The traumatic impact of psychosis
The experience of psychosis can often be perceived as a deeply traumatic event. When you have a psychotic episode, the feelings you experience can be so frightening and overwhelming that they can leave an emotional imprint that is very difficult to erase. This feeling of intense terror and distress can trigger the development of post-traumatic stress disorder (PTSD) . (Bendall et al., 2006).
When you experience a psychotic disorder, the symptoms not only affect you psychologically, but can also completely destabilize your perception of reality. Hallucinations , especially critical or imperative voices, can make you feel like you are constantly being judged or controlled by entities that you cannot see but that you feel overwhelmingly. These threatening or insulting voices can make you feel overwhelmed, giving you orders or criticizing you continuously, and this can prevent you from finding a moment of peace. Paranoid or controlling delusions , the firm belief that someone is persecuting you, who wants to harm you, or who is manipulating your thoughts and actions, can generate an unbearable fear that keeps you in a state of constant alert, as if your life is in danger.
Promoting positive mental health in a first psychotic episode
These experiences are created by your own brain and are perceived as extremely personal and intimate, making everything you experience seem focused solely on you. This can make these perceptions even more difficult to manage, as it is as if your mind has become the threat, and is accompanied by a sense of confusion and chaos that can make you feel completely disconnected from reality. In the most extreme cases, these symptoms can lead you to believe that harming yourself is the only way to relieve your distress. (Shaner & Eth, 1989).
The emotional impact of hospitalization
Furthermore, once immersed in a psychotic episode, hospitalization in a psychiatric unit is sometimes necessary. Although the aim of this admission is to protect you and offer you treatment, hospitalization can often be an experience that exacerbates the feeling of vulnerability. Finding yourself in an unfamiliar environment , surrounded by unfamiliar people, can make you feel confused and more disconnected from your reality, and you may perceive the behavior of other people admitted or even the staff as a threat. And often, what should be a safe space can become a disturbing and stressful environment.
The hospitalization process can be one of the most stressful times for a person with mental health problems, as it involves a loss of freedom and autonomy that, in moments of emotional fragility, can be unbearable. Not being with your family, the insistence of professionals on the need for treatment and the lack of understanding of the reasons for your admission can aggravate the situation, and can make you feel increasingly alone and disconnected from the world . In addition, factors such as high noise levels and the lack of privacy due to sharing spaces can intensify this feeling of loss of control and generate deep and constant anxiety. Therefore, the way in which the staff cares for you can make a big difference. Feeling fairness, respect, empathy and support from professionals will facilitate your recovery.
Trauma not only comes from the experiences experienced during psychosis, but also from the way treatment is approached and the environment during the recovery process.
With all these aspects in mind, health professionals do everything possible to avoid full hospitalization, and it is only resorted to when there are no other viable alternatives. There are other less invasive options that seek to keep you as connected as possible to your environment and your daily life. For example, intensive care programs can be followed in the community, such as incipient psychosis programs , which allow close monitoring without the need for hospital admission. There are also other options such as home hospitalization , where you receive treatment at home, or partial hospitalization , in which you go to a center during the day, but can return home at night. These alternatives allow, whenever possible, the treatment to adapt to your daily life, with the aim of minimizing the emotional impact of hospitalization and maintaining a sense of autonomy. In certain cases, if hospitalization is necessary, with the aim of minimizing these experiences, in recent years more welcoming environments have been designed that promote a hospital experience that respects people's rights.
The recovery model, a paradigm shift in the approach to mental health
Relationship between psychosis and post-traumatic stress disorder
When you reflect on all of these experiences, it can feel like your life has become trapped in a deeply complex cycle of suffering. The trauma comes not just from the psychotic experiences themselves, but also from how you handle the situation, from how your environment can contribute to the feeling of being out of control, isolated, and afraid . The fact that these experiences are both internal and external makes it a double struggle: you are not only fighting against your own brain, but also against the world around you. And this set of experiences can end up leaving very deep emotional scars.
PTSD is a mental disorder that can appear after experiencing a very stressful or traumatic experience, and is characterized by the presence of symptoms such as intrusive memories of the event, nightmares, intense anxiety and a constant feeling of alertness.
When you experience a psychotic experience, the possibility of developing post-traumatic stress disorder (PTSD) is a reality that affects many people. PTSD is a mental disorder that can appear after experiencing a very stressful or traumatic experience , and is characterized by the presence of symptoms such as intrusive memories of the event, nightmares, intense anxiety and a constant feeling of alertness, as if danger were imminent. People with PTSD may avoid places or situations that remind them of the trauma, and often experience emotional disconnection or difficulty relaxing. Prevalence rates of PTSD related to psychosis vary widely, from 11% to 67%, with an average of 39%. These figures reveal that a large proportion of people who experience a psychotic episode may also suffer from the emotional and psychological consequences of this traumatic experience. In the case of those experiencing a first psychotic episode (FPE), the prevalence of PTSD ranges from 31% to 46%, with a mean rate of 38.5%. This means that almost half of people who have their first psychotic episode could develop PTSD. (Berry et al., 2013)
Taken together, both psychotic symptoms and the conditions of hospitalization can have an immense impact on your mental health. Trauma comes not only from the experiences you have during psychosis, but also from how you approach treatment and how your environment is handled during the recovery process. This accumulation of experiences can leave a lasting mark, and it is important to recognize the weight of this in order to address it appropriately.
Some of the symptoms of post-traumatic stress disorder (PTSD) that you may experience, even a year after the psychotic episode, are:
Flashbacks and nightmares.
Intense anxiety.
Avoidance of situations that remind you of hospitalization or psychosis.
Constant feelings of hypervigilance or fear.
These symptoms can persist and affect your emotional well-being and your ability to lead a normal life . However, it is important to know that there are specific treatments for PTSD that can significantly help you reduce these symptoms and improve your quality of life.
Therapies such as cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR) have been shown to be very effective. It is important that you share these feelings with your referring clinician, as they may be able to help you get the support you need to manage and treat these symptoms. Early detection and appropriate treatment can make a big difference in your recovery and well-being.
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