My Strategies for Dealing With Radical Psychotic Doubt: A Schizo-Something Philosopher’s Tale
Year: 2022
Type: article
Abstract: I am a 45-year-old Swedish philosopher with “schizo-something”: I have never been given a precise diagnostic label, but a psychiatrist once said that although I do not tick enough boxes for schizophrenia, I am somewhere in the ballpark. I could fill a book with all the odd experiences and issues I have had, but let us keep it short: The world I inhabit is not very firm. It is flimsy, and occasionally flutters and falls apart, as if someone tore down the painted backdrop at the scene to expose what lies behind: a dangerous place where everything is slightly off, skewed, two-dimensional and washed-out , and full of murderous demons. The mainstream world can grow back up over the demon world again, covering it, until the next time it falls apart. Sometimes it does not fall apart, but remains thin enough to be translucent. When I first became a psychiatric patient, I worried about taking antipsychotic medication. This was my problem: Either the mainstream world is real, I am mentally ill, and antipsychotics will help me, or the demon world is real, demons are out to get me, in which case antipsychotics might hide them from me, making me a much more vulnerable target. What should I do? This problem can not be solved by argument or so-called reality testing. As Wittgenstein famously pointed out, some assumptions about the world are so basic that we can not argue for them, we just know; all arguments about facts presuppose that these basics are in place already. Real-life illustration: I find myself torn between believing in the mainstream world and the demon world. My demons can teleport around using mirrors and other reflective surfaces. Now, I try to argue with myself. I say, look: mirrors might look like portals to an alternate and inverted world, but they are actually just surfaces smooth enough for light to bounce back at the same angle as it came in. But… how do I know this? Answer: I learned it in physics class. Or… did I? Have I even been to physics class, or do I just think that I remember this? I could Google the matter, but where do websites even come from? Why should I trust them? If you doubt one, two, or three things, it might be possible to prove that these things are true via evidence and rational argument. When you doubt everything, that is a whole different problem. Eventually, I (temporarily) solved my problem by employing a strategy that I, in hindsight, label “Jamesian.” (Hindsight, because I was only twenty years old at the time and had yet to study philosophy.) William James argued that there are (rare) situations in which a neutral suspension of judgment is not possible, we must believe in one of our options, and yet we lack sufficient evidence one way or the other. When this happens, we can choose what to believe. I made a complete leap of faith and chose to believe in psychiatry and take my medication. My then-psychiatrist tried a number of antipsychotics before striking gold with Haldol. It made me feel amazingly mellow, but not sluggish, and firmly anchored to the mainstream world. I would be on it for years, until I would consider myself cured and quit. Being off meds would work for a while until I had a dramatic relapse (usually triggered by travel or increased job stress), at which point I would go back on the drug and recover. However, after six consecutive years of medication compliance, Haldol began to simultaneously lose its desired effect and produce nasty side effects. I suffered facial muscle tics and on-off blurred speech. These were mild as antipsychotic side-effects go, but it felt horrible, in particular not knowing how much I would further deteriorate if I stayed on the drug. Eventually, I decided to quit again, but not because I was under any illusion of having been “cured” this time. I thought that all things considered, enduring all the horrors of the demon world would be my least bad option. When I quit my medication, I really hit the limits of my Jamesian coping strategy. It is one thing to choose what to believe as a one-off mental feat, and quite another to cling to that belief long-term, in the face of contrary and evermore pressing experiences. Eventually, this strategy just did not work anymore. I could repeat all I liked that demons are not real, without believing my own words. I needed a new strategy and eventually came up with one I call Pyrrhonian, after the Ancient Greek philosopher Pyrrhos and his follower Sextus Empiricus. I then developed it further together with a psychodynamically trained and amazingly pragmatic therapist. (Whom I saw for my own money. Psychiatric public health care in Sweden used to include a wider range of therapy options, but nowadays, it is mostly medication and CBT.) Sextus argued that we can not know what is true or false, but once we acknowledge this limitation and learn to suspend judgment about everything, we can find peace of mind. Funnily enough, madpeople feature in one of his many arguments for skepticism. Madpeople see the world differently than sane people do, but whose worldview is correct? Sextus writes that we have no way of knowing. Most people think, he writes, that madpeople have “imbalanced humors” which distort their picture of the world, whereas sane people have “balanced humors”, and therefore see the world as it truly is. (Just replace “humor” with “neurotransmitter”, and the passage could have been written today.) However, even if we could prove that there is a difference in humors between the mad and the sane, we would still not know who’s got it right. For all we know, there are madpeople with humors that make them see the truth, while everyone else’s humors distort their thinking and perception. There is no truly impartial perspective from which we can tell which humors should count as balanced or imbalanced, and which worldview as correct or distorted. To achieve peace of mind, we must accept that this is the case, relax, and learn to live with it. But how do you decide and act without any firm beliefs about the world? Sextus gives the rather unsatisfying answer that you can just as well do what everyone else does, and simply follow your local customs. That answer would not have consoled me if I had read him as a twenty-year-old first-time psychiatric patient. However, after quitting my medication, I realized that I now had strategies open to me that makes sense regardless of which world is real. Either the demons can not kill me because they are not real, or they very likely would not kill me because they have been stalking and threatening me for decades and I am still alive, so those threats seem pretty empty. This thought is much more soothing to me than insisting over and over on only the first part. Furthermore, I have ways of dealing with them, either by talking back to them and trading jokes for their threats, showing I am not that scared anymore, or engaging in little magic rituals to keep them at bay. If they are real, I am justified in handling them like this; I am also justified if they are not real, because these actions keep me calm, keep me from spiraling into ever higher stress levels and fear levels, and thereby keep me from a full psychotic break-down. I do not have to fret and panic anymore over not knowing what is real, because I know what to do either way. So far, I have described this Pyrrhonian strategy in very cognitive, intellectual terms, but it is as much of an attitude as an intellectual exercise. I try to relax my mind in a way roughly analogous to relaxing my muscles. Instead of desperately trying to ignore the feeling of fingers poking the back of my head or the way my surrounding environment shifts and goes wonky, I try to accept the fingers, accept the shifts. Let them happen. It is fine. I can roll with them. It’s now been 4 years since I quit antipsychotics (and the benzos, sleeping pills, and beta-blockers which I was also prescribed). I have managed to work full-time, and I have traveled to conferences and workshops, sometimes abroad, despite environmental changes being one of my biggest triggers. I am also more creative than I used to be; I even got two (Swedish-language) short stories accepted for publication in anthologies. I did not realize when I was on Haldol that it had a negative impact on my creativity, but it is obvious in hindsight. Nowadays, I think losing my creativity again would be a high price to pay for getting back on the drugs. So far, the Pyrrhonian strategy has been hugely successful for me; I think it might be worth experimenting with for other people who are not helped by medication or traditional reality testing. If I do have a real breakdown again in the future, I hope that my brain has “rebooted” by then and that Haldol will once again work marvels for me, as once it did. Nevertheless, thinking back on those four years and all the difficult experiences that I have managed to handle with my new, Pyrrhonian strategy—far from perfectly, it is been a bumpy ride, but without total breakdowns or hospitalization—it seems plausible to me that I will be able to manage medication-free for the rest of my life.
Source: Schizophrenia Bulletin
Author: Sofia M I Jeppsson
Institution: Umeå University
Language: English
Topic: Mental Health and Psychiatry
Subfield: Philosophy
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W4283754583