POV of Someone Who Committed Violent Incidences During First-Episode Psychosis
~2286 Words
{Please don’t read this if you think you’ll feel unpleasant emotions such as anger, disgust or loathing by reading this. Please don’t continue reading if you think I’m trying to apologize with this post. I don’t think an apology is in this case the immediate answer. Sometimes people don’t want to be reminded of traumatic events, sometimes people never want to hear anything from the offender ever again, and some apologies can be worse than no apology at all. Also, please don’t read this if you think I’m trying to promote violence. I do promote realistic and comprehensive narratives of experiences, including minimizing omission on things that matter to me.}
I.
I experienced elevated mood, grandiosity, and fantasies of grandeur in December 2020 before the onset of the suspicions I had in January 2021 that I now recognize are paranoid delusions. Proximate to fantasizing about grandeur (the lines between my delusions and fantasies during this time was unclear), I remember writing a few messages in the GW2 chat interface based on loose (and retrospectively erroneous) associations, as well as abruptly leaving a server on Discord in either November or December 2020 while experiencing high arousal from emotions that have a negative valence. Retrospectively, I had been in hypomania. I do not count this time as having been clinically in psychosis, as this was before I had made explicitly known any delusions to people.
I spent >~978 days in clear-cut, definitive psychosis. The first signs I can trace are Discord DMs to a former friend on 01/24/2021, where including the words “hatred”, “HATE HATE HATE”, and displayed signs of anger (“ACTIVELY p***** me off”); this was retrospectively the onset of suspicions that were based on false beliefs, and which I go by as the “official” start of my first episode of psychosis.
…which ended when I was given antipsychotics for the first time, probably between September 21 and September 28, 2023 (the last day I have of a photo of psychotic activities that I engaged in).
Using September 28, 2023 as the ‘last day in first-episode psychosis’ — which, since antipsychotics don’t work immediately, means I could be slightly undercounting — that’s 342 days in 2021 in psychosis, 365 days in 2022, and 271 days in 2023, making at minimum 978 days in first-episode psychosis with neither of my parents whom I was living with nor I having the knowledge that I was in psychosis. Neither 2021, 2022, nor 2023 are leap years.
II.
There was one day in September, 2023. It was a little over 6 months after I had turned 26. I had lived over 9,670 days before this occurred. That’s over 232,080 hours.
It was an action that I took about ten seconds, from grabbing a pair of scissors sitting on an otherwise nearly pristine expanse of countertop, to stabbing my Dad in his back with a pair of scissors.
Even the second before I struck with the pair of scissors into his back, I didn’t believe I would ever do something like what I did — stabbing.
I had believed that I had no more schizophrenic genes than the average person.
“Turkey illusion is a cognitive bias describing the surprise resulting from a break in a trend, if one does not know the causes or the framework conditions for this trend. The concept was first introduced by Bertrand Russell to illustrate a problem with inductive reasoning.” — Wikipedia
Because of this, I was handcuffed by the police for a second time in my life.
No, not everyone becomes violent during psychosis, and the people who do may only be violent in very rare times — that stand out because of the harm they cause, and possibly because of the bizarreness of the delusions.
Personally, I have never been violent outside of first-episode psychosis.
If you’re wondering what the first time I got handcuffed by the police was — it was only a month before the stabbing, in August 2023, for throwing one or two vegetable chopping knives at the faces of one or both of my parents when I was in the kitchen. Thankfully, it missed the target/s. My Mom called the police, and I was taken to the emergency department, handcuffed to the bed, and yup, it was a dehumanizing experience. As far as I remember, there wasn’t even someone who came in asking why I threw knives at my parents’ faces; and no one bothered to explore whether this had been only recent behaviour or not. And yes, they didn’t identify me as having been psychotic in that trip to the ER. I came home with no suggestion from anyone working at the hospital that I had been in psychosis, and certainly no antipsychotics.
I do want to note that the two actions in my almost-three-year-long first-episode of psychosis that were the most physically dangerous, shocking, unusual, and the ones that got me handcuffed and involuntarily taken to the ER by police, both occurred after I had gone off my only medication at the time, 60mg Fluoxetine. In the last days of a trip to China, I couldn’t find the medication, and I believed my uncle had stolen it (he probably hadn’t; I probably had packed too little medication with me for vacation, either due to undercounting days of vacation or literally miscounting capsules). That was in the first or second week of May 2023. And after running out of medication, I thought it would be a fascinating, low-risk idea to just stay off the medication entirely — I wanted to see what I would be like without it; what would the au naturel me be like? Cue the next four months, when in August, and September 2023, the only two sharp-object-involving incidents during my psychotic episode happened.1
It goes almost without saying: I feel guilt for going against what I personally value (eg peacefulness, composure, serenity) and remorse for the results of the times I have been violent during first-episode psychosis. And I feel remorse (though this has crept on more slowly) for aggressive acts (including ones in which law enforcement wasn’t called) that have resulted in probably irreversible psychological trauma and emotional distance.
III.
Here’s an analogy that hopefully can help non-sufferers of psychosis relate to how surprising actions during psychosis can be to even to those who engage in the actions:
For some, it’s like having their first menstrual period.
Depending in the culture they grew up in, and its timeline within human civilization, they may have no idea what a menstrual period is. They may have no idea that among some people in the population, at some age, this periodic condition would develop, and they would be among the population affected by it.
Likewise, you may not know what psychosis is. There is no mandatory education in school. Generally, nobody goes up and tells you you’re at higher risk for it than the general population. Even if you’re currently psychotic or have been psychotic before, you may think psychosis is something wildly different from what you have ever experienced. This was the case for me.
There’s something else in common with this experience of psychosis on that fateful September day has with menstrual cycles: I saw blood, too.
It is like if you had been wearing a pair of pants as an ignorant pre-teen, and simply did not have the education, and didn’t know you were destined to have your period at that time, that place, and then – it happened. Even worse, it had been somebody else’s pants you were wearing.
A difference was that in September 2023, during an episode of psychosis, the blood was not my own.
IV.
That was how I first accessed treatment for my psychosis — through being taken to a hospital in handcuffs, then transferred to another hospital, then speaking to a psychiatrist who identified my experience as psychosis, then placed on antipsychotics.
It’s unfortunate that my actions in psychosis had to escalate to stabbing for my reality to be recognized as what it had been by both myself and others. For me, since I was treated with antipsychotics shortly after, that was near the end of my episode of psychosis — the timing which might make the stabbing even more memorable to myself and my treatment team at the time.
“Peak–end rule: That people seem to perceive not the sum of an experience but the average of how it was at its peak (e.g., pleasant or unpleasant) and how it ended.” —Wikipedia
I was shocked by what happened — no way did I anticipate it — and felt distraught and humiliated as I was looking back on the event in the hospital.
I had sent more messages than usual, with the content of some of my writing being about some very personal things, that had little to do with somatic concerns, and which I had never mentioned before in 2022 to the reception of my family doctor’s clinic. Looking back, I now know I spent each day of the 365 days in 2022 in psychosis, and some of those times hypomanic. The person who read my messages had not recognized that I was in the throes of psychosis and/or hypomania.
I also visited my family doctor’s clinic once in June/July/August/September 2023 fearing that I had a somatic health condition, which I felt reassured after my doctor said they did not believe I had that health condition. That was during the throes of psychosis, and less than a month to four months in time to the two trips I was involuntarily admitted to the ER for the rage that was unleashed as the knife-throwing incident. My GP had not recognized that I was in the throes of psychosis.
V.2
A study finds that “In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2).
This article mentions:
In a Danish birth cohort followed to age 44 years, 2% of all males with lifetime arrests for violence and 9% of all females had schizophrenia. When we exclude those with comorbid substance misuse, these figures drop to 0.8% for males and 6% for females (Reference Brennan, Mednick and HodginsBrennan et al, 2000).
While this study mentions incident rates of schizophrenia spectrum disorders during 2000 and 2018 in Denmark:
Among 21,538 patients, yearly incidence rates per 10,000 individuals were similar during the observation period for schizophrenia (2000: 1.8; 2018: 1.6), lower for schizoaffective disorder (2000: 0.3; 2018: 0.1) and increasing for schizotypal disorder (2000: 0.7; 2018: 1.3).
The article from earlier also mentions:
In the ECA study in America, 2.7% of individuals who reported community violence over one year had schizophrenia (Reference Swanson, Holzer and GanjuSwanson et al, 1990). In a Finnish cohort study, those with schizophrenia accounted for 4% of those registered for at least one violent crime (Reference Tiihonen, Isohanni and RasanenTiihonen et al, 1997). In Dunedin, New Zealand, 94% of a total city birth cohort were followed up at age 21 years. Without considering comorbidity, just over 10% of past-year violence committed by these young adults was attributable to schizophrenic spectrum disorders.
So it looks like schizophrenics are about twice as likely to be registered with violent crimes than the general population.
What % of people in first-episode psychosis commit violence, though?
According to this study, “Pooled estimates of the proportion of patients with first-episode psychosis committing any violence, serious violence and severe violence were 34.5%, 16.6% and 0.6%, respectively.”
VI.
My first outburst was an incidence of verbal aggression in December 2020. I remember three words that I screamed when my only sibling, and their significant other were staying over during the holidays. Looking back, the content of my words was far from true; they conveyed rage and had no literal merit.
By the end of August 2023, I fit the all criteria for Intermittent Explosive Disorder according to the DSM-5 with the exception of Criterion F:
The current DSM-5 criteria for Intermittent Explosive Disorder include:[13]
Recurrent outbursts that demonstrate an inability to control impulses, including either of the following:
Verbal aggression (tantrums, verbal arguments, or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to the destruction of property or physical injury (Criterion A1)
Three outbursts that involve injury or destruction within a year-long period (Criterion A2)
Aggressive behavior is grossly disproportionate to the magnitude of the psychosocial stressors (Criterion B)
The outbursts are not premeditated and serve no premeditated purpose (Criterion C)
The outbursts cause distress or impairment of functioning or lead to financial or legal consequences (Criterion D)
The individual must be at least six years old (Criterion E)
The recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use (Criterion F)Criterion A2: More severe destructive/assaultive episodes which are more infrequent and occur, on average, three times within a twelve-month period. These could be destroying an object without regard to value, assaulting an animal or individual. This criterion includes high-intensity/low-frequency outbursts.
If I were to write an apology, it would be for more than the two incidences which my parents called law enforcement for.
I have harmed all three of my first-degree relatives with verbal and physical aggression during first-episode psychosis.
I had never been violent toward anyone before first-episode psychosis, and haven’t since receiving antipsychotics.
Paragraph added on 11/10/2024
Section added on 12/16/2024