Why specialize in “Psychosis” and altered states work?
Content Warning: This blog post discusses sensitive topics related to mental health, including personal experiences with “psychosis”, mental illness, trauma, and suicide. It also addresses themes of hospitalization, hospital and police violence towards those diagnosed with mental illness, medication, family history of mental illness, and moral injury within mental health systems. Readers may find some descriptions distressing, particularly those involving psychiatric treatment, secondary trauma, and loss. Please exercise care while reading. If you’re struggling and want to talk to someone right away, check out my resources page.
People often ask me how I got interested in mental health particularly psychosis and altered states. The truth is, it’s always been a part of my life. Some of my earliest memories of my grandma are watching her dose herself with insulin after developing diabetes likely due to decades of treatment consisting of various anti-psychotics, ECT, and intermittent hospitalization. She had experiences that were clinically called “paranoid delusions” where she sometimes believed her kids were being harmed when they weren’t. By the time I was born, she no longer had those experiences, but my family said that my grandma’s personality had changed dramatically from someone who participated enthusiastically in life, to someone who had very little energy or excitement for anything other than food. My grandma was always extremely medicated when I saw her, to the point of having difficulty motivating herself to use the remote control. Honestly she was kind of scary to be around at a young age. Not because of mental illness, but because of her flat affect and public insulin injections, both things caused by the “treatment.” Part of my story has been better understanding her story, by working in the system that she was caught in. She died at 62 of a stroke, an issue associated with Thorazine use—the antipsychotic medication that she took for most of her life.
My grandmother on her wedding day
When my mom’s generation began struggling with their mental health, she suggested family therapy, but her parents refused. My mom witnessed family members start with adolescent anxiety and have that balloon into hospitalization for psychosis and eventually chronic institutionalization. Like my relatives, I began to struggle at a young age. First with daily panic attacks at age 8 and later depression and suicide attempts at age 12. At age 8, after my parents realized what was happening, my mom taught me deep breathing techniques and took me on walks before school to help me calm my nerves. At 12, my parents took me to counseling. I was lucky to hit it off with my counselor and I found therapy incredibly helpful. I felt much better by the time I went to college, but the combination of poor nutrition, partying, pulling all-nighters for school, and my own immaturity made the transition difficult. I plunged into a deep depression. During this struggle, I experienced a frightening vision that I could not discern if it was “real” or not. I worried that someone was following me and couldn’t shake the thought that I was developing the same illness that seemed to run in my family. Far away from my counselor and my family for support, I sought the help of a psychiatrist for my distress. He diagnosed me with the same thing my grandmother had been diagnosed with about 50 years earlier and prescribed me medications for it. The medicine helped at first, but leveled off pretty quickly. I still thought of dying every day. I eventually stopped taking the prescribed drugs without consulting a doctor and was lucky to not have any issues. The diagnosis was a source of confusion for many years after that. I wondered what it meant, if it could predict my behavior, or worse if it could predict my future. After eventually learning that mental health diagnosis is largely based on the consensus of a homogonous group (mostly highly educated white men), rather than solid evidence, I happily gave up on wondering and went back to my mom’s explanation of diagnoses. “People just like to sort and organize things. A mental illness is just a list of things that someone thought went together. It’s not like a real thing the way diabetes or cancer is.” I’ve yet to hear a better explanation than my mom’s of mental health diagnosis. When meds didn’t do much, I kept at therapy. Other things that aided in my recovery were nutrition, expressing myself through art, music, and dance, focusing on relationships with people who treated me well, and finding greater self esteem through volunteer work and caring for my elderly grandfather.
Me at age 12
When I became a dance/movement therapist, I was inspired to hear about people like Marian Chace and Trudi Schoop, who could have worked with my grandma when she was hospitalized if they’d worked in Detroit instead of DC or California. They believed that there was meaning in the expressions and movements of people experiencing altered states. Marian Chace worked with and studied under Freda Fromme Reichman and Harry Stack Sullivan, two important figures in psychotherapy for psychosis and this greatly influenced her work at psychiatric hospitals. Chace even worked with Fromme Reichman’s most famous client, Joanne Greeberg, who wrote about her schizophrenia diagnosis and subsequent recovery in her best-selling book, I Never Promised You a Rose a Garden. The legacy of both dance/movement therapy and my own family in hospitals inspired my inpatient work which I did for 8 years. I also understood that if my mom hadn’t been so savvy about mental health treatment and my counselor so protective of her clients, I would have been hospitalized at least once, but probably more. Despite my reservations about hospitals—largely shaped by their ineffectiveness for my loved ones—I knew they wouldn’t be closed anytime soon. I wanted to treat other people’s families the way I hoped someone would treat my own family members still navigating the mental health system. The way I would have wanted to be treated if I were hospitalized.
Trudi Schoop, Dance Therapist
Working in the psychiatric inpatient hospital system was far more challenging than I anticipated. I faced significant secondary trauma, including multiple suicides of clients and coworkers, witnessing patients nearly die from unaddressed medication side effects, and seeing clients subjected to restraint, seclusion, and forced medication. Some staff members even baited clients into behaviors that would incur these punishments. Simple dignities such as being able to go outside, have visitors, or have access to food were highly controlled. My trauma was compounded by the fact that I was part of the system that caused the harm. I later learned that this experience fit the definition of moral injury, which the center for PTSD describes as “a traumatic or unusually stressful circumstances,” in which “people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations.”
Throughout my time in various hospitals, I encountered many clients diagnosed with psychosis, schizophrenia, and schizoaffective disorder. Alarmingly, I observed that many had tried numerous medications or lived in group homes but had rarely, if ever, been offered talk or creative therapy. The focus on “severe mental illness” overlooked underlying reasons for their struggles and perpetuated outdated beliefs about mental health such as the chemical imbalance myth that the head of the FDA Psychopharmacology Advisory Committe says was always just “a useful metaphor.”
Staff meetings often prioritized efficiently pumping people through the system over effective support, with little attention given to helping clients with the specific issues that brought them in. It was disheartening to hear jokes made at clients' expense, often by those in positions of authority. This created a culture that was not only unhelpful but also hostile to those we aimed to assist.
Advocating for psychosocial solutions while maintaining relationships with colleagues proved exhausting. Clients were frequently treated as though recovery was unattainable, with a narrow focus on medication compliance, the same prognosis so many of my family members were given.
While this work has been a source of personal shame, it is also true that I experienced profound joys and successes within that environment, which is why I stayed for so long. I did my best to offer client driven therapy groups and have meaningful one on one interactions with clients, often witnessing clients support one another and co-create dances that moved the room to tears and/or goosebumps. I sent letters to the state health authority when I witnessed harm to patients and provided self-addressed stamped envelopes to clients for the same purpose. I ghost wrote an expose and offered tips to local news outlets exposing unsafe hospital practices. I gently called out cruel jokes in staff meetings, leading to coworkers changing their language at least when I was in the room. I gave clients recovery oriented resources and helped them strategize ways to get out of the hospital and get the support they needed once out. I disclosed my own past mental health struggles with psychiatrist coworkers as a way to debunk assumptions made about clients. I hope I contributed more good than harm in a system that struggles to do so, but eventually came to the realization that no matter how good of a therapist I was, I couldn’t really protect people from the system.
Fortunately, I learned about peer support and the recovery model, as well as initiatives like the Hearing Voices Network. These approaches resonated deeply with the dance/movement therapy frameworks I had been trained in and offered more compassionate alternatives for supporting individuals in their recovery.
When I left the hospital system due to PTSD, I also stepped away from counseling and therapy for over a year. I took a job in another field with a pay cut but, more importantly, a supportive boss. I needed time to learn from my moral injuries, grieve the clients I had lost, and process the person I had been at the beginning of my career. During this time, the tragic death of a client made local news after he was shot and killed by police during a mental health crisis. He was someone I had known for years through several hospitalizations and was fond of. This event rocked me in a different way than previous traumas; his loss pushed me to permanently leave the hospital system that had failed him and so many others, seeking to provide something gentler, more practical, and more personal. I decided to focus on working with people like him, my relatives, and ultimately myself—those who sometimes have unusual relationships with reality yet deserve competent and respectful care.