The First Episode

Psychosis. You hear that word and you think of psychopaths, insane asylums, sociopaths, and sometimes murderers. The list goes on and on. I know this because I, quite ignorantly, once had thought that way.

My brother is Psychotic. There. I said it.

I no longer have that negative stigma associated with that word, but those who do not know what it entails surely do. Hopefully this blog will help shed some light on what it’s actually like to deal with this terrible illness—something as tangible and as real as any other illness. This blog will not be sugar coated, and I want to accurately account for all of the events that led to my brother’s first break with reality.


My family was as normal as any other family, I suppose. Growing up, my parents were happily married and often took us on family camping trips to the beach and mountains. We were very fortunate to be able to take as many vacations as we did. I will always be thankful for my father and mother who reminded us that family, above all, was most important. I was the oldest child of three. My sister was the youngest, and my brother was squeezed in between as the middle child.


My sister and I were relatively studious individuals who consistently did well in school. My younger brother, on the other hand, really struggled to make passing scores. Middle school, like most young adolescents, was a difficult time for him. While completing homework assignments and making good grades were easy for my sister and me, for my brother, it was so much more challenging. School was a nightmare for him, rather than a comfortable safe zone like for me and my sister. And so began the parent conferences. Let me say this loud and clear: teachers do not get nearly enough credit for what they do. It’s an impossible task to ensure that each student in a classroom of 30 unique individuals receives the modified education best catered to their needs. It’s impossible for a teacher to notice every little thing, though they do a pretty bang up job at it. That being said, the teacher couldn’t have possibly known that my brother didn’t know how to open the lock on his locker in the sixth grade. He was much too shy to ask for help, and his books and disorganized papers would simply be thrown in a messy book bag. He couldn’t turn in assignments that were lost in the abyss of his black hole of a book bag. That was only one of the several troubles he encountered in middle school.


In high school, things started looking much better for him. He changed his all black wardrobe to lighter colors and started hanging out with the “it” crowd. My brother is a very likeable person, and it’s beyond easy to love him. He didn’t have a lack of friends, and the new medication for his ADD really helped him focus in school. He started making straight As and Bs, and it was almost hard to believe that the awful middle school experience ever happened. With his new friends came a lot of peer pressure to be that friend to make everyone laugh. That guy who will jump off a balcony for everyone’s entertainment. That guy who will hug a random stranger in the hallway just for a laugh. That guy who will be the first one of his friends to experiment with drugs.


And so, my brother smoked pot for the first time at the tender age of 14. Is this the moment that changed his life forever? If he wouldn’t have tried marijuana then, would things be different today? It’s not good to question the What Ifs, because Dr. Who does not exist, and therefore we cannot expect a time lord to take us back in time to change history. We must deal with what is happening now.

Marijuana is a gateway drug. This is the truth, simple as that. I could go on and on about the effects of drugs and repeated marijuana use, but I’ll try to keep it brief. To an average person, most people would agree that weed is one of the milder drugs. There are very strong advocates out there who believe marijuana is good for medicinal purposes and you should have the right to use it for recreational reasons. With the legalization of the drug in a few states here in the US comes an even more acceptance of these ideals. I’d like to think that most people would agree that marijuana is not a consequence free drug. Although it’s not as severe as, let’s say, methamphetamines, there are still harmful effects that can happen. We all know that stoner who is a little slooooow. The ability to retain information and cognitive abilities will decrease with repeated marijuana use. This is common, and we are all familiar with it.

How about something called drug-induced psychosis? Heard of that? No? I hadn’t either. The name is simple enough to decipher, but have you actually heard of anyone experiencing it? It may have something to do with how rare it is. According to the National Alliance for the Mentally Ill, about 3% of individuals will experience psychosis in their lifetimes. Some people are predisposed to this condition and just need the right conditions to trigger an episode. Although we aren’t certain, we believe this is the case with my younger brother.

After my brother graduated from high school, things took a turn for the worse. Weed wasn’t enough, and he began experimenting with harder drugs, even heroin. As you can imagine, watching someone you love go through this destructive lifestyle was extremely hard. Having moved out of our home because my parents could not tolerate the drugs under their roof, he began living with friends. My parents had to do what they had to do, as hard as it was. We have been through rehab and countless therapy sessions with him and have learned that when you allow the addict to continue to live with relatively no consequence to their drug abuse, you actually become an enabler. Without meaning to, you are encouraging the behavior by allowing him to stay in a well provided home without him fully experiencing what life would be like without someone supporting you financially. It was a simple ultimatum: If you do not make an effort to stop doing drugs, then you have to leave. My parents were willing to do whatever it took to get him sober, like paying for his rehab treatment, therapy, and even paying for college. He simply did not want to stop.




For the past two years, my brother and my family battled together with his addiction. It was way more than that, though. There was a reason he turned to drugs, if only to escape from his own mind for a while. He struggled with depression. It was most intense during a break up or when a friend wronged him. My brother trusts people so easily, which sometimes blinds him to upcoming treachery. These terrible lows mixed with his repeated substance abuse ultimately became his undoing. His mind simply could not take any more, and had to do what it had to do to survive.




We were in New York City for my dad’s work conference when we first knew something was wrong with my brother. We didn’t know the severity of the situation, but we knew something was wrong. He had texted the people closest to him with frantic messages about his poor state of mind. He said he was completely sober and everything he was experiencing was too painful to handle. His girlfriend convinced him to get help and drove him to the emergency room. I’ll never be able to thank her enough for taking him to the hospital that day when we were trapped hundreds of miles away from him. We couldn’t change our flight, so we just had to wait. Again, we still had yet to know the full extent of the situation.




When we landed late at night, my parents went to the hospital right away, and I stayed with my sister at home. I was naturally concerned, but we have experienced similar events with my brother before. Looking back, I didn’t take the situation as serious as I should have. I learned from my parents that he was acting strange, and his toxicology screening indicated there were benzos and THC in his system. I assumed the strange behavior was from the benzos. He was really paranoid around the medical staff and believed it was all a big conspiracy. At one point, he winked at my father as if he was in on some big secret.




His condition rapidly declined. My parents told me about his current state, but it still did not prepare me for the first time I saw him in the hospital. I had no idea what to expect. My parents didn’t really want my sister and me to see him, because they were afraid it would be too much for him. Finally my mom had texted me, “Why don’t you come on up here and see if anything registers with him?” So I happily agreed. Halfway there she texted me again, “I have to warn you that it’s really bad.”




Writing this next part is really difficult for me, because it’s the single most terrifying moment in my life. I still feel this heavy dread in my stomach when I relive this, and I’m not sure it will ever go away. Here it goes…
I walked into the crowded emergency room, feeling the stares of the sick patrons waiting to be seen. I remember the sullen mood was almost a living thing in that waiting room. I approached the counter and asked to see my brother. She told me what room he was in and pointed me in the right direction. I passed through several doors until I found his room. The lights were off, making the situation that much more foreboding. He was lying in the bed with my dad sitting against the wall and my mom sitting at the foot of his bed. Their expressions were solemn.


My mom broke the silence and said, “Come give your sister a hug.” I went to my brother’s side and hugged him. I pulled away to get a good look at him and asked, “How do you feel?” He stared blankly at me and after a notable delay, he finally responded, “Better.” The word came out sloppy and slurred. I could see the herculean effort it took for him to say that one word.  He could only say up to 3 words at a time. Anything above that was too difficult for him. I continued to probe him with a few questions about how he was doing, sometimes getting an answer, sometimes not. When I didn’t get an answer, that was the hard part. He’d simply stare at me without blinking for several minutes. His eyes wouldn’t move, his head wouldn’t turn, and he didn’t have any subtle shifting of his body. He just stared. And stared. And stared. Sometimes at me. Sometimes at the ceiling. There was no indication that my question registered at all with him. You could speak directly to him, and he was utterly unresponsive. His large brown eyes were wide and unfocused as he stared at the same spot for several minutes, sometimes even hours. It was terrifying, and I have never felt so helpless.


How could he go from speaking plainly one day to being reduced to a catatonic state the next? I could not understand. Those of you reading this, I hope you never see your brother, sister, parent, friend, or your loved one in that kind of state. It’s shocking, and nothing can prepare you for it. It’s incredibly unnerving, and even the hospital staff was a little on edge. When his stare became too much for my mom she asked him as gently as possible, “Why are you staring? What is it you see up there?” After several moments he finally responded, “Everything.”




I could feel my face growing hot, and I knew I was about to lose it. I quickly excused myself and left his room, walking aimlessly down the hospital hallways. I found a chair in a corner and sat down and cried. It wasn’t a loud, screaming kind of cry (that came later) it was mostly silent tears. I quickly texted my closest friends what had happened. I talked on the phone with my best friend who calmed me down and made me feel a lot better. She’s a nurse and was calm and rational while I lost it. I thank God for her every day. I pulled myself together for my brother and headed back in his room. I kept repeating the mantra, be strong for him. Do not let him see you cry over and over in my head. I tried to relax and remain calm when I asked him a question, only to receive a blank stare right back at me with deafening silence.




How could the brother you know and love suddenly turn catatonic like that? It was almost like a bad dream. I guess it’s still a bad dream. How could that person change so quickly? It was so unexpected. With his condition heavy on our hearts, we now had to worry about the care he was receiving at this particular hospital.




You see, this hospital did not have a psychiatrist. Patients like my brother have to rely on a video conference to see a “specialist”. One that wasn’t available for hours. My brother’s condition was deteriorating at an alarming rate, and while he was in the hospital, he did not receive psychiatric care. At all. My brother was in the emergency room for several days with no psychiatric care. The ER’s job is to medically stabilize. They are not equipped to handle a case like my brother’s. Before admitted, he was taking antibiotics to treat an infection in his leg. He was not allowed to leave until his culture came back negative. That means, he was stuck in that incredibly tiny, sterile, hospital room for days without being treated. It was criminal neglect, plain and simple. Why in God’s name would his culture prevent him from getting the care that he needs? If the hospital staff responded appropriately, understood the need for specialized care and transported him somewhere as soon as he started showing signs of his condition, maybe things would be different today. Maybe my brother would be back to normal with a scary experience that reminded him to never do drugs again. I can’t help but think about those days without treatment, and what might have happened if he was treated immediately.




Like I said before, I cannot go back in time. This is the reality now, and I have to accept it. He did not receive psychiatric care for an entire week, and he is now still in a psychosis one month later. He’s improved some. He’s no longer catatonic, which is a great sign. However, he’s just not my brother now. For those that do not know my brother, if you spoke to him now, you might not realize something is wrong with him. He’s extremely content and compliant. He’s also happy. Don’t get me wrong, I’m thrilled to know he’s not suffering the terrible depression he battled, but on the other hand, it’s not him. His girlfriend had since moved on and only visited him once. She’s now with another guy, which shows what kind of character she is. We were afraid to tell him, for fear of how he would react. Everything about his psychosis is so unknown. My mom finally told him and he nodded, processing it. He finally said, “Well, that’s good. I’m glad she moved on.” It was spoken in a pleasant tone, not at all how he would normally react to knowing his girlfriend left him to be with another guy while he was in the hospital.




He will sometimes say conflicting ideas such as one moment telling us how much he liked his roommate, and then right after going on and on about how rude his roommate was. There are several other examples of this behavior, but bottom line—my brother is not the same person he once was. Deep down, I believe that his old self is still in there, just waiting for the right time to come out. He’s in a psychosis. He’s not a psychopath. He’s not dangerous. He’s just in an alternate state of mind.




The definition of psychosis is as follows: the experience of loss of contact with reality, and is not part of the person’s cultural group belief system or experience. – NAMI. There are generally two types—hallucinations and delusions. There is a difference, although some people use the terms interchangeably, they are very different. Delusions are false beliefs. In my brother’s case, he believes the hospital poisoned him. While the hospital did not do any good for him, of course they did not poison him. Hallucinations, on the other hand, can be experienced in auditory or visual phenomena that others cannot perceive. Unfortunately, my brother has experienced this one as well, though not as frequent.




Today is November 13, 2014, and we are still no closer to finding an answer than we were a month ago. Does he have brain damage from substance abuse? Does he have schizophrenia? Is he going to get better? What are we going to do for long term care? Will he be able to have a normal life? Will this be a recurring thing? There are so many questions with no answers. I’ve never known anyone to go through this, and there isn’t much material on the internet to reference. Sadly, I feel alone, even though I’m far from it. I have a wonderful family, and even though every day is a struggle, we will stand strong for each other. I have great friends who are invaluable to me, and I thank God I have people to talk to about this.


I guess all I can really do right now is continue to pray and take things one step at a time.