To Whoever De-Escalates My Next Schizophrenic Episode

I hadn’t planned on checking social media that morning.

I’d woken up in my studio apartment in a yellow San Francisco Bay Area Victorian. I rose from bed, made coffee, and sat down at my desk to tackle a work project. I had a pressing deadline, and I didn’t have time to get distracted.

Although, one glance at LinkedIn couldn’t hurt…

I nearly spat out my coffee when I saw the post at the top of my feed: “19-year-old Win Rozario called for help for himself while he was having a mental health emergency and the police murdered him in his home, in front of his family.”

One thought consumed me: It could have been me.

As someone living with schizoaffective disorder, bipolar type (a combination of schizophrenia and bipolar disorder), one of my greatest fears is being killed during a crisis. Too often, mental health crises are met by untrained responders who resort to force. This is why people experiencing mental health crises are 16 times more likely to be killed by police than other civilians stopped by law enforcement.

Stories like Win Rozario’s are why I spent the last seven months developing a new online course, “Mental Health Crisis De-escalation From a Lived Experience Perspective.” Having taught crisis de-escalation professionally and been on the receiving end during my episodes, I know what works and what doesn’t. I’m blending evidence-based de-escalation strategies with my lived experience to make the world a safer, more understanding place.

To whoever de-escalates my next schizophrenic episode, here are five things I’d like you to know:

1. I don’t want to hurt you.

Despite the stereotype that people with serious mental illness are violent, people think we are much more violent than we actually are. Research on this topic varies, as different studies use different population samples as well as different definitions of violence and mental illness. But the general agreement is that the vast majority of people with serious mental illness are not violent. And though some studies find larger links between violence and mental illness, others find no link at all. Due in part to careless de-escalations, we are 14 times more likely to be the victims of violence than to be arrested as the perpetrator.

When de-escalators fear for their safety, they’re more likely to use too much force. That’s exactly what happened during my first severe episode of mania and psychosis.

I was marching up and down a San Francisco General Hospital stairwell chanting the hook of a rap song. Then police officers tackled me to the ground from behind and took me to the behavioral health unit in handcuffs. I suspect they used a disproportionate amount of force because they saw me as potentially violent. In reality, I had no violent inclinations.

If you see someone like me in psychosis, please consider your options. Instead of using force, try to empathize, communicate, and collaborate. You’ll be much more likely to achieve safe outcomes for everyone.

2. You caught me on a bad day.

I think many healthcare workers and first responders who see me in psychosis assume I’m always like that. But most of the time, I’m an ordinary San Francisco Bay Area millennial. I work full-time as a communications manager for a national nonprofit organization, have a degree from UC Berkeley, and give back to my community through advocacy and volunteer work. By recognizing that someone’s crisis behaviors are not indicative of who they are, you will be able to keep their humanity in mind and de-escalate them safely.

3. There’s a good chance I’ll remember this.

I can’t tell you how often others falsely assume I can’t remember my crises. Yes, memory gaps can happen with serious mental illness. But when I’ve checked my medical or police records or talked to people who witnessed my episodes, I’ve found I remember the incidents well.

Assuming those in crisis won’t remember anything is dangerous. It can cause de-escalators to use too much force because they think we won’t be traumatized. But people in crisis are capable of the full spectrum of human emotion, thought, and memory. Keep this in mind the next time you encounter someone in crisis.

4. Work within the logic of the delusion.

An essential rule in crisis intervention with individuals experiencing psychosis is to never directly challenge our delusions, as this can cause further escalation. Instead, find ways to work collaboratively toward your goals without contradicting us.

My mom implemented this strategy perfectly when I was paranoid about showering due to fears of being watched. Despite typically showering daily, my concerns led me to avoid it.

Psychosis Essential Reads

A First Episode of Mental Illness

Navigating Mental Crises

When I explained this to my mom, she responded, “Thank you for sharing that with me. It's completely reasonable not to want to feel watched in the shower. How about we try a sponge bath at the sink with your clothes on?” Her response honored my feelings while finding a practical solution that respected my beliefs.

5. Even if I can’t say it in the moment… Thank you.

People in crisis may struggle to express gratitude in the moment. When experiencing mania or psychosis, communication can be challenging and thoughts may be clouded by paranoia. Though I can’t always express it, I am still grateful to de-escalators who treat me with respect and dignity.

I often think about a police officer who responded to my mom’s 911 call during the ten months of psychosis I experienced at my onset. I was terrified he wanted to hurt me the whole time he was in our home, so I was irritable and uncooperative. But he let my unruly behavior roll off and employed proper de-escalation techniques to soothe me and guide me into the ambulance.

I wish I knew the name of that officer so I could thank him. But I don’t, and I can’t. So instead, I’ll thank you. On behalf of all the people you’ll safely de-escalate who may be unable to express gratitude in the moment, thank you.