Joseph

Age at interview: 22

Age at diagnosis: 21

Brief Outline: Joseph experienced a brief period of psychosis in his early 20s when he was working as a chef. He had delusions and was not his normal self. He spent less than four weeks in hospital. He fully recovered from his psychosis and does not take any medication.

Background: Joseph works as a gardener and after the interview began working as a Peer Recovery worker.

More about me...

Joseph was some months into a new job working as a high end chef when he first experienced psychosis. The work was demanding, with long hours, often working 75 hours a week, but rewarding. He had been pushing himself and had been promoted and he feels that he put more pressure on himself than others expected of him. The week before the psychotic episode he had been moved onto a new section of the kitchen. At the time he was getting less sleep than usual, about four hours, compared to his usual six, didn’t have time to eat properly, and was having a lot of caffeinated drinks. On reflection, when he left work that Friday he had a feeling that he might not be going back.

After a long weekend at home he became physically ill and collapsed. His girlfriend called an ambulance and he was taken to hospital. He remembers feeling a kind of relief that he was finally being “taken care of”, that he was now in “safe hands” away from the Intense lifestyle he had as a chef.

During the psychotic episode he had a lot of “intense thoughts” and was making connections between seemingly random bits of information. He was using his mobile phone to make notes about the things he was thinking. He also remembers using ‘google’ search engine on his phone in unusual ways, as if it could answer any questions he had, such as where his girlfriend was. On one occasion he remembers noticing that his girlfriend hadn’t posted on twitter for six months and thinking that this must mean she had died. He experienced real grief at losing her, which continued until he saw her again.

While some of the experiences he had during the psychotic episode were bad, there were times when he felt very good. He had a huge amount of energy and remembers cartwheeling along the corridor of the hospital at night when other patients were asleep. One time he experienced ‘euphoria’ looking out of a large hospital window at a view over the city. His sense of taste was heightened and whatever he ate, it was as if he was tasting it for the first time. 

But he also describes his senses becoming overloaded, for example he remembers finding one light near his bed painfully bright, and he was acting in ways that were out of character. He could get very angry and be violent. He remembers breaking a light and having to be restrained. He didn’t feel particularly aware that what he was experiencing was delusional at the time. 

Staff at the hospital were very good and always had time to listen to him. He remembers a psychiatrist telling him after he left hospital to be kind to himself, which he thinks was good advice. Rather than rush back to his old job, he decided to start work as a gardener and he thinks this has helped with his recovery. At the time of the interview he was considering working as a social care worker.

Joseph’s friends and family have been a good support to him throughout his experience and visited him in hospital, which he says was a very difficult experience for them. After he left hospital he moved back to his family home. It was a tough time for him, adjusting to the medication he was on, and coming to terms with what had happened and he appreciated his family giving him time to recover. 

While in hospital Joseph was prescribed sleeping tablets which had the opposite effect, and haloperidol (anti-psychotic), which took time to work and made him feel “weighed down”. Procyclidine (anti-cholinergic), which was prescribed to counter some of the side effects of the haloperidol, made him hyperactive and increased his emotional sensitivity so that even watching the TV felt like sensory overload. Although Joseph wanted to come off the haloperidol quickly, the psychiatrist reduced it very slowly over eight months, which was a difficult time. Joseph feels he only really recovered once he came off the medication. 

Joseph was never given a formal diagnosis, but the terms ‘manic episode’ and ‘psychotic episode’ were used by clinicians. That was enough for him to investigate more about his experience and he collected information about his experience from friends and by reading back through the notes, text messages and search engine history on his mobile phone during the episode.

Joseph was working as a chef and pushing himself to achieve more and more. On his last day of work before his first psychotic experience he “kind of knew” he wouldn’t be coming back.

In the kitchen, yeah. So I only really had one day handover with this guy. And there was a lot to learn, was just about picking it up. And then, yeah - long days. But then because it's a new section, at home I was then rewriting everything the guy had written, because it was all in quite poor handwriting. So I was writing it up again. Reassuring myself. So, little sleep, little food. And then - so, that was for about a week. And then by the Friday I'd gone to work early. Just to make sure I was set. And then I realised I'd left my phone at home. So, ran home [laugh]. And it's about half an hour journey. And then came back. Got back just as when everyone was starting. So I wasn't late, because I'd already got there early, but [laugh]. Just - And then, yeah. Did a day's work. And by the end of it, that's when I had - it was just having these really weird realisations. And I wouldn't necessarily say all bad. I remember speaking to a doctor after the episode, and he was saying "It's not unusual before an episode, like some artists notice they're more creative prior to." So it was kind of - I kind of felt - yeah, I was having all these weird revelations and that. And a lot of them delusions, maybe some of them were, were quite good - I don't really - can't remember. I don't think anyone really noticed anything. I can't, it's hard to say. 

So at the time, you said that you - you didn't really notice anything out of the ordinary?

No. 

That it was - It sounds almost like it was just a progression?

Yeah.

Of getting better and better, and pushing yourself, almost to be better and better and better?

Yeah. I'd say so. And then- but I think maybe in the back of my mind I knew it was too much. Certainly that week. And without ever really explicitly thinking it, I kind of knew that I wouldn't be coming back to work the following week. 

Joseph describes eating breakfast just before he collapsed and was taken to hospital. He felt disinhibited and like something in him had changed on a mental and physiological level.

What happened was, it was a bank holiday, that Monday. So, parents had gone back home. My girlfriend had stayed the night. That night, I believe - oh sorry, the night before, there was a party. Or a small gathering in the floor above, where I stayed with my friends. And I'd gone up, just for a little bit, until four in the morning. So, still only had a couple of hours sleep then. So by the then Monday, bank holiday, I was pretty frazzled at that point. And, yeah. It definitely got worse, the symptoms. I sort of went to make breakfast, and given that I'm used to cooking [laugh] quite a lot of food in a short space of time, to a high standard - cooking just eggs and bacon was the hardest meal I'd ever cooked, at that point. I was just - Almost like you're a bit quite drunk. Not being able to focus. So, just - yeah, and it was just not cooked well. Put it on the plate. And then, yeah - walked in, into the bedroom and that, gave it to my girlfriend, we ate it. And then I never usually eat the fat on, on bacon. And then my girlfriend said, "Oh, you should try it." And then - I'd usually say no, but just because the symptoms were coming on stronger, and I'd - you're more in a disinhibited state, and like - also it went with my belief at the time that, something to do with how - I really don't remember, but fat was - yeah, certain carbohydrate, just to give me more energy, I'm not sure exactly. But I just remember having this - like it was because it wasn't cooked properly, it was just this big bit of blubbery fat, and I just downed the whole thing. And it tasted fine. And I couldn't do that now. So, it almost at a physiological level I was changed, not just mentally. Like the actual way I perceived taste had changed.

Despite a very brief one-off episode of psychosis, Joseph lost his social skills and found ordinary tasks challenging. He was also adjusting to the effect of his medication.

And eventually - I didn't even realise what I'd lost, so quickly. Like social skills got so bad that, overnight, that I, I didn't even realise that I didn't have them. Sorry, that I had them before. And so it was just about rebuilding all of those things. So, now - 2017- quite a bit later, feel in a position where I am stable. And I won't say there's an end goal to recovery, but I certainly feel “recovered” in most senses. And as I say, the episode itself was quite - relatively brief.

So it got to the point at that time where it was calming down. But it was still the shock waves. And so yeah, it's almost like post-traumatic type symptoms then. So, just.

So, how did that - What was that like?

It was very - Made it very difficult to - Like I'd gone from being manic, and extroverted, zero inhibition

Yeah.

And then the flipside of that is you realise what you did, and then you just - you're then having to watch yourself so much more. So, and some people said, "It looked like my brain was just going through treacle." And I just had to - everything I was doing, I was just over-analysing and thinking. Because I was so aware of the crazy stuff I did, that I was just over-thinking about what I was saying. And felt a bit of an alien, because I just couldn't feel I could interact normally with people again, after such an outburst. 

So there's a lot of self-awareness 

Yeah. From going to being self-aware but in a different away, and a lot of disinhibition, to yeah, the extreme.

Okay. And that sort of continued up until you left hospital, it sounds like.

Yeah. Yeah. So even by the time I'd got back to the family home. I remember trying to change my bed sheets, and - pretty normal task that I'd do quite regularly beforehand - and I just couldn't do it. I got so frustrated that I just punched the sheet, and just hit my hand on the floor. And, I didn't break anything, but it got particularly swollen. And it was just an example of I just suddenly couldn't deal with day to day - certain day to day activities, which you just wouldn't even think about before. And the particular drug I was on gave you a - because it's used to treat Parkinson's, so gave me a tin man type effect. So your hands were very straight. 

When Joseph “passed out” during his first psychotic experience, his girlfriend was with him and called an ambulance.

My Mum takes this olive leaf extract supplement. You're only supposed to have about 15ml a day. And I had some in my room, which I'd been taking a little bit a day, it's quite good for you. But due to these, this belief and thought patterns, I was pouring myself glasses of it, and drinking it. So, yeah. Strange.

Due to a belief about the oil, or?

Yeah, something - as I say, I can't quite remember. But something to do with your complex carbohydrates being really what I needed at the time.

Right. okay

Anyway. Couple of hours later - don't know if this was - I fainted naturally, or if I faked it. Either way, I just remember passing out, falling on the floor. Oh, sorry - I wet myself. So, urine going everywhere. And then my girlfriend - that's when my girlfriend obviously knew there was something seriously wrong. So she called the ambulance, 999. And whilst we were waiting for the paramedics to come, she undressed me, got me proper. And then sat me at the end of the bed, then quite quickly the paramedics came. And they - that's my start to being funnelled through the system.

Joseph never really got a diagnosis, though words like “manic episode” and “episode of psychosis” were “thrown around”. He was glad that there was no concrete diagnosis.

It's kind of a point of contention. Because I mean, I don't remember what was said at the time. It was all - as I say - I was getting all these physical health checks. Countless needles, and they tried to put me in an MRI scanner, but I was just too fidgety, moving around, that they couldn't get it. Anyway. So, by the time we got to somewhere where they could sort of start to look at diagnosis, a few words were thrown around, and - and I'm quite thankful that they didn't give me a diagnosis, other than 'an episode'. But even then, there was no concrete words. It was just - some people were saying 'manic episode', some people were saying 'episode of psychosis', or 'psychotic episode'. And it was just - nothing was really concrete. I never really got a diagnosis. Which I'm - I personally am glad about. Because for me, it was - it was just - I can see how it happened. It happened over quite a short period of time. And obviously it could happen again, but on the whole I, I don't think it's a recurring thing, so. So, to suggest a manic episode, suggests that you're more bipolar and you have periods of low depressive episodes. And so it's - I didn't. And I haven't had a depressive period before, then. So, yeah. I didn't really get a proper diagnosis.

Joseph had big memory blanks from his first experience and unanswered questions about what he had been doing and saying. He looked back through texts, computer history to help him understand what he had been doing and saying.

I suppose I wasn't looking for a diagnosis, or something to fit into, I was just looking at all the unanswered questions. I have got big memory blanks, of - Some of it I remember clear as day. But there's other bits which are just complete - Like the bits in between - travel. So I remember everything in the hospital. Don't remember how I got from the hospital to the acute ward. 
And yeah, bits in between, I've got complete memory blanks.

So I was asking a lot of people. And then just due to the digital modern age, I was able to look through texts, and yeah, the computer history, and all these sort of things. Which gave me a big insight into it. And I think without being obsessive about it, it was - it was useful, to just get an idea of what happened and how it might have happened. Just because - Not to - just for the sake of knowing, but it does inform me to what I do next. That's it.

Mmm. Okay. So, sounds like it was mostly internet. But you said also talking to people?

Yeah. So people that were around me at the time, I'd just say, "What was I like?"

Okay.

"What was I doing?"

Right. Right, right. So again, it was just more information that would help you understand what was happening for you through it, and.

Yeah. There was a lot of things that was hidden from me for quite a while, just because that would have been a bit too much for me to hear. Yeah, obviously things that I did that were very out of character. They felt that it wasn't the right time for me to hear. And that was probably right. 

When Joseph’s mum didn’t make it to see him in hospital one day he thought she had died.

I would like to avoid telling war stories, because it's not necessarily helpful to people, but. I think some instances, it is. So for example I felt - Well for example, when I first got to the hospital, most of my family could make it, but my Mum couldn't. And I was being told that she's at home. And I just read that as she'd died. And it wasn't a dream, where you think someone's died, I actually felt - I kind of - I know what it feels like to have lost my Mum, because I reacted in the same way. Because that's what I genuinely believed at that time. And I think it happened with a few other people. And then even with my girlfriend, because she obviously had to get home and get some sleep. But I'd woke, don’t know if I was awake or not, I was awake at night anyway. And looked on my phone. And I was looking for her, and I typed in her name, went onto her Twitter profile, and her last post was about six months before. And I just interpreted that as that she had died. There was just no other way. That's kind of - shines a light on how you think when you're in that state. Like you just see 'okay, she hasn't posted for six months, that she's deceased', and that's the only way of seeing it. And then I reacted in the same way as if it had been a truth, that had been - yeah. And so it was all those things, I suppose. I mean it wouldn't have been as real obviously if it had happened, because soon as then I saw these people again, you then get the relief. And then - But it's still just - I can't say I've had flashbacks over the year, but I've certainly every now and then I'll just be gardening and I'll just remember. And, yeah. It is something you kind of have to live with for a little while. Even though you know it's alright. But that period of time, it felt very real, so. It's just dealing with that with care.

Sometimes Joseph felt like he was “bumping along the bottom” and at other times he felt like he was flying. He compared it to moving up levels in a computer game.

I would say it was over a short period of time, but still it was - it just started with the thoughts being a bit more - Well I'd say to start with for example, something quite mundane even. So at work, you want to perform a bit better, so you think 'oh, it'd be great if my brain was a bit more active'. Like if I could be - what it would be like if I was on top performance all of the time. It's just entertaining - everyone has funny ideas, entertain that, would it be possible? And then you start looking at maybe ways of doing that. Sort of over-clocking your brain, you could ramp up. So you're just always on it. And because, yeah, as a chef I think for some people it's they are - always sort of doing pretty good, there wasn't too much highs and lows. Whereas I felt there'd be some days if I hadn't eaten enough, then I'd just be really bumping along the bottom. Regardless if anyone really noticed or not, it's hard to say whether it's just something I felt. And then other times I'd have loads to eat, got enough sleep, and I'd just feel - yeah, just like I was flying throughout.

Felt like you were flying, did you say?

Oh, when I was - yeah, just in a normal sense. Just like I was just - yeah, everything was going out properly. And it was, I was enjoying myself. 

Yeah. Had you felt that way previously?

Yes, I mean, that's sort of over the course of the career. 

Yeah.

So, when - So, back to my point about starting with a mundane thing like that. And then eventually it grew to, well I was taking sort of caffeine supplements, and even just - Looking back now, it's really strange. But playing a video game, in like an order that if it, the video game, sort of ramps up slowly. So then the more, the harder the game gets, the sort of higher level my brain was working. So, delusions that. It sort of got - that each day would get a little bit worse.

Joseph remembers tasting avocado while he was recovering in hospital and it being like the first time he’d tried it. He also remembers a sense of euphoria looking out of the hospital windows over the city.

Yeah. I didn't eat much at all in the hospital. I had to be fed. I think I wanted to be fed. I'm not sure. But I was spoon-fed everything. And food had a particularly big impact on me, because it's - I'm not sure if other people with psychosis feel this, but it's a sensory overload? So all the senses on high alert. Lights were way too bright. So there's a light at the top. I don't know, it was just the brightest thing I'd ever seen in my life. And I just was shouting at the nurses for them to turn it off. And they were saying they couldn't, blah, blah, blah. And a few months ago, I think I asked my family about that. I said, "Do you remember that light? Was it me, or was it - was it actually that bright?" And they said, "No, it was just a normal light." [Laugh]. So it's kind of sensory overload. 
So, going back to the food. That was sensory overload. And there was - Hospital food is quite similar to the food you were perhaps fed when you were like 5 years old, or something. So, peas and mash. So, I felt as if I was eating everything for the first time again - I was eating, yeah so the peas, it was just - I was just really interested in the taste. And it tasted like - a bit like obviously when you put salt on avocado or something, and it tastes ten times better. But obviously it was just bog-standard hospital food, so it wasn't particularly special. 

So, to go back to your question - I did eat, yeah, better, in the acute ward. Now I enjoyed the food, I didn't have a problem with the hospital food, so. Not sure if it was great, or it if was just me [laugh]. Yeah.

Lovely description, sort of sensory - really heightened –

Yeah.

Heightened senses.

So, that's what I go back to saying about how it wasn't all negative. The - It is kind of a cool experience, to have eaten something that you've eaten loads of, and for it to feel it's the first time again. And - another example is the first time I - So the first day in the hospital. These huge glass windows. And I just looked out on the whole of the city, and that was just - my head dropped. And I got quite a big sense of euphoria, just looking out at the city. And, yeah. I wouldn't want to forget that. There's a lot of stuff I would forget as well, so [laugh].

Joseph had visits from a Community mental health team. They did a ‘wrap plan’ with him to get some routine into his life, but what he found most helpful was just being able to “chat” like he would to a friend.

I had a community mental health practitioner come, about once - to start with it was about once a week. And then about once a month. Or every couple of weeks. And, and that was - yeah, amazing what they did 

Okay. What sort of things?

Well, the first couple of weeks, not - it wasn't so good. As I say, it was different people. And they, they sort of helped develop a wrap plan. Which is, yeah. To be honest, I didn't - I don't remember much about it, because I didn't much find that helpful. But it was just about creating a routine for yourself, and putting in writing what you want to achieve, and stuff like that. But I found most helpful was just not really talking about what happened as such, even though we did, but just to chat, just conversation. Because I wasn't really ready to see my friends that regularly. There was a few friends that had heard what had happened and contacted me, and we met up, and that was really useful as well. But just someone, a professional, that - completely unbiased, and has seen it loads of times before, was just - yeah, incredibly useful. 

Joseph felt a “big weight off” when paramedics arrived to take him to hospital after he collapsed at the start of his psychotic experience.

I'd say then when they turned up, it was kind of like this big weight off my shoulder. I'd finally been taken care of. Not that I was particularly - I wasn't unhappy as a chef, but it was just - it is a very intense lifestyle. And deep down it wasn't something I wanted to do the rest of my life. So it kind of felt like I'd just been handed over. Not to say that any of the symptoms left, but I definitely got that sense of 'okay, I'm - whatever happens [laugh] - I'm just somewhat in safe hands now'.

And then they - Yeah, then they - They definitely clocked it was a mental health thing, I reckon. Because I do roughly remember the conversation. And they were amazing. They were just sort of speaking about - asking questions, and –

The paramedics who came?

Yeah. And they - Before sort of I got taken to the hospital, they just asked me lots of questions, and being very patient with me. And I remember almost feeling in a bit of a video game. So again, it's hard to describe. But in some video games, say you're talking to a character, if you don't respond to what they've said to you straight away, they just sort of stand there - the animated person stands there and just nods their head, and waits for your response for as long as possible, until you respond.

Okay.

Just because it's a video game.

Yeah, yeah.

And that's kind of how I felt I was in that situation. Because they were so patient. They were just - Just long periods of time before I answered. It was almost like I was testing it. Because I was just waiting. And then I'd say something.

What will they do? 

Taken into the ambulance. Then I was, yeah, driven through the rain. Getting my blood pressure done all- whilst I was in the ambulance. Taking down the information. Still feeling a bit like it was a video game. Almost like, yeah. I suppose the whole thing about the video game, it's also like a dream-like state you're in. So, nothing feels particularly real. It's almost like you could do anything - Not that I did, that I'm aware of, but you could just slap someone, and it wouldn't have a great effect, because it's - they're not real. That's not to say I didn't have an emotional connection with people still, it's just - yeah. That kind of disconnection.

When he collapsed, Joseph was taken by ambulance to hospital and assessed for “everything under the sun”. After a week he got the “three signatures” and was sectioned.

On the whole it all happened over the space of a week, with build-up. And then I was admitted to hospital. Went into hospital, treated for - tested for everything under the sun, in terms of physical health checks. Lumbar puncture, and brain scans, everything. Was there for about a week, whilst having the peaks, in terms I'd say of the episode. Friends and family very concerned, visiting me. And then eventually we got the three signatures to say okay, it's a mental health disorder and think we should Section two. So that's when I moved to an acute ward. I was there for about a week, maybe two. Before I was then moved back down to near where my parents live.

Joseph describes a “tin man” effect of one medication that made him feel “dull”. He was prescribed another drug to take with it to lift his mood but that made him hyper.

And the particular drug I was on gave you a - because it's used to treat Parkinson's, so gave me a tin man type effect. So your hands were very straight. 

What is that called, do you remember?

Haloperidol. 

Haloperidol?

Yeah.

So was that the one they had started you off?

Yeah.

And that was now kicking in 

Yeah, pretty much. Yeah. Yeah, so when I - As far as I know, when I was first put on the haloperidol, I was given clonazepam as well. And they were saying the haloperidol is sort of the obviously long term antipsychotic. And then the clonazepam is just to, it’s used as an anti-anxiety, and it's just - not that it was really used to treat anxiety for me, but it was just to sort of level me out slightly, I think. 

So is that not long term, maybe?

That was only for a few weeks.

Few weeks?

Yeah.

And did that have any effect, or?

It's hard to say. I'm sure it did. But honestly, I've got nothing to compare it to.

Mmm. So this haloperidol, you felt that it was giving you this tin man effect?

Yeah. So it was definitely a - It did the job of an antipsychotic. In the sense it did just dull everything.

Right.

And then the weeks went by at home, taking this, where I felt - yeah, you're just very low. And I suppose depressed. Maybe I wouldn't call it that at the time, but just definitely very dull emotionally, dull everything. Couldn't sort of easily do normal activities. And then I said this to the doctor, and they said "Oh, well how about I prescribe you some procyclidine? And - which is supposed to alleviate some of the symptoms, the negative symptoms of the haloperidol. 

What's it called?

Procyclidine.

Procyclidine. Mmm.

Which ended up being a bit of a disaster for me. Because okay, it reduced the symptoms - and I took it - for the first couple of hours I felt really great. Finally felt a bit more normal. Like the haloperidol had been weighing me down, I felt a bit better, that I could talk a lot more easily. 

And then the more it kicked in, the more I talked, the more hyperactive I got. Couldn't watch TV, because that was sensory overload. And everything they're saying on there, like - particular bad situations in war zones around the world - I would watch it, and obviously everyone watches it and doesn't like seeing it, but it was - it just hit me so much harder. I just - And then, yeah. That hit me really hard, seeing that. So I couldn't really watch TV. And I just, yeah - spun out. And then I just couldn't sleep on it. And it was just a really bad move, taking it. So then I went back, and I was so happy to finally be back on the haloperidol. And but then of course, then that - I just kept on going up and down. So then I kept sinking. Knowing that I didn't to take to the procyclidine again, but it was still in the cupboard, and I was so fed up of the blunted feeling, that I just then took the procyclidine again. And the same thing happened. And that was the last time I took it, because it - yeah, I just knew it wasn't the right thing to have. And I don't really agree with treating side effects, negative side effects of a drug with another drug, which also causes negative side effects. Which you then might need another drug. - Phoned the doctor about it, saying I'd like to just come off. I could have easily not taken it. I think maybe there was the odd day, I just didn't. But on the whole, I did as I was told. I went with it, I took it. I was saying to the doctor, "Listen, I'm taking it. But we've really got to reduce." And it did take a lot longer than I thought. Months went by, and it was just - The appointments with the doctor were so spread apart, you just lose hope. And then you'd still have to take it. And there wasn't really much to fill the day with. And then. So yeah, it was a particularly tough time, post-hospital.

Joseph lived at home after he came out of hospital. He describes the importance of support from his parents in giving him time to recover.

So, what role do you think that the family's played in supporting you?

Well yeah, tremendously. In just, well the one - just giving me time to recover. And also, just in their conversations. Just going with, with what I was saying. And not really trying to control, or. Because I was quite resistant, in the first couple of weeks coming home. There was a lot of resistance. One, just - I just wanted to get back to the city, and. Yeah. Just wanting - Oh, the other thing was just wanting to go for a walk on my own. And I think that had been something my parents had been told that I shouldn’t do straight away. So I was, yeah. I felt housebound, pretty much. Well, I was, in some sense. Yeah. I think I said I wanted - I just wanted to walk to town, to get some razor blades. And I was just getting told that I couldn't do that. And then I just - Not something I'd ever done before, I just let out this huge roar. Yeah. And my Mum was just - she found that really upsetting. Just hearing me burst out with this roar. Because it was quite - yeah. Obviously an aggressive sound. And very unlike me. 

Joseph chose to leave his profession as a chef and has retrained as a gardener. He talks about the benefits of having a less stressful job.

And something I'd say probably to most people, but specifically to chefs, is that if you've either burned out, or want to - just a change from the kitchen - gardening was absolutely amazing for me. Because it's similar enough to cooking, in the sense it's very hands-on. It's - Some of it is working with food still, and growing food. It's, yeah. But then it's a very - quite therapeutic. And whereas in the kitchen you've got to get so many plates out in a certain amount of time, with the gardening - so you're sort of re-landscaping someone's house, or just - yeah, doing the general maintenance, things can take months to grow. And it's - you've got that time. And another thing I'd say is that I don't lose sleep over cutting a tree slightly wrong, or - just when I go to bed, I don't think about that. Whereas in the kitchen there's a serious chance you could poison someone if you haven't dealt with it correctly, or a bad review. I'm not saying 'oh, you should do gardening instead of cheffing'. I think it's a great career still, but certainly if you - if you do burn out due to it, then something like gardening is similar enough. And for me, it's just a temporary thing. So it's been great, yeah.

Joseph’s girlfriend was there when he collapsed at the start of a psychotic experience and she has been with him throughout his experience.

And what about sort of - you know - your relationship? You mentioned your girlfriend.

Mmm.

How important has that been? And how do you think the experience of psychosis has sort of changed that, or affected that?

Yeah, it's definitely - without being too crude - she's helped me go to the toilet, and changed me, and all of these things. It's definitely created another level of [laugh] - a sort of stronger bond, that either - I mean I think, you know, she could have quite easily just said, "I'm not dealing with this." And gone another way. And there has been sort of difficulties following. But on the whole, I think - yeah, has just made it stronger, and. I think it's nice having someone who was with me throughout, still there. It's just not that I present symptoms now, but if I'm a little bit over-excited sometimes, it's nice having just someone that is kind of keeping an eye out. And sometimes someone will say something like "Oh, be careful." [Laugh]. Or whatever. Like notice maybe an early warning sign - and it's just me being a bit more perky one day, or. So it's difficult to say whether you want people to watch out for you or not. I would kind of argue that I'd like people to look out for me as much as I'd look out for them, or anyone else that hasn't experienced anything like it in the past. Because just as much as I need people looking out for me, to prevent relapse, people - I needed it when everyone needs it, before they’ve ever experienced anything. So I don't like people treating me different for that.

Joseph said the best advice he was given by a medical professional was “be kind to yourself” and it made him re-evaluate things and take things “really slow”.

I really just remember the doctors saying to me, a couple of them, that - just be kind to yourself. And yeah, I feel I could have quite easily ignored that. But just split second decision, I just thought 'okay, I'll listen to that'. And that's the route I took. And I think it was the best decision. Because I just took a really slow time. The people around me gave me the space to do that. 

And eventually - I didn't even realise what I'd lost, so quickly. Like social skills got so bad that, overnight, that I didn't even realise that I didn't have them. Sorry, that I had them before. And so it was just about rebuilding all of those things. So, now - 2017- quite a bit later, feel in a position where I am stable. And I won't say there's an end goal to recovery, but I certainly feel “recovered” in most senses. And as I say, the episode itself was quite - relatively brief.

Joseph wasn’t eating or sleeping well around the time of his psychotic experience and he thinks his immune system was very low.

You said you weren't eating, you weren't sleeping. 

So it was about four hours sleep a night. 

Yeah. 

And only enough time to cook a pizza, which - I don't know if you've ever gone long periods without eating a lot - it's hard to then eat a big meal. 

Okay. 

So, yeah. Not a lot of food. And then - oh, I think the doctors told me it's the three S's. So, a lack of sleep. Stress. And substance. So for me, substance wasn't anything illicit. But yeah, I'd say heavy use of the caffeine. That would definitely count as substance. And I think that definitely had an impact. And it's just a group of things. 

Was that just that week that you'd been moved, and you were kind of training yourself. Was it just that week that you were doing this? The lack of sleep, and the not eating properly, and too much caffeine? Or had it been something that had been anyway? You were -

It was particularly bad that week, or maybe month leading up to. 

Yeah, long days are not unusual. So unless you live close, you will get only about - I suppose it averaged about six hours sleep. So, that was unusual, that I was doing more like four. I mean, six still isn't great, but it was enough. So it was particularly - Yeah, so my immune system was probably very low. Like all my levels, very low. 

Joseph could have returned to his work as a chef but is glad that he didn’t. He took time to re-evaluate what he wanted and has taken on some gardening work for a while, which is “quite therapeutic”.

I could have gone back into the kitchen, or just - as the doctors say, 'be kind to yourself'. And I just thought well, I didn't go through all of that just to go back to what I was doing, and if there's anything good I can take from it, it'd be just to re-evaluate what I want to be doing.

Or if I were to go back into the kitchen now, I'd kind of do it differently. So, it certainly gave me that time to do that. I was receiving statutory sick pay, which obviously helped to give me that time, to re-evaluate. And my employer was very good, saying "If you want to come back at Christmas, or in the New Year -." Which was several months after. We can think of something, work something out. And it - New Year came round, and I met up with them. Still on medication at that point, so - you know - sort of kept it rolling, in a way. I kept on giving the doctors note. But, so I just wasn't ready, basically. And I think that's something I feel a lot of people just want to rush back into - rush straight back into what I was doing before, like normal life, the job - you know, living on your own. But, and it was hard. But I'm happy that I just sort of held out. And, yeah. Even then, I - I went to a couple of sort of college and university open days. Which is good, but I still wasn't ready. But just preparing, dipping my feet in the water to sort of - but doing it gradually.

And something I'd say probably to most people, but specifically to chefs, is that if you've either burned out, or want to - just a change from the kitchen - gardening was absolutely amazing for me. Because it's similar enough to cooking, in the sense it's very hands-on. It's - Some of it is working with food still, and growing food. It's, yeah. But then it's a very - quite therapeutic. And whereas in the kitchen you've got to get so many plates out in a certain amount of time, with the gardening - so you're sort of re-landscaping someone's house, or just - yeah, doing the general maintenance, things can take months to grow. And it's - you've got that time. And another thing I'd say is that I don't lose sleep over cutting a tree slightly wrong, or - just when I go to bed, I don't think about that. Whereas in the kitchen there's a serious chance you could poison someone if you haven't dealt with it correctly, or a bad review. I'm not saying 'oh, you should do gardening instead of cheffing'. I think it's a great career still, but certainly if you - if you do burn out due to it, then something like gardening is similar enough. And for me, it's just a temporary thing. So it's been great, yeah.

For Joseph, recovery is not about returning to how you were before the experience of psychosis, but about focusing on “whatever comes out of” those experiences.

Yeah, it's an interesting one because when a lot of people were talking about recovery, especially in the early stages, they were talking about - It was almost said in a way that was like recovering back to how I was before? And, especially if you look at the definition for recovery, it's to re-cover where you were.

And there was a lot of things not right with how I was before. So just the being able to have routine and get up, and wash, and all these normal things. Obviously positive attributes to my character. Obviously I want to keep all those things, and restore what I'd lost. But I've done a huge amount of just recovery in the sense of, 'right I'm just going to forget about trying to get back to wherever I was, or - and just focus on what I'm doing now, and whatever comes out of that if I -'. Not to change my character or who I am, but naturally you will be slightly, be different, an- obviously for the better.

When people have learned a lot from their mental health experiences and feel a sense of recovery they might want to help others. Joseph wants to share his experiences to provide hope for others about the future.

Well what I’m saying is a lot of people that have a mental condition, when you do get to a point where you feel you've learned a lot from it - and you feel a certain degree of recovery, you like to help others. So yeah, currently I'd like to do support work for other people with mental health conditions. That'd probably be my biggest asset. It's like I've written down a lot of the things that I've learned, so I feel I can help and use - Without being directive, and saying "Oh, this is what I did, this is what you should do." But just - if nothing else, just as some sort of symbol of hope. And it wasn't so much the episode that was the bad period, because there was some highlights. For me anyway it was afterwards, with the realising- and just this bleak kind of future that just - If you've got nothing lined up, then it can yeah, look really pretty grim. So provide hope. To be a peer supporter.

Joseph says it’s important to know, and let others know, that the psychosis will end and that you can be your own agent of change.

At least from a lot of people around me at the time, might have heard about psychosis or similar sort of mental health disorders, but on the whole you don't know a lot about it. And even if you do, you might not have seen one in person. And even if you've seen one in person, it might be very different to the one, or the person you care about. And so that's why I'd like to share more, and it's just for like fear reduction. So I feel the more you know about these sorts of things, it's - and the more you know about how 'oh, it's temporary' - okay, a lot of people do live with this for the rest of their life, but it's not like, 'okay, Joseph's crazy now, and he's [laugh] - that's how he is for the rest of his life'. He's not. Yeah, just to show people that - just say to them, "It does end." And just don't have that fixed view of what life will be like. Like it's literally anything - yeah. There's a lot of things, like knock-backs and stuff, that are going to make it difficult, and cuts in funding, and all these sorts of things. But that's not to say you don't have your own agent of change to actually do something about it.

When Joseph was delusional he found it most helpful when staff just let him talk.

It's probably easiest to say what I felt useful, and not useful. So, yeah. So the patience definitely,. Which is, can be hard if they've got a hundred and one things to do. But I did find the majority of nurses did have the time for me. And yeah, that was probably the best thing. They just sort of - to talk things through. And not to give a blockage - So, when I was saying more delusional thinking, as far as I remember, no one said, "Okay, stop that, that's ridiculous - just stop." They, they went along with it. To a - Yeah. In a - Yeah, it's a balance. Because you don't want to go along with it so much that it just affirms all the delusion, and you think 'wow, someone else is actually agreeing with me'. And then you just become more delusional. But it's just, yeah. Letting someone talk, and express it. 

After he experienced psychosis, Joseph’s friends came to see him in hospital and visited him at home. He appreciated having conversations with them.

So, yeah. The support net- I mean, I had a good group of friends from before. A lot of them had gone to university, and obviously we all moved apart, but some of them - when they'd heard, they would sort of come around, and met up with me which was really useful.

With you after you'd come out of hospital, sort of -

Yeah. Yeah. Mmm.

And have you kept in touch with them, or?

Yeah. Yeah. All of them, yeah. See them regularly now, so.

And were they quite understanding? Did they understand what was happening?

Yeah. The nice things was, they didn't ask too many questions. Because I wasn't ready. And didn't really know partly what had happened. And over time, I've developed a way of telling my story in a nutshell. Which I feel people can understand. And you'd also be surprised how - Obviously it does depend on who you're talking to. But on the whole, you'd think with the stigma, and - I just felt everyone wouldn't understand, or. But it's funny, the people I've told - especially close friends - have just been, "Wow, you've - you've seen a lot." [laughing] you know, they just - yeah. Then there's no judgement. And they're just pleased that I've recovered.