“Peace is every step”
Thich Nhat Hanh

From Psychosis to Psychologist
by Rose McDuff, PsyD (pseudonym)

Growing up, Rose had a winsome personality and was a highly capable student. Pursuing a decades-long interest in psychology, she entered a doctoral program in psychology in her early 30s, performing well for four years.

In 2015, her life went off course. She developed visions and experienced what she termed “heightened spirituality.” She went on long walks, saw people meditating in the sky, and believed she was performing shamanic ceremonies. Her studying was hampered by distraction from thoughts of telepathic communications with others. Her doctoral program required trainees to undergo therapy. In one session, as she described her experiences, she thought to herself, “This sounds like schizophrenia,” but quickly reassured herself that that could not be true. Her therapist did not express anything out loud about her possibly having schizophrenia.

Difficulties studying made Rose decide to take a leave of absence from school, returning to her home state. Using a previously earned masters degree in Community Counseling, she found employment as a therapist in a community mental health agency. Increasing paranoia made it difficult to work and get along with her coworkers. Conflict with her supervisor over her performance led to loss of that job. Soon, without income, she depleted all her savings, and was paying for her studio apartment and other needs on credit.

In 2017, for no apparent reason, Rose began to believe the FBI was monitoring her. She sent a series of accusatory texts to her sisters, her doctoral program faculty, and old friends she thought were colluding with the FBI. In her vision, a Mexican cartel murdered therapists where she last worked. Distressed by this, she spent the next day on a bench mourning people she believed were killed.

After receiving some of Rose’s texts and concerned messages from her friends, her older sister sprang into action. Her sister investigated state policy on emergency mental health interventions and found a “Persistent and Acutely Disabled” (PAD) category that allowed involuntary hospitalization with a psychiatrist’s and judge’s approval. PAD meant that a person’s health was deteriorating and would likely worsen without mandatory treatment.

One of Rose’s friends helped Rose’s sister complete the necessary paperwork, and police arrived to take her to a mental health evaluation. Rose was hospitalized for two weeks, and proceedings began for court-ordered treatment. Despite being delusional, Rose was able to learn what arguments could circumvent involuntary treatment and convinced a judge’s representative that she was mentally stable and did not need medication, leading to her release. On arriving home to her apartment, she learned she was about to be evicted for nonpayment of rent.

For the next two months, Rose intensely believed she was fighting for justice from the FBI and that the secret service was protecting her. Her sister and mother again sought and obtained involuntary hospitalization for her under the PAD protocol. However, the prosecuting attorney was on vacation, and her hearing was deferred. Rose was released to await a scheduled court date.

Home again and annoyed by her family and friends sending police to check on her, she wandered around their neighborhoods pounding on doors to inform people how it felt, until police were called. She resisted arrest and was jailed for one night. Psychiatric evaluation at the jail resulted in her placement on mental health watch.

Upon Rose’s release from jail, her sister secured her transfer right away to a psychiatric institution, to await her pending court case. Based on testimony of the arresting police officer and concerned family and friends, Rose received court-ordered treatment requiring her to take a small antipsychotic medication dose. Feeling persecuted, she refused to speak to her psychiatric nurse practitioner, instead working with a lawyer to gain hospital release. Eventually she was sent to residential care for recovery, and when released, she was court ordered to take a large paliperidone injection. The hospital discharge paperwork she received documented her diagnosis as “paranoid schizophrenia.” She cringed upon reading it.

Soon Rose began to realize that she had been delusional and that her roommates could not possibly be a part of the secret service. The medication allowed her mind to clear, and her delusional belief system collapsed. She began restoring relationships and rebuilding her career. She started by calling her mother and tearfully asking for help.

The recovery process was slow and painful. It involved apologizing, securing employment, and undergoing psychiatric treatment with medications and psychotherapy. In an emotional phone call to her university’s dean, Rose explained that she had been ill with schizophrenia but was recovering. He expressed relief that there was an explanation behind her erratic email messages and said he believed that just like Elyn Saks, Rose could also succeed.

Rose returned to school in January 2019 to resume work on her dissertation. Concurrently she worked full-time first as a peer support specialist and then as a mental health clinician. She underwent weekly individual therapy and exercised regularly. She attended support groups and made friends with peers who appreciated the stigma of mental illness and the accompanying shame. Despite this progress, she still couldn’t fathom having a worthwhile life given her diagnosis of schizophrenia. She felt a lot of despair about her life prospects.

Encouraged by her dissertation chair and university advisor, Rose applied for internships to complete her doctorate. Having to disclose her psychiatric and legal history was stressful, and she received assistance in crafting skillful yet honest wording of her experiences. Happily, she was offered multiple interviews nationwide. She traveled to interviews across the country and matched with an APA-accredited internship in the Midwest which she began in 2020.

Wondering whether medication was still necessary, Rose worked with her prescribers to slowly discontinue it. This led to another psychotic episode, in August 2021, precipitating a month-long hospitalization followed by a one-month partial hospitalization program. She was stabilized on monthly paliperidone injections, driving a 90-minute round trip for each. She began to grapple with the realization that medication would be a life-long and sometimes inconvenient necessity. An understanding site supervisor supported her recovery and her family looked after her. Rose proudly completed her doctoral degree in September 2021. She attended the graduation ceremony and celebrated with her family via Zoom.

In November 2021, Rose began a postdoctoral fellowship via telehealth at a private practice clinic. She struggled with recurring feelings of despair and shame fueled by the diagnosis she carried and the painful memories being ill, especially the delusions. Living alone with few interactions other than with her parents deepened her negative emotional state.

In the summer of 2022, she moved back to her home state to be near friends and family. These renewed relationships helped fend off her despair and enabled her to continue to move forward with her career. She used her own training to combat her feelings of worthlessness and followed a regular schedule that got her out of bed when she didn’t feel like it.

Rose reflects that her treatment and subsequent recovery required not only skillful medication management, but also social support and connection with a sense of purpose and a renewed understanding of her spirituality. She listened to hours of the Zen master Thich Nhat Hanh on communicating effectively and learning to love oneself and others. She practiced mindfulness and meditated. The combined strength she gained from all of these pursuits enabled her to overcome the limitations of her psychiatric history and realize her dreams.

Rose applied for a psychologist license. She agonized over what to reveal about her psychiatric and legal history, spending months gathering the required documentation and carefully wording her history. She hired a lawyer, and had to present her case at numerous board meetings and complete a fit-for-duty evaluation. The licensure board offered her a consent agreement conferring the psychologist license under conditions of her compliance with its required provisions. She agreed and was awarded her license in March 2024.

Rose is currently supervised as a new psychologist until June 2025, when she can practice independently. She is grateful to her friends, family, university, internship supervisors, and state licensing agency for their forward thinking about what is possible despite a history of schizophrenia. Most importantly, she rejoices in her ability to care for herself and help others. Her psychiatric illness did not, as she feared, destroy her life and career, but these experiences have deepened her capacity to love and help others.