This is a short story about my experience with psychosis and depression, written for FEPSY.
Through psychosis: a first-hand account of madness
A short story for FEPSY
Psychosis is a dynamic state of mind that manifests in unique ways to different individuals. For me, it started out as social withdrawal and anxiety that escalated into full withdrawal into my mind. At the heights of my psychosis, I was outwardly unresponsive. The real drama resided in my head. Thoughts of delusions and paranoia captured all of me, so much so that I was trapped in my own world of deluded thoughts. The line between reality and dreams was blurred in that few days. I was caught up in a nightmare that I could not wake up from.
The first episode…
…happened in April 2013 when I was home for a holiday in Singapore. I was a graduate student then in Basel, about halfway through my PhD program. Shortly after my water baptism that Easter, I behaved in an odd manner. It began as withdrawal and anxiety. I was experiencing excessive anxiety from the smallest thing. To curb this anxiety, I tried to talk to my mother about it. But I could not express myself properly. The most that I could do for a few days was to get her attention by calling “Mummy,” and stop at “I…”. It was frightening to me. Even though I am a soft-spoken person, I usually had no problems articulating my thoughts in an adequate manner. 
I was also not keeping up with my appointments with my friends and sisters. Time was passing me by but I could not be engaged with the passing activities and events. It took me longer to get ready than usual on the day where I was supposed to go out with my sister on a shopping trip. When we were at the mall, I was following them aimlessly. I did not engage in the conversations that they were having, and also I shut the incoming stimulus of events around me. I felt like a walking zombie. I could not be engaged with people or normal social activities like hanging out and shopping. I could not also express my thoughts in writing or speech. All I could focus on were the fear of being found out. About what, I was not sure. And there were moments where I swear I could see, from the corners of my eyes, the flashing lights of a police car coming to get me. 
I was lucky that my family was around me when it started. They quickly noticed that there was something wrong with me. My mum scheduled for me to see a private psychiatrist, and my sisters brought me there. When I realised that they had scheduled for me to see a doctor, I was angry. “I’m not crazy,” was what I insisted. I refused to step pass the threshold of the clinic, so the doctor came out to see me. But I was afraid of him. I thought he looked like a church friend that I met in Basel. And that he was trying to communicate with me in a covert manner. 
I started having paranoid thoughts about my friendship with that particular church friend. I was suspicious of his motives behind our friendship, so much so that I started having delusions about him. I thought that he wanted to steal my identity and get away from a crime. I thought that he was involved in a high profile court case happening in Singapore then regarding a potential misuse of church funds. I felt that I had a sudden insight and revelation about this matter, and had wanted to report him about it. At the same time, I felt guilty as he is a friend of mine. It was a chaotic and frightening. 
The following day, my family brought me to the emergency room of the Institute of Mental Health in Singapore. I experienced the heights of my psychosis then. I was unresponsive again, completely trapped in my delusional thoughts. I thought that I was going to die so that my younger sister could live. So I sat there waiting quietly for life to leave me. When I was given food and water to drink, I played with the food until it was all mashed up without eating. While playing with the food, I was thinking to myself “Should I confess my crimes? Or should I not?” With every thought, I broke the piece of food into a smaller piece. Exactly what crime I have committed, I’m not sure again. While in the waiting room to see the doctor, I kept thinking of that I am going to be brought to a judge who would deal with my case. When I finally got to see a doctor at IMH, I was not responsive. In the end, they sent me, along with my mum and sisters, on a non-emergency ambulance to another hospital. 
At that hospital, I was in and out of my nightmares and the reality. I was for the most parts disengaged from reality while the doctors ran MRI scans, EEG tests, spinal taps on me. I was running a fever then and caught up with the delusional thoughts in my mind. I thought that there was a unified language in the world after I heard nurses conversing. The MRI scan was like a trip to an outer space expedition. The interpretation of my surrounding was altered and malfunctioning. I was trapped in a living nightmare that I could not get out of. However, I began to slowly emerge from the my psychotic state after a few days. The doctors started me on an antipsychotic drug, Risperidone. I was hospitalized for about a week. I requested to leave the hospital as soon as I was “awake” to reality again. There started my eight month journey of recovery and reintegration into society in Singapore. I went back to graduate school in Basel after that break to continue with my studies.
A second close call
About a year after my first episode, I stopped my medication as my doctors (both in Singapore and Basel) thought that I was doing well. In addition, I was struggling with a terrible outbreak of acne and weight gain, which I attributed to the mediation (both improved after I stopped the medication). At that time, things were going well again – relationships with my colleagues are excellent, I was maturing even more as a scientist and my personal life in church was thriving. Things were going in full swing again as I prepare to finish my experiments and start writing my thesis. It was a stressful period of time for me as I try to complete in the last experiments. But all was well. Until an eventful lab outing in mid-October 2014. 
It was an enjoyable and memorable outing with the lab (it still is to me). However, during dinner, there was a discussing about an ex-graduate student of the lab. She had struggled with bipolar disorder, and had caused some problems in the lab due to her fluctuating moods. People gossiped about her. For me, it was terrible to bear. Because I felt for her and her struggles with mental health. I felt that if people could talk about her like that, they could be easily talking about me and my struggles. I felt, at that point in time, hacked up into pieces waiting to be chewed up by the mindless gossipers (a little drama in retrospect, I know). 
From there, it was a downhill ride. Within days, I was back in a vulnerable mental state again. At first, I was very emotional about the incident; I could not stop thinking about what happened and kept dwelling on it. There were a lot of tears and hurt feelings. From there, my mental state started to unravel. I could not keep focused on a given task at hand, and whatever that I thought about will be negative. Nothing could cheer me up from the low mood and lack of focus over the weekend. When I went back to work on the following Monday, it got worse. 
I could not focus on my work in the lab. Moreover, I felt a paranoia creeping in on me. I started to misinterpret incoming stimulus again. In particular, I received an email about a lecture about scientific imaging integrity from a colleague. I followed the link and quickly found that one has to be registered at the jurisdiction faculty at the University to attend the lecture. Out of the paranoia thinking creeping into me, I thought that it was a witch hunt for people not showing integrity in their scientific work. It evolved into me questioning myself my own work ethics; if I were being completely honest and steadfast with my imagings. 
Luckily, I was aware of these delusions and paranoid thoughts creeping into my mind. I had insight that these aberrant thoughts and feelings were signs of a relapse. It was like a déjà vu of my first episode. Only this time, I was prepared. I talked to one of my closest colleague in the lab, who knew about my first episode. She quickly implored me to stop my work and see my psychiatrist in Basel. She would not let me off until I called up the emergency number and made an appointment. Having a medical training background, she knew how to handle someone experiencing a psychotic episode. She caught my attention back constantly by, for example, deliberately dropping the salt bottle and trying to engage me with beautiful pictures of the Swiss mountains that she had taken on her weekend hiking trips. 
I felt like a wreck when I made it to my doctor’s office that evening. I explained to her that I was experiencing positive symptoms again: delusions, paranoia and this time a lack of focus as well. There were more outbursts of tears and lamentations. She suggested that I start again on my medications immediately, which I refused at point blank at first. Because I felt like I was back to square one again in my recovery. The life that I tried to piece back so painstakingly after my first episode was falling into pieces again. Starting on my medications again made me feel like I am a loser. But then she managed to convince me that I need that treatment immediately and psychiatric drugs work best for early cases of psychosis. 
She then asked if I wanted to be admitted into the hospital as I was living alone in Basel. Again, I refused. The thought of being hospitalized was terrible. I had the sudden image of me being chained up and locked in a ward with other psychiatric patients. I burst into the tears again. When I recovered from the tears, I told her about my concerns of being hospitalized. I asked her how it would look on my medical record if I were hospitalized again? What about my work – how can I leave it unattended? How can I account to my family? What would happen to my future? In the end, she relented and gave me more time to decide if I needed hospitalization. But only after she asked in an indirect way if I were suicidal. I told her I was not. She made me promise her that I would go back the next day for another appointment and let her know my decision. She let me go home only when she saw that a colleague of mine was there to accompany me back. 
She also mentioned that this – the decision against medical advice to be admitted into a ward – will be reflected in my dossier too. In retrospect, I am in some ways glad that I refused to go to the hospital. I think that being in a foreign, German-speaking environment would not do me good in my vulnerable mental state. Who would I know to trust? How would I interpret the events going around me? But I still shudder at the thought of me wandering around in my vulnerable state. What if I got run down by a car? What if I burnt the kitchen while preparing dinner? These considerations are futile now, as I decided against admittance to the hospital then, and I managed to find my way back to the clinic, doing a lot better than the day before.
Once again, I entered a recovery journey from a close call from full-fledged psychosis. I was shacked but not beaten down. I filled my time with activities that I enjoyed, to keep occupied but not too busy. People were very understanding and supportive. My sister flew in from Singapore to spend some time with me. My colleagues and boss remained supportive throughout the whole duration of my recovery period. My church friends were there for me by spending time with me and in prayers. My doctor supported me medically. I am very grateful to all of them.
A third downward spiral
Recovery from the second close call was smooth sailing. I managed to gather myself together within six weeks and prepare for the final stage of my PhD: thesis writing. But I was not back at my 100% yet. I struggled with lethargy and lack of motivation for work. I needed more sleep, and also found it difficult to make it out of the house for work on the weekdays. But I could still get by as the focus of my work then was to wrap up my work. The pressure of squeezing in more experiments into the final stage of my PhD was lifted by my boss. All that remained was putting together a thesis and defence. Then I went home for an eventful holiday…
I made a trip home in December 2014, and experienced a downward ride again. Perhaps it was the change in environment, jetlag or simply the upcoming stress of relocation from Basel to Singapore. Whatever the reason, I could not get myself to stop thinking about the things that I have to do in order to move back to Singapore on a long term basis. Returning my apartment, defence, thesis deadlines, and job hunting. I let these anxieties and worries choke me. I imagined the worst possible scenarios in each challenge that I was going to face. 
That scared the hell out of me. I started to imagine how things would fail; I let the monsters of my imagination overcome me. I was paralyzed with fear and anxiety. This anxiety and low mood affected my concentration. I could not focus on churning out my thesis introduction, results and discussion. This then in turn made me feel worse about my situation. I started to go into a downward spiral of depression. 
It got so bad that there were days where I could not function at all. All I wanted was to lie in bed all day and wallow in self-pity and fear. I even morbidly hoped that I would have another relapse so that I could have a legitimate reason to give up on my PhD, give up on life altogether to retire and not do anything. Dark thoughts of suicide then crept into my mind… It was again a dark period in my life.
But I grit my teeth and went on. I decided again to not give up on my PhD and continued with my thesis, word by word. Then, words became paragraphs, paragraphs became sections, sections became chapters. Before I knew it, my thesis was taking shape. My supervisor remained supportive all though my thesis writing. He even allowed me to write my thesis at home in Singapore. Only asking for updates from time to time to track my progress but not give stress. 
Time flew by as I juggled thesis writing and recovering from this downward spiral. Soon, I decided that it was time to go back to Basel to complete the final journey of my PhD: defence. I was not quite ready at that point in time as well. A small thing like checking in online for my flight caused anxiety in me. But I had to move on from my state of limbo, be progressive with my life. In the end, with a heavy heart and unsettledness, I went back to Basel to complete the final lap. 
It was difficult at first. I struggled with a lot of negative thoughts and low moods still. But I managed to pull through. With lots of encouragement from my colleagues, support from my family and determination, I started the application process of thesis defence. I set small goals and took my time in finishing them. I had the time and space in Basel to rebuild my confidence and being over that period of time. 
I also had weekly psychotherapy sessions in my clinic in Basel. My psychologist and I talked about my moods, thoughts, challenges that I faced weekly. It was good to have someone impartial to talk to on a regular basis. It helped me track my progress weekly, and also have a friend to simply listen to whatever that is on my mind. I did not have to shoulder the negativity alone in these sessions. Talking to my psychologist also helped me think through and analyse certain issues that I had. 
I successfully defended my thesis in April 2015, and received a magna cum laude degree. Many people have the impression that PhDs are the “smart people”. However, in my opinion, the continuous decision to hold on during difficult times of graduate school is perhaps a more important factor than intellect. The consistent hard work put in through the years is more vital than being clever. 
I am back in Singapore now, waiting to start a new career in science communications. I eagerly anticipate the new people that I will meet, new challenges that I will face. 
Of course, I would not be able to go through these years without the help of my family and friends, supervisor and colleagues, and my medical teams. Most important of all, I would not be able to be at where I am today without the hand of God moving powerfully in my life. 
There is no joy in having mental illness per se. But there is joy in its purpose. I hope that this experience will be used to become a positive influence in someone else’s life. Then all that darkness would have a greater meaning and purpose, and it would somehow be all worth going through.
July 2015

What is a Psychosis?


Early intervention and psychosis clinic
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CH-4051 Basel

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