What is Psychosis Actually Like

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

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.