What is Psychosis Actually Like

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

One of the most common questions people ask about psychosis is also one of the hardest to answer:

What does it actually feel like?

The difficulty is that psychosis rarely feels like a person becoming ill. More often, it feels as though the world itself has changed. The beliefs, perceptions, and conclusions that emerge during psychosis often seem entirely reasonable at the time. The problem is not that reality feels distorted. The problem is that the distortion feels real.

In this video, I reflect on two very different episodes of psychosis, separated by almost a decade. Along the way, I discuss paranoia, delusions, hospital admission, relapse warning signs, voice hearing, insight, recovery, and the challenges of recognising psychosis when you are living through it.

This is not intended as a universal account. Psychosis takes many forms. It is simply an attempt to describe what it felt like from the inside.

Key Concepts

• What psychosis feels like

• Delusions

• Paranoia

• Voice hearing

• Relapse warning signs

• Insight

• Schizophrenia

• Hospital admission

• Recovery

• Lived experience

Watch the Video

https://www.youtube.com/watch?v=JdDKK1i8aiI

Transcript

The Problem With Explaining Psychosis

When people ask what psychosis feels like, my default answer is usually this:

It feels like the world around you is changing rather than you are changing.

That's the closest description I've found.

The difficulty is that psychosis doesn't necessarily feel unusual from the inside.

The beliefs make sense.

The conclusions feel logical.

The emotions feel justified.

What changes is the framework through which reality is being interpreted.

One analogy I sometimes use comes from the John Wick films.

Imagine that everyone around you has secretly received a message about you.

Suddenly people seem to be paying attention.

Conversations feel significant.

Ordinary events feel coordinated.

The entire social world appears to have shifted in some subtle but important way.

That's often what psychosis feels like to me.

Warning Signs

Although psychosis itself can be difficult to recognise, I do have warning signs that tend to emerge beforehand.

These include:

• Intense emotional reactions.

• Uncontrollable crying.

• Heightened sensitivity to music.

• Strong emotional responses to films and stories.

• Increasing preoccupation with unusual interpretations.

Many people who experience psychosis develop personalised relapse prevention plans because warning signs vary considerably from person to person.

Recognising those early changes can be an important part of staying well.

My First Episode

My first psychotic episode developed gradually.

I was using large amounts of cannabis and had already begun behaving in increasingly unusual ways.

My thinking became more paranoid.

My behaviour became more impulsive.

I started finding personal meaning in unrelated events.

One evening I became convinced that poems, websites, and online content were secretly about me.

I emailed strangers asking how they knew details about my life.

At the time, these questions felt entirely reasonable.

Looking back, they were early signs that something was seriously wrong.

Waking Up Certain

The next morning I woke up with complete certainty that I was going to be murdered.

I didn't know by whom.

I didn't know why.

I had no evidence.

But none of that mattered.

The conviction arrived fully formed.

The certainty was absolute.

This ultimately led to contact with healthcare services, involvement from my family, and eventually admission to hospital.

The Reality Television Delusion

One of the defining features of my first episode was a delusion involving the illusionist and television presenter Derren Brown.

Years earlier I had applied to take part in one of his television programmes.

During psychosis, I became convinced that I had secretly been selected.

Suddenly everything made sense.

The behaviour of hospital staff.

The unusual events unfolding around me.

The structure of the psychiatric ward itself.

All of it became evidence that I was participating in an elaborate reality television experiment.

The remarkable thing about delusions is not how strange they appear afterwards.

It's how convincing they feel at the time.

When Language Changes Meaning

One experience stands out.

While attending a guided meditation session on the ward, I heard the facilitator say:

"When you feel ready to face the challenges of the day, you can leave."

Most people would interpret that statement in a straightforward way.

I interpreted it as an instruction to escape.

Within hours, I had absconded from the ward.

This illustrates something important about psychosis.

The words themselves were ordinary.

The interpretation was not.

The Psychiatric Intensive Care Unit

Eventually I was returned to hospital and admitted to a psychiatric intensive care unit.

Far from reducing my delusions, the environment initially strengthened them.

The bright colours.

The security cameras.

The enclosed layout.

All of it seemed consistent with the reality television narrative I had constructed.

At the same time, clinicians were dealing with a separate issue that I knew nothing about.

An ECG had identified a previously unknown heart condition, which complicated decisions about medication.

Because I wasn't receiving antipsychotic treatment immediately, the delusion continued to grow more elaborate over the following weeks.

The Morning Everything Changed

After approximately six weeks, I was prescribed a small dose of quetiapine.

The following morning I woke up and realised:

I wasn't on a television show.

I was in a psychiatric hospital.

The shift was abrupt and disorientating.

The previous six weeks suddenly appeared completely different.

I remember feeling as though I had gone to sleep inside a television studio and woken up in a hospital that happened to look identical.

It was one of the strangest experiences of my life.

Eight Years Later

After recovery, I spent eight years without antipsychotic medication.

During that time I completed my degree, pursued postgraduate study, worked in mental health services, and eventually undertook doctoral research.

Then, while writing up my PhD thesis, psychosis returned.

The second episode was very different.

The themes were more focused.

The paranoia centred primarily on my former partner and concerns about my daughter.

I became convinced that things were being moved around the house, that my coffee was being tampered with, and that my hair was being cut while I slept.

I had no evidence for any of these beliefs.

Yet they felt entirely real.

The Importance of Saying It Out Loud

One thing proved protective.

Eventually I began describing my beliefs aloud to other people.

The moment I heard myself explaining them, something changed.

Internally, the ideas felt plausible.

Externally, they sounded much less convincing.

Speaking them aloud created a degree of distance from them.

For the first time, I was able to hear how unusual they sounded.

That realisation played an important role in my decision to seek help voluntarily.

Turning Myself In

I often joke that I "sectioned myself."

Obviously that isn't literally possible.

But the description captures something important.

I drove to A&E, explained what was happening, and asked for help.

At that stage I still had some insight.

I wasn't certain that my beliefs were false.

But I wasn't certain they were true either.

That uncertainty was protective.

It created enough doubt to allow intervention before the situation became more severe.

Voice Hearing

People often ask whether I hear voices.

The honest answer is complicated.

I've never experienced the classic form of voice hearing that many people associate with schizophrenia.

I've never had running commentaries or multiple voices having conversations.

Instead, my experiences tend to be much more ambiguous.

For example, I may hear somebody say something and later discover they never said it.

Or I may become unsure whether a remark was genuinely spoken or merely perceived.

These experiences can be extremely difficult to reality-test because they often resemble ordinary speech rather than obviously hallucinatory voices.

Why the Second Episode Was Different

The second episode unfolded differently for several reasons.

By then I had worked in mental health services.

I understood psychiatric terminology.

I was familiar with hospital environments.

I had spent years researching psychosis.

Most importantly, I retained some insight.

The first episode involved absolute certainty.

The second involved doubt.

That doubt made all the difference.

It allowed me to seek help before the situation escalated further.

Looking Back

One thing I've learned is that psychosis is not a single experience.

Even within the same person, different episodes can look remarkably different.

The themes may overlap.

The concerns may recur.

But the form can change dramatically.

What remains consistent is the feeling that the world has changed.

Not you.

The world.

And that is perhaps the greatest challenge of psychosis.

When reality feels altered, it can be incredibly difficult to recognise that the change may be happening within your own perception rather than outside of it.

Final Thoughts

If I had to summarise psychosis in a single sentence, it would be this:

Psychosis feels less like becoming a different person and more like waking up in a different world.

That world can be frightening.

It can be meaningful.

It can be confusing.

And it can feel completely convincing.

But recovery is possible.

I've lived through psychosis more than once, and one of the most important lessons I've learned is that certainty is not always a sign of truth.

Sometimes the willingness to doubt your own conclusions is what ultimately brings you back.

Further Reading

• Fought Disorder

• How Language Holds: Schizophrenia Beyond Structure

• DAIS-C Corpus

• Video: How Do You Trust Yourself After Psychosis?

• Video: Residual Symptoms After Psychosis

• Blog: Living with Schizophrenia

Unusual Coincidences and Psychotic Experience

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

People often describe psychosis in terms of hallucinations or delusions. Less attention is given to the subtle experiences that sit somewhere between ordinary life and psychotic belief.

One example is ideas of reference: the tendency to interpret events, conversations, or pieces of information as personally significant when there is little or no evidence that they are.

For many people, ideas of reference are not simply unusual thoughts. They can be persistent, emotionally exhausting, and difficult to explain to others. They also raise fascinating questions about meaning, coincidence, pattern recognition, and how human beings make sense of the world.

In this video, I reflect on a series of experiences involving ideas of reference, unusual encounters, and the phenomenon psychiatrists sometimes describe as aberrant salience. Along the way, I discuss life as both a patient and a healthcare assistant, the social experience of psychosis, and why certain interactions have remained with me for years.

Key Concepts

• Ideas of reference

• Delusions of reference

• Aberrant salience

• Dopamine hypothesis

• Psychosis and communication

• Schizophrenia

• Pattern recognition

• Recovery

• Lived experience

• Meaning and coincidence

Watch the Video

https://www.youtube.com/watch?v=0vx0pXtTnjk&t=3s

Transcript

A Strange Encounter in Manchester

Several years ago, while living in Manchester, I had an encounter that has stayed with me ever since.

I was walking along Oxford Road when I began talking to a man selling The Big Issue.

During the conversation he asked what I was studying.

I explained that I was conducting research on schizophrenia.

He paused and then asked:

"Do you have the condition yourself?"

I was surprised.

When I asked how he knew, he replied:

"You know your own kind, don't you?"

I've thought about that exchange many times since.

What exactly did he notice?

Was it something in my appearance?

My behaviour?

My manner of speaking?

Or was he simply making an educated guess?

I still don't know.

The Question That Stayed With Me

The encounter raises a question I've returned to repeatedly:

Can people with psychosis recognise each other?

Not in a supernatural sense.

Not because they possess special knowledge.

But because they share certain ways of communicating, interpreting events, or relating to the world.

The man seemed genuinely unsurprised when I confirmed that I had schizophrenia.

Whether he was correct through intuition, observation, or coincidence remains impossible to determine.

But the experience left an impression.

Ideas of Reference

The encounter also highlights one of the most persistent symptoms I experience:

Ideas of reference.

Ideas of reference involve interpreting external events as though they are directed specifically at you.

For example, I might be standing in a café queue when somebody nearby says:

"He's such a dick."

Objectively, the comment is probably directed at somebody on a phone screen, a friend, or an unrelated situation.

Yet my immediate experience is often different.

For a brief moment, my brain processes the statement as though it were aimed directly at me.

It's as if the normal contextual cues arrive too late.

The personal interpretation comes first.

The correction comes afterwards.

Living With Ideas of Reference

One reason ideas of reference are so difficult is that they require constant intervention.

When the interpretation occurs, I have to consciously respond:

"That isn't about me."

This isn't something I do occasionally.

It's something I do repeatedly.

The symptom remains present even years after my psychotic episodes.

In fact, it's the only psychosis-related symptom that has never fully disappeared.

The experience can be exhausting because ordinary public environments contain an endless stream of conversations, comments, and fragments of speech.

Each one has the potential to trigger the process again.

Talking to Another Patient

While working as a healthcare assistant, I once supported a young patient who was experiencing ideas of reference himself.

We discussed the symptom and I explained that psychiatrists call it ideas of reference.

He asked a question that caught me off guard:

"Does it ever go away?"

I hesitated.

The honest answer, in my case, was no.

But I could also see how distressed he was.

Rather than focusing on prognosis, I talked about coping strategies.

Learning to recognise the symptom.

Learning to challenge it.

Learning to continue living despite it.

It was one of those moments where professional knowledge and lived experience collided in a very human way.

When Ideas of Reference Become Delusions

Ideas of reference and delusions of reference are closely related but not identical.

With ideas of reference, there is still room for doubt.

You can tell yourself:

"That probably wasn't about me."

With delusions of reference, that uncertainty disappears.

The interpretation becomes certainty.

The message is no longer potentially directed at you.

It is directed at you.

That distinction may sound subtle, but psychologically it is enormous.

Do People with Psychosis Understand Each Other Differently?

One of the most interesting observations I've made is that conversations between people experiencing psychosis often feel different from conversations between patients and staff.

Patients and clinicians frequently seem to be talking past one another.

They're operating within different frameworks.

Different assumptions.

Different styles of reasoning.

Yet when two people experiencing psychosis talk, something else sometimes happens.

The content may be unusual.

The logic may be unconventional.

But there can be a surprising sense of mutual understanding.

It's as though both people recognise a shared symbolic language beneath the surface.

Bill and the Jigsaw Piece

I remember meeting another patient shortly after arriving on a psychiatric intensive care unit.

His name was Bill.

He was welcoming, thoughtful, and communicated in a highly symbolic manner.

At one point I was talking with another patient when Bill emerged from the occupational therapy room carrying a single jigsaw puzzle piece.

He handed it to me and said:

"It's the piece you're missing."

I still have that puzzle piece.

Looking back, the exchange feels strangely representative of psychosis itself.

A symbolic gesture.

An ambiguous meaning.

A moment that seems deeply significant even though its interpretation remains uncertain.

Aberrant Salience

The explanation that makes the most sense to me comes from the concept of aberrant salience.

According to this theory, psychosis involves disturbances in how significance is assigned to experiences.

Events that would normally seem ordinary begin to feel important.

Patterns emerge everywhere.

Connections appear between unrelated things.

The world becomes saturated with meaning.

This idea fits well with my own experiences.

Many of the moments that felt profound during psychosis involved linking together events that were probably unrelated.

The significance was real.

The connections were often not.

Dopamine and Pattern Recognition

The dopamine hypothesis offers one possible explanation.

Dopamine plays an important role in learning, motivation, and pattern detection.

Too little dopamine can impair learning.

Too much dopamine may contribute to seeing patterns that aren't actually there.

In everyday life, pattern recognition is useful.

It's one of the ways human beings understand the world.

During psychosis, however, that system may become overactive.

Coincidences become messages.

Random events become clues.

Ordinary experiences acquire extraordinary significance.

The Appeal of Mystery

Despite finding scientific explanations persuasive, there remains a small part of me that still wonders about some of these experiences.

How did the man in Manchester know?

Why do certain symbolic encounters feel so powerful?

Why do some coincidences linger in memory for decades?

I don't think these questions require supernatural answers.

But I do think they reveal something important about human beings.

We are meaning-making creatures.

We look for patterns.

We tell stories.

We search for significance.

Psychosis magnifies those tendencies until they become impossible to ignore.

Looking Back

When I reflect on psychosis now, I'm less interested in proving whether a particular coincidence was meaningful.

What interests me is why it felt meaningful.

How significance was assigned.

How connections were formed.

And how the mind transformed ordinary events into experiences that felt profound.

Understanding those processes has taught me far more about psychosis than any individual coincidence ever could.

Further Reading

• DAIS-C Corpus

• How Language Holds: Schizophrenia Beyond Structure

• Fought Disorder

• Video: Delusions, Meaning, and the Stories We Tell Ourselves

• Video: Residual Symptoms After Psychosis

• Blog: Living with Schizophrenia

Experiencing Delusions in Psychosis

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

When people think about psychosis, they often think about hallucinations. Voices, visions, and unusual perceptions tend to dominate public discussions.

Delusions are different.

They are not simply strange beliefs. They are experiences that can feel profoundly real, emotionally convincing, and deeply connected to a person's sense of self. They often emerge without warning, reshape how events are interpreted, and draw together elements of personal history, memory, fear, hope, and meaning.

In this video, I reflect on my own experiences of delusions across two psychotic episodes. I explore how delusions formed, how they changed over time, and why I believe they often draw upon significant experiences from a person's life. Along the way, I discuss ideas of reference, the role of personal history, the influence of culture, and the strange relationship between delusions and self-understanding.

This is not intended as a clinical account of delusions in general. It is a reflection on what delusions felt like from the inside.

Key Concepts

• Delusions

• Ideas of reference

• Persecutory beliefs

• Cotard syndrome

• Truman Show delusion

• Personal meaning

• Psychosis and identity

• Aberrant salience

• Recovery

• Lived experience

Watch the Video

https://www.youtube.com/watch?v=Nrukkk9Qjx8

Transcript

What Delusions Feel Like

One of the most important things to understand about delusions is that they don't usually feel like beliefs.

They feel like knowledge.

When I became psychotic for the first time, I woke up one morning absolutely convinced that I was going to be killed.

I didn't know who was going to do it.

I didn't know when it would happen.

I didn't have evidence.

But evidence wasn't the point.

The conviction existed at a deeper level than reasoning.

I knew it in the same way that I knew my own name.

It was embodied knowledge.

A certainty that seemed to exist throughout my entire body rather than simply in my thoughts.

The Persecutory Delusion

My first major delusion was straightforward in one sense and overwhelming in another.

I believed that people were planning to torture and murder me.

The details were vivid and terrifying.

Looking back, what strikes me most is not the content but the certainty.

There was no process of weighing evidence.

There was no internal debate.

The conclusion arrived fully formed.

The feeling came first.

The explanations followed later.

When One Delusion Becomes Another

Something fascinating happened during my admission.

While standing alone in a hospital chapel, I suddenly reconsidered the entire situation.

The persecutory delusion dissolved.

In its place emerged a completely different explanation.

I remembered applying years earlier to appear on a television programme hosted by Derren Brown.

Almost immediately, I became convinced that I had secretly been selected.

Everything around me suddenly made sense through this new framework.

The unusual behaviour of staff.

The strange sequence of events that had brought me to hospital.

The conversations I was having.

The forms I had been asked to complete.

All of it became evidence that I was participating in an elaborate reality television experiment.

The certainty remained.

Only the explanation changed.

The Primary Delusion and the Delusion Bucket

Looking back, my experience was that psychosis often involved a dominant narrative.

At any given time, there seemed to be one primary delusion organising everything else.

Around that central narrative sat numerous smaller delusions.

A brief conviction that I was dead.

A belief that I was about to become a father.

The idea that hidden messages were embedded in newspapers, television programmes, and conversations.

These subsidiary beliefs would emerge, persist for hours or days, and then disappear again.

The main delusion remained.

The supporting cast changed regularly.

The Cotard Experience

One evening I stood alone in my room under the ward lighting and became convinced that I had already died.

This resembles what psychiatrists call a Cotard delusion.

The feeling wasn't metaphorical.

I genuinely believed that I had crossed some boundary between life and death and was now wandering through a strange and confusing afterlife.

The conviction lasted for several hours before disappearing as suddenly as it had arrived.

At the time it felt entirely real.

The Escape Room

Much of my first episode revolved around the idea that I was trapped inside a giant puzzle.

I interpreted messages in newspapers.

Writing on ward walls.

Comments from staff.

Conversations between patients.

Everything appeared meaningful.

Everything seemed connected.

I became convinced that I was participating in a kind of reality television escape room and that the only way to leave was to decipher the clues correctly.

Looking back, I can see connections to my personal history.

Years earlier, a close friend and I had spent an entire night solving a complex online escape room game.

It was a memorable experience.

That memory appeared to have been incorporated into the structure of the delusion itself.

Why Personal History Matters

One thing I've noticed repeatedly is that delusions rarely emerge from nowhere.

The form may be unusual.

The logic may be distorted.

But the raw material often comes from real life.

Important memories.

Unresolved conflicts.

Personal fears.

Significant relationships.

Experiences that mattered.

Psychosis seems capable of drawing these elements together into new and often bizarre configurations.

The result is something that feels both deeply personal and profoundly unfamiliar.

Guilt, Identity, and Self-Discovery

During my admission, a psychiatrist once asked whether I felt guilty about anything.

My response was immediate:

"Do you want the whole list?"

That answer captured something important.

Much of the psychosis felt like an attempt to process years of accumulated emotional material.

Guilt.

Relationships.

Identity.

Fear.

Self-worth.

Questions I had avoided for years suddenly became impossible to ignore.

One example involved my sexuality.

During the episode, I became convinced that I had discovered something important about myself.

The reasoning that led me there was profoundly disorganised and delusionally influenced.

Yet when I look back, there was also a kernel of truth hidden within the confusion.

Psychosis did not create that aspect of my identity.

It merely brought it to the surface in a highly unusual way.

Delusions and Culture

Psychiatrists have long noticed that delusions often reflect the culture in which they occur.

The underlying themes remain surprisingly consistent across history.

People experience surveillance.

Control.

Persecution.

Special significance.

Thought broadcasting.

Thought insertion.

The details, however, change with the times.

Today someone might believe they are being monitored through technology or reality television.

A century ago the same underlying concerns might have been expressed through entirely different cultural symbols.

The structure remains familiar.

The content evolves.

Delusions as Meaning-Making

One reason I find delusions fascinating is that they often seem to function as meaning-making systems.

They provide explanations.

They organise uncertainty.

They connect events that would otherwise feel disconnected.

The problem is that the resulting explanations are frequently detached from reality.

That doesn't mean they are random.

Many of the themes embedded within my delusions reflected genuine concerns, conflicts, and experiences from my life.

The conclusions were false.

But the emotional questions being explored often felt very real.

A Word of Caution

Whenever people discuss meaning in psychosis, there is a risk of romanticising mental illness.

That isn't my intention.

Psychosis was terrifying.

It was disruptive.

It caused enormous suffering.

The fact that delusions may contain personally meaningful themes does not make psychosis desirable.

Nor does it imply that treatment is unnecessary.

The challenge is holding two ideas at the same time:

• Delusions can be profoundly distressing and detached from reality.

• Delusions can also draw upon genuine aspects of a person's history, identity, and emotional life.

I don't think those ideas are mutually exclusive.

Looking Back

When I reflect on my psychotic episodes now, I don't simply see bizarre beliefs.

I see a complicated interaction between biology, language, memory, culture, emotion, and personal history.

The delusions themselves were often false.

But the experiences drew attention to questions that were real.

Questions about identity.

Relationships.

Fear.

Meaning.

Guilt.

And who I wanted to become afterwards.

That complexity is one of the reasons I continue to find delusions so fascinating.

Further Reading

• Fought Disorder

• How Language Holds: Schizophrenia Beyond Structure

• DAIS-C Corpus

• Video: How Do You Trust Yourself After Psychosis?

• Video: Residual Symptoms After Psychosis

• Blog: Living with Schizophrenia

Trusting Your Perceptions After a Psychosis

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

One of the least discussed consequences of psychosis is what happens after recovery begins.

Most conversations focus on symptoms, treatment, medication, and relapse prevention. Much less attention is paid to a deeper psychological question:

How do you trust yourself again?

Psychosis creates a unique challenge because it undermines one of the assumptions most people take for granted: that they can generally rely on their own perception of reality. During a psychotic episode, a person may feel completely certain that their beliefs are accurate, only to later discover that those beliefs were profoundly distorted.

What happens after that?

How do you rebuild confidence in your own judgement? How do you distinguish healthy caution from endless self-doubt? And what happens when you've experienced psychosis more than once?

In this video, I reflect on my own experiences of learning to trust myself again after psychosis, including the challenges of recovery, relapse, insight, and the complicated relationship between self-trust and external validation.

Key Concepts

• Recovery after psychosis

• Insight

• Delusions

• Relapse

• Self-trust

• Perception of reality

• Psychosis recovery

• Uncertainty

• Mental health stigma

• Lived experience

Watch the Video

https://www.youtube.com/watch?v=325GQQtNf5o

Transcript

The Problem Nobody Talks About

One of the strangest consequences of psychosis is what it does to your confidence in your own mind.

Before psychosis, most people move through life with a relatively straightforward assumption:

If I think I'm okay, I'm probably okay.

Psychosis disrupts that assumption.

During a psychotic episode, you may feel completely certain that nothing is wrong. In fact, that certainty is often part of the problem.

Then, after the episode ends, you realise that certainty can be misleading.

And that's where the real difficulty begins.

Because afterwards, you're left asking:

How do I know when to trust myself again?

The challenge isn't simply recovering from psychosis.

It's recovering your relationship with your own judgement.

Becoming an Unreliable Narrator

Before psychosis, I trusted my perception of reality.

Not because I had carefully evaluated it, but because I had never had a reason not to.

Then I experienced psychosis.

And suddenly I found myself in a position where I had been completely convinced that my understanding of reality was accurate when it wasn't.

That changes things.

You move from:

"I trust myself."

to:

"Can I trust myself at all?"

The difficulty is that psychosis doesn't simply challenge specific beliefs.

It challenges the process by which you form beliefs in the first place.

Afterwards, you can start doubting everything.

Not just your past perceptions, but your present ones as well.

It's a profoundly destabilising experience.

Recovery Takes Longer Than People Expect

The first thing I'd say is simple:

Give yourself time.

Psychosis is exhausting.

It's psychologically exhausting.

It's emotionally exhausting.

It's physically exhausting.

Whatever combination of biological, psychological, and social factors contributed to the episode, the aftermath often feels like recovering from a major assault on the mind.

In my experience, genuine psychological recovery can easily take six to twelve months.

Not symptom recovery.

Not discharge from services.

Psychological recovery.

The point at which you begin to feel confident enough to re-engage with life, trust yourself, and move forward again.

That process cannot be rushed.

The Trap of Endless Self-Monitoring

After psychosis, it's very easy to become preoccupied with questions like:

• Am I getting ill again?

• Is this normal?

• What if I'm relapsing?

• How would I know?

These questions feel sensible.

But they can become a form of rumination.

The more you monitor yourself, the more uncertainty you discover.

And the more uncertainty you discover, the more you monitor yourself.

Eventually, you can find yourself trapped in a cycle where your life revolves around checking whether you're becoming unwell.

I don't think that's healthy.

At some point, you have to stop comparing your current self with your psychotic self and simply start living again.

You have to give yourself permission to move forward.

Starting Again

The advice I usually give is surprisingly simple:

Start again.

Treat recovery as a fresh beginning.

Instead of constantly asking:

"Can I ever trust myself again?"

try asking:

"What happens if I decide to trust myself anyway?"

That doesn't mean ignoring symptoms.

It doesn't mean refusing help.

It doesn't mean pretending relapse is impossible.

It simply means accepting that complete certainty is no longer available.

You move forward without it.

And in many ways, that's what everyone does.

Psychosis just makes the uncertainty impossible to ignore.

My Second Episode Changed Everything

For years, I assumed that if psychosis ever returned, I would recognise it immediately.

That seemed reasonable.

After all, I'd experienced it before.

I knew what it felt like.

Surely I'd see it coming.

The reality turned out to be much more complicated.

Several months before my second admission, I became concerned that I might be relapsing.

I went to my GP and explained that I thought something was wrong.

I'd been off antipsychotic medication for years, but I asked to restart treatment because I felt I was slipping into psychosis again.

At that stage, I was taken seriously and prescribed medication while waiting for specialist review.

Insight Isn't Everything

When I eventually met with specialist services, I encountered a problem that taught me something important.

The assumption seemed to be:

If you have insight, you can't be psychotic.

I wasn't convinced.

I was trying to explain that recognising some symptoms doesn't necessarily mean you're completely well.

Psychosis isn't always all-or-nothing.

Insight can fluctuate.

Awareness can coexist with emerging symptoms.

Unfortunately, the situation was interpreted differently, and I was advised that psychosis wasn't the issue.

Several months later, I was admitted to hospital under section after a full relapse.

Why Previous Experience Doesn't Guarantee Future Insight

One of the biggest surprises of my second episode was how different it looked from the first.

The first time, my delusions were broad and expansive.

The second time, they were much more focused.

Because the presentation differed, I repeatedly told myself:

"This can't be psychosis. Psychosis looks different."

That turned out to be a mistake.

The underlying process was similar.

The content was different.

This taught me something important:

Having experienced psychosis before doesn't guarantee you'll recognise it the next time.

Sometimes previous experience helps.

Sometimes it doesn't.

Reality is messier than we'd like it to be.

Don't Hand Your Mind Over to Other People

One risk after psychosis is that people stop trusting themselves altogether.

They begin relying entirely on external judgement.

Family members.

Clinicians.

Friends.

Support workers.

Feedback from other people can be incredibly valuable.

But there's a danger in abandoning your own perspective completely.

After psychosis, your inner voice may feel less reliable than it once did.

But that doesn't mean it becomes worthless.

You still need to listen to yourself.

You still need to pay attention to your own experiences.

Recovery isn't about replacing your judgement with somebody else's.

It's about learning how to integrate both.

The Unreliable Narrator

One metaphor I often return to is the idea of the unreliable narrator.

Before psychosis, I assumed I was a reliable narrator of my own experience.

After psychosis, that certainty disappeared.

But I don't think the solution is to throw the narrator away.

The narrator may be imperfect.

The narrator may occasionally make mistakes.

The narrator may sometimes misinterpret events.

But it's still your narrator.

You still need to hear what it has to say.

The challenge is learning to balance self-trust with humility.

To recognise that you can be wrong without concluding that you're always wrong.

That's a difficult lesson.

But I think it's one of the most important parts of recovery.

Final Thoughts

If you've experienced psychosis and find yourself wondering whether you'll ever trust yourself again, my advice is simple:

Give yourself time.

Accept uncertainty.

Start again.

And don't spend your life trying to solve an impossible question.

You may never regain the kind of unquestioning certainty you had before psychosis.

But certainty isn't the same thing as trust.

Trust can return.

Not because you've eliminated every possibility of error, but because you've decided that living requires some degree of faith in yourself.

Recovery begins when you allow yourself to move forward despite the uncertainty.

Further Reading

• Fought Disorder

• How Language Holds: Schizophrenia Beyond Structure

• DAIS-C Corpus

• Blog: Living with Schizophrenia

• Video: Residual Symptoms After Psychosis

• Video: Ideas of Reference Explained

Living with Residual Symptoms

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

Much of the public conversation about psychosis focuses on acute episodes: hallucinations, delusions, hospital admissions, and crisis intervention.

What receives far less attention is what happens afterwards.

For many people, psychosis does not simply end. Some symptoms fade completely, while others remain in altered or reduced forms. These residual symptoms can persist for years, shaping daily life long after the acute episode has passed.

In this video, I discuss several residual symptoms that remained after my own psychotic episodes, including ideas of reference, intrusive inner speech, passivity-like experiences, and what I describe as "somatic anxiety"—persistent fears centred on bodily functions or symptoms.

The goal is not to present universal truths about schizophrenia or psychosis. Rather, it is to explore how one person has attempted to understand and manage experiences that sit somewhere between acute illness and complete recovery.

Key Concepts

• Residual symptoms

• Ideas of reference

• Inner speech

• Coprolalia

• Passivity experiences

• Schizophrenia

• Pragmatic language impairment

• Somatic anxiety

• Recovery after psychosis

• Symptom management

Watch the Video

https://www.youtube.com/watch?v=dLAx-Fevens

Transcript

What Are Residual Symptoms?

Residual symptoms are symptoms that remain after an acute psychotic episode has ended.

When people talk about residual symptoms, they're often referring to negative symptoms such as reduced motivation, emotional flattening, or difficulties with social engagement.

My experience has been somewhat different.

After my first episode of psychosis, most of my symptoms disappeared. What remained were ideas of reference.

Following my second episode, additional unusual experiences emerged that have persisted to varying degrees ever since.

Ideas of Reference

Ideas of reference are probably the most persistent symptom I've experienced.

In simple terms, they involve interpreting events, conversations, or pieces of information as though they relate directly to you when they do not.

For me, this often occurs when I overhear somebody speaking to someone else.

The conversation has nothing to do with me, yet I experience it as though it contains a message directed at me, usually involving some form of criticism or negative judgement.

Many explanations of ideas of reference frame them as primarily psychological.

I have a different view.

My own thinking is that ideas of reference are closely related to linguistic processing and the pragmatic aspects of communication. In particular, I suspect they are connected to the social communication difficulties often associated with schizophrenia.

As a result, I tend to intervene linguistically.

When I notice an idea of reference emerging, I deliberately challenge it:

"That isn't about me."

I don't necessarily say this aloud, but I consciously respond to the interpretation.

I've learned that if I don't challenge the thought, it tends to accumulate momentum. The referential thinking becomes stronger and more persistent.

If I respond early, I can usually keep it under control.

A Coprolalia of Inner Speech

After my second episode, I developed a symptom that proved surprisingly difficult to explain to clinicians.

The closest description I could find was what I called:

A coprolalia of inner speech.

Coprolalia is most commonly associated with Tourette syndrome and refers to the involuntary production of socially inappropriate or offensive language.

My experience differs in one important respect.

The language remains internal.

Rather than being spoken aloud, intrusive words and phrases enter my inner speech without invitation.

These are often highly offensive terms—racial slurs, insults, or other language that feels completely at odds with my values and intentions.

The experience is involuntary.

I don't choose the words.

They simply appear.

Why It's Difficult to Study

When I began looking for research on this experience, I found surprisingly little.

There are occasional papers discussing related phenomena, but very little specifically focused on psychosis or schizophrenia.

What I did find was something interesting:

Large numbers of people describing similar experiences online.

Anecdotally, reports of intrusive offensive inner speech seem relatively common.

Scientifically, however, the phenomenon remains poorly understood.

This creates a familiar problem for many people with unusual symptoms.

The experience feels real and significant, yet the scientific literature provides very little guidance.

Learning to Live With It

Unlike ideas of reference, I haven't found an effective strategy for eliminating intrusive inner speech.

You can't stop inner speech from occurring altogether.

The experience arrives whether I want it to or not.

As a result, my approach has largely become one of acceptance.

The words appear.

I acknowledge them.

I allow them to pass.

The symptom remains unpleasant, but fighting it tends to make it worse.

One of my recurring fears is that the intrusive language will somehow become externalised—that I might involuntarily say something offensive aloud.

Intellectually, I recognise that this is unlikely.

Emotionally, however, the possibility can still feel frightening.

Somatic Anxiety

Both of my psychotic episodes were preceded by periods of what I would describe as somatic anxiety.

These weren't delusions in the usual sense.

They were intense preoccupations centred on bodily functions and symptoms.

Before my first episode, I became convinced that I might become incontinent in public.

The fear originated from an offhand comment made during a university lecture on psychoanalytic theory.

The lecturer explained that psychological mechanisms help regulate behaviour and used urinary continence as an example.

For most students, this was an unremarkable illustration.

For me, it became an obsession.

I began wondering:

What if that mechanism fails?

The idea grew into a persistent source of anxiety.

Eventually, the anxiety became so intense that I developed genuine urinary symptoms, which only reinforced the fear.

The experience taught me how profoundly thoughts can influence bodily experiences.

Fear of Losing Control

Before my second episode, a different anxiety emerged.

This time it centred on speech.

I became increasingly afraid that I might involuntarily say something offensive, racist, homophobic, or otherwise inappropriate in public.

Part of this fear was linked to a strange experience during my first psychosis.

One night, while lying in bed, I appeared to speak an entire sentence without consciously intending to do so.

I experienced the movements of speech production—the sensation of my lips and tongue moving—but without the normal feeling of initiating the utterance.

Whether this reflected psychosis, a sleep-related phenomenon, medication effects, or some combination of factors remains unclear.

What mattered was that the experience stayed with me.

Years later, I still worried that something similar might happen again.

Passivity and the Problem of Trust

One reason these experiences are so unsettling is that they challenge the assumption that our actions are fully under our control.

Most of us move through life with the expectation that our thoughts, speech, and actions belong to us.

Passivity experiences disrupt that certainty.

Even isolated incidents can leave a lasting impression.

They raise uncomfortable questions:

• Can I trust my perceptions?

• Can I trust my actions?

• What if something happens again?

These concerns are difficult to explain to people who haven't experienced them.

They sit somewhere between symptom, memory, and anticipation.

They're not necessarily signs of active psychosis, but they continue to shape how you think about yourself and your future.

The Airplane Story

One example stands out.

While travelling on a flight, I fell asleep next to a young woman.

At one point, she accidentally dropped a stack of papers into my lap.

I handed them back and thought nothing of it.

Moments later, however, a familiar question emerged:

Had I said something inappropriate while asleep?

There was no evidence that I had.

Nobody reacted.

Nothing unusual had happened.

Yet my mind immediately generated a hypothetical explanation.

Perhaps she had dropped the papers deliberately to wake me because I had been saying something offensive in my sleep.

This is what residual symptoms can look like.

Not full-blown delusions.

Not psychosis.

But a tendency to interpret ambiguity through the lens of previous experiences and fears.

Living With What Remains

Recovery is often imagined as a complete return to normality.

My experience has been more complicated.

The major symptoms disappeared.

The psychosis ended.

But some experiences remained.

Ideas of reference.

Intrusive inner speech.

Anxieties about speech, control, and perception.

Over time I've learned that recovery is not necessarily about eliminating every unusual experience.

Sometimes it's about understanding them, managing them, and reducing the influence they have over your life.

The goal isn't perfection.

The goal is learning how to live well despite what remains.

Further Reading

• How Language Holds: Schizophrenia Beyond Structure

• DAIS-C Corpus

• Formal Thought Disorder Resources

• Blog: Living with Schizophrenia

• Video: How Do You Trust Your Perceptions After Psychosis?

• Video: Ideas of Reference Explained

My Experiences of Psychatrists

Editor's Note

This transcript has been lightly edited for clarity, readability, and flow. Repetitions, filler words, and transcription artefacts have been removed while preserving the original meaning and perspective.

Introduction

People often talk about psychiatry as though it is a single thing.

My experience has been very different.

Across two episodes of psychosis, inpatient admissions, tribunals, community treatment, academic research, and eventually working alongside psychiatrists professionally, I encountered clinicians with radically different styles, personalities, and ways of understanding mental distress.

Some focused on diagnosis. Others focused on meaning. Some were deeply interested in my experiences. Others were primarily interested in risk, symptoms, and treatment.

In this video, I reflect on every psychiatrist who played a significant role in my journey. Along the way, I explore how language can influence delusional thinking, why certain interactions stayed with me for years, and what I think makes a good psychiatrist.

The aim is not to criticise psychiatry or psychiatrists. Quite the opposite. The aim is to explore how different approaches can shape the experience of care from the perspective of someone living through psychosis.

Key Concepts

• Psychosis and language

• Delusions and interpretation

• Psychiatric communication

• Clinical relationships

• First episode psychosis

• Recovery

• Schizophrenia diagnosis

• Psychoanalytic and medical models

• Lived experience

• Therapeutic alliance

Watch the Video

https://www.youtube.com/watch?v=AH9WJOt4GM0&t=5s

Transcript

Why I Wanted to Make This Video

I've spoken elsewhere about the differences between my first and second episodes of psychosis.

What I haven't discussed in as much detail is the fact that I've also had very different experiences with psychiatrists.

One thing I've learned is that psychiatrists are not interchangeable.

They have different personalities, different philosophies, different communication styles, and different assumptions about what psychosis is and how it should be treated.

Looking back, I've had encounters that were frustrating, fascinating, reassuring, confusing, and sometimes unexpectedly influential.

This is a chronological tour through those experiences.

The First Diagnosis

My first significant encounter occurred during an acute psychotic episode.

I was taken into a consultation room and asked what was happening.

I responded with what I would now recognise as severe thought disorder and word salad.

The clinician listened briefly, turned to the people who had brought me there, and said:

"I'm going to go ahead and diagnose psychosis."

The consultation ended there.

What interests me now is not the diagnosis itself but how I interpreted it.

At the time, I was experiencing a complex persecutory delusion involving surveillance, conspiracy, and murder.

Within that framework, the statement wasn't processed as:

"You are experiencing psychosis."

It was processed as:

"We are officially declaring you insane so nobody believes you when we kill you."

The same sentence acquired an entirely different meaning because of the delusional framework surrounding it.

That experience would later become one of the reasons I became interested in the relationship between language and psychosis.

When Ordinary Language Becomes Delusional Material

Later that evening the same clinician phoned and explained that no medication could be prescribed immediately and that the crisis team would be seeing me.

He ended the conversation by saying:

"Try and make it through the night."

To most people, this is an entirely ordinary statement.

To me, at that moment, it sounded sinister.

Within my delusional system it became:

"Try and survive what we're about to do to you."

This is one of the most important lessons I learned about psychosis.

The problem wasn't the sentence itself.

The problem was the interpretative framework I was bringing to it.

Psychosis transformed neutral language into evidence.

"I'm Going to Take Your Blood"

My next major interaction occurred on an acute psychiatric ward.

A doctor entered the room and explained that blood tests were needed.

Unfortunately, the phrase he used was:

"I'm going to have to take your blood."

Again, this was a perfectly ordinary clinical statement.

But to someone experiencing psychosis, words carry unusual weight.

The phrase immediately connected with a series of existing fears and associations.

Suddenly "take your blood" became linked with persecution, imprisonment, and symbolic meanings that existed entirely within my delusional world.

Looking back, I don't blame the doctor at all.

But the experience taught me how important lexical choice can be.

Small differences in wording can have surprisingly large consequences when someone is psychotic.

The Psychiatrist Who Wanted to Understand

During my stay in the psychiatric intensive care unit, I met a psychiatrist whose approach was completely different.

He was warm, curious, and genuinely interested in understanding how my delusions worked.

Rather than dismissing unusual ideas, he explored them.

He asked why certain things felt significant.

He wanted to understand the symbolic connections I was making.

For the first time, I felt that somebody was interested not only in what I believed but also in how those beliefs were constructed.

Those conversations helped me begin seeing humour in my own experiences.

At the end of every meeting he would say:

"It was very interesting talking to you. Thanks for coming in."

I still remember that.

The Psychiatrist Who Had No Time for Nonsense

The next psychiatrist couldn't have been more different.

He was efficient, direct, and had little interest in discussing the broader meaning of my experiences.

Everything felt highly structured and task-focused.

At one point I handed him a carefully written letter explaining my understanding of my situation.

He took it from my hand and simply said:

"I can read."

That interaction told me everything I needed to know about his communication style.

It wasn't necessarily wrong.

It was just very different.

The Psychiatrist Who Saw Me as a Person

After leaving intensive care, I was transferred to an acute ward and met one of the most influential psychiatrists in my journey.

What stood out was that he treated me as a person before treating me as a patient.

When family dynamics complicated ward rounds, he calmly redirected attention back to me:

"Oli is my patient. I'd like to hear from Oli."

That moment stayed with me.

He also took time to explain legal entitlements, discuss recovery, and engage with my interests.

At one point he noticed references in my notes to Philip K. Dick and started talking with me about Dick's writing, psychosis, and A Scanner Darkly.

For the first time in months, I felt as though I was having a genuine human conversation rather than simply being assessed.

The Community Psychiatrist Who Helped Me Finish My Degree

After discharge, another psychiatrist played an equally important role.

At the time I was sleeping excessively and struggling to complete my university dissertation.

Rather than telling me to lower my expectations, he focused on helping me succeed.

When medication was causing difficulties, he explored alternatives.

When physical health concerns emerged, he took them seriously.

Most importantly, he supported a gradual reduction in medication following recovery from my first episode.

That decision ultimately created the conditions that allowed me to complete my degree, pursue postgraduate study, and eventually undertake a PhD.

The Psychoanalytic Psychiatrist

Years later, during my second episode, I encountered a psychiatrist whose approach was strongly influenced by psychoanalytic and psychodynamic traditions.

He was fascinated by meaning, identity, masculinity, and unconscious processes.

Our consultations often lasted hours.

He was far less interested in diagnosis and medication than any psychiatrist I had previously met.

At times I found this refreshing.

At other times I found it frustrating because I wanted practical solutions and symptom management.

The experience taught me something important:

Different psychiatrists can have radically different assumptions about what psychosis actually is.

A Shared Language

The final psychiatrist I worked with approached things differently again.

Because of my academic background, he was comfortable discussing psychosis using technical language.

We could talk openly about hallucinations, illusions, diagnosis, and phenomenology.

The relationship felt collaborative.

Rather than translating everything into simplified language, he trusted me to engage with the concepts directly.

Those conversations often felt less like assessments and more like attempts to solve a problem together.

What Makes a Good Psychiatrist?

Looking back across all of these encounters, no single psychiatrist did everything perfectly.

What stands out instead are recurring themes.

The psychiatrists I remember most positively tended to:

• Listen carefully.

• Take an interest in my perspective.

• Explain their reasoning.

• Treat me as a person rather than a diagnosis.

• Remain curious.

• Respect my goals and ambitions.

Psychiatry is often discussed as though it is a uniform profession.

My experience has been that individual psychiatrists can differ enormously.

Some focus on symptoms.

Some focus on meaning.

Some focus on risk.

Some focus on relationships.

The best clinicians, in my experience, manage to balance all of these perspectives without losing sight of the person sitting in front of them.

Further Reading

• DAIS-C Corpus

• How Language Holds

• Fought Disorder

• Formal Thought Disorder resources

• Side Quest Stories: Psychosis in Their Own Words

• Blog: Living with Schizophrenia