Navigating Manic Psychosis
Some advice on a wild mindstate, from experience and observation
If you’re experiencing severe mental health issues, consult a medical professional or call emergency services.
Years ago, after an intense LSD experience, I had what I’ve previously called a “spiritual crisis”; a medical professional probably would have called it hypomania or mild psychosis.1 I mostly managed to mask my symptoms, but internally was lost in a confused mess of speculation and fantasy.
After about two years of introspection, self-confrontation, and reading everything I could2 on the subject, I finally escaped the gravitational pull of manic psychosis. The hangover—an intense depression, which quickly faded into a sober, somber reentry into reality—lasted another two years.
It’s an experience I wouldn’t wish on anyone, but I’m strangely grateful for it. Mania opened the door to some beautiful mindstates, and forced me to learn to navigate those spaces safely—though I nearly drowned as I learned to swim.
Jump Into the Fire
You can climb a mountain
You can swim the sea
You can jump into the fire
But you’ll never be free
—Harry Nilsson, Jump Into the Fire
My best model for manic psychosis involves two changes to information processing:
Deeply relaxed priors: ideas that would normally seem preposterous suddenly seem plausible
Confusion of probability and utility: ideas that generate strong emotions (positive or negative) feel more likely to be true.
Most adults walk around with a stable, normative set of beliefs about how the world works. When something odd happens—an old friend calls just as you were thinking about them; a car follows you for a few turns through the suburbs; the radio plays a song that perfectly describes your situation—you’re able to shrug it off as coincidence.
But when your priors are relaxed (through drugs, mental illness, or other means), that worldview becomes malleable, and aggressively absorbs new “evidence”. Suddenly minor coincidences open up wild possibilities: what if my friend can read my mind? what if this car following me is actually a stalker? what if the universe is trying to communicate with me through songs?
For me, a psychotic episode would typically start with one of these coincidences, leading me to concoct a bizarre hypothetical explanation; other times the hypothetical3 would just pop into my head, apropos of nothing.
And it would immediately grab me.
The moment that hypothetical appears, there’s a huge burst of dopamine and adrenaline.4 There’s a sudden feeling that you’re on the verge of a fantastically important discovery: You’re being followed! Magic is real! The universe is alive!
It feels like you’ve broken through into a new world, or like you’ve been let in on some cosmic secret. It can be exhilarating or terrifying, inspiring or paralyzing.
Relaxing your priors opens up highways to both ecstasy and despair. And the strength of those feelings reinforces the sense of discovery.
Confusing Probability and Utility
A psychotic idea doesn’t take root due to the evidence in its favor, but due to the size of the feeling it generates. Like with Pascal’s wager, the implications of the hypothetical are so immense that it can’t be ignored, no matter how preposterous.
Strangely, those intense feelings make the idea seem not just more worthy of consideration, but more plausible. The same bias takes place in normal cognition: we inflate or deflate the probability of something happening based on how good or bad the outcome would be.
This contradicts the basic process of decision theory: we’re supposed to estimate the probability of an outcome, separately estimate the utility of that outcome, and then multiply the two estimates together to arrive at an expected payoff. But our brains aren’t very good at this. Instead we combine our estimates for probability and utility into a single gooey heuristic—and then we end up playing the lottery or not wearing seatbelts.
The relationship between probability and utility estimates isn’t straightforward, but as an example, one widely-cited study found that people buying a car tend to underestimate its price, while people selling a car tend to overestimate. The effect varies heavily, and even inverts, across people and scenarios.
And if something as inane as wanting a good price on a car can mess with our judgement, the possibility of an extreme outcome can completely subvert it. This is why reasonable people end up obsessing over ideas like heaven and hell or Roko’s basilisk—making immense promises or threats is the easiest way to trap someone in a maladaptive (and often oppressive) belief system.
Under neurotypical circumstances, some sort of thresholding kicks in, and we discard low-probability, high-consequence scenarios without a second thought. But when your priors are relaxed that escape hatch closes, and the most outrageously improbable nonsense starts to feel like a very serious possibility. Fame, fortune, disease, disaster, heaven and hell, the end of the world, enlightenment; all of it feels palpably present, lurking just around the corner.
I just talked to Jesus
…I know he the most high
But I am a close high
—Kanye West, I Am a God (ft. God)
Another common cognitive bias is overconfidence. And just like the mixing of probability and utility, during a manic episode this bias becomes wildly exaggerated.
Grandiosity was a primary feature of my mania. Occasionally I would obsess over an abstract, socially-relevant hypothetical (e.g. the singularity), but the majority of my delusions were self-centered. And even with the more abstract delusions, there was a sense of revelation, enlightenment, a conviction that I’m onto something.
To put it as plainly as possible, at the root of all my mania sat a single aberrant belief: I’m special.
This belief clicked into place during the initial LSD trip. I vaguely remember being convinced that I’d discovered some sort of mind-based time travel, which would effectively kick off the singularity. For those few minutes, I was undoubtedly the most important person in the world—in history even.
I can’t describe how immensely good that felt—in a flash, every hardship, every shitty thing I’d done, every embarrassing moment, was wiped clean by my unparalleled contribution to humanity. And even though delusion itself soon dissolved in the light of reality, that feeling burrowed deep into my brain and became a new, solidly trapped prior: I’m special.5 Every subsequent delusion was an inference made from this belief.
Grandiosity is a common feature of psychosis, especially when it stems from a manic episode. And it makes sense that the strongest delusions would be egocentric—those are the ones with the most tangible consequences! What’s more thrilling: humanity on the verge of singularity, or you being the genius birthing it? What’s more terrifying: armageddon, or the possibility that you’re the Antichrist?
This sense of personal exceptionalism can manifest in a thousand different ways: you might think you have special powers, that you’re being hunted by the CIA, that you’re Jesus, that the universe is sending you messages, or that you’ve become an enlightened master.
For me, grandiosity was the true idée fixe. My specific delusions shifted over time, but all of them grew out of and reinforced a wildly inflated self-image.
Behold, the stone it gleams like gold
Out of control the beast unknown and untold
And so my ghost, it leaves my home
But not for long because it's cold where it goes
—Dan Deacon, Build Voice
It’s hard to articulate how good it feels to walk around with a manically inflated ego. It’s better than (and oddly similar to) cocaine; it’s better than sex with a wildly desirable partner (but again, oddly similar!). It’s like snorting pure, uncut self-love.
The hangover is commensurate.
Throughout my hypomanic era, I had many minor comedowns. I’d say something “brilliant” and get nothing but weird looks; I’d overconfidently approach someone attractive and get shot down. The delusion would dissolve into a sense of confusion and dissonance; depression might follow. But that sense of I’m special always managed to hold on, deep in my psyche, just waiting for another chance to build voice.
And most of the time it succeeded! It might take a minute or a week, but inevitably I’d return to that manic state, and become deeply invested in some grandiose fantasy. Until one day I finally broke.
I was meditating (a practice I’d taken up with all the fervor of someone convinced they’d reach enlightenment any day now) on an early spring day. The view was particularly beautiful, and I suddenly found myself in a calm, abiding mindstate. At the time, this was rare—most of my sits were spent maniacally fantasizing or depressed and ruminating.
The calm lasted only a few seconds.
Suddenly I was struck by what felt like an external force—two years of narcissism, of strange and often destructive behavior, hit me in the center of the forehead. In a flash, I gave up my self-image as not only a special person, but as a good person.6 And I immediately felt like dog shit.
I wept—really, wept—on and off for about eight hours, until I fell asleep. The next day I started working (from home, thankfully) at 9 AM, made it until 5:01 PM, then repeated the process.
These two days were the worst of my life, the only time I’ve really felt I’d be better off dead.
The feeling slowly abated over the next two weeks, to the point that I was only experiencing standard depression—everything was painful, but I was able to function. After about two months I was having good days again; after about two years I was finally in a healthier frame of mind than when I’d first taken the LSD.
Throughout this time, the delusional beliefs mostly dissipated. I could still get caught up in a manic stream, but now I saw it for what it was: my own narcissism, feeding on itself. I was always able to escape before it got out of hand.
My last real episode was at a Radiohead concert, maybe a year into recovery. I overheard two guys behind me saying, “He’s such a genius! A total weirdo, but a genius!” Obviously they were discussing Thom Yorke (who is indeed both these things), but a little voice in my cannabis-stained head said: “it’s you! they’re talking about you!” Luckily I caught it before the idea took root. I felt myself standing on a precipice, looking down into the void; all I had to do was grab hold of this idea and I could go for a wild ride.
Once and for all, I declined.
Learning to Swim
The psychotic drowns in the same waters in which the mystic swims with delight.
As time has passed7, I’ve realized that there are aspects of mania that are not only positive, but wholesome. Or to put it differently, mania is part of a wider set of mindstates, some of which are very desirable.
I mentioned relaxed priors as a precondition for manic psychosis. Relaxed priors are probably most closely associated with psychedelic drugs, but are also increasingly used to model dream states. I’d argue that many meditation practices have the same effect (and there is some evidence that meditation can induce psychosis). I compared all three here.
Relaxing your priors is a double-edged sword. If you have some deeply-ingrained maladaptive beliefs (e.g. “all social situations are dangerous” or “alcohol will always make me feel better”), techniques like psychedelic therapy can help unclench them. But most of our priors (e.g. “my thoughts are private” or “I’m a normal human, definitely not a prophet”) are pretty useful, and it’s hard to unclench the bad ones while leaving the good ones intact. (Though a good therapist or trip-sitter can help!)
Since coming down from the heights of mania, I’ve found I’m able to “breathe” into my priors, relaxing them when I need more creative juice, and strengthening them when I need to focus. (The mental movement seems to be related to wide and narrow attention, which we’ve talked about before.)
More importantly, when I do slip back into the manic rush of ideas—a headspace I’ve dubbed epiphany city—I’ve gotten better at discarding the most insidious ideas and tending to the good ones. I refer to this as discernment, a term I take from Tanya Luhrmann’s book When God Talks Back:
Discernment is an old concept in the Christian tradition…In the medieval era, when few (if any) doubted the reality of spirits and the supernatural pressed in upon the everyday like a damp, low cloud, discernment of spirits meant the ability to distinguish godly spirits from demonic ones.
Luhrmann studied the Vineyard Church, where parishioners literally hear the voice of God—which unsurprisingly can say some pretty ungodly things. For them, discernment is the practice of deciding which voices and intuitions should be labeled “divine”, and which should be written off as egoic or demonic.
At the height of my mania, I too might have attributed to cosmic forces the mad rush of ideas pouring into my brain. But it can just as easily be modeled as noise—relaxing your priors causes a stream of random ideas to bubble up into consciousness. Some are good, some are bad, most are just weird. But the worst ones—especially those that trigger intense narcissism or terror—are deeply tantalizing. Discernment, for me, is the ability to recognize and discard those ideas, while still letting the good ones flow forward.
And if I do start to get sucked into a problematic train of thought, I’m able to “ground” myself out of it. There are a handful of techniques I’ve found helpful here:
Refocusing on the present situation
Naming or describing objects around me
Eating or drinking, especially heavy foods
Breathing exercises, or counting my breath
You can find a more complete list of grounding techniques here.
All of these techniques pull your mind towards immediate sensations and away from abstract, future- and past-oriented thinking. Psychosis is, by definition, disconnected from reality—and there’s nothing more real than what you’re seeing, hearing, and feeling right now.
With these techniques at hand, I’ve been able to safely explore headspaces that tend to induce mania. Since my return to reality, I’ve taken moderate amounts of cannabis, psychedelics, MDMA, and nitrous oxide—and meditated a great deal—all of which can push me back into epiphany city. But so far I’ve been able to keep at least one foot on the ground, following the interesting ideas and letting the psychotic ones float by.
That’s not to say I’m completely out of the woods. There’s always danger here, and given my history, I need to be exceptionally careful. But I believe my experience has inoculated me, and left me with a stronger mental immune system. I’m not invincible, but I’m well aware of the danger, and I’ve gathered some invaluable skills to help me explore safely.
My greatest regret is that it took me so long to talk to anyone about this. A good therapist or spiritual advisor could have saved me years of pain. But when I was reasonable enough to know I needed help, I was too embarrassed by the ridiculous thoughts rattling around in my head to seek it out. It’s still hard for me to see it written out here.
But the lessons I learned have been immensely valuable. I hope that sharing them might help others navigate this bizarre, labyrinthine headspace.
If you’re experiencing severe mental health issues, consult a medical professional or call emergency services.
Some quick definitions for some of these terms:
Mania: mental illness marked by periods of great excitement or euphoria, delusions, and overactivity
Hypomania: a less severe form of mania
Psychosis: a mental condition in which thought and emotions are so affected a person has trouble telling the difference between what’s real and what’s not
To get it out of the way, here are a handful of the delusions I seriously entertained in the months and years following my trip:
That other people could hear my thoughts
That I was at the center of an elaborate, long-running, Truman Show-esque practical joke
That the universe/God was sending me messages through license plates
That distant sirens were somehow connected to my presence in the area (either coming for me or protecting me).
That the word “he” in any conversation I overheard referred specifically to me
It’s hard to say how much I truly “believed” these things. I always remained aware that these ideas were too crazy to articulate, and some distant, quiet self knew I was lost in fantasy. But they dominated my awareness to the point of affecting my behavior.
The book that made the biggest difference was Facing the Dragon: Confronting Personal and Spiritual Grandiosity. I reviewed it here.
During a recent conversation with someone in a state of cannabis-induced mania, I asked them if they were speaking purely hypothetically, or if this (absurd) idea of theirs was something they were seriously considering. They replied that there’s no real difference between the two.
This, to me, is a perfect description of how psychotic ideas arise: the distinction between an implausible hypothetical and an eminently plausible possibility breaks down.
Obviously I don’t know if these neurochemicals are actually involved, but the feeling is so similar to cocaine-fueled ideation and to the anticipation of danger (e.g. looking over the edge of a cliff) that I have to imagine they are.
There is a video somewhere of me at age three or four, singing a children’s song called “I am special” in unison with a dozen other kids (the irony of this was lost on us). I still wonder if this had any effect on my later delusions. The 90s were a weird time to be a kid.
My best guess as to what happened here: I found my way into a now-familiar mindstate where priors are relaxed, and for the first time unclenched the I’m special prior. This allowed a huge amount of dissonance and unprocessed evidence to release into my consciousness.
Even throughout my manic era, I understood that there was something important and novel about this state of consciousness. This led me to deliberately stoke it, despite the danger.