages and backgrounds.

This is what I remember about the worst psychotic episode of my life, as experienced in late February and early March 2024.

If it doesn’t sound very coherent, that’s because it was not. You cannot logically and calmly argue your way out of a highly paranoid psychotic episode after all.

Anyway, let’s get on with the story of it now.

As usual it is a fairly lengthy post, but trust me when I say that it could have been much longer.

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I wake up suddenly. I’m on a plane that appears to be landing. Taxiing on the runway for an awful long time. Feel like I’ve been asleep for days, weeks, months, decades even.

Perhaps my whole life. Yet I don’t feel remotely rested. No clear memory of the past week either. Am I dead now?

I decide that I must indeed be dead. Now I’m just waiting for ‘the afterlife.’ Being agnostic, I genuinely don’t know what awaits me. Perhaps this is hell? My personal version of it at least. Am I getting spiritual now since I’m at death’s door?

I’ve always been pretty cynical about spirituality but perhaps everyone who has a brush with death experiences such shifting ideologies.

The plane just keeps on taxiing so very slowly. Soon enough we’re out of this featureless airport. Why is this such a long journey anyway? Where am I being taken?

Now I’m moving past a badly rendered, cardboard Silent Hill-like backdrop of the outskirts of some nameless town. Past petrol stations, shops, hotels and bars, all burnt out, war torn and decaying.

It reminds of the outskirts of Havana for some reason, a city I have very mixed feelings about having visited briefly on a boozy, escorted press trip some years ago while in the grip of an unfortunate mixed manic episode.

Only one person on this flight, must be my ‘handler.’ As soon as I turn to her to ask her where I am she simply disappears from view.

Perhaps she was never even there? Maybe I’d simply imagined her company to make me feel less afraid. And who is even piloting this plane, is it on autopilot perhaps? The plane has now started to feel more like a bus. I am shuttled out of it by two nameless people.

They seem anxious to get me off this strange plane-bus hybrid and grab my bags. I feel a strange desire to gently touch them physically, just to check that they are real people, but they resist this.

Being Admitted

The next thing I know I find myself in a large, draughty, featureless room. A holding pen of sorts. I’m sat at a desk, being made to do a seemingly endless amount of paperwork by Carrie, who I later learned is a nurse in a secure mental health unit where I’d just arrived.

A man is also present, perhaps he is there for security reasons. Have I been acting aggressively? I honestly have no idea.

Between them they seem to be improvising for my benefit, asking me endless questions I fail to give sufficiently positive answers to, shuffling papers and killing time, while they work out what to do with me and where to put me.

I feel completely adrift and helpless here. No agency whatsoever.

I must be in some kinda purgatory. Perhaps I have died and they just don’t know where to send me yet.

So I do what I often do in a crisis. I start to catostrophise…

They’ve never had a case like this before. Maybe I’m just a bad person. A suicidal mass murderer about to meet my maker and face my final reckoning?

Maybe I’m racist to boot? I didn’t think so of course, but I must be a fairly awful person to have met this fate. After all, only bad people go to hell don’t they?

I’m in limbo. The no man’s land that awaits the morally bankrupt. Yes, that must explain things. There’s no other credible explanation.

Have I killed the one person who loves me more than anyone, myself or even both of us?

Again I didn’t think so, but in my confused, psychotic state I am clutching at straws, trying to figure out my new reality in real time. I certainly felt responsible for a lot of things that would make little logical sense.

And now I must pay the price. To spend eternity here with just my catastrophically depressive thoughts for company.

Captive in my Room

Then I’m in a low rent ‘hotel room’ of sorts. I feel like I’ve been here before, many times actually. Am I like the proverbial cat with its nine lives?

It has an adjoining bathroom with a fabric shower room door with a sunny nature scene printed on it.

I later realise that this is my actual private room in the secure mental health unit.

But right now it feels like that peculiar borderless land that exists when you disembark from an aeroplane. A holding pen of sorts. Passport control maybe.

I’m giving myself up for committing some unspeakable atrocity. The people I’m giving myself up to seem angry with me, like I am inconveniencing them, endangering them even, simply by rocking up here, giving myself up and continuing to exist.

So who am I and what have I done? Am I the biggest mass murderer in history perhaps? Could I really be the worst human that ever lived? Worse than Adolf Hitler even?

Or just the most egotistical person that walked the earth. Well someone has to be after all, so why not me?

Do ‘evil people’ even feel remorse? I like to think that I’m a reasonably good person with pretty good values, but this experience is making me question everything.

So I meekly give myself up by arriving in this moral hinterland. It’s the only right thing to do after all. But any shot of redemption is well beyond me now. I just have to accept my fate.

I put my hands up in surrender but stay in my room. This is something of a paradox. They’re not going to come into my room to kill me. There are laws governing such things. They have to wait for me to come out of my room before they shoot because that’s the correct protocol.

By now I am utterly convinced that I’m surrounded by armed policemen who will surely blast my body with countless gun shots the second I step past the safe threshold of my ‘cell room’, as apparently I am ready to admit to some deplorable act I cannot even remember.

I can’t actually hear or see any armed police though, so what on earth is going on?! Obviously all this is simply going on in my head but it certainly feels real enough to me.

Yet I still don’t surface from my room, as I’m too cowardly to face the music.

I’m still scared of dying it seems, even though I seem to have convinced myself that I’m already dead. I’m scared of the pain of being shot to pieces or maybe of simply not existing anymore?

Of the black, limitless void. Perhaps there is no God after all, or perhaps I’m simply meant to rot in hell for all eternity to atone for my sins in the real world.

My Worst Fears

I used to think my greatest fear was public humiliation. That must have already happened by now. But it seems I’m charting deeper, choppier mental waters now.

Maybe I’m most scared of losing my mind, disappearing into myself. Of being surrounded by the rest of the world going about its business, while being unable to communicate with them that I can see and hear them.

Recognising significant people in my life while being completely unable to communicate with those I love, trapped in myself in some nameless hospital ward for the rest of my life.

So when presented with this stark thought, perhaps it’s easier to decide that I am dead, that this is hell and I am just some unredeemable monster.

My delusions deepen. I now think that I’m some gargantuan Godzilla beast capable of tearing down entire countries, planets and civlisations with the slightest, casual flick of my wrist.

Yes that is literally what I think I am now. A giant careless monster with no functional moral compass.

A Monster in Hell

So if this is hell I simply need to survive it somehow. That means staying awake for eternity. And eating more and more, to get even stronger and bigger.

To never sleep again. I’m already a hideous, colossal beast after all and I need my strength to survive hell.

How could things possibly get worse?

I just have to stay awake and keep running and eating. So that’s what I do, I wreak absolute havoc in this place.

But there’s a problem. My worst fears are soon confirmed.

Hell could not possibly be real. I’m not a man of faith after all. Agnostic with a leaning towards atheism at best.

Ergo it must all be an elaborate simulation populated by ordinary people from different nations across the globe. A cast of thousands, all speaking different languages to accommodate everyone who dies.

It’s like one big survival horror video game, but I still plan to survive it and maybe even write about it one day. And therein lies the issue.

If I do so I’ll be giving away the biggest secret of life and death. And obviously that cannot be allowed.

Imagine the chaos it would cause if everyone knew that there is no afterlife? If all we had to live for was the here and now. No redemption. No religion to provide a moral compass for many people all over the globe.

This is how paranoid I am at this point. I’m catastrophising wildly but have zero insight. A dangerous combination.

Not only have I killed myself, and the person I love the most, and who gladly returns that love, but everyone I like and care about too. All dead by my own careless hand.

In surviving hell and selfishly outliving even its professional ‘actors’ I surely am responsible for the wiping out not just everyone on Planet Earth but all known civilisations.

I will carry that on my conscience for all eternity. I deserve nothing less.

Turning Point

At some point later my partner comes to visit me in the hospital. I recognise her instantly and am greatly relieved to discover her seemingly alive and well. Yet I cannot seem to communicate this to her. Have I brought her back from the dead only to suffer more at my own hand?

I am convinced that we are both long dead and being controlled by some powerful demons. To spare her further agony I need only to use the special code that will release her from her torment and also allow me to die. Well it is too late for me but I can still save her.

I just need to say her initials to prove that I am still worthy of her love and forgiveness and release us both from this bespoke hell.

For some reason I am paralysed with fear. I even think that she has come to kill me in order to save mankind from my horror.

I know that I am not man enough to kill myself, so she has been summoned by God to do the job for me. Or perhaps my captors have organised her visit. Because that’s just how pathetic a creature I have become.

So our first reunion seems to have failed. She leaves frustrated that she has not been able to wake me from this nightmare, that I have been unable to say her real name despite spending some considerable time in her patient, loving company.

And so I am still trapped in my own bespoke version of hell. I have yet another tortuous night to endure. I spend most of it pacing around my room, looking out the window and clinging on to my bed with severe stomach cramps. In reality I have been constipated for at least a week you see, having very little privacy in hospital.

My thoughts are racing even more wildly than ever and I am not remotely sleepy, despite feeling completely exhausted.

I also seem convinced that if I sleep I will die and will have therefore sealed my fate of wiping out all known civilisation. I pretend to be asleep as I can hear those supervising me trying to engage me with conversation, but I am too far gone for that.

At turns they seem amused by me, angered by me and exasperated for not letting them sleep and for my ‘play acting’ at being asleep.

This is just the price I have to pay for killing everyone outside of this ersatz hell, which seems to be set in some remote jungle on an obscure island well off the beaten track. So my pale, skinny body will never be found and I will die taking these secrets with me.

This is just where everyone goes to die and now I have ruined this dark secret for everyone.

Then there are the letters. What seemed to have prompted this episode was a pair of very long, angry letters. I had received one from my partner written in a foreign tongue I did not speak.

I ‘dreamt’ that I’d sent one in return, equally barbed, in which I’d threatened to kill myself. I was convinced that this unfortunate epistolary exchange was the reason I ended up here. I’d somehow shown my handlers my letter, which had made the staff and nurses panic.

I remember a nurse coming into my room to administer some medication, along with some toast. She seemed deeply stressed and annoyed with me.

This was another of my ‘blended reality’ moments, much like the punch to the head. I was trying to make sense of my reality, but still convinced by my own bizarre hell narrative.

Had I actually taken an overdose or something? Or just finally taken whatever medication I was prescribed that day?

I’d had another ‘nightmare’ in which I kept repeatedly killing myself and then coming back to life, returning to hell repeatedly, looking for answers as to what was wrong with me.

What was my true diagnosis and could it possibly account for my awful behaviour? This couldn’t possibly be all because I was bipolar and had a difficult upbringing could it?

How I’d let the Staff of Hell Down

Back to hell now and my paradoxical dilemma.

Most of the people populating this hell simulation come from relatively poor countries you see, mostly from African nations. Yet there I was selfishly wishing to capitalise on this whole sorry experience by writing about it for money in a comparatively wealthy, first world country.

Since I’d exhausted them all, I had not only wasted their time but I was also responsible for their eventual death.

Since word could not get out about this ‘fake hell’ and I had killed them all by refusing to simply die myself, I had to pay a price.

Their solution was to kill me and leave me for dead here in the jungle of this far-flung, remote island, but first I had to fake my own death for their cameras.

I keep running on the spot in my room and faking my death, throwing myself on the cold, hard bathroom floor, faking being shot in the back by a gunman, very unconvincingly. I was never a great actor or liar.

My captors want to film my efforts because when word gets out of the truth behind hell they will need a fall guy and that’s me. So I keep attempting to fake my own death for them.

I felt that I was doing so at the dying request of my hell handlers in order to save humanity.

Reality

I later learnt that I’d been refusing food, drink or medication, such was my intense paranoia. I’d been fighting for my life on a drip in Croydon Hospital. I remember very little about my stay in Croydon.

I remember only the visceral shock of being punched in the head by another patient in A and E, the sterile white light ceiling fixtures of my empty room, my bag and possessions surrounding me, and first arriving at the hospital with my partner there to greet me.

I was desperate to get away from this hospital, having zero insight by this stage.

I am ashamed to say that I was absolutely terrified of her at the time, convinced as I was that she was trying to kill me, or worse make me lose my mind and be trapped in a mental health facility for the rest of my life.

Turning Point: Love is the Answer

The next day though something finally clicks into place. Have I slept or stayed awake? I have no idea but feel like it must be the latter.

My sense of time passing is massively distorted. I feel like I have been ‘asleep’ hallucinating wildly for millennia, in reality it has only been a week or so.

Her visit must have worked! It’s a bloody miracle. We’re both alive and living in the real world which is largely populated by kind, caring people.

I’m not in a bespoke hell anymore, but in hospital for people with acute mental health needs.

Finally I wake up to myself. I calmly pack my black leather bag into a lockable container underneath my bed. I put my personal affects away on the shelves in my room, I come out of my room and start to use my real name. I am Julian again.

I am not my father, mother or brother, nor am I some massive monster capable of heinous things.

I’m able to smile again, eat and drink something, notice my surroundings fully, look in the mirror at my scratched up, skinny face, take my tablets and even interact positively with my mental health handlers and fellow patients.

I am way chattier than usual of course, maybe quite manic still, yet on different medication. I’m no longer on a massive dose of Quietapine.

I’m now taking a small, manageable dose of Olanzapine. The doctor tells us that it’s one of the more reliable mood stabilisers and anti-psychotics out there and I trust him fully.

Mostly I’m just so relieved to be alive in a world populated by so many good, caring people who have not given up on me. Most miraculously of all this includes my loving partner.

Even complete strangers and mental health workers seem to be on my side now, wishing me well and helping me get better. I do so at a fairly rapid pace.

Insight has finally returned, despite having virtually no memory of arriving here and of being in Croydon Hospital for nearly a week.

The worst of this nightmare is behind me. Now I just have to deal with the reality of losing my freedom and being sectioned in a secure metal health hospital ward on one-to-one supervision.

I am clearly very unwell indeed, and here in hospital for my own benefit, but I have certainly felt much worse recently.

I have hit rock bottom but from here the only way is up. There is always hope, little bursts of joy and small victories to celebrate. And I fully intend on doing so.