My idea of psychosis starts with the supposition that my neurons are bathed in cortisol, the “fight-or-flight” hormone. The cortisol mechanism evolved to elevate to make you run from saber toothed cats and then to recede when you laugh about nearly being eaten alive in the safety of your own cave. In the modern world, there is hardly anything to physically fight or any reason to flee. There are still plenty of threatening things in society and the corporate world, and there is no clear beginning or end point to many of these problems.

I experience this presumed overdose as a hyperawareness. I am searching for what is wrong. I am worried about the opinion of others. I am concerned about personal and moral failings. I am anxious about the accuracy of information. I am debating back and forth my perceptions and my perceptions of the perceptions of others. All these things are threatening. The world takes on another look. Things normally unnoticed appear significant. The whole world looks different and unsettling because it is seen anew. It is threatening because it is unfamiliar. Something posted on the wall, ignored before, seems to have special significance. Was it put there for me? Was it put there to deliver a message or to shame? There is a name for this phenomenon: Ideas of reference. And there is a certain logic to it, too. Because you feel vaguely threatened and are searching for the source of the threat, why wouldn’t you examine every possibility? And to make matters worse: Are you responsible for the threat? Is it a response to something you did? Are you guilty of anything? All this happens in a brain working at 100 miles per hour trying to sort this all out.

A large part of being crazy is simple pattern matching. Word play. My parents were married on Whidbey Island north of Seattle. Whidbey…wood bee…would be. Would be? What would have been? What would have been if I hadn’t been born? Would the world be a better place? That is a pretty damaging thought and possibly a dangerous one. Nazi. Naught zees. Not see? Why didn’t I see that before? What am I not seeing? It wasn’t that I was dreaming of committing atrocities. I was more worried that I would be falsely implicated in them for some reason. There is a lot of guilt and fear associated with this line of thought.

My most recent episode, and “episodes” are what they are politely called, started with this book. I wanted to write this book and thought I needed to set aside time for it. I was in my late 50’s and decided it was now or never. I proposed to Peter Whitney, my boss at Axsun Technologies, that I just work three days a week. My intention was that I would work weekends as well but needed quiet time during the week for the book. It was a poor financial arrangement for me since I was only paid for three days. The advantage was that I had two days of quiet time for the book and two days quiet time for my photonics work on the weekend. Interaction with others happened during my three weekdays.

As an aside, I’ve found out that writing actually takes very little time. It is not many hours, but it is a lot of days. I needed to sleep on every event in the book to get the next idea. Wordsmithing itself is not all that time consuming. Once the events I’m describing here played out, I found that writing just one hour in the morning did the job, but I had to keep it up for months and months of sleep cycles.

My plan, while agreed to by Peter, was controversial. He wanted to delay my leave for a while. A problem arose because the company was purchased by an outside investment company, Anzu Partners. We badly needed someone to buy us from Philips Corporation who had no interest in us. (Philips had recently acquired Volcano Corporation, of which we were a part.) Without a buyer, Philips would have shut us down. Anzu made a good investment. We were losing money but worked to turn around the company and earn the rescue. Anzu got us for a song. They were taking us on at the exact moment when we became profitable, so they didn’t have to spend another nickel to support us. We had a strong optical coherence tomography business that we would grow and then Anzu and some of us with stock options would profit a few years down the road. Anzu wanted everybody on board pulling the oars in synchrony. Nobody said anything, but my three-day plan rankled. I could feel it. The whole thing came to a head at an evening meeting where senior employees were introduced to the board. Several board members made comments of public exasperation with me. I was not a team player in their eyes. It unnerved me that I was never taken aside, and all of a sudden everything was public, even though earlier I could feel the transgression in my bones. I didn’t go crazy suddenly. It had all built up over the preceding months of tension.

I noticed that a lot of small cities in Minnesota had entries in the American Heritage dictionary. It seemed to violate the Copernican principle. It made self-effacing Minnesota seem more important than it is in reality. Even my mother’s hometown of Hibbing, population 21,000 in the dictionary’s entry, was mentioned. There is a narcissism that goes with being crazy. Everything seems to center on you. In my current, less stressed state, I can see that many small towns in Wisconsin have similar coverage. The towns are small, but generally have populations greater than 20,000. An exception is Sauk Centre, Minnesota at a population of 3,700. It is listed in the dictionary because Sinclair Lewis was born there and wrote about it in his novels, including Main Street.

In my latest episode I pondered the idea that “nothing is sure in this world except death and taxes.” That’s a joke because it’s seen as a perverse truism, but what if it was really an ironic joke meaning the opposite of what it says. Sure, some people don’t pay their taxes so there really is nothing certain about taxes. But what about death? Is that certain? I was mulling over that in conjunction with another idea. There is a physical reality around you as you are opening doors and sitting down at your desk, but much of what you know was just told to you by other people. How reliable are they? They are the people that told you that Jesus Christ is our Lord and Savior and that the world is 6,000 years old. The crew that says the earth is 4.5 billion years old and the universe 13.8 billion, are they any better? Are other people reliable sources of information on anything? Do they lie to you? They tell you that gasoline runs your car. An automobile is black magic. Maybe they just tell you that to make a buck and the gasoline doesn’t really do anything. If death is not certain, a lot of other things aren’t as well.

This is an endless chain of “reasoning” in the sense that I would latch onto one hypothesis and follow its logical implications. If death is not real, then why have I been kept in the dark? Who knows about this? What is the purpose of me not knowing? Those in the know, do they have evil or benign plans for me? Are they trying to hurt me or help me? I mulled over both possibilities. Perhaps they were trying to gently introduce me to the truth. Now that I know, what should my plan be? How do I confirm all this? Again, I thought these things in the sense of thinking them, but not in the sense of fully believing them. I was dredging up all kinds of wild thoughts and accepting or rejecting them as best I could. It was as if the scientific method was still functioning, but Occam’s razor was shot. My fundamental self-doubt was still intact.

That whole line of thought was very upsetting. Instead of firm intellectual ground below me, I had very, very thin ice. Discussing “what is reality” is a fine diversion in the parlor over tea but you should leave it at that. Real reality is very serious business. I couldn’t talk to anyone about this since I knew these thoughts were crazy. What would they think? That, after firm persuasion from my wife, landed me in the hospital.

Hospitalizing me is a talent my wife, Jeanne, has acquired over the years of our marriage, although each time is improvised. It requires the help of a mental health professional. My psychiatrist was someone I saw once every six months to pick up my scripts. He worked in a busy group office with lots of patients vying for the attention of the receptionist over some sort of insurance problem. I favored first-in-the-morning appointments. He was always late and a bit disheveled. My wife had no idea how to contact him.

Jeanne enlisted the help of a child psychologist she knew. We went over to the psychologist’s office in the evening, and the two of them started working on me. I was reluctant to go. Stubborn, actually. I was looking around the office with its child-sized table and chairs and brightly colored toys. What were they telling me? That I’m a child? Acting like a child? I resisted and resisted. They said you’re going, you’re going. It was late. I finally gave in. They found me a bed at the Arbour Hospital in Jamaica Plain, Massachusetts. First Jeanne drove me to the emergency room at Lawrence General Hospital. They loaded me in the back of an ambulance for the long ride into Boston. I arrived in the early morning and had to go through the check-in procedures before landing in an adequate, but very compelling bed. I needed sleep. It didn’t matter that I was in a room with three other troubled strangers and staff were sweeping flashlight beams to check on us.

The next day I met the doctor. He asked me what my problem was and I, trying to feign sanity, said that I overinterpret things. Signs on the wall, what people say, the like. He thought it sounded “exhausting.” He had a kind of breezy and vaguely British style about him. I liked him. I was unnerved later when he went on vacation and there was a substitute doctor. She was kind of dark and quiet and seemed a little sinister to me. She was also the electro-convulsive therapy (ECT) doctor. I wanted to stay away from ECT.

In my state, such an unfamiliar setting, while safe, was unsettling. The surroundings and people were unfamiliar and literally strange. It was a hard place to be in a wary state, not that I was cowering in the corner. I tried to be cooperative and went to meetings and made my bed. I was worried about being locked up forever, lost in the bowels of some institution. There were rumored to be wards with locked rooms and restraints on the other side of the building. I definitely wanted to stay out of there. You could see the windows on that ward from the basketball court outside the building. Just being that close put me on edge.

It was an eye-opening place for a person used to plain-vanilla suburbia and the blinking computers and instruments of an optics lab. I slept in a room with three others. The person just across the aisle from me made big money under the table from painting over a 10-year period. He became unmoored when his partner left the business and he had been bouncing from institution to institution ever since. There didn’t seem to be too much wrong with him, but he was angling to get into another program. There were people on permanent disability. One person back from ECT looked just terribly, terribly sad. He sounded like he should be crying, but he wasn’t. There were drug addicts, grateful to the Lord that they had been clean for a few weeks. One thoughtful person just had anger management issues, not that I saw any. He tried to learn from the Bible and the Quran, and always tuned in on television preachers in the common room. There was a woman very conversant in psychological terminology and had diagnosed her whole family. She spent a lot of time on the phone talking to legal authorities. I didn’t think she was very introspective. A kid, accompanied by his worried mother, showed up for a couple of days. He took an interest in me because I was from MIT and challenged me to a game of chess. He was in the process of applying to colleges, very fancy ones. I have no idea why he was at Arbour. He seemed normal to me, but now he has a record that he will have to explain for the rest of his life.

As I said, the usually overlooked became large and significant instead. I was amazed at the amount of trash generated at mealtimes. Arbour had a cafeteria with hot meals, but the plates were paper and the utensils plastic. All of the trash bins were heaped with paper cups, straws, napkins, cereal boxes, and those peel-off plastic tubs with butter and maple syrup. I saw it as a parody of unsustainability. It confirmed to me that the world had gone nuts and we could not go on like this for much longer. I misjudged the capacity of incinerators and landfills.

The medication station had me doubting the value of what I do in life. I would stand in line with my tiny cup of Kool-Aid waiting to wash down my pills. There were always delays as attendants called one another over to help with a sub-menu or a sub-sub-menu on the computerized patient tracking system. It was as if all this technology had sent us backwards. It was another parody of progress. I was doubting everything, even the truth and value of my work, and here was proof that it was all worthless!

I had a lot of time to observe. I was curious about the thick cables outside the window that led to the apartment houses across the lawn in what was a nice Jamaica Plain neighborhood of winding streets. What was the purpose of them? What kind of spycraft was involved? It turns out that what looked like residential apartment houses were Arbour administrative buildings with a need to connect to the main hospital building.

The telephone is the link to the outside world. The ward had one mounted on the wall with a too-short armored cable to the receiver. I had to bow my head to talk. When it rang, it was almost never for you, and you would have to scurry around to find the lucky recipient of the call. In the open, your business was everybody’s business on that telephone. Some spoke loudly and you knew every detail of their preoccupations. I tried to keep my voice down and not speak at length. Jeanne called. My kids called. Friends called. I didn’t know what to say.

Visitors were permitted during certain hours. Walid Atia, Steve Minehan, Carla Fujimoto, friends mentioned elsewhere in this book, visited.

There is not that much to do on a ward. They have group meetings and encourage people to talk. I would try to say something innocuous. They have arts and crafts groups, a little like what your five-year-old does in school. There is scheduled television time. Sometimes they had group games. I worked on jig-saw puzzles, read my Kindle, and paged through an annotated Bible.

I assembled a jig-saw puzzle that had a painted 1930’s street scene. It was a picture of Main Street with an antique store, bakery, and the like. A mother pushing a baby carriage and kids in newsboy hats and flyer helmets populated the street. The word “Americana” arced across the top of the picture. That bothered a loud-mouthed patient. “Ameri-cana?”, she announced to everyone. “Ameri-can!”, she corrected. Late one night I found the puzzle piece incorporating the final “a” in Americana missing. I found the situation a little bit spooky and threatening. This woman made many other loud pronouncements as well, over a period of days. There was cheering and clapping when she was finally moved to another ward. I wasn’t the only one she annoyed. I stayed on the ward through a very quiet Christmas. Jeanne stopped by, but there was little other activity with the skeleton staff.

This time they didn’t perform ECT. Under medication, my mood improved, and I slowly lost hold of my crazier thoughts. I wasn’t verbally angling to get out, but was relieved when my doctor, the breezy Brit, suggested it was time for me to go home and that I would be let out in the next couple of days. On the appointed morning, I sat anxiously by the telephone with my belongings in a brown paper bag with handles waiting for Jeanne to arrive and usher me into the free world.

I was still holding some nutty thoughts at arm’s length when Jeanne drove me through the streets of Jamaica Plain towards Interstate 93 North to home. Returning to work, I gradually settled back into everyday reality. Without the quick turn-around from ECT, the whole lingering experience left me with a visceral sense of the paper-thin basis of reality. It is true that most of what we know is just stuff others have told us. How reliable are these people and what is their personal reality? Best to not dwell on that.

There is crazy and then there is crazy. I’ve never heard voices. I’ve never had hallucinations. That is not to excuse myself. I have had psychotic features, according to diagnosis. Strictly speaking I’m not sure I’ve had delusions:

      Delusion (noun) de·lu·sion | di-lü-zhən Psychology : a persistent
      false psychotic belief regarding the self or persons or objects
      outside the self that is maintained despite indisputable evidence
      to the contrary.

I have had crazy thoughts, but I’m not sure enough of myself for one to say that they were “maintained”. It is common with observers of deluded people to say that they thought this or that crazy thing. Maybe you would have claimed that had you talked to me amidst a psychotic episode. I would say that these notions were considered, but not thought in the sense of my being sure of myself. Having said that, I’m not sure anyone would think any better of me with that explanation.

Previously, at Bell Labs, I was very concerned about what people said about me behind my back. People did gossip. People were critical. I was paranoid, although I don’t think I was all that abnormal. I was right to be concerned. Ultimately, I was fired from that job. If you end up in the hospital because of it, that is a clear dividing line.

Again, I don’t want to excuse it, but paranoia is a self-preservation instinct. By nature, I’m a very careful person, to the point of personal and professional impediment. I worry about what others think, but I don’t typically worry about physical harm. This kind of thing has been a burden all my life.

With the notable exception of that jump, my innate caution and reluctance to do the irrevocable kept me from doing stupid things. It is possible to move around and do everyday chores since those functions reside mostly in the autonomic systems. The problem is when the conscious mind is preoccupied 100 per cent. Usually the mind alternates between conscious thought and daydreaming at a comfortable pace. In fight or flight mode, where you are fixated on a vague, but inexplicitly pressing problem you are occupied fully. It is very draining. In this most recent episode, I was so preoccupied that I couldn’t get one work-related thought in edgewise. I stood in front of a computer trying to make my optical system work. I would make one click and then be bombarded by extraneous thoughts. Another click and then the same. I couldn’t make progress. I left for home.

People think that there is no self-awareness in a psychotic state. Judgement is certainly impaired. To say that you just think silly things and take them at face value wouldn’t be true. I knew I was crazy. I knew not to share these thoughts with anyone. That is not a healthy instinct. In my case, it is borne out of a fear of asking questions and of revealing myself. I was always the person at the back of the class who asked no questions. That engendered in me a strong self-reliant instinct. That is a fine thing most of the time, but not in a psychotic state.

As I write this, I have been rereading Daniel Kahneman’s Thinking Fast and Slow. It strikes me that psychosis, or maybe just psychotic features, are just unthrottled normal brain behavior. I don’t for a minute think I’m brain damaged. Kahneman and others divide cognitive function into two parts. (1) A fast, automatic and unconscious associative memory he calls System 1 that does pattern matching and unconsciously conjures up “stories” to explain the surrounding environment, and (2) the slow, calculating System 2 that closely examines what System 1 serves up. These stories, or conjectures, are sometimes true and sometimes false, but they are immediately served up to keep pace with the world. They very often err on the side of caution, he believes, because it is safer. We naturally respond cautiously to novel situations. Animals suspicious of novelty survive longer and go on to reproduce, making them more fit in the Darwinian sense. It is up to the slow thinking System 2 to examine these conjectures more closely and to possibly overrule them, which takes time and conscious effort. System 2 is the part of the mind that does calculations and logical thinking. System 1 is intuitive. In familiar surroundings it can be quite accurate in its predictions given that you have experienced this material over and over again. It is not surprising that under stress, System 1, working in an unfamiliar emotional and differently focused environment will cough up more and more unreliable hypotheses, and at a very rapid rate. It is doing this because it is dealing with more and more novel information and stimulus brought about by this chemically induced hyperawareness. It wouldn’t be unreasonable to think that System 2 would be overwhelmed in such circumstances. That is what is so upsetting. Your System 2 knows that you are crazy and can’t sort it out fast enough. That is my interpretation. I leave it to the experts to poke holes in it.

All of this pattern matching, obsessive chain thinking, willingness to reject fundamental suppositions is like a superpower that can be used for good or for evil. I use that tenacious thought process and willingness to discard preconceived notions in my engineering work. The troubles I’ve had are not a product of brain damage or fundamentally disordered thinking. It is a problem of modulation, perhaps from the cortisol. The difference with me is that I may routinely skate slightly closer to the edge.