Twenty years ago, I woke up in a hospital and said I was dealing with something called psychosis. I didn’t understand what that meant. At age 13, I was more concerned with the classes I was missing at school, a band concert I was looking forward to, and the mark of mental illness I felt right on my forehead. When I left the hospital, I felt free – until my next hospitalization, just a few months later. I lost hope. It took me years to fully accept my condition and discover what living well with it might look like – much more than just acceptance drug and going to therapy— a return to life and a license to stalk me dreams.

This week, we interviewed Ray Kotwicki, a psychiatrist with a holistic view of mental health and recovery. He is the Medical Director of Intensive Outpatient Services at Hightop Health. Kotwicki says, “We can’t separate someone’s head from the rest of their body,” emphasizing the complicated relationship between physical and mental health. He believes that mental health recovery is multidimensional with “physical, psychological, social and existential components.”

What are psychosis and schizophrenia?

Psychosis is an umbrella term for a variety of experiences that alter our perceptions of the world, including things like visions, hearing voices, disorganized thoughts, and fixed, unusual beliefs. In addition to the traditional symptoms of psychosis, many people with schizophrenia live with negative symptoms, a manifestation that can somehow take some of the color out of life through blunted emotional expression, social withdrawal, loss of interest in activities and a dissipation in MOTIVATION.

Kotwicki acknowledges that while these “negative” symptoms have a greater impact on a person’s recovery, they are easier for clinicians to ignore than the more esoteric ones. He shares that families may mistake this for a lack of “personal responsibility,” when these elements are just as much a part of the condition.

A final aspect of schizophrenia is anosognosia, which Kotwicki describes as a phenomenon where a person “doesn’t notice that their perceptions are distorted in some way.” Anosognosia, or the inability to recognize one’s illness, is common in many neurological conditions, such as brain injury (Steward and Kretzmer, 2022) and dementia (Hallam et al., 2020).

Possibilities of recovery

Kotwicki emphasizes the individual nature of mental health recovery. After an experience of psychosis or a diagnosis of schizophrenia, many begin to give up their aspirations for the future. Expectations can be tempered. However, many return to their hopes and dreams. Seeking mental health support can be one component of recovery, but Dr. Kotwicki discusses others such as “college support” and “relationship building.” He describes recovery as “doing the best we can with one’s circumstances.” He says, “I want everyone to know that (there is) hope and recovery and imminent possibilities for people with schizophrenia.”

Treatment options

There has never been a time when so many options for the treatment of schizophrenia were available. Antipsychotic drugs relieve the symptoms of psychosis in many people. These are available in oral and injectable form that can last from a few weeks to a few months. Kotwicki shares that one benefit of long-acting injectables is that “you don’t have a reminder every time you take a dose of your disease.” For someone struggling to accept their condition, this can be huge.

More recently, interventions to target negative symptoms have also become available, including a class of drugs that Kotwicki describes as “looking at a different system in working on the muscarinic system as opposed to dopamine.” This novel mechanism could alleviate both psychosis and negative symptoms of schizophrenia.

Psychological and social interventions, including psychotherapies such as cognitive behavioral therapy for psychosis and recovery-oriented cognitive therapy are also often elements of treatment.

Full health

Kotwicki also expresses the importance of recognizing the interdependent relationship between mental health symptoms and physical health. He shares that historically, the medical system may have overlooked the physical health of people with schizophrenia, focusing primarily on their mental health. “Physical and mental health are inextricably linked,” he says.

With effective support, many live well with schizophrenia and related conditions. Moreover, as knowledge about psychosis and what can lead to recovery expands every day, there is every reason to optimistic.

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