10 Jun 2015

The other side of sanity

11:34 am on 10 June 2015

What it’s like to lose your grip on reality.


Cameron Miller showed up to work one day completely out of his mind.

He was working in retail five years ago when he pulled his manager into the back room and began ranting to her about Buddhism.

“After sustained conversation, it became very clear that there was something extremely wrong with my head,” says the 25-year-old.

“I had these delusions that everyone at work, from the staff to the customers, were conspiring to help me achieve some huge goal.”

Cameron was experiencing a psychotic break. He no longer had a grip on reality and was exhibiting the classic signs of disturbed thinking, hallucinations, and delusions.

But while a person with psychosis will often experience paranoia, believing that an individual or organisation is making plans to hurt them, Cameron experienced the complete opposite.

“I had pronoia which is the delusion that people were secretly conspiring to help me. It is much more pleasant, but no more grounded in reality,” he says.

A person suffering from psychosis loses the ability to tell the difference between what is real and what is in their head.

The condition affects around three out of every 100 people, making psychotic episodes more common than diabetes. About 80 per cent of people affected have their first psychotic episode between the ages of 15–30.

No one is born psychotic; it’s triggered by mental illness, a traumatic situation, or extreme stress. People are especially vulnerable if a  family member has psychosis, and in some people, it can be triggered by drug and alcohol use.  

While there are no definitive answers as to why psychosis affects young people at higher rates, it may have to do with the fact young brains are going through huge changes.

Consultant psychiatrist Dr Arran Culver, who specialises in children and young adults, says it’s a busy developmental time for young people.

“They’re establishing their identity, developing more lasting relationships, and separating out from their family. There’s also a lot of pressure with education and first jobs.”

Until the age of about 25, the brain is still a “work in progress”, says Culver. It’s vulnerable to things going wrong, especially when drugs and alcohol are involved.

Psychosis has multiple causes and effects each sufferer differently. What they share is that the person loses contact with external reality, usually taking the form of hallucinations, delusions, confused thinking, and changes in behaviour.

Signs of psychosis

Signs of psychosis Photo: Brodie Nel


Like many of his peers, Cameron smoked marijuana a few times a week and dabbled in psychedelic drugs from time to time. Doctors later told him his drug use and his genetics had likely triggered his psychotic break.

The warning signs appeared in his first year of university while he was working on his final assignments.

“The first delusional thought I remember having was this wonderful idea that I could just combine my two major essays into one. It was a very compelling idea to me.”

Cameron noticed that no matter how hard he tried, he couldn’t get to sleep. He lay awake in bed for hours with boundless amounts of energy.

“I could measure the amount of sleep I got that month in hours - maybe 10?”

As days went by, his essay grew more and more elaborate, and everything around him seemed to relate to it. He believed people on the street were talking about his work and thought the music videos he watched at night were full of encrypted messages about how to make his essay brilliant.

“In psychosis it’s common to over-perceive significance. While I was psychotic, everything was my world and everything was related to me,” he says.

Within a couple of weeks, Cameron’s mind had spiralled into large scale delusions of grandeur, and what should’ve been a straightforward essay, had morphed into a multimedia project that he thought would revolutionize the entertainment industry.

“It kind of starts snowballing and you begin connecting pieces together, creating bigger and bigger delusions, until you get to the point where you’re not really living in the real world anymore.”

Since a lot of the symptoms were inside his head, it took about a month for people to notice something was seriously wrong.

Cameron’s manager was trained to identify signs of mental instability, and after Cameron spent his shift trying to explain to her the intricacies of Buddhism, she called a crisis assessment team.

“My parents had to come down and I got shipped off home to Whanganui to start treatment,” says Cameron.

The first point of call was a dose of antipsychotics that he happily took. “I thought the doctors were giving me psychedelic drugs to push me further out into this new realm of thought I’d discovered.”

It was another month before Cameron got a complete hold on reality, and before he did, the delusions continued at home. One night he woke up with the solid belief that he was a computer program.

“The delusion was so convincing that when I went into the settings of my dad’s antivirus and fiddled around, I could feel physical changes happening in my head, as if I was editing myself.”

Being immersed in psychosis was not completely unpleasant. While it was intense, it was also exciting and left Cameron feeling like an important person with an important purpose.

For those who are vulnerable to psychosis, marijuana is really bad.

The traumatic part was coming out of it.

“When you’re in psychosis you operate under a very dream-like logic and just accept the ideas that come into your head. I had to consciously build my rational thought again,” he says.

The realisation that he’d been “crazy” for several months affected him deeply. He became increasingly anxious and more susceptible to self-doubt and loathing.

At the risk of going through it all again, Cameron decided to stop taking drugs completely.

“I have absolutely no temptation anymore. It’s associated with an intensely traumatic experience. I get handed joints and I just pass them to the next person.”

Dr Culver says it has become quite common to see young people who’ve had psychotic episodes triggered by drugs.

“For those who are vulnerable to psychosis, marijuana is really bad.”

A recent study found young people who smoked marijuana just a handful of times were twice as likely to develop psychosis over the next 10 years as those who didn’t.

Young people who have a family member suffering from a psychotic disorder are most vulnerable, with a one in 10 chance of developing psychosis, even if they never smoke pot.

However, if the same person uses marijuana regularly, it doubles their risk to one in five.

Apart from drug use, psychotic symptoms can occur in people suffering from mental illnesses like schizophrenia and bipolar disorder, but Dr Culver says he’s wary of labelling young people with mental illnesses too early.

“It’s better to just deal with the symptoms young people are presenting with, rather than trying to fit them into a diagnostic box, because we can often get it wrong.”

One thing doctors know for sure is that intervening early is especially important, since the longer psychosis goes on for, the more difficult it becomes to treat.

“If it’s left untreated, it can cause some major problems with functioning and can impact education, chances of getting a job, and relationships with family and friends,” Dr Culver says.

“It can have lasting consequences for young people because it comes on at such a pivotal phase.”

The stigma attached to psychosis is a barrier to sufferers seeking help early. People may be afraid of what people might think, or scared they’ll be sent to a mental institution and pumped full of meds.

But in the majority psychosis cases, people don’t need to go to hospital, and medication is a small part of treatment.

I think a large amount of stigma is still there. We’re starting to get better about things like anxiety and depression, but there is still this kind of ‘boogie man’ about psychotic people.

Cameron is open about his psychotic break, hoping it will help cast light on a topic still shrouded by misconceptions.

“I think a large amount of stigma is still there. We’re starting to get better about things like anxiety and depression, but there is still this kind of ‘boogie man’ about psychotic people.”

The stigma is not helped, says Cameron, by the fact that the only time psychosis gets publicity is when someone “snaps” and behaves violently.

Recently, psychotic episodes have been reported in relation to high-profile cases of violent crime, like last year’s Sydney siege and the killing of a US police officer in May, but research shows it is far more likely people with a serious psychiatric illness will be the victim of violence.

Going through a psychotic break dramatically altered Cameron’s life. When he started university he had his heart set on becoming a lecturer; now that’s not an option.

“The academic environment is a huge stress for me,” he says.

“I think because my delusions were so wrapped up in my academic work at the time so there is a huge amount of negative association, particularly with assignments. It’s a big part of why I’ve flunked so many things.”

Despite the setbacks, Cameron is on a steady slope upwards. He’s working part time and wants to become a counsellor.

Cameron’s psychosis was caught early, and Dr Culver believes that’s key to reducing the long-term damage psychotic episodes can cause. But he says more information and education is needed so more people feel empowered to seek help.

“We put a huge amount of community education out there about meningitis and rheumatic fever,” he says. “Psychosis is way, way more common than either of those two things.”

If you or someone you know is in danger, call 111. There's more information about mental health support and services here

Video shot and edited by Tom Furley.