When your reality is defective: psychosis.

The Merriam Webster Online Dictionary defines psychosis as a “fundamental derangement of the mind characterized by defective or lost contact with reality especially as evidenced by delusions, hallucinations, and disorganized speech and behavior.”   Have you ever been told your mind was deranged? Or that your reality was defective? It’s not an easy pill to swallow.

Imagine each day starts with a sunrise, wife at side, drinking reheated coffee and joking about what you’ll both do when graduate school is over and you can afford to feed the kids more than Raman.

Next imagine waking up alone in a hospital, remembering wife and graduate school and reheated coffee — only to discover none of it happened.

What is going on? Either this is a movie, where your wife rescues you from the clutches of evil, some villain who’s trying to stifle your presence in the real world — or you ARE crazy.

Here’s the next step: you ARE crazy. A calm, collected, reflective, and insightful sort of crazy. All you know is you have memories that seem real but aren’t.  You must accept your situation.

Problem is those memories don’t go away.  Real or not, these memories are real to you.  The medications keep them at a distance, but the thoughts, the feelings, the love you feel for that partner and best friend you never had, none of that goes away.  And you don’t want to forget them. You don’t want to forget who you are, who you imagined you were.

It doesn’t get easier.  The questions that follow, now existential and pervasive, come without answers:

If my judgment is defective, and if I can’t recognize what is real and what isn’t, how can I ever trust myself again?”

“If not my own, whose judgment can I trust?  Who decides what is real and what isn’t?”

And the final question:  “How can I trust someone else’s judgment over mine?  Isn’t it possible I’m right, and everyone else is wrong?”

In the end, a broken mind is a hard thing to accept, especially when it doesn’t feel broken. The ego needs to trust itself.  But even more complicated: the question of perspective.  Who gets to decide what’s real, and how do we know those people aren’t psychotic like the rest of us?

Alex Natalian, Psychiatrist and Author     Alex Natalian is a penname for psychiatrist KRR.

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