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An exploration of four life course interviews from gay men who have experienced meth Induced psychosis. Is trauma a predisposing factor?
Saturday 13th November 2021
Written by Mike Power- Addiction counsellor
The phenomenon of sexualised drug use has been described as the perfect storm for sexually transmitted infections (Kirby and Thornber-Dunwell, 2013) and the research is increasingly focused on the negative effects on sexual activity, with very little focus on mental health and, in particular, the percentage of men who have sex with men induced with psychotic symptoms associated with crystal methamphetamine.
What Is Meth Psychosis?
During meth-induced psychosis, a person may develop symptoms of delusions, hallucinations, paranoia, and violent behaviour. This state may make it difficult for an individual to separate their own perceptions from reality. Additionally, it can also make them dangerous to their own selves or those around them.
A person who abuses meth recreationally is two to three times more likely to develop psychosis than those who do not use this drug. Those who use the drug chronically, however, are at even greater risk with a multitude of 11 times the likeliness of developing it.
Prior to developing psychosis, a person who uses meth may encounter a pre-psychotic state that is marked by delusional moods and ideas of reference, or believing in the increased significance of everyday events. Delusions and hallucinations accompany the aspect of full-blown psychosis.
People who are dependent on meth, who use a higher dosage, and have simultaneously experienced childhood trauma, and/or started taking this drug from a young age are at an increased risk of having psychotic symptoms. The sleep deprivation that often accompanies meth use may aggravate these symptoms as well.
2 out of 5 gay men that go for treatment have stated that they have experienced psychosis, which is often a frightening and traumatic episode for an individual. It can often lead to a person being arrested by the police under the law and shifted to a psychiatric unit, both events that can further lead to trauma,
For most individuals, after the drug has worn off and they've slept and eaten, the symptoms of psychosis gradually diminish as well. On the other hand, some might experience psychosis for weeks or even months in a few cases. Many gay men experience a similar set of delusions under psychosis, the belief that they are either being watched or followed, someone might've hacked their computer system, the police or their drug dealer can hack their phone, and even that someone might upload their pornographic videos online.
Of course, sometimes these events can actually be happening; they might not be psychosis at all. However, they are also common symptoms of chemsex, the phenomenon of combining and taking drugs to enhance the experience of sexual activity with a partner, especially when combined with lack of adequate sleep. Most people who have been involved in chemsex have experienced these symptoms, or have met people who have experienced them. For some, they occur as soon as the drug high starts, for others, a few hours afterwards; for others, it might start one to three days into the chemsex session. For some, the symptoms wear off after they sleep and stop doing drugs; for many, the symptoms last for a few days, while for a few, they can last for a few weeks after usage. Some experience it at a more acute level when they are alone as compared to when they are engaged with others; while for others, it's the other way around. For most individuals, they might be convinced that their symptoms are actual reality. On the other hand, others might not easily be convinced, however, they then continuously try to prove their delusions as reality. In nearly all cases, there is an obsessive thought process associated with the usage of the drug, usually with high levels of anxiety, perceptions of danger or persecution, and belief in conspiracies.
I have always been curious why some people are more prone to psychosis than others, my assumptions were based on the possibility of underlying trauma or mental health issues that could act as a contributing factor. I based my investigations with the help of various interviews regarding the life course of people who had experienced severe psychotic breaks while using meth. The following are the results that were displayed in accordance with each significant aspect.
Mental Health
The main theme that particularly stood out amongst the others was the experience of complex mental health issues by all four men throughout their lives, leading to self-harm for one and multiple suicide attempts for the other three. All four participants were diagnosed and treated for clinical depression. All four men had also experienced a prolonged period of depression and hopelessness in their lives, the following are examples of the conversion on mental health from two of the four interviewees.
John: 'I have always felt depressive and this has been something that stems from a young age [from] coming to terms with [my] sexuality.'
Jason: 'In primary school, that's when I first remember having depressive thoughts.'
Two of the men had experienced a prolonged period of anxiety in their lives.
Jack: '1 think I've had anxiety issues since I was l
ike ... three years old and they just kept increasing over time.'
Mark: 'I was always really anxious and scared as a child and still [am] now.'
Childhood suicide attempt (1)
Mark: 'My first suicide attempt was when I was six years old, and thrice more after that until the age of 12. I remember being kept in a children's hospital for months and having to see a psychiatrist every week.'
Adult suicide attempts (3)
Jason: 'I was really, really, really depressed to the point that I felt suicidal. I went through my first suicide attempt at Edinburgh University [when] was I was 18. I had actually felt great for attempting it, but crappy that it didn't work. That was when I was 18. I overdosed on paracetamol and alcohol, and got admitted to hospital.'
Jack: 'I still don't really understand why. My mum gave me two packs of paracetamol and I took all of them. It was about 48 tablets. I just did it and it was a spontaneous thing which I had not really planned. I just did it. Afterwards, I was quite sick, but I carried on with work and functioned and got back. I didn't really tell anyone about that.'
There was one person who inflicted self-harm from a young age.
Jason: 'I used to cut myself when I was around 15. I never learned how to express pain, anger, rage, and sadness. I always kept everything inside.'
Trauma
Mark: 'My first memory was being kicked down a flight of stairs by my father. I'm not sure how old I was but I was young. Then, when I was seven, he threw a coffee table at me and broke my ankle.'
Mark: 'I always remember my mum screaming while he was beating her. One Christmas Eve my father was beating my mum so badly, she was screaming for me and my sisters to get my Nan. We were too scared to run and get help because we thought Santa Claus might just be coming.'
Queer-bashing (2)
Jack: 'Summer of 2000 I was queer-bashed in Brighton — me and a friend. It was a group of guys and they hit us over the head with a 12-inch wrench. I ended up with a fractured skull. I split up with my boyfriend at the same time, who I was living with, to move out of Brighton. Who really wants to stay there? Then, when I attained my qualification as a nurse in December my HIV diagnosis came back as positive. Taking drugs was sort of reasonable but then, in that year, it really escalated.'
Sexual assault (2)
Mark: 'I was living in San Francisco. One day, I was high on crystal meth when I met some weird guy on the streets who pulled out a knife, put it to my throat, and raped me. I just froze and let it happen.'
Jack: 'There was a guy who I was chatting with who was gay as well. I opened up to him, and while I was increasingly emotional and crying, he said, "we can talk about this more if you want". So I went home with him. It was one of those awkward situations in which I never quite know and have always felt difficult labelling it. But, for me, it felt like he sexually abused me. It's one of those early moments of putting trust in somebody and feeling that they've abused that trust.'
Bullying (1).
John: 'The bullying — that's when it got really bad. Because I started to develop really early; I was the first one with body hair and changes in my voice, and I've always been quite campy, and kids were horrible to me.'
Two of the men started their respective psychotic episodes.
Jack: 'I was scared, I was terrified, I was taken to the Maudsley Hospital where I spent five weeks. I spent a day in the room on my own, I think — it seemed like it, it seemed like a long time. Then I was still experiencing the symptoms of psychosis and the space where they put me down during that time felt like hell with darkness surrounding me. I was arguing with the psychiatrist. My diagnosis was acute and transient psychosis.'
John: 'I was sure that everyone had been taken and I thought, because I was God, the whole world was dead and I was the only person left alive. I came out of that somehow and I went down the street and then I phoned the police, the ambulance, and the fire brigade — no, just the fire brigade and the police, I think, that's all. When they turned up I guess they took me to a place of safety. That was very traumatic.'
Relationship with your own self and others
Another common theme that was displayed was attachment issues with others and feelings of being weird, strange, or not good enough about their own selves; alongside complexity in family attachments and forming healthy intimate relationships.
Parental attachment (3)
Jack: 'My parents had issues in their own marriage, but as a child, I felt guilty because of them. I thought I was the issue, [that] I've ruined their lives and on top of that I was gay, very sensitive, and artistic.'
John: 'There was a fourth child, the oldest of all of us, who died when he was 12. I was born a year after him. I kept mainly to myself and would go to my gran's and would slightly start interacting in that safe space for both myself and my parents so that they'd feel better. Then there was the whole realisation that I was gay, and there was always this comparison of me with this 12-year-old child who died, who was always lovely.'
Attachment to self (4)
Mark: 'I always felt weird and odd like I never fitted in this world.'
John: 'I wasn't naturally outgoing. I was quite introverted, shy, and awkward. I even found it difficult to make friends. I suppose you just assume everyone's the same and they should be acting the same way as you. I just don't understand why everyone reacted in a weird manner around me. When I was about 18, I remember someone saying, "You're odd". I didn't think I was odd, and then I realised I was odd.'
Intimate relationships (4
Jack: 'I met a man that I looked up to and thought, "wow, you're something special". But it was fucked. It was a pattern of relationships that I was relative to me since it was a short-term thing, but then again he was very caring and looked after me. But sexually it was very dominant, very rough, bordering to violence even. But we watched really good films; we talked.'
Attachment to self-sexuality (4)
Mark: 'I grew up having to shake hands with the men in my family; we never hugged or kissed. When I was young, I tried to kiss my grandfather, he pushed me away and said only poofs kiss men.'
John: 'I realised I was gay when I was probably about 11 years old. I thought a gay person was someone who wanted to be a woman, so I knew I wasn't gay. Then when I was 13, I realised that gay men were men that fancied men. I came out when I was 15, and my parents didn't react brilliantly. They were quite supportive, but we'd go to family therapy, and it was all very strange. Everyone was like "don't tell anyone". It became this huge secret that was a bit weird.'
Usage of Crystal Meth
The next theme was the crystal meth use itself. All four participants injected on occasions, but not regularly. The theme following on from this was days without sleep: two participants went an average of two nights, while the others went between five and even eight nights. The final theme was nutrition and fluids while using, with three saying they would not drink or eat on a binge and with one saying he could eat and drink while under the influence of methamphetamine.
Injecting (4)
Jack: 'I started to slam (inject) more. I'd only pretty much done it about two or three times my entire life and then it increased to more like every two or three weeks or every month or so. A big transition was in February 2014, I think. I was introduced to a website called nasty king pigs. That was a whole new level. I started meeting with dark people. There was a guy who I was very scared of due to his aggressiveness. Just horrible.'
Sleep deprivation (4)
Mark: 'I would usually stay awake for three days at a time; the longest I had stayed awake for was eight days.'
Jack: 'I suppose there would be times when I didn't sleep for three days straight, and sometimes even more because the problem is I could not sleep.'
Diet and fluid intake (3)
Mark: 'I could not or would not remember to eat or drink while on a crystal meth binge. I could easily lose five kilos of body-mass with one session.'
Discussion
The first main theme to arise was that all four men experienced mental health issues throughout their lifespan. In the last two decades, there has been a historic development of public and scientific awareness of LGBT lives and the issues surrounding them. This awareness can be traced to larger sociocultural shifts in understandings of sexual and gender identity. Before the 1970s, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders listed homosexuality as a 'sociopathic personality disturbance' However, times have advanced and it is believed that minority stress theory has shed light on a foundational structure for understanding sexual minority mental health disproportions . It theorises that sexual minorities experience distinct, continuing stressors related to their stigmatised identities, including victimisation, prejudice, and discrimination. These distinct experiences, in addition to every day or universal stressors, disproportionately compromise the mental health and well-being of LGBT people. This correlates with the mental health and intertwines with the trauma theme; however, would this make a person vulnerable to methamphetamine psychosis?
Trauma came out as a dominant theme in the interviews, from bullying to queer-bashing and family violence. Paul Schulute, the author of Paths to Recovery for Gay and Bisexual Drug Addicts, says studies show gay and bisexual men have a higher rate of experiencing sexual abuse and, as a result, are more prone to PTSD; also, 53% of gay and bisexual men are still scared to come out at work and report hearing offensive comments (Schulute, 2015). Additionally, many men who have survived the AIDS epidemic are prone to survivor's guilt; the 'why me?' syndrome thus contributes to the perfect storm of mental health consequences for many gay men, with one of these being devastating methamphetamine psychosis. This correlates with the interviews with all four participants experiencing some sort of abuse or trauma in their lifespan that might have led to PTSD symptoms. Even though it was not discussed, three of them were HIV positive, all had significant attachment issues with themselves and family members, alongside struggling with healthy intimate relationships; or on the parallel side, is it simply a case of staying up for three days, not eating, and being dehydrated that pushes the mind to go psychotic.
What ever the cause may be, what I do know that for a good majority of gay men seeking treatment for meth amphetamine addiction there are symptoms of trauma whether it be historical or trauma from psychosis its self. Trauma informed care is an essential part of the rehabilitation process.
When treatment is required
"My name is Mike Power, I am a fully trained addiction therapist. The topic of drug induced psychosis is something that I am incredibly passionate about. Why you may ask? Because I have been there and experienced first hand how terrifying this can be alongside how poorly it is misunderstood and managed by well meaning health and social care systems. That is why at Mike Power counselling & Twin Rivers rehab our mission is to provide the best trauma informed care for all our clients that either need one-one support of residential treatment."