Raymond had grown up in privilege. He had attended a prestigious boys’ school and was well liked by football mates and always the first to suggest a party. He had been offered a place in a finance course at university and was the heir apparent to his father’s highly successful business. His future was secured. Then it changed. He began withdrawing from friends and isolating himself from family who could hear him pacing and talking to himself late into the night. He began to express unusual ideas, once enquiring whether his mother had noticed that his father was slipping drugs into the food she cooked. Where once he had taken pride in his appearance, he became disheveled and didn’t seem to care. Then one night Raymond became so frightened and incoherent that his family called the Mental Health Care Team and shortly after a new word was added to his identity ‘psychotic’.
Disturbance Inside is Reflected on the Outside
The onset of a psychotic episode is not only experienced on the inside as reality becomes increasingly disparate from others but also between the person and their relational world. Hurtado et al (2024) notes that psychosis is ‘often associated with loneliness, the absence of confidence and a perceived lack of social support’, which ‘can aggravate internalised stigma, depressive symptoms and/or suicidal tendencies, and worsen the course of the disorder’. This is a vicious cycle that requires attention.
How Does the Cycle Operate?
Recognizing a lack of research to understand these dynamics, the authors undertook a study to ‘explore people’s subjective experiences, focusing on social issues and personal relationships from the first appearance of psychotic symptoms, and examining the subsequent evolution of these consequences.’ Information from focus groups and interviews with thirty-six participants was subjected to thematic analysis of the impact of the disorder on social relationships.
What Did They Find?
Most participants reported that their first psychotic episode resulted in changes to their perception of others, producing isolation or active rejection of family, friends and colleagues and loneliness exacerbated by the impossibility of explaining what was happening to them. Some also spoke of a loss of a sense future with a breakdown of plans and ambitions which fueled depression.
Following recovery, participants’ experiences differed. None reported recovery of pre-morbid levels of social activity although some did speak of a satisfactory level of intimacy in previous relationships with family and friends. Others spoke of developing new and rewarding friendships with colleagues who had a shared mental health experience. Hope, belonging and a sense of a future is significant in maintaining emotional well-being. This is coherent with previous reports that demonstrate that ‘the generation of social relationships during the course of illness is an important predictor of treatment outcomes.’
In Conclusion
Psychosis is a very ‘inside’ experience which rapidly impacts the outside socio-relational world. Attention to rebuilding a supportive network with family and friends is a central plank of recovery and a central factor to address in therapy.
María M. Hurtado, Amelia Villena, Casta Quemada & José Miguel Morales Asencio (28 Sep 2024): Personal relationships during and after an initial psychotic episode. First-person experiences, Journal of Mental Health, DOI: 10.1080/09638237.2024.2408245
This Directors Note is a tribute to Prof Alan Rosen who’s courageous and groundbreaking work at the Royal North Shore Hospital and Community Mental Health Services taught me this and so very much more.
©Copyright Bower Place Pty. Ltd. 2024
