Updates & Blogs Self-injury Insights Picking up the pieces after psychosis by Jessica Oakwood Content warning: this blog contains mentions of psychotic experiences, suicide attempts and self-injury which some might find distressing. During psychosis I had delusions where I thought that people were out to get me. I believed that Extinction Rebellion were targeting me for not recycling enough, that an intricate web of journalists were monitoring my every move, and that I was on a TV show like The Truman Show. A symptom of various conditions, including schizophrenia and schizoaffective disorder, psychosis is often characterised by delusions, hallucinations and/or disorganised thoughts and speech. I have mainly delusions, which is where you believe things which aren’t aligned with reality. I’ve had two psychotic breaks now and I have a diagnosis of schizoaffective disorder, which means I have a mood disorder as well as psychotic symptoms. Around my thirtieth birthday I was sectioned under the Mental Health Act because I was acting erratically and had several beliefs which did not line up with reality. I was very confused in hospital and thought I’d actually been kidnapped by a cult or that I was on some kind of reality show about my life. After a month they released me but I was still very ill. I went home for my landmark birthday which I celebrated with my friends and a rainbow-tiered unicorn cake, but instead of having a nice time, I thought my loved ones were actually in a conspiracy against me and that people were filming me constantly. A few days after my birthday I thought that the world was “telling me” to die and took an overdose of painkillers and used a kitchen knife to cut up my arm. Rather than just one or two cuts, I literally attacked my arm over and over with the blade. I had texted my friends and family erratically to say goodbye and my dad came home to drive me to the hospital before the ambulance arrived. For a long time after psychosis, I had a visible reminder of this experiences on my left arm. There were a lot of cuts. I had indiscriminately marked my arm trying to harm myself. Over time, the cuts became scars, which became reminders of everything that had happened the summer i turned 30. It’s been three years now and the scars have mostly faded, you can see the lines when you look at my skin in the light. During psychosis as well as impulses to self-harm by cutting and overdosing, i also have other impulses such as to put out cigarettes on myself and eat hair clips. Luckily I am hospitalised when my psychotic symptoms reach their nadir, so I am rarely able to act on these thoughts. People often talk about self-injury as a way of managing difficult emotions. But during psychosis, it was the result of delusions wrongly telling me that I was a bad person and needed to be maimed or killed. There was no release when I self-harmed, I just thought I was doing what the universe wanted me to because my beliefs were confused. I didn’t really know what was going on and I didn’t try to hide it from anyone. It’s difficult to get across to someone, but during psychosis, your thoughts can be very chaotic. You really believe things which sound strange to others and often for me, it involves believing people are trying to harm me and that I need to harm myself because “it is part of the next chapter of the story”. For me, these behaviours were not addictive and it’s not something I do on a regular basis. People often assume that self-injury such as cutting is associated with conditions such as depression and BPD but in my experience, many people with psychosis hurt themselves in similar ways to this and the percentage of people with psychosis who attempt suicide in their lives is also high. People don’t often talk about psychosis and self-harm but I’ve heard from others that it’s something which people experience. I’ve heard from other sufferers that they harm themselves during psychosis because they feel that if they harm themselves they will be saving other people as the universe can “use up some of the bad” so they do this thinking they are helping others. These kind of odd beliefs are often part and parcel of psychotic experiences. Similarly, people going through psychosis sometimes feel they have trackers in their body and try to cut them out which could be described as self-harm. Suicide attempts are also extremely common during psychosis. I was aware of self-harm before I had these experiences, because several friends in my life have used cutting to manage distressing emotions. Although I was aware of self-injury, I hadn’t done it before myself. Psychosis really felt like such an intense trauma. For a long time afterwards I felt like I had been very out of control and that is was my fault somehow even though at the time I had no control over what was happening because I didn’t have insight that I was ill. I really believed strange things with 100% conviction and it made me act very erratically. I also fear psychosis because I might harm myself and have no understanding of what I am doing - I kept going up to a local bridge with thoughts that I would jump off, and was often brought home by the police. Outside of psychosis I’d always had maladaptive coping mechanisms such as alcohol misuse and binge drinking, but I’ve finally managed to get sober, so things are going in the right direction for me. Ditching the booze also decreases my chance of relapse and you’re not meant to drink on antipsychotics anyway, which I will most likely have to take for the rest of my life. Since psychosis I have OCD-style intrusive thoughts when I see things such as knives and often worry I will harm myself. I feel a lot like I have to reshape myself after psychosis and to use these experiences to rebuild myself after hitting rock bottom. I hope others who have these experiences of self-injury, whether because of psychosis or something else, know that they are not alone and that they can talk about it with others. Jessica Oakwood is a journalist and mental health campaigner. You can find her on Twitter https://twitter.com/lifeinunreality and on her blog https://lifeinunreality.wordpress.com.