UCSF

This manuscript is an ethnography about people, typically young (14-25) but not exclusively so, and families seeking care in early psychosis clinics, and the psychiatric professionals who provide them with services. I offer insight into living and working in the midst of potential psychosis. I attend to psychosis as experience rather than psychiatric symptom, as something beyond a label that can be assigned to individuals correctly or incorrectly. This study neither tests nor tables the question of what early psychosis is or whether or not early psychosis can be identified and treated. Instead, I show how experience comes to be declared or dismissed as psychosis iteratively through conversations between young people, clinicians, and family members. Diagnosis then proceeds both formally and informally through processes that attempt to order odd, fleeting experiences by chronology and conviction, thereby rationalizing what resists making sense. And yet, in early psychosis clinics diagnostic uncertainty continues to simultaneously demand and destabilize the clinical application of psychiatric categories. I attend carefully to moments of failure, resistance, and destabilization in early identification and intervention. It is within these sites of profound uncertainty that alternative possible explanations and desires emerge—to be personally addressed by a voice that no one else hears, to be worthy of trust and psychotic, to be listened to. Anthropology widely theorizes psychosis as a condition of madness and as extraordinary, most typically through the lens of schizophrenia. This literature highlights the spectacular and unusual aspects of psychosis, its ruptures. Psychosis emerges as an extreme of human experience, distinct from the ordinary and as something that threatens subjectivity across multiple domains. This study, based on 12 months of ethnographic fieldwork access to specialized US early psychosis clinics, shows that in the scene of early psychosis, the symptom evades discernment in its ephemerality, its subtlety, its truth. Psychosis continues to evade rationalization not necessarily because of its extraordinary character, but also in its proximity to reality. I look to the accounts of psychosis shared herein as helping to elucidate ordinary experience not because they are extreme or opposing versions, but because they are in fact ordinary. The widely maintained premise of psychosis as extraordinary, bizarre, and spectacular leaves much of psychotic experience unrecognized and establishes in advance the fact of its unfamiliarity. While anthropology has widely theorized psychosis as extraordinary, my fieldwork poses a new question: if psychosis can be so ordinary, how mad must the ordinary be?