My Friend's Crack Psychosis

TODAY was a hot day. Not as hot as yesterday; but still, I was sweating like a swine. I spent most of the afternoon drinking with my friend Greg Arious, who bribed me with heroin to wander all the way down the main shops ~ where I'd already been and did not want to return ~ to get him a mobile phone charger.  Without one e was stuck alone in his flat, cut off from the outside world and too ill to move.

As I walked in, he showed me an almighty slash down the curtains where his girlfriend, Lou, had rent them in two with a knife. She had then severely threatened the nextdoor neighbour before storming off into the night.

While I was there her Mum phoned twice. Greg told the whole sorry tale. Her mother is going frantic, not knowing where she is. She wants her daughter sectioned (put in compulsory psychiatric care). Greg was crying. Lou is having a psychotic breakdown. She's already had at least one, and so has Greg (on speed) and so have I (on crack and on nothing). By the sounds of it, Lou is extremely paranoid. She needs to see a doctor as soon as possible, but how that's going to be sorted I've not a clue. Obviously she needs  to see one quickly because this knife-wielding will get her into serious trouble.

Of course she is piping crack on a regular basis and this will be doing her mental state no good at all. Last week she lost her and Greg's only all-night dealer by losing her temper and flinging racist abuse in his face. The dealer rang Greg to say she should count herself lucky not to have taken a serious beating for what she said in front of the dealer's friends.

I passed on my own all-night dealer's number only to get a frantic midnight text from a drunk and distraught Greg freaking out because the delivery boy was taking excessive time with the gear and crack.

I know you are probably thinking I ought to select my friends with more care. But I have known Greg and Lou for over twelve years and for all their faults, I love them. When I was in my old middle-class house-share in a leafy, bourgeois and surprisingly smack-ridden suburb, they lived practically next door, which I only found out when I was on my way out of there.

I am extremely worried about Lou and hope to God that she gets some help before she lands herself in truly serious trouble. If anyone can persuade her into hospital then I can. I'm not one to over-rate my abilities. But a knack for reasoning with those who have crossed the brink of insanity is one talent I do possess. When I last had a major psychotic episode even though my viewpoint would certainly have differed from my doctor's, I knew I was severely mentally ill. I ended up in a psychiatric hospital's emergency reception because Naomi, who ran the Dual Diagnosis "Nutter Club" took me straight there. I had turned up an hour late hallucinating and hysterical with such extreme elevation of mood I was in fits of uncontrollable laughter, couldn't follow half of what was being said and was convinced everyone I met that day was off the television. I agreed to go to the hospital because I'd been having recurrent bipolar symptoms for years that cycled so quickly, no doctor had ever seen anything bar the depression. Finally my shrink had seen me in a manic state about six weeks previously but that was nowhere near as severe as this time. My urine screens were clear, because during this period I was taking no street drugs at all.

To be losing your mind and know it is such a profoundly saddening experience, that when my own psychiatrist eventually passed his verdict of manic depression and schizophrenia I went home and cried. I had met people with schizoaffective disorder; they seemed the most badly messed up bunch of all psychiatric patients.

If I could only get Lou to the emergency reception she would at least be in a safe place. If they found out about the knife-wielding fury they would probably want to keep her in. (But they might not.) The very least a stay in hospital would get her is physical rest in a relatively safe place, and some badly needed sleep. Greg says she hasn't slept properly in days. Plus she would get a prescription for medication that would be on hand when she felt she needed it, even if she doesn't want antipsychotics in the long term.

My reason for going back  to the Seroquel (quetiapine) by the way, is to establish that I can tolerate the stuff. My big psychotic mania last year became so severe there were times when I completely lost touch with reality. On my own, screaming at the top of my voice. I need antipsychotics, so if I do become manic again, I can stop it ever getting that bad. If I hadn't sought medical attention, I'd have ended up hospitalized against my will, which would have been extremely upsetting. merely thinking about the state I got into is upsetting enough. I am haunted by the memory.

That's why I think Lou would be better off going to the hospital before she gets put there. If hers is a purely crack-induced episode, a break from the pipe will help her get better. What am I saying? The two most popular drugs on mental wards are cannabis and crack ~ the two things most likely to put you in hospital to start with!

I'm not including crystal meth, the substance that seems to cause more havoc in the United States than all others combined, because, as yet, there's no meth "scene" in this country.

The more I think about drugs, the more upset I am by the unhappiness they cause. Ironically it was Lou who pointed out some weeks ago that drugs bring nothing good. I knew that fact, but had long been reluctant to admit it to myself. That's because when I did, on my darkest days, get glimpses of the appalling damage I'd caused myself over the years, i only clove to my beloved heroin all the more.

Any and all pain simply turned me back and back  to the heroin. Heroin, the strongest painkiller in the world.

Years ago I simply stopped thinking about the mess I was in, accepted that I was hopelessly addicted and went on burying my head in the sand by using every day that I could.

I don't know how exactly my own mental problems fit with past drug use, but I suspect the damage was caused in the 90s, by Es and trips. Of course crack never helped matters and heroin is a psychic bullet-proof vest. When you come off it you're left psychically weak and very vulnerable. Psychic forces that a healthy individual could easily deflect are now overpowering. Flooded with psychic influences and impressions, my insecure mind could no longer cope ~ hence my schizomanic breakdowns.

Once you've had two or more episodes, bipolar schizoaffective disorder is usually considered a lifelong condition. Symptom-free periods are called "remissions", during which the Monster lives on, slumbering, ready to spring up and attack without notice. I have been warned that methadone could be stabilizing my mood, meaning that when I finally get off the stuff , my mental state might actually deteriorate. But I'm willing to take that risk.

Naomi and the psychiatrist, both of whom are dual diagnosis specialists, seemed to believe that whatever causative role drugs may or may not have played, my mental problems are independent of my drug problems. That's the expert opinion. I just want to see how well I am in the future. I always promised myself two years completely opiate-free before I even consider giving up.

As for Lou, whether she has a purely crack-induced psychosis or deeper psychological troubles, I have no idea. I just sincerely hope that she gets well soon ...


Links: substance-induced psychotic disorders


Differential diagnosis of substance-induced psychosis and schizophrenia in patients with substance -use disorders