Patte Randal: A doctor’s story of recovery from psychosis

Dr Patte Randal believes her psychotic episodes have helped her find purpose and direction in her life. Photo / Babiche Martens

In a new book, Dr Patte Randal shares her story of recovery from psychosis. She tells Joanna Wane why our approach to psychiatry needs to change.

I have jumped off the top of a flight of stairs, believing I would miraculously float to the ground as gravity no longer existed for me. I have travelled on the edge of time. I have been terrified that I, and my baby, were caught in a nuclear winter. I have lain on the floor of a mental health facility, believing that I could become two-dimensional and escape between the molecules of the wall.

It reads like a science fiction fantasy, but for Dr Patte Randal — who spent three decades working in psychiatry and mental health — the episodes of psychosis she’s describing were vividly real. Terrifying and nightmarish, yet touched with what might almost be called ecstasy.

The first time she spiralled into what she prefers to call an extreme state, Randal was 24 and working on her doctoral thesis at Sussex University in the UK. On a hiatus from medical school, where she’d quickly learnt there was no room for showing emotion or vulnerability, she’d suddenly found herself alone with a young son after the collapse of her marriage. When her father died of lung cancer, it felt as if the invisible anchors that held her world in place were being set adrift.

A notebook she kept at the time shows her mental state unravelling. Randal didn’t know what was happening, but she didn’t find it frightening, either. To her, it was a “mystical experience, full of meaning and revelation”.

She remains thankful to this day that she wasn’t locked up in a psychiatric hospital (Tony Ryle, the director of the student health centre who took her on as a patient, would later become known as the founder of cognitive analytic therapy). Medication was still the first line of treatment, though, and a potentially fatal reaction to the antipsychotic she was given left her reeling.

“In retrospect, I can see that the real-life happenings prior to this extreme experience triggered a meaning-making crisis in my ‘psyche’ or soul,” she recounts in Finding Hope in the Lived Experience of Psychosis, a deeply personal book she’s written in collaboration with Auckland psychiatrist Josephine Stanton, a close friend and colleague for the past 30 years. “The hard reality is that gravity still existed and it came back to meet me with a thump.”

Randal and Stanton met when they were both training at Carrington Hospital as psychiatric registrars. The book weaves together their intersecting memoirs as doctors with first-hand experience of psychosis — from the outside through their professional work and from the inside, through Randal’s dual perspective as both practitioner and patient.

Stanton, whose groundbreaking research in the late 90s explored the stories and experiences of mentally ill New Zealand mothers who had killed their children, is still practising as a child and adolescent psychiatrist in an acute inpatient unit.

Randal, who lives in Raglan, is retired from clinical practice but has developed a collaborative resilience-building tool called The Gift Box that’s being field-trialled for use in recovery-based therapy. Last month, she was one of the speakers at a professional development symposium for GPs held in Auckland.

Once diagnosed as bipolar, Randal now thinks that has never been the case. She says each of her seven psychotic episodes happened at times when her life had become too painful and didn’t make sense. In the book, she also explores how events from her childhood played a part. “People who know me have had to take [reading it] very slowly because they’ve been in tears.”

A picture Randal drew during a psychotic episode, describing it in her notebook as a "swirling black vortex surrounded by frightening ghostly figures".

It’s now been 20 years since her last extreme state, which she was able to recover from without taking antipsychotics. In her case, at least, drug treatment seems to have done more harm than good. In 2001, a rare neurological side effect from risperidone affected her ability to speak, reducing her voice to a whisper. While her speech has slowly regained some strength, she’s stayed off medication ever since.

During those acute phases, there’s no question that Randal’s behaviour would have been erratic and disturbing. Yet to her, they were extraordinary, formative experiences, “even in the most extreme times, which had a mix of terror and a sort of ecstasy”. Her notes sometimes produced insights she later incorporated into her therapeutic work.

“The thing that’s been so hard is the impact they’ve had on my family and the other people around me,” says Randal, who has a good relationship with her three adult sons. “But I do see it through the lens of a kind of spiritual emergency that presented me with a bigger picture, as if my life had a direction with a purpose that I could find if I looked for it.

“It was like a tipped-up cosmic jigsaw puzzle and I had to put the pieces back together. Then when I did see them all, it was overwhelming. It was too big a picture. But now I can bear it. I can bear the picture.”

Randal can still remember the moment she decided that she wanted to be a doctor. At the age of 10 or 11, she was watching a little girl sitting opposite her on the train as she swayed her fingers rhythmically in front of her eyes, mesmerised.

“Now I realise it’s called stimming and she probably was autistic,” she says. “We didn’t have those frameworks then. But I could see there was something going on that was very different; something fascinating and important. I had this intuitive leap and thought, gosh, if we can understand what’s happening with that little girl, we can understand what it is to be human.”

As it turned out, she and Stanton came through their training at a time when doctors were expected not only to be superhuman, but the undisputed expert on the lives of their patients. The lived experience in the title of their book turns that dynamic on its head, laying out the case for a paradigm shift in mainstream psychiatric treatment: not “doing to”, from a position of power and authority, but “being with”, by engaging with people in a more meaningful way.

“It’s the subjective versus the objective, really,” says Randal. “And as doctors, we are supposed to be objective. We were being taught to listen to the person in order to make a diagnosis. So we were listening for symptoms. Of course, there’s a place for that, but we weren’t taught to listen to the story. And we weren’t taught to understand our own stories or how to manage our own emotions. So that’s where the lived experience comes in.”

The climate has already started to change, with more doctors openly sharing their mental health struggles, including psychic distress. A greater emphasis on recovery for psychiatric patients is also emerging in medical school, giving hope of a possible future that doesn’t require a lifelong dependence on medication. In the UK, a group of psychologists have formed a group called Drop the Disorder to campaign against a “culture of psychiatric diagnosis in mental health”, and Randal says there’s a lot of international research being done on how to safely take people off prescription drugs.

Randal, left, and Josephine Stanton in 2013 at a psychiatry conference in Edinburgh where they presented their "doctors as patients" research. Photo / Supplied

The book itself emerged from an earlier piece of research by Randal and Stanton, published in the British Medical Journal, on doctors who’d themselves become psychiatric patients. Most believed facing their own mental health challenges had made them better doctors, but they didn’t know how to go about sharing that experience in a meaningful way.

While the identities of the doctors in that study remain confidential, Randal has always chosen to speak openly about her own extreme states. At times, that’s cost her dearly. At one stage, concerns about her suitability as a psychiatric registrar led to her temporary removal from the Auckland training scheme.

Stanton’s clinical work is embedded within mainstream psychiatry and although the two women frequently challenge each other’s views, their friendship is founded on academic rigour and mutual respect. Right from the start, Stanton remembers Randal engaging with a level of intellectual sophistication she’s found to be unusual in a doctor. “Medical school training is very much about learning facts and people don’t do a lot of that sort of philosophical thinking.”

Medication has its place, believes Stanton, particularly for acute psychosis. The reality is it’s also the easiest approach for under-resourced staff on the frontline who lack the time and support to take a more nuanced, therapeutic approach. (The Gift Box, for example, uses a series of cards in different categories to help people understand their patterns of behaviour and articulate their experiences when they can’t find the words. Practitioners need to be trained in its use and the full process takes up to 12 weeks to complete.)

“When I was first a psychiatric registrar, we used to give people a lot of intense sedation and may well have put them in a room by themselves,” says Stanton, who stresses that people who suffer from a psychotic illness are much more likely to be the victim of violence than inflict violence on someone else. “The unit I work in now has had its seclusion room decommissioned. Fifteen years ago, I would have said you couldn’t manage without it. Actually, you realise that you can.

“As psychiatrists, we do have expertise and we do have a lot to offer, but it’s really important to offer it in a way that doesn’t trump people’s own knowledge, but helps bring forward the expertise and resources they may not even realise they already have.”

Randal painted this picture of a vivid dream she had where her dog Buffy had accidentally killed her Burmese cat Yoko, who was actually still alive but in pieces, like a jigsaw puzzle, on the floor. As she woke, she distinctly heard the words "You are to be professor of psychiatry". Her life, however, would take a slightly different path.

In her endorsement of the book, former mental health commissioner Mary O’Hagan says Randal has used her lived experience to foster connection, meaning and hope while many of her colleagues were steeped in “psychiatric pessimism”. An American production company has expressed interest in making a documentary about it.

In certain circumstances, believes Randal, extreme states can happen to anyone. Much of her professional career has been spent working with people who have what’s known as treatment-resistant psychotic illness, a term she doesn’t have much time for. “I always believed it was our medical approach that was resistant. The important thing is learning to manage one’s vulnerability and acknowledging we all have vulnerability. And even after the most extreme things, there is hope.”

• Finding Hope in the Lived Experience of Psychosis: Reflections on Trauma, Use of Power and Re-visioning Psychiatry, by Patte Randal and Josephine Stanton (Routledge, $47.99) is out now. For more information on The Gift Box and other therapeutic strategies, visit talkthatheals.org