Beneath the Noise

Into the Fog of Psychosis Part 2: Aftermath

• Emily Jatcko • Season 1 • Episode 2

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New Year’s Eve has always been my favorite holiday—until 2018, when it became a dividing line between the person I was before my hospitalization and the one I was trying to become after. In Into the Fog of Psychosis: Part 2, I walk you through what comes next—the exhaustion of recovery, the identity crisis that follows psychosis, and the quiet war of trying to exist in a world that wasn’t built for people like me.

From job interviews that feel like performances to the infuriating reality of getting (and affording) the right medication, this episode is about what happens after the crisis, when the world expects you to be fine again. Because the truth is, recovery isn’t linear, it isn’t neat, and sometimes, just existing is the biggest battle of all.

All music found on Pixabay

Emily:

Welcome to Beneath the Noise. New Year's Eve has always been my favorite holiday. I know it sounds a little silly when you think about Christmas or Halloween, but to me New Year's has always felt different. Christmas has its own set of expectations, family presents and this undeniable pressure to make everything perfect. Halloween is fun, but it's not the same kind of reflection. New Year's is just about celebrating that you've made it through, that you've seen another year, even if you're not exactly sure how. It feels a little easier like the whole world is letting you off the hook just for showing up. But New Year's Eve of 2018 was different. That year it wasn't a celebration. It was the space between worlds One where I had just left the hospital and the other where I was trying to figure out how to live again. I was still buzzing with energy, but it wasn't the excited, hopeful kind. It was more like I had been yanked out of one reality and dropped into another and I wasn't sure if I was ready for it. The meds, the exhaustion, the confusion they all clung to me like a fog I couldn't shake off. But insurance had cut me loose. So here I was at home, no longer in the safety of the psych ward, trying to piece together something that resembled a normal life.

Emily:

When I think of New Year's, I think of my grandmother. I used to spend every New Year's Eve with her drinking Sprite and champagne flutes, staying up too late. Our heads filled with the anticipation for the year ahead. It wasn't glamorous or fancy, but it was ours. There was something magical about it, even if we were just a couple of girls watching the clock tick down. I remember the turn of the century, the year 2000,. When everyone was holding their breath, thinking the world might end, whatever that means to a seven year old. We stayed up late that night watching the ball drop on national television like it was something monumental. It felt important back then, like we were a part of something bigger, something the world was watching.

Emily:

The first few weeks after I left the hospital were the hardest. It wasn't just about figuring out how to be in the world again. It was about figuring out how to be in my own skin. The confusion was familiar. I hadn't been in and out of treatment constantly, but I had been hospitalized a handful of times and with each one it felt like the same struggle, the same slow rebuild. It wasn't new, but it also wasn't something I could easily shake off. My history of mental health struggles was like an old coat I couldn't take off, no matter how heavy it felt. I was tethered to this reality where these episodes kept resurfacing and even though I tried to fight them, there was always a sense that they were inevitable. And this time I was an adult. I didn't have the cushion of childhood and lack of responsibility I used to.

Emily:

As mentioned in the last episode, I had my first bipolar diagnosis when I was 12. I remember this moment clearly, like a label placed on me that I didn't fully understand at the time, but I knew it would follow me. And here I was years later, living with the consequences of that label. Whether it was a misfit diagnosis or not, it didn't matter. It was a part of who I was, and every time I felt the fog come over me, it felt like that diagnosis was pulling me back in, like I had no choice but to face it again, to accept that it was part of my story.

Emily:

I wasn't disconnected from my past. If anything, my past was right there, wrapping itself around me in a way that felt like it had been written long before this moment. It wasn't just the meds or the hospital or the aftermath. It was the reality of living with a disorder that had shaped my life since I was a kid. The cycle was familiar, and while I wasn't always expecting it, I wasn't surprised either. It was just something I had to live with day in and day out, and sometimes that felt like the hardest part. There was this strange feeling of disconnection, though, like I was watching myself from the outside, trying to figure out what had happened to the person I used to be, and in a way that felt like the biggest loss of all, the loss of myself. I didn't know how to reconcile the person I was before my psychosis with the person I was after. I felt like two halves of myself were fighting for space inside of me, and neither one seemed to fit the world I was now facing.

Emily:

The thing is, I had always struggled with my identity. From the moment I was diagnosed for the first time, there had been this quiet undercurrent of confusion about who I was and where I fit. Mental illness had shaped so much of my life that I never fully explored who I might be without it. Now, in the aftermath, it was as if I was left with a blank slate. Now, in the aftermath, it was as if I was left with a blank slate. Except it wasn't really blank. It was filled with fear and uncertainty and this nagging feeling that I would always be defined by my mental health history, by the diagnosis, by the cycle that kept repeating itself.

Emily:

I had spent days, maybe weeks, circling around the same thought, trying to make sense of it all. I wasn't just recovering, I was becoming someone new, and once again I started to wonder maybe that wasn't a bad thing. But who was I now? I had no idea, but there were moments, tiny flashes, when the fog would lift. I'd see a glimpse of something that felt like me. It wasn't much, but it was something. It wasn't all introspection, though. Life didn't just stop because I was figuring out who I was. I knew I had to try, I had to push through, even though every part of me was screaming to hide.

Emily:

The idea of going back to work, of finding something to hold on to, felt both terrifying and necessary. So I started looking. The process felt like a series of tiny steps. I was taking on shaky ground, but one day I finally landed an interview. A family friend had gotten me an interview for a respectable office job where she worked, for a respectable office job where she worked. And let me tell you, I walked in there with every ounce of hope I had left Hope and about a thousand doubts I was trying to bury beneath it.

Emily:

I sat in their lobby fidgeting with the edge of my shirt. Was I overdressed? Underdressed? Everyone was in jeans and I was wearing my only nice outfit that fit at the time after my weight gain from the medication A navy blue blazer and dress slacks with a blouse. I see the television lobby displaying the food trucks available every week there. People are smiling and asking each other about the weather. I think to myself that I can do this. I can fit in here. I can fake it till I make it, just like every time before. Then someone says my name and the adrenaline rushes through my veins. I am more than nervous. I am petrified.

Emily:

When I sat across from the interviewer, I felt that familiar mix of energy and exhaustion, like I was living in two places at once. There was this part of me trying to perform, to be the person I used to be before everything came crashing down, but the fog it hadn't lifted completely. I could still feel the weight of the meds, the disjointed sleep patterns, the overwhelming sense that I had was still piecing myself together bit by bit. It had been months and still I wasn't right. I didn't feel like I was pretending to be someone else. I felt like I was pretending to be me and it wasn't going well.

Emily:

The interviewer asked me about my strengths and weaknesses, and I kick the metal barrier between us by accident. The sound of it clanging against my shoes cuts through the quiet like a thunderclap. It echoes in my head louder than the question itself, reverberating in my chest. For a second I'm frozen, caught in the absurdity of it all. Here I am, dressed in my best I've-got-it-together outfit, trying to be someone I'm not sure I even am anymore. Embarrassment rushes in hot and thick and I feel my face flush. The silence between us is unbearable. It's stretching out forever. They're waiting for me to answer, but it feels like all the words I've ever known are stuck somewhere between my chest and my throat.

Emily:

The interviewer finally breaks the stillness. Her voice calm, too calm. Take your time. No rush on these questions. Rush on these questions. But what am I supposed to say? What is my strength right now? How do I even define it, when the biggest thing I've done is survive. Is that enough? And my weaknesses? Where do I even begin? What's my greatest accomplishment? Well, how do I tell them that I've come back from the edge of the abyss? I've stared into that black void, felt it breathing down my neck and somehow found a way to pull myself back. But is that a strength, or is that just the bare minimum? I can't even say that out loud without sounding like a wreck, a broken person who's still trying to find their way through the mess. The question feels ridiculous. Now there's no easy answer. My mind spins trying to find something I can give them, something that doesn't feel like just a jumble of pieces waiting to be put together.

Emily:

Eventually, the interview was over. Walking out, the weight of the doors closing behind me felt like the weight of the world. My shoulders sagged, like everything I had been holding up just caved in all at once. I didn't feel relief, I didn't feel angry, I just felt numb. I don't even know how I got to the elevator. My feet moved, but nothing else did. I felt like a shell moving through space without any real connection to what just happened. I didn't need to hear the we'll get back to you line.

Emily:

I already knew I wouldn't get the job. It wasn't just the job, though, it was everything. I had shown up, tried to fit into a world that felt like it was miles from where I was and had failed. Not because I didn't have the skills or the drive, but because I wasn't even the person I used to be. I was a version of me that barely felt real, one that still hadn't figured out how to live. In this new body, in this new mind.

Emily:

The elevator dinged and I stumbled out into the lobby, each step heavier than the last. I just wanted to get out. I wanted to go home and collapse into the kind of nothingness that could shut my brain off, if only for a moment. I couldn't even look at the people around me. They were all so normal, living their lives without this weight hanging over them. It was so easy to hate them, so easy to resent the world they seemed to fit into so effortlessly.

Emily:

It didn't feel like I had accomplished anything, I hadn't overcome anything, I hadn't found some new version of myself. All I had done was try to survive, and I hadn't even done that very well. I wasn't moving forward. I was just stuck Like I had fallen into a pit and kept digging, only to find more darkness. I wasn't sure if I'd ever find the light again. It was the abyss again, and for a second I thought maybe it was where I was always meant to be as I sat in my car.

Emily:

After the interview it was clear I wasn't ready. Not for the job, not for the world outside, but somewhere deep inside me I felt a whisper. The whiplash from my hopelessness almost hurts. It wasn't hope exactly Not yet. But there was something else, something softer, a quiet reminder that there was more to my story than the last few months. The journey wasn't over and I wasn't done yet.

Emily:

And then I realized just how exhausting recovery is Like. Seriously, if recovery was an Olympic sport, I would have a participation trophy collection the size of a small car. You know the ones with the glittery text that say good job, you showed up. I'm just here, half walking, half sprinting through life, pretending to be put together, while my brain's still on its coffee break. Honestly, recovery should come with a nap break every 20 minutes. Now, don't get me wrong. There are days when I can laugh about it, the absurdity of it all. But the truth is recovery is not just a matter of showing up or willing yourself through it, though I cannot stress enough how much you have to do that. It's a long, winding road that no one tells you about. And the reality of recovery with bipolar disorder it's a lot messier than anyone could have prepared me for.

Emily:

Bipolar disorder isn't something you bounce back from. Sure, the manic highs can feel like you're on top of the world, but the crashdown, it's a different kind of exhaustion, the kind that seeps into your bones and the depressive episodes that follow. They don't just hit, they linger, pulling at every inch of your energy and willpower. But what people often don't understand is how complex it really is. Bipolar disorder is characterized by extreme mood swings, including manic episodes when you're high energy and feel invincible, followed by depressive episodes that can feel like a bottomless pit. These mood swings can last anywhere from days to weeks, and sometimes even longer. In some cases, rapid cycling, where a person experiences four or more episodes within a year, can make everything feel like a constant rollercoaster the medication, the therapy, the trying to maintain some kind of normalcy, while your brain and body are fighting to find equilibrium again. It's hard, and then there's this persistent feeling of waiting for the other shoe to drop. I'm not the same person I was before, and that's not just in my head. It's in the way I interact with the world, the way I feel things more deeply, the way my mood swings can hit without warning.

Emily:

50% of people with bipolar disorder experience their first episode before the age of 25. For me it was around age 12, but I wasn't properly diagnosed until much later. Like other mental health conditions, bipolar disorder requires ongoing management. Even with treatment, episodes can still sneak up. The stigma surrounding bipolar disorder can also add to the challenge. Stigma surrounding bipolar disorder can also add to the challenge. Many people with the disorder experience judgment or a lack of understanding from others because of the drastic mood changes.

Emily:

It's not just bad days. It's a mental health condition that affects nearly every aspect of your life, from relationships to work to just being present in the moment. And the thing about medication is that it doesn't fix you. Lithium, seroquel, depakote they're not magic pills. They stabilize things, they help, but they don't make the lows disappear and they don't make the highs feel any less reckless. And then there's the side effects Weight gain, fatigue, sleep disturbances. Those add their own layer of discomfort to an already complicated journey.

Emily:

Recovery with bipolar disorder is like trying to get on a moving train that's always just a little too far out of reach. And with that comes the hard truth. I wasn't prepared for the moment when I had to face the reality that I wasn't just recovering, I was changing. I wasn't just a person living with a mental illness, I was becoming someone with a disability. It wasn't that I was legally disabled not in the official sense anyway but the reality of my condition is impairing my ability to function. I couldn't show up in a way that I used to. I couldn't keep a job consistently, couldn't make decisions with confidence, couldn't even be sure I was going to make it through the day without feeling like I was losing control. There were days when the idea of sitting in an office or meeting a deadline felt impossible. The exhaustion from fighting my own mind was too much, and the weight of feeling different, like I wasn't living the way the world expected me to, was suffocating. Even though I didn't go the route of disability benefits, I still had to face the fact that I couldn't keep up the same way I used to. I had to make decisions that I never thought I'd have to Like, finding a balance between pushing myself back to work and acknowledging that my mental health was a real barrier to me doing so, and the shame that came with that. It was huge. There's an unspoken rule that if you just try hard enough you'll be able to push through anything. And I couldn't. I felt like I was failing at what everybody else seemed to take for granted Just functioning.

Emily:

The stigma that comes with bipolar disorder is like a weight on your shoulders that no one else can see. It's the quiet judgment People don't always voice, but you can see. It's the quiet judgment people don't always voice, but you can feel. It's that moment when somebody asks why you're so moody or why you can't just snap out of it. It's the moment when you feel like you have to apologize for not being able to be that perfect, high-functioning version of yourself. People don't see the reality the exhaustion of managing unpredictable mood swings, the mental fatigue of trying to look normal or the emotional toll of not knowing when the next episode will hit. There's this unspoken expectation that you should be able to manage it, that with the right amount of willpower and therapy, you should be able to lead a quote-unquote normal life. And when you can't, when your brain doesn't let you, the shame is suffocating.

Emily:

And the worst part of it all, it's not just society's stigma, it's internal. It's me thinking I should be able to push through, that I should be like everyone else, but the truth is I couldn't, and the more I tried, the more I felt like a failure, like I was letting everyone down. It made me hesitant to talk about it, hesitant to admit that I wasn't okay. What would people think? That I was unreliable, that I wasn't enough, that I was just making excuses. Living with bipolar disorder often felt like a full-time job within itself, one that didn't come with any sick days or weekends off. It was a job I didn't ask for, but one that I had shown up to for every day, no matter how tired I was. The hardest part wasn't just the work, it was managing that invisible barrier, the stigma that seemed to follow me and that, I think, is where some of the real struggle lies, not just in the physical exhaustion of working, but in the constant carrying the weight of not being enough and feeling like I was failing because of something no one else could see. I know I'm not alone in this. The stigma surrounding mental health is real. Know I'm not alone in this. The stigma surrounding mental health is real, but it's just one piece of a much bigger puzzle.

Emily:

Disability in general, whether it's mental, physical or otherwise, comes with this huge societal weight attached to it. Ableism is rampant in our culture, especially in the US. We've built a society that places a premium on productivity, independence and the idea that you should always be able to pull yourself up by your bootstraps, no matter what. And if you can't keep up, if you can't function at that level, well then something must be wrong with you, right. What people don't realize is that this deeply embedded ableism doesn't just affect those who are physically disabled. It affects anyone whose mind or body doesn't align with the ideal of constant efficiency and success. People with mental health conditions, chronic illnesses or invisible disabilities are constantly fighting this message that they're not enough. We're told we should be able to work, perform, succeed, and if we can't, it's our fault. That somehow, if we just tried harder, we'd be okay, that somehow, if we just tried harder we'd be okay.

Emily:

Ableism shows up in many ways, from the casual, offhanded comment to systemic exclusion in the workplace, in education and even in healthcare. It is in the way people look at you when you say you're struggling, as if they can't see your pain. It's in the way employers and institutions expect you to work at full capacity, without recognizing the limitations that mental illness and disability can impose. It's the absence of accessible infrastructure, the lack of mental health support and the idea that if you can't fit into the mold of productive, you're somehow less than I think it hurts most when we internalize this the idea that we are somehow less valuable, less worthy, because we can't meet the standards set by a system that wasn't designed for us. We're made to feel like we're failures because we can't meet the standards set by a system that wasn't designed for us. We're made to feel like we're failures because we can't keep up with a world that doesn't even make space for people like us, and that, to me, is the real cruelty of ableism. It's not just the external judgment, but in the way it seeps into our own self-worth, making us feel like we don't belong. It has taken me a long time to realize that it wasn't just about me being weak or not trying hard enough. It was about a society that wasn't designed for people like me, for people who need flexibility, understanding and, most importantly, a space to just be. But that space it's hard to find when you're constantly being told that the only way to be valuable is to keep up, no matter the cost. And here's the real kicker Disability is not something that happens to a select few.

Emily:

It is something that can and will happen to all of us eventually Age injury, chronic illness. It's not a matter of if. It's a matter of when. Disabled people are the only group of marginalized people that anyone can join, literally at any time. I don't mean to be a fear monger, but I have a point. In a society that values independence and productivity above all else, we're constantly pushed to believe that being disabled is something that can only happen to other people.

Emily:

But the truth is, disability is a part of the human condition. It's a part of life and at some point it comes for everyone. The fact that we don't talk about it more openly, that we ignore it while it's staring us in the face, just perpetuates the shame and stigma surrounding it. So why is it that we continue to treat disability, whether mental or physical, as something that makes someone less, something that should be hidden, ignored or overcome at all costs? We all deserve to live in a world that acknowledges our inherent value, no matter our abilities, and yet we continue to fail to create that world.

Emily:

And, truth be told, some days it felt like the weight of all that was just too much. Some days I couldn't fight against the world's expectations anymore, so I did what I had to to get through, and for me that meant curling up on my couch, my trusty spot for when the weight of the world felt like too much to bear. On one of those days, I found myself back in my familiar spot, watching catfish. Again, the world outside didn't matter. My mind slowed down just for a little while. I wasn't thinking about my diagnosis or my next steps. I wasn't measuring my worth against anybody else's expectations. I was just existing, and maybe that was enough. For that moment, I find myself thinking that a lot in recovery, it's okay if things are just enough.

Emily:

Recovery isn't something you finish. It's something you live with day after day. I used to think it was a race, a straight line you crossed once and for all. Fuck, I thought I'd crossed it, but it's not how it works. Some days the fog doesn't lift. Some days I'm still figuring out how to be me, but somewhere along the way I started realizing that it's okay to not have it all figured out. Some days, enough is just getting through the day, and in that I found a strange kind of peace, not because I was better, but because I was starting to accept that this is who I am. Maybe that's enough for now. Accepting that enough was okay is one thing, but staying stable that was a whole other battle.

Emily:

Recovery isn't just about getting through the worst of it. It's about doing the work every single day to keep yourself from slipping back under. There's this idea that once you've come out of a mental health crisis, things just magically level out like you've beaten it. But the reality is maintaining your mental health is a full-time job, one that doesn't come with days off and, at the center of it all, medication. But here's the thing no one tells you. Getting on the right treatment takes time. You don't just walk into a doctor's office, get handed a perfect pill and suddenly feel like yourself again. It takes months, sometimes years, of trial and error, side effects, adjustments and learning how to advocate for yourself in a system that isn't always built to listen. And as an example of that, let me tell you about Depakote.

Emily:

When I first got put on Depakote, I was willing to try anything. Well, they were willing to try anything. I had just come out of a full-blown psychotic break and my doctors were throwing everything at the wall to see what would stick. Seroquel, risperidone, latuda was a fun one, but we landed on a cocktail relying on a heavy anchor of a couple thousand milligrams of Depakote a day, and at first it seemed like it was helping. My moods weren't as extreme, my brain wasn't running a mile a minute, but then the side effects kicked in.

Emily:

Like I've said many times in this podcast, I was exhausted all the time. Not oh, I didn't sleep well last night, but bone deep can't keep my eyes open. Exhaustion, and I gained weight fast. A lot of weight until I barely recognized myself in the mirror. A lot of weight until I barely recognized myself in the mirror. My brain felt foggy, like I was constantly wading through static and the worst part I felt nothing. No highs, no lows, just this dull, empty, medicated haze that made me feel like I wasn't even living my life. I was just watching it happen from a distance, and I stayed on it for over a year because I was afraid to ask for a change, because my doctors told me it was working, because I thought maybe this is just what stability feels like. And if that was the case, stability sucked.

Emily:

It took me a long time to realize that just because a medication is helping you from falling apart doesn't mean it's actually helping you live. That's why self-advocacy is so important. I had to fight to get off Depakote. I had to push back when my doctors wanted to keep me on it. I had to remind them that stability at the cost of actually feeling like a person is not stability at all. Then I finally found a doctor who listened to me, not just to my symptoms, not just to my chart, but to me. I told him how Depakote made me feel like I was barely existing, how I was muted, weighed down, not myself. And instead of telling me just to give it more time or that maybe this is what I was supposed to feel like, he actually heard me. He took me off Depakote and put me on Vralar instead, and for the first time in a long time, in a long time, I felt clear, I felt awake, I felt like me. Vralar isn't perfect no medication is but it works for me. It keeps me stable without making me feel like I'm disappearing inside of my own head.

Emily:

It took me years to get to this point. Years of trial and error, years of pushing back, years of doctors who didn't listen, before I found one who did. And even then, after that, there was another problem Getting the medication. Braylar is brand name only, no generics, and in the wonderful broken system that is US healthcare, that means it's stupidly expensive. And at the time I was on Medicaid, which, spoiler, did not cover it. So even though I had finally found a treatment that worked, I couldn't actually get it.

Emily:

My doctor knew how much the medication was helping, so every month, four months, he gave me samples. I'd come in, sit in his office and he'd hand me a small box, just enough to get me through to my next appointment. And that's how I stayed on my meds, just enough to get me through to my next appointment. And that's how I stayed on my meds, not through insurance, not through a system designed to keep people stable, but through the sheer kindness of a doctor who cared enough to make sure I didn't spiral while we figured out a long-term solution. Do you know how ridiculous it is to have your entire stability dependent on whether or not your doctor had enough free samples that month To have to ration your healthcare medication like it's a rare resource instead of a basic necessity. I was lucky. I am lucky, but lucky shouldn't be a factor when someone is getting the treatment they need.

Emily:

And then finally, after months of stress and uncertainty, vralar was added to Medicaid's formulary Just like that. One day it wasn't covered and then suddenly it was no warning, no explanation, just a quiet update to the system. That meant I could now get a medication like a normal person instead of relying on samples. And while I was relieved, I was also furious, because why did it take so long? Why did I have to fight for something that was always necessary?

Emily:

That's the reality of mental health care in the US. Even when you do everything right find the right doctor, follow the rules, take your medications, you are still at the mercy of an inaccessible, expensive and bureaucratic system that treats life-saving medication like a luxury. And if you're poor, unmedicated or uninsured, you don't get access to the good meds unless you're willing to fight for them. So when people say, just take your meds, I always want to ask do you know how hard it is to get them? Getting my medication covered should have felt like a victory, and in some ways it was no more rationing samples like some kind of back alley drug deal. No more calling the pharmacy like hey, any chance I could get my life-saving medications without taking out a second mortgage. The system had finally graciously decided that I was allowed to function Amazing.

Emily:

But the thing about mental illness is that the work never really stops. The meds help, but they don't fix everything. They don't make everything go away. They don't erase the years I spent playing medication roulette, collecting side effects like Pokemon. They don't undo the fact that I have to keep doing this appointments, refills, explaining my entire psychiatric history to new doctors who should have it in their system but never do somehow. And I get to do this for the rest of my life. Some days the thought makes me want to walk straight into the ocean, but other days I remind myself I've already made it through so much.

Emily:

I still take my meds every day. Mostly, we're all human. I still go to therapy, even when my therapist hits me with the how does that make you feel routine? And I have to resist the urge to say deeply, susan, it makes me feel deeply. I still build routines into my life, even when I don't want to. I still do the work because I know what happens when I don't. I still do the work because I know what happens when I don't. I know what it feels like to slip, to spiral, to stare at the ceiling at 3am wondering if I ruined my life again, and I never want to go back there.

Emily:

Managing bipolar disorder is a commitment, a lifelong, no exit. Congratulations, you're in this for the long haul commitment, and it's not easy. But I also know that every time I fight for myself, whether it's pushing for the right medication, setting boundaries or just making it through another god awful, mondayful Monday I am choosing to stay. I am choosing me. And after everything all the fear, loss, rage, exhaustion I'm still here. I don't have all the answers, I don't know what the future holds, but for now I know this I have a treatment that works. I have a life that, even on the bad days, is still mine, and for now that's enough. Because, let's be real, some days it's just about making it through, and if I do that, that's a win you.

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