Psychotic Break Survival Skill Kit: Moderate Impairment

Psychosis has a pattern and habit of evolving and growing without bounds into something more even more elaborate and complex than first experienced by the person affected by this unique set of symptoms. Therapists, psychiatrists, and friends and family with a vested interest in our health will work with to unravel and hopefully make more sense of an affected person’s distorted picture of the world during the course of their treatment and recovery. Most first episode psychosis, however, takes people by complete surprise and onsets late during a person’s development, sometimes after adolescent and even late adulthood.

So, if your experience with psychosis begins to worsen or becomes a new norm in your mental status as a persistent fixed delusional system in effect, to benefit from this skill set or any advice a different approach will be necessary to gain peace of mind in the most desperate of times. The more complex the system, the deeper and more real feeling and experience of the psychosis.  As it evolved further, you will benefit from more simple and concrete skills should be for combating escalating disruptions to your reality. As psychosis deepens, so does the persons capacity to see beyond immediate circumstances and seemingly discreet events or ideas without real connection become enmeshed.


Preparedness. This will be critical in executing your skills for surviving moderate impairment from psychotic symptoms correctly, safely, and without incident. This survival skill set for moderate impairment will draw on your self-awareness to preserve and maintain your own safety. Always review the skills learned here with your therapist before implementing them in your living environment.

Safety during psychotic break with moderate symptoms will be more challenging because your self-awareness is dramatically impaired. At this point, you aren’t just hearing voices; you may also want to and feel inclined to respond to them. Voices can be loud and may be saying things to you that you may or may not understand. The voices can be speaking to each other, to you, or any number of combinations. This article will explore what to do before you feel like you need to react to them or listen to their commands.


The critical skill here is remembering your internal voice is the only voice other people can hear or that you need to listen when becoming overwhelmed with the noise.  If you stare at someone and attempt to communicate with your mind the other person may act bizarrely or feel threatened. Certainly, you will appear bizarre and threatening. Should you feel you need to stare, and use your mind powers, do not stare blankly, smile and use non-threatening gestures to articulate your needs.


You may desire or feel like you need to reply to the voices. Go ahead. But remember, whenever you speak, you’re making noise, and may be on someones radar already because you are acting bizarrely. So, if you need to speak to them, do so in a public area and not isolated on your own or it will appear that you are responding to internal stimuli.


With moderate symptoms, common players or themes including the FBI or CIA may begin speaking to you or you may believe you are a part of an investigation. This is a typical delusion or false belief that seems as real as it is threatening. If you feel you need to investigate, or participate in the investigations or chatter of the voices, do so in a manner that does not put yourself or anyone at risk of harm or feel like they are being intruded upon like friends or family in a household. Remember, if you are going to play the part of an investigator charged by your voices to search or dig for their demands, you shouldn’t be doing anything illegal, and be above the law.


Ultimately, your basic needs will need to be addressed while all these delusions are at work and incorporated into your activities of daily living. At this point in time, your money may be exhausted or your living situation at risk. Paying the rent, and other bills, including internet and wifi all require resources which can become scarce during the break. Begin stocking food away. This food should be easy to consume and prepare. It’s hard to cook meals when you barely have the capacity to bathe. But stock pile only the necessities, and never food that is perishable or messy when you may be having a hard time keeping things and/or yourself clean. It is one thing to suffer from catatonia, but to feel bugs crawl all over your body when you are immobile due to a new active symptom can be avoided by keeping your supply of food well-managed.


Locomotion. This is the skill or maintaining a budget in the most difficult of situations and keeping enough money on hand for a way of getting around town. Many times, when we are too sick to work, we lose the functional ability to maintain employment and lose valuable income quickly and without warning. Unless you are already in the system and are receiving benefits, first episode psychosis will interrupt your career sometimes when you least suspect it.  Regardless, my recommendation is to take the bus to get around familiar areas, even if you are a regular driver, when very symptomatic. It doesn’t require much talking, or navigating complex intersections just pressing the stop button to get off and go about your day. It is not uncommon to lose a vehicle somewhere from confusion or get involved in a car accident due to impaired or lose of judgement.

At this point, all communication should be written down on paper. This should include important phone numbers of friends, supports, both natural and artificial like therapists and case managers. When and if you don’t have access to power, or even a cell phone, these numbers should be easily accessible when you are feeling confused or scared and should be on hand to draw upon in a panic. Make copies, and put this information in multiple locations if you lose the ability to travel or are conserving gas and cannot make it to the city due to feeling paralyzed by symptoms. 


When you believe you are out of options (which is never really the case) and you feel or others feel you are at risk of imminent harm, begin making your way to the hospital. As presented earlier, you will need to be able to tranport yourself safely or call 911 and wait for the emergency medical staff to arrive at your location.

Upon the arrival of emergency services from the local area, when the police or other emergency personnel locate you and you cannot speak sensibly, or cogently enough to decipher your self-reporting, be prepared to be taken to the closest emergency room for psychiatric triage, and evaluation.


For your safety, and the safety of the people apprehending you due to lose of behavioral control,  I recommend putting your hands in the air or behind your back and wait for further instructions. Since it has already been determined you are an immediate risk if left to your own devices, you are now in the custody of emergency medical staff.

Be sure to listen as closely as possible to the instructions of the authorities charged with your safety and participate in their protocols to avoid an escalation of force and mandatory treatment measures.


1 thought on “Psychotic Break Survival Skill Kit: Moderate Impairment

  1. Unfortunately many police encounters with the mentally ill, due to mutual misunderstandings and lack of adequate training, lead to bad results. Physical altercations, arrests, or even death are all outcomes which are more likely to occur in that setting than police interactions with those who are not suffering from mental disability. Hopefully, with an increased spotlight on this issue over the last few years, productive reform will be forthcoming.

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