Audible. This book was narrated by the authors, Mara Altman and Kat Alexander. They’re best friends.
If you have witnessed a loved one in an acute psychotic episode, you know it’s essential to find some patterns in their behavior, in their thinking, and in their experience of their choices or lack of choices, because not only is it likely the psychosis will happen again, but it’s likely part of a larger psychological picture that includes ACE (Adverse Childhood Experiences) and potentially another more all consuming diagnosis or disease.
These women narrated their story with Kat speaking for herself, speaking about herself, during the lead up to her first psychotic episode, during subsequent breaks over the course of four years, during deep dark rebound depressions, and during weeks of frantic manic escape in which she lost all perspective, all ability to judge what was real and what was important. Kat was a danger to herself, cut off from reality, not capable of keeping track of IDs and money, losing phones, ending up naked with blistered feet from walking around barefoot, and battling hallucinations and delusions. Because Kat actually had a support system, she was eventually able to achieve insight about what was happening to her thinking and behavior during manic (psychotic) episodes. This is an incredibly difficult process and it’s usually time consuming. People need patient and reasonable loved ones to kind of orchestrate the process. Usually theres a lot of just waiting as time and further breaks can help demonstrate what is going on and what solutions are available.
Mara narrates her views during these moments, during the ER visits, during the time spent figuring out how to affect a treatment course for Kat, during her doubts that their friendship would survive. This is the best description of psychosis I’ve ever read. That Kat is capable of describing and telling what it’s like to not know you’re manically losing your own story, your own life, and potentially relationships with it, is invaluable for mental health professionals and caregivers and loved ones. Hardly anyone hangs in with psychosis. Friends bolt. Parents grow exponentially exhausted. Doctors are burned out or just never were dedicated to any form of humanism in their approach to people with psychosis as a part of their life, their nervous system, their diagnosis.
Mara and several other people in Kat’s orbit do what most people do not-they understood that Kat’s psychosis (Bi Polar I) was not her. They understood that some of the things she said, most of which she didn’t remember, were not her fault. They worked to keep boundaries and to hold empathy and sympathy. They took advantage of the only supports we have for psychosis. And after an absolutely astounding round of episodes that only people involved with someone with psychosis could understand without an extensive and detailed description and retelling, Kat finally came around too. This is rare, I think, but I don’t have the numbers to back that up.
Loved ones quit on their family members or love interests. They don’t understand. They lack financial and emotional support. The chaos can be too much and family systems break. Mara, Kat’s best friend, is unique in her stayability. This book is worth listening to for the strategies Mara uses, for the techniques she lists in tracking a loved one through ER visits, 5150 holds, medication adjustments, and manic whirlwinds.
The format is remarkably simple and successful, both women narrating alternatively every single interaction and all the details of Kat’s episodes and Mara’s responses. They used media as well. Hearing audio of Manic Kat (video too) versus Regular Kat, is way more effective than just words. This is recommended reading for anyone already practicing in mental health, for every caregiver, for every ER worker, and for every person living with psychosis who is ready to see that insight can come. It CAN take root. It takes a tremendous amount of vulnerability, resilience and resources, but it can come.