Foreword

Foreword

Psychosis is an experience of endless fascination to both scientists, who are attempting to understand it, doctors who must treat it, patients who endure and sometimes revel in it, and the lay public who frequently fear it.

Suzy Johnston has accomplished an audacious and rare undertaking in penning an unusually frank account of a psychotic breakdown. If that was all that she had done the book would still be worth reading – but something much more important is being undertaken here.

Despite all the research effort that has been invested all over the world, the medical model still struggles to capture the psychotic experience. Questionnaires, interview schedules, blood tests and brain scanners have all been deployed in an attempt to illuminate what is going on in psychosis, and although meaningful leaps have been and continue to be made in our understanding, it’s still the case that we probably know least about the psychotic mind, compared to all other experiences that fall within the medical remit.
Perhaps one key piece in the jigsaw that has been missing is the detailed first person account – and it’s easy to see why this has been problematic in incorporating these into the scientific view. Once people recover from psychosis, it is not a part of their lives they necessarily relish revisiting, indeed their memory for it seems to fade rapidly, a bit like a vivid dream after one has awakened in the morning from
a feverish sleep.

But the extended first person account is something I believe psychiatry ignores at its peril for I contend it’s only a blow by blow description over an extended period which holds out any hope of illuminating what it’s really like to undergo some of the most frightening and vivid experiences open to humankind.

We have too easily jumped to conclusions in modern psychiatry that we know what someone is going through when, for example, they answer yes to the typical hasty screening question asked distractedly in the Casualty Department - ‘Do you hear voices?’

In fact not only is there a vast individual variability we neglect to our peril, but trying to get at what its really like to have these experiences can only be properly elucidated by detailed and coherent first person accounts like the one you currently hold in your hands. While brain scanning and blood tests have their place, they are never going to tell us what it feels like when the brain and mind stray beyond the limits of experience that you can discuss meaningfully with your neighbour. In my clinical experience treating psychosis on a daily basis at The Bethlem Royal and Maudsley NHS Hospitals Trust, part of the complexity of the issue is the unique sense of isolation enduring a psychotic breakdown engenders.
Clinicans like myself are not just wrestling with the convolution of an intricate mechanism like the mind
appearing to not function in an understandable manner, but each person reacts differently to their psychotic experience – and each person’s family, friends and neighbours seem to do so as well.

It’s only when the wider public and policy makers come to understand how dreadfully difficult managing psychosis and assisting sufferers is, that proper resources might at last begin to be diverted to properly treating this serious and common medical emergency. This, and for a whole host of other reasons, is why this book is so very important.

Raj Persaud FRCPsych
‘The Mind’