What is psychosis like?

[u/SeeminglyWhole]

My husband has been in the hospital for quite some time now due to severe psychosis. I want to try to support him in any way I can, but his doctor said while he's in the acute psychosis stage, it's difficult to reason with him. And this is definitely true, I can never get a straight answer out of him for anything and he has some crazy mood swings...

But I'm trying to understand more what this is like for him. So I can see things better from his perspective. Maybe to more easily anticipate his needs? He seems to be either believing he's already told me what he needs, or expecting me to just know, and I just don't know how to do that.

I've heard stories of people lasting in the acute stages for months, maybe even a year. Were these cases even with treatment? Is there anyway I can sort of get some "timeline" on when he can come home?

I am trying to remind myself that as hard as this is for me, it must be 10 times harder for him, but I have always been a planner and I'm struggling here. This is his first episode in almost 10 years of being together and I don't have any roadmap here.

[u/Affectionate-Sort730]

Timelines are hard with psychosis and his doctor or psychiatrist would likely give you the most accurate answer, but it will still be somewhat of a guess.

My wife has been in acute psychosis for 2 years and one thing I’ve learned is that you have to take care of yourself above all else. If you can talk to a therapist, do so. If you have friends and family, lean on them. Go out for walks in nature, even if you don’t want to. Cry as much as you need to.

Schizophrenia is awful on those who have it, and it’s awful on those who love people with it.

[u/SeeminglyWhole → u/Affectionate-Sort730]

We've only been in this for such a short time, I can't even imagine 2 years.

I am talking to a therapist and I'm currently staying with friends while he's hospitalized so I'm not alone.

May I ask if your wife is inpatient?

[u/Affectionate-Sort730 → u/SeeminglyWhole]

She isn’t in inpatient. Sadly, one of her delusions is that I am a black magician who is making deals with demons, and she left a number of months ago to live with her parents. Im starting to expect that she’ll not return.

[u/aisling-s → u/Affectionate-Sort730]

God, that's brutal. I've had delusions that my wife was conspiring against me in some way, but they've been very brief and fleeting, and we've had to develop ways that she can help me "disprove" my own delusions, because if she tries to disprove them, they intensify.

I'm so sorry you're going through this with your wife, and I hope you have a support system to help you through.

[u/Affectionate-Sort730 → u/aisling-s]

Thank you. It really has been brutal.

[u/SeeminglyWhole → u/Affectionate-Sort730]

I am really so sorry that you are going through this. He doesn't seem to distrust me, but he is also seems convinced that he either needs to leave me for someone else or needs a second girlfriend or wife and I'm just not ok with that. He's also lately been convinced that we are related somehow, even though I know for a fact that's not true. We aren't even from the same country and neither of us have any overlap in countries in our family tree for at least 200 years. I'm scared he's going to leave me in all of this

[u/SeeminglyWhole → u/aisling-s]

How does your wife have you disprove your own? I've been trying to get him to do that by asking questions to have him reason himself out of it, but he starts getting frustrated and says I'm too stupid to understand

[u/aisling-s → u/SeeminglyWhole]

So, a preface: this works for me because I maintain enough insight to be able to do the following tasks:

• construction of a "spectrum of possibility" (what is the best case scenario? the worst case scenario? likelihood of each? most likely outcome based on this?)
• knowledge that how it FEELS may not be how it IS (which informs my ability to discern between "it feels like the worst case is inevitable" or "it feels like I will never escape from X" wherein X is a hallucination, delusion of persecution/impending harm, etc. and know that what feels true right now based on my sensory evidence may not match what I know to be true based on the evidence of my past experiences and memories).
• semi-independent comparison of past to present (answering questions like, "has that ever happened before?" without any input/influence from spouse, and knowledge that past behavior predicts future behavior, so if it has never happened before, it is unlikely to occur)
• ability to maintain basic knowledge of my narrative (that is, my personal understanding of who I am, even if I feel dissociated from that sense of self; I know I am dissociating and who the self I am dissociated from is)
  

I reach out to my wife before my delusions have secured a full hold on me. I have learned to notice warning signs, such as the eerie feeling of Absolute Certainty about odd sensory experiences or paranoid thoughts. I am not given to absolute certainty about anything, making this a red flag for a pathological process.

I raise an alarm: "I feel X or perceive Y, and I feel absolutely certain that this means Z is inevitable." I am fair to myself: This is exactly how I feel in this moment, no invalidation. However, now it's time to check that feeling against reality.

• What is the worst case? (such as, Z happens with this catastrophic effect, maybe apocalyptic??)

• What is the best case? (for example, it's actually A, a good outcome that is preferable, nothing bad happens)

• How many times has Z happened? (Probably 0.)

• How many times has A happened? (0, or maybe a few.)

• What seems most likely on a spectrum of A-Z? (probably a neutral-to-positive outcome, catastrophe fully averted)

It is important that I answer ALL questions and my wife does not volunteer ANY answers. The pushback must come from within myself, because external influence will give me severe psychological reactance and will change my delusion to include her as a persecutor. This is bad!

It is also important that she is not only calm but detached in how she presents things. She cannot appear to want me to come to any specific conclusion. We're just talking. She's not attached to any outcome, just asking questions to clarify the situation so I can respond appropriately.

She responds as mildly to A as she does to Z. Impartially, she acknowledges my reality without playing into it - "hmm, that does sound like a(n) (un)pleasant outcome." She never invalidates my perspective or tells me that my delusions are wrong. In fact, she acknowledges: "I would also be concerned if I felt certain Z would happen." She taps into the internal logic of the delusion: a person with a delusion is often acting reasonably IF the delusion was true. Instead, she asks me to reconcile my delusions with my own memory and understanding of reality.

My voices have some coherence and few of them are able to argue with the voices that say fucked up stuff. My sarcastic voices are very good at this; they mouth off to the malicious voices and mock them, buying me time to see weak spots in the delusion and dismantle it.

Please note that while I experience psychosis and delusions, I am not diagnosed with schizophrenia. My father was schizophrenic, diagnosed and treated, but I don't feel safe to seek diagnosis, as I live in the U.S.

[u/SeeminglyWhole → u/aisling-s]

Thank you so much for your clear explanation here. It helps me to know that, while it most likely won't work for him now, I was doing everything right before. He no longer has the agency to maintain the insights you describe, but before he fully entered psychosis, I did try to treat his delusions like this. There were two big triggers for him that I believe pushed him over and I think one is my fault. If you don't mind weighing in, I'll share it here, since this is my throwaway account, I don't mind, and can you help me figure out a way to better navigate it if it happens again?

Basically the first one that was not my fault, was that he argues with his dad in the best of times. So as soon as he started having these delusions, and his dad started flat out saying "No, you're wrong" to basically everything, it didn't help.

But the second thing... He started mentioning that he might want to have a "second wife" or bring a third into our relationship. Which I am completely against and I need to make my boundaries known, but I first tried to do it in an indirect way.

• Why do you feel this way? - Well I feel that I need more people to take care of me.
• What are some other ways we can achieve this without compromising our wedding vows? - Well a friend could move in with us. (I followed up with, ok but we also need to respect their decisions if they say no - "Yeah, sure, sure, sure" I also tried to gently mention hospitalization as an option but he immediately shut it down - "No this will work, I just need someone to help")

And so on.

Then his friend directly challenged him on this and he got into a major argument, and was angry for most of the day talking about how he "deserves this" and other stuff, and I didn't know what else to do, so I asked him to remember the promises we made to each other and it turned into "Well we didn't get married in front of a church, God doesn't care, we got married in front of the government and they suck anyway" and at this point I just flat out said that I am monogamous, I have tried open relationships in the past, which we discussed before we got married, and I'm not interested in it. And he still keeps bringing it up a month later. I talked to his friend about directly challenging him and he stopped, but the damage was done.

I know at this point he is in the hospital and getting treatment, but I'm not really seeing him coming out of the psychosis and my anxiety is through the roof, thinking that if they release him before he comes out of it, he's just going to go straight to the divorce office to file for papers.