This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.
I am a 35-year-old woman who lives in a small town in upstate New York. I had my first psychotic episode at 27. During those three months before I was hospitalized, I did things that I have spent the eight years since trying to understand and to forgive myself for. I want to write about the forgiveness, because the medication and the therapy and the case management and the long-acting injection are all well documented in articles like the ones in this library, but the slow, private work of becoming a person who could live with what I had done during my illness is less talked about. It is, in my experience, the heaviest part of the recovery.
What I did, briefly
I will not retell the full story. The summary is enough. During the three months of my untreated first episode, I did the following: I screamed at my mother in a way that frightened her so badly she did not speak to me for six months. I accused my best friend of being part of a conspiracy and told her, in front of her children, that I never wanted to see her again. I drained most of my savings buying things I believed would protect me from threats that did not exist. I sent a long, paranoid email to my entire workplace. I was fired. I broke up with my boyfriend by leaving him a voicemail that he played for the police when he reported me missing. None of this was who I was. All of it was, also, me. The illness used my voice and my fingers and my checking account.
The early months after the hospital
The medication brought my mind back online slowly. The first thing the medication did was let me see the wreckage. I came home from the hospital to a stack of mail I could not open, a phone full of voicemails I could not return, and an inbox of emails I could not bring myself to read. My mother came over and helped me sort through it. She read the worst ones out loud to me so I would not have to read them alone.
For the first six months, I was paralyzed by shame. I would not leave my apartment. I did not return calls. I assumed everyone hated me, because in my head I hated myself. The voices, by then, were quiet. The shame was the louder voice. It said: You did this. You are a danger to people you love. They will never forgive you. You should not be allowed back in your own life.
The first thing my therapist said
My outpatient therapist, in our second session, said this: "The person who did those things during your psychosis was you, and was not you, at the same time. You will need to learn to hold both."
I did not understand what she meant for years. I thought it was a clever sentence. I now think it is the most accurate description of post-psychosis recovery I have ever heard. The illness was real. The damage was real. The person who did it was me, in the sense that the body and the voice and the actions were mine. The person who did it was not me, in the sense that I would never, sober and well, have made those choices. Both of those things are true. Forgiveness lives in the gap.
The four things that helped
1. Apologies, where it was safe to make them
I made apologies in stages. The first was to my mother, in person, about eight months in. I said, "I know what I did and I know what it cost you. I do not expect you to forget it. I am asking for the chance to be your daughter again." She cried. I cried. We started over slowly. The second was to my best friend, in a letter, almost two years later. She did not respond for four months. When she did, she said she would meet me for coffee. We are friends again. The friendship is different. It is also real.
The third was to my old workplace. I never sent it. I wrote a letter to my former boss apologizing for the all-staff email and asking him to know that the woman who sent that email was unwell. I never mailed it. The act of writing it was, for me, enough. I did not need him to know. I needed me to know.
I did not apologize to my old boyfriend. He had moved on. The kindest thing I could do for him was to leave him alone. Sometimes forgiveness means not asking for any.
2. A book about composite shame
The book that changed me was The Center Cannot Hold by Elyn Saks. See our review of her memoir. She describes, in plain language, the things she did during her own psychotic episodes. Reading those passages was the first time I understood that I was not uniquely terrible. I was, instead, a person who had had a terrible illness. There is a difference. Reading her book gave me the difference in the form of words.
3. The slow work in therapy
My therapist and I spent, I would estimate, the better part of three years working on the question of self-forgiveness. We used elements of compassion-focused therapy — see compassion-focused therapy for psychosis — and elements of trauma work. The same techniques that help people forgive themselves for things they did under duress turn out to apply, in adapted form, to things people did under psychosis. We wrote letters from my present self to my psychotic self. We wrote letters from a wise, future self to my present self. We built a story of what had happened that was honest about my actions and honest about the illness and refused to collapse one into the other.
4. Doing one small good thing every day
For two full years, I made a discipline of doing one small good thing every day. Buying coffee for the person behind me in line. Calling my grandmother. Holding the door at the post office. None of these things "balanced the books." The books cannot be balanced. What they did was give me daily evidence that the person I was now was capable of generosity and of care. Slowly, the evidence accumulated. Slowly, I started to believe it.
The work of forgiving myself for what I did during psychosis was not a single decision but a thousand small ones, repeated over years, until the woman in the mirror was no longer mostly her wreckage but mostly her recovery.
If shame about a past episode is so heavy that you are having thoughts of self-harm, please call or text 988. Survivor's guilt and post-psychosis shame are documented and treatable. You do not have to carry them alone.
What I know now that I did not know then
- You did not choose your psychosis. You did not consent to the illness. The standards we apply to actions taken under sober choice do not apply to actions taken in the middle of a brain crisis.
- Forgiveness is not the same as forgetting. It does not require you to erase what happened. It allows you to carry it without it carrying you.
- Some relationships will not return. That is part of the cost. It is not, by itself, evidence that you are unforgivable.
- The people who do return are giving you a gift. Receive it without performance. Be honest. Be present. Do not treat their forgiveness like a debt you have to keep repaying.
- Self-forgiveness is part of relapse prevention. Shame is, in the literature, a documented driver of medication non-adherence and avoidance of care. The kinder you are to yourself, the more likely you are to stay well.
- It is allowed to take years. Mine took six. Yours may take more or less. There is no schedule.
Where I am now
I am 35. I have been stable for eight years. My mother and I talk every Sunday. My best friend's children are now teenagers, and one of them calls me Aunt. I have a new job that I love. I have a partner who has known me only as the person I am now. I do not introduce myself by my illness. I also do not hide it. The shame is no longer the loudest voice in the room. Some days it is not in the room at all. Other days it visits, sits in the corner, and leaves on its own.
For more, see apologizing to people I hurt during psychosis, how I stopped blaming myself, and compassion-focused therapy for psychosis.
This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.