Living with Residual Symptoms

18 Jun

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.