Odd thoughts and confusion. Watching letters rearrange in a newspaper and mean something very profound. Hearing voices of friends and spirits…some benign and some harsh and menacing. Jumbling thoughts into circular patterns that are paralyzingly and overwhelming. Feelings of boundless energy where everything seems to connect to everything else in brilliant and meaningful truths.
These experiences are called psychosis by modem mental health professionals. A year ago I wrote an article that goes into some depth about Holistic support for those experiencing psychosis. In this article I want to further delve into exploring alternative approaches to helping people who are going through these states. To give you some background I have worked for ten years as a therapist and I have worked both in acute psychiatric settings as well as in private practice where I specialize in working with people going through extreme states.
One of the challenges of helping people who are going through extreme states is trying to find out what triggered this change. Here is a brief list of reasons someone could be experiencing an extreme state:
Reasons for Psychosis
Quick and sudden medication changes. For a large percentage of folks I see one of the main reasons for an extreme state is that someone has drastically changed or stopped psychiatric medications they have been prescribed. Medications such as antipsychotics, mood stabilizers and benzodiazepines are extremely strong neuroleptic drugs and quick withdrawal off them can induce psychosis, just as cold turkeying off of heroin can often induce hallucinations, insomnia and severe agitation. However, with psychiatric medications, the effect of stopping or changing them quickly can have pervasive challenging effects for weeks and sometimes months.
Severe Stress. For those who are susceptible to these states, severe stress such as the loss of a home, a break up orfinancial problems can lead to spiraling bizarre complex mental states. Even more minor stress like starting college, moving out of one’s parents home, starting a new job, etc.
Alcohol and street drugs. All drugs can induce extreme states but for some people certain substances can work to quell psychosis. Oftenpeople will use alcohol, opiates, downers and marijuana to reduce distressing symptoms. Generally I have seen people become psychotic most commonly from taking psychedelics such as mushrooms or acid or from taking methamphetamine, cocaine, ketamine, synthetic marijuana like Spice and K2.
Previous Trauma. Trauma such as emotional, physical and sexual abuse is increasingly being tied to extreme states. I have worked with many people who become easily dissociative and confused due to being abused many years prior. They can easily be triggered by current experiences, memories or dreams.
Sleep Problems: This is a very early indicator for certain people to develop increased mania, confusion and psychosis. Sleep problems can be related to stress, trauma, dietary and other factors.
Diet. Yes diet can spike an extreme state. I have seen people spin into long manic states from drinking too much coffee. Certain foods such as wheat, dairy, processed foods, glutamates and histamine rich food can induce extreme states.
Spiritual emergence. I have worked with many people who describe complex spiritual experiences. While the modern world tends to label this as a delusion, there is a time honored and cross cultural tradition of seeing these states through a spiritual lens. There are many terms for this including kundalini rising, spiritual emergence and possession. Most indigenous cultures view these states in terms of being out of balance with natural and spiritual forces.
Oppression. Yes this can be at the root of an extreme state. Racism, sexism, homophobia and other types of oppression are core forms of systemic trauma that can cause people to fall into deep distress and into extreme states.
When someone has entered a period of extreme confusion with strange perceptions and beliefs, disorganized speech and perhaps wild or racing energy the main approach in the Western world is to take the person to a hospital. For many people this can be extremely traumatizing. The emergency room is mainly a place for medical emergencies and someone in an extreme state is then meant to give up their belongings, change into scrubs and made to stay in an isolated room under florescent lights for long hours. For the symptoms of distress a person is offered benzodiazepines like ativan and antipsychotics such as zyprexa. If a person appears too wild and becomes angry and intense they may be given an intramuscular shot of antipsychotics.
This would be extraordinarily traumatic for most people and the experience is augmented because the individual is in such a heightened sensitive state. After a while someone who is going through an extreme state is told they will be placed on a “hold” and will be made to stay in a locked unit for at least several days. Again this is often very traumatic for those going through this state.
The individual is then transferred to a psychiatric unit where they are mixed in with other people going through psychosis. A doctor will then see the patient and almost universally prescribes either antipsychotics or mood stabilizers, or a combination of the two along with benzodiazepines. There is generally no deep discussion of potential side effects, long term health complications or problems with withdrawal off these drugs. Sometimes the person is told they have a lifelong disease and sometimes they are told they have a chemical imbalance that can be remedied by a psychiatric medication.
If the person becomes more organized in thought they are likely returned to the community in a few days with a new prescription and a follow up appointment with a prescriber and occasionally a case manager or a therapist. If they stay in the hospital and continue to appear deeply confused they can be committed for a period of up to 180 days and are sent to a step down facility or a state hospital where they are forced to stay in a locked unit for many months. Before a commitment a person can still choose not to take medications but after commitment a doctor can force someone to take strong neuroleptics against their will. If they refuse they will be forced to take the drugs by injection.
So this is the standard mainstream care for someone going through an extreme state. Though there a lot of problems with this way of managing distress, there are a few positives. A hospital unit usually generally provides a safe respite so that a person doesn’t hurt themselves or others. There is structure in a hospital setting with three meals a day and regular bedtimes that can be helpful for someone who has stopped nourishing themselves regularly or sleeping at normal hours. There are also often group activities and encouragement to socialize which can be helpful for those who have isolated for long periods.
Sadly though, hospitalization is the only mainstream option when someone is in the throes of crisis and in a bizarre or altered stated. The primary focus in these places is psychiatric evaluation and medication management. For those who have already been in the system and have stopped their medications, the goal is to return the person to “complying” with taking regularly scheduled meds. For those experiencing a “first break” psychosis, there is generally a goal of coming up with a provisional diagnosis along with prescribing a course of neuroleptic antipsychotics and/or mood stabilizers. In depth examinations of the etiology of distress or offering alternative non-drug methods of achieving stability are not generally emphasized.
Once a person discharges they are generally offered only cursory support. They may have a case manager, a therapist or a prescriber they see infrequently and often people are still quite fragile and disorganized when they discharge. The role of helping people who are still experiencing bizarre and unusual perceptions generally falls to family members. One of the leading causes of rehospitalization is due to the psychiatric drugs themselves. Most of the neuroleptic antispychotics cause so many side effects, especially at high doses that they become intolerable for people and they decide to stop them. The withdrawal effects off these drugs can be horrendous and induce spikes in mania, sleeplessness and bizarre thinking that will lead people right back to the hospital. This is the turn mill reality of modern mental health care- a truly broken system in which people designated as having schizophrenia or bipolar get funneled in and out of hospitalization repeatedly while their mental health deteriorates.
Alternatives to Hospitalization
For many people hospitalization does not present a best case scenario for handling an extreme state. Beyond the horrible side effects of antipsychotics in a medication focused approach, one of the main reasons is that increasingly longitudinal studies are showing that the prescription of antipsychotics for those labeled with schizophrenia, schizoaffective disorder or bipolar disorder are causing worsening outcomes over time. Long term studies by numerous scientists are showing that those who are medicated tend to have far higher disability and unemployment rates than those who have chosen not to medicate. This is a tricky question because sometimes psychiatric drugs can be quite useful in the short term- for helping to quell a mania or bring severe anxiety under control. But long term there is no question that side effects and withdrawal problems can lead to worsening physical, mental and emotional health.
For those who are looking for alternative approaches and if there is no imminent danger present, it is important to look at various holistic options for working with severe distress. These are some general guidelines for helping someone in this state.
1- Housing and support. Make sure the person has adequate housing and lives in a safe well maintained home that is relatively clean. This is a fundamental class issue and there are millions of people in the U.S. who are homeless or who live in substandard housing. This is a systemic issue that needs to be addressed. It is generally key to have a circle of support that provides very close care of the person from a week to several months. Round the clock care such as living with family members and close allies is often optimal but having the best and most loving support team is key here. It is important to watch out for burn out here and make sure there are multiple people involved in helping the individual to recover.
2- Nutrition. Healthy food is an extremely important part of working through these extreme states. When someone is in a heightened or manic state, the body is asking for calming, rooting and grounding food. It is key to reduce foods that exacerbate distress such as caffeine, sugar and processed foods. Foods that are helpful include lots of vegetables and especially leafy greens, tubers such as sweet potatoes, beets and carrots.
Avoid “fast carbs” such as white wheat flour foods and choose whole grains such as quinoa, brown rice and amaranth for grains. Wild caught fish and game high in Omega 3 anti inflammatory oils are very good to add. Wild greens are also extremely dense and nutritious. My basic rule of thumb is to avoid “PAWCS”… Or Processed food, Alcohol and drugs, Wheat, Caffeine and Sugar. Some people feel sensitivities to other foods such as dairy, nightshades, corn or excessive fruit. It’s important to eliminate all allergenic inflammatory food if possible.
3. Destim. Creating an environment that is conducive towards feeling calm and relaxed is very important. That means lowering lights, reducing electronics, not having loud intense music or media playing, etc. Spending time in quiet natural spaces near flowers and trees can be immensely healing.
4. Structure. Having an organized plan throughout the day can be really helpful even if it just means eating at regular meal times. That can mean doing certain activities such as crafts, art projects, gardening, taking walks, knitting, playing games throughout the day. Talk based communication can often be really hard during an extreme state and non-verbal forms of connecting can be really helpful.
5. Finding Meaning. The experience of an extreme state can be very confusing and lonely. Most people do not understand when someone is going through strange and wild perceptions and thought patterns. It is key to find peers and helpers who is open to what the person is going through and willing to explore those places to help find meaning and understanding. When I went through my psychotic process as a much younger man I was deeply helped by an herbalist healer and a therapist. As a therapist I often help people who are going through these states and I can understand how isolating they can be. Often people turn away or avoid someone in these states and its key to have allies who are willing to stay present and open to the person’s experience.
6. Safety. For some people in this state there may be a desire to hurt oneself or to act in ways that are endangering. This can be very tricky to manage and every situation is different. Round the clock care can be helping along with soothing talk and listening to what is going on for a person. Often these tendencies can be reduced with a lot of kindness, care, attention, good food, herbal approaches. But at times things can get out of hand and truly dangerous and at that point I think hospitalization is warranted. if at all possible it is best if family and friends brings the person to the hospital because the alternative is to call the police which is deeply traumatic and often dangerous if there is extreme volatility going on. Deciding how to manage this can be one of the hardest decisions for a loved one to make. But the paramount concern at that point is making sure everyone stays safe and unharmed.
7. Love. A key component to the healing process is having family and friends around that will provide warmth and care. Again, it is key to avoid too much “therapy” and instead focus the energy towards quieter activities such as playing light soothing music, crafts, coloring, time in a garden or nature walks. Love in this case generally means being with the person without judgement and avoiding heavy criticism, fear, shame and anger if at all possible. It does not mean unconditional acceptance of all actions and behavior. Certainly some behavior is off limits such as abusive language or actions or movement towards hurting self or others.
8. Herbs, supplements and drugs etc.
In general people who are looking for alternative ways of working through an extreme state are not taking psychiatric medications and are looking for other options. Every extreme state is different and every individual is different and so there is no hard and fast rules about how to help people in these situations but I will review a few basic ideas.
Generally gentle herbal approaches can be applied to anyone..but that comes with caveats. Some people are deeply sensitive and very few herbs are helpful. The basic idea is to think of using nourishing tonics and broths as nutrient dense vitamin and mineral rich supplements that can help repair and bring someone back to a steady grounded state. Infusions of oat straw, nettles. red clover and alfalfa are very helpful here. Take a look at this guide to doing this here…
Then making regular bone broth with herbs such as shitaki, maitake seaweeds and astragalus can be really nourishing as well. Here is an article on doing that here…
Traditional indigenous techniques of smudging with herbs such as sweetgrass, cedar and sage is very helpful as well as using aromatherapy sprays and diffusers with essential oils such as lavender, rosewood and sandalwood. You can purchase these items here.
“Visual herbal therapy” such as spending time in gardens, parks and nature is often key to helping someone in an extreme state. Massage with infused oils such as rose, lavender and lemon balm can really help a person to get grounded and return to center. You can purchase some of these items here.
And finally, teas that are relaxing and gentle such as linden, oat straw, lemon balm, skullcap,rose, holy basil, lemon and catnip can be added aspart of a program. I recommend purchasing tea blends from Mt. Rose Herbs such as easy day, evening repose, happy tummy, love and peace tea blends here
Using stronger herbs that are relaxing is something to consider for people who can tolerate them and are not in danger of herb-med contraindications. These relaxing herbs include motherwort, passionflower, hops, valerian, California poppy and kava. These herbs tend to be taken as tinctures and have stronger effects that are relaxing and sometimes sedative. I encourage looking at Herb Pharm’s nervous system tinctures here.
Finally for some people marijuana can be useful to manage extreme states as a way of reducing anxiety, restlessness and mania. I have noticed in my own practice is that this only helps a certain percentage of folks and one must be cautious about this approach. Strains of marijuana that are high in THC tend to exacerbate psychosis for some people while strains high in cannabidiol (CBD) are often useful for their relaxant and pain relieving effects. For an in-depth discussion of marijuana and its potential efficacy and also concerns, please read this piece by Will Hall here.
Outside of gentle herbs, I tend to suggest avoiding supplements except fish oil, flax oil, liquid vitamin D and magnesium powder. There is increasing evidence that pill based synthetic supplements like these are not effective or sometimes harmful in the long term. I tend to support getting most nutrition through nourishing infusions of herbs, whole organic and wild foods because I believe the body assimilates the nutrients better.
Finally for some people who are having a hard time sleeping and herbs are not helpful, there may be a desire to try over the counter sleep aids. The main two aids out there are benadryl and melatonin. Both are fine to take in the short term but may pose issues if taken for long periods of time. If they can help a person get much needed rest then they can be useful.
In general, helping someone work through an extreme state takes perseverance and patience. It’s good to have multiple people involved to help reduce the risk of burnout or a poor reaction to the situation. It can take quite a while for some people to reconstitute. Creating a relaxed environment, healthy nutrition, herbal support, good structure with loving and kind people around is key for helping people to heal and recover. Like a plant that is hidden in darkness- sometimes just letting a little light in will help it to flower.
You can also find me at the Facebook group Herbs for Mental Health.Share This: