When Depression Includes a Terrifying Break With Reality

Ginny Cutler, CPCC, LMFT
16 min readJun 18, 2021

The story of my ‘event’, my recovery, and how I learned to help others recover.

My interpretations of this artist’s rendition of The Scream: the screamer is standing next to a fence, screaming, as ‘normal life’ is on one side, and a frightening, distorted land and skyscape is on the other.
Photo by Yosh Ginsu on Unsplash

As the pandemic unfolded, and many began to struggle with new or exacerbated mental health challenges, it triggered the memory of a dark but deeply defining experience of my own.

It was an episode of a severe kind of depression that carried the label ‘Major Depression with Psychotic Features.’This kind of depression is so catastrophic it can break you. It came close to ending my life before it even got started.

Depression with psychosis is a rare subset of the more common Major Depression. Psychosis means the ‘presence of hallucinations and/or delusions. Those are the hallmarks of psychosis, further defined as a loss of ‘contact with reality.’

But this is no where near the whole story. This definition is limited to ‘consensus reality which is itself, a shell of the reality that’s truly ‘there’ in each moment. As for ‘out of touch’ with realty, psychosis is represented as a distortion of everything, including the self. In my experience, I was still me, able to clearly observe what was happening around me, to me. I was in a horrible, distorted, altered reality and I desperately wanted out of it. But it was close.

Unless there is a physical cause, such as a tumor or an illness that alters the brain, triggers of psychosis can be excessive stress, uncertainty, and traumatic events. For anyone with susceptibility, and that includes those of us not in touch with or listening to our deeper, honest selves, this pandemic could do it. It becomes dangerous when the experience includes a sense of utter aloneness and isolation. That means people may not ask for help. And a particularly dark altered sense of reality is frightening and can increase the risk of suicide.

I want to share my experience in the hope it can help even one person get through something like this. I share what worked and didn’t in piecing together a Recovery Plan. I end up with the profound realization of the role my childhood limiting beliefs played in my tendency toward depression and what is escalated into.

It is amazing that so many are opening up about their own experiences. Depression, particularly severe depression is one of the hardest and loneliest things a human being can endure. it’s frightening and devastating and we have to talk more about it, particularly about how we can help someone we love that might be in the throws of it.

What happened

Looking back on a confusing and chaotic childhood, of course, I was unhappy most of the time. I felt ‘wrong,’ misunderstood, and judged. Despite that, I had friends, played sports, and did reasonably well in school despite hating it. I felt trapped in my family, trapped in school, and would often shut down to cope. Depression was my default.

I left home at 18, thinking I would finally be in control of my life. Within a year, it all came crashing in on me. I was working full time in my stepdad’s company learning bookkeeping. I hated that too. But I needed the money to pay for living expenses now that I was on my own, going from one trap to another.

My work environment was heavy with people using drugs. I started using easily available amphetamines to get through my days, and no doubt that was a contributing factor to what was building. I had disconnected from old friends. I had little in common with my work friends beyond regular complaining about work, other people, and life in general. I was going through the motions hoping something would change. I slipped into a routine, uninspired existence. I couldn’t see how to get out of what I had created. I was already depressed and withdrawing.

At some point, I noticed this depression was different. There was a numbness, then a harsher emptiness appeared. Everything began to feel ‘wrong,’ distorted in a sick way. I got scared. The emptiness now had movement, becoming a roiling inky blackness. It began to feel like an ominous presence lurking in the background. A menacing cloud moving in the air, filling up the space where people might stand. This brutal void seemed to always be right there behind me, somehow alive. It felt evil. To me, it was ‘not of this world,’ but I didn’t know what that meant.

Photo by Yosh Ginsu on Unsplash

Each day that passed, it grew more substantial, more consuming, more menacing. It was incrementally replacing the life I once knew with an ugliness and ominous isolation so frightening it was crushing any sense of hope. It was a heavy, dreaded thing that I was utterly powerless over. It wanted something, and it seemed to be waiting. I grew desperate. The more this dark presence filled my waking life, the more I felt life as I had known it slipping away. That sense of loss was unbearable. This was impending annihilation.

I was utterly alone in this terrible place. Any sense of connection to any other human being was fading fast along with the only reality I had known all my life. My only relief was sleep. I would somehow make it through the day, go home and crawl into bed to escape. In sleep, everything turned off for a while — no dreaming, only welcome oblivion.

II didn’t believe I could talk to anyone. I felt there wasn’t a soul in the world who would understand what was happening to me, much less help me. So I didn’t ask for help. And I couldn’t take much more.

Sleep was a temporary relief, but waking up was like taking a sword through my heart. The dread would flood back in and devastate me all over again. The presence was always there, waiting to suck up my very essence, and it was patient.

Until one day, something else happened. I had the vision of myself standing on a fence, looking at either side at once. On the left was the oppressive, threatening blackness that commanded all. It WAS everything. There were no people there, no signs of life in that terrible place — only that evil emptiness, oddly filled with a living, predatory essence. Standing there, I understood why people end their lives. I saw how that could make sense, how it could feel like the only solution.

On the right, there was life as I had known it could be. Full of light, thriving nature, lush foliage, bright blue sky, and warm, nurturing sunshine. I could sense the goodness there, the ‘rightness’. Looking at that scene, I felt a flicker of longing somewhere in me. It was pushing up, trying to get bigger. And then I had this thought. ‘I want my shot at a life of my own, where I can feel alive and have purpose and connection and love and meaning and happiness, and my very own life story.’

It struck me that as trapped and unhappy as I had believed I was growing up, that didn’t matter anymore. I wanted life, and I wanted my chance. And somewhere, a switch flipped. I thought, ‘I have to ‘try, and my only chance is now. I had to reach out. I had to tell someone.

As if I were being moved, I got up, went to my work, and walked straight into the office of someone I trusted. He looked at me, really looked at me. I tried to talk, but all I could do was cry. He didn’t miss a beat. He sprang into action. He called my family, and they were on a plane within hours.

The Long Road back

It took me more than three years to climb my way out of that devastating place and back into life.

I now understand what happened. I know what it was like. The interplay of emotional wounding from my childhood, physical and psychological distortion from amphetamine abuse, and something way beyond my sense of a personal self, trying to get my attention. Telling me compellingly my life was way off course, which became clearer as I began to find what worked for me in my recovery. Forty years later, this experience is still accessible in my mind and still has a lot to teach me.

Over time I had to change my life completely, from the inside out. What follows is not an ‘exhaustive list of what needs to be in place for recovery. Instead, it is what worked for me, what I was able to piece together with help, re-engage in life, and rebuild myself:

Asking for help

Telling someone was my last hope, and people responded. It wasn’t perfect, and it didn’t need to be. People helped me help myself to come back. I felt seen. They cared. They didn’t have to understand what was happening; they only knew I was in crisis and were there for me.


One of the first interventions considered for me was medication. It was the late 70’s so I don’t even remember what they gave me. It wasn’t until a decade later that the first SSRI came on the market, and medications continued to improve. I might have moved through recovery a bit quicker if a medication could have taken the edge off and allowed me to be available for other healing interventions. But medication at the time wasn’t helpful. It blocked my process, seeming to dull the hint of possibility and hope I glimpsed. So I quit that. Medication was not a part of my recovery.

Talk therapy

For a long while, I was not emotionally and cognitively available for talk therapy. I didn’t want to go anywhere near that darkness. I needed to feel grounded again. Later, talk therapy helped me process the fear and trauma of the experience and acknowledge a lot of childhood pain and resentment. It would set me on a path to discover years later that my own learned, limiting beliefs were the trigger for my depression. These beliefs came forward in my habitual negative self-talk. They were not true, of course, but they sure felt like it. They would trigger unnecessary fear and shame and create ‘stuck.’ I see them now at the core of most of my bad experiences.


I got lucky. I got to work with a psychologist, who happened to specialize in death and dying, thanatology. He taught biofeedback to support people in that transition. And he taught me how to reconnect with my body first and get back a slight sense of control. This also reinforced my new motivation to take care of my body.

He put an electrode on my finger and hooked it up to a little black box with red digital numbers. The numbers told me the temperature on that finger. I would concentrate on making the numbers go up by relaxing. My body responded, increasing my blood flow by reducing muscle tension. That changed how I felt. Then I was more available for talk therapy. Since that early work we did together, I haven’t spoken to this man, who I always believed saved my life. I’m looking for him now; I hope I can tell him the powerful impact he had on my life


If I thought something I ate or drank might influence my feelings, I immediately stopped it like coffee. I stopped all chemicals, anything ‘over the counter,’ even aspirin. I had already eliminated all alcohol or drugs as the depression became frightening. I didn’t know about processed food or sugar, or artificial sweeteners at the time, but I knew I wanted to clean out my body. So I ate straightforward foods. I was afraid of anything from the outside, influencing or altering my mind or energy in any way.


I didn’t talk much about the whole experience with anyone; I’m still not sure why. But I gradually began to spend time with family, then friends. I visited my brother in Quincy, California, and brought home a puppy from a litter the local vet found in the forest.


Now I had responsibility for a little puppy life, requiring me to focus on his caretaking, his emotional and physical needs. Since I still lived in that apartment, we did a lot of walking. He needed play, and lots of it so I learned to play again. That alone was a lot more activety than I had been having for a long time, and it made a tremendous difference in me too.


I wanted to go to college. I knew it was up to me to make sure this kind of experience never happened again. No one else could do that for me. I had to take full responsibility for my mental, physical and emotional being. I had to know; How can this kind of thing happen? I wanted to know about the brain, how the body and mind worked together, and how our environments constantly influence us. I never realized everything was connected before, but now I was sure it all contributed to this ‘perfect storm’ event. I thought school was a place to start.

Purpose and Meaning

Later I would understand the impact a lack of purpose had on me. It was a hell of a way to do it, but this crisis gave me that insight. Now I had one. I knew that if I could help even one person in the world survive and come back from something like this, I was going to do it.

A Recovery Plan like this develops organically. Step by step it creates your life going forward. All the pieces work together. The plan is flexible, changing as you change, as you get better.

Important things to know about severe depression

It is Life Threatening

That sense of utter aloneness is a dangerous thing. We are hard-wired to be connected to other humans, to survive and thrive. Isolation can kill us.

Severe depression is dark energy

Severe depression is extreme and pervasive. It stays. If you’re energy sensitive, this intense depression can be difficult for you to interact with, so have some support for yourself

Everyone’s experience of depression is unique

No, you can’t fully understand what someone is experiencing, even if you have been through something similar yourself. Depression doesn’t have the same causative factors, expression, or path to recovery in any two people. Also unique is how an individual interprets the experience and its ultimate impact on their lives. But when we think we know, when we label something, we risk missing the truth. Then we risk losing our ability to support the person who is deep in a harrowing experience.

Hallmarks of severe depression

A crushing sense of aloneness and isolation are common. Low energy, sleep disturbances, and loss of pleasure are also standard. Those symptoms make everything worse. There is often a sense of emptiness or numbness, a lack of motivation or volition. And a sense of wrongness or brokenness and distortion permeates.


It takes time and vigilance. It happens as we interrupt then change pieces of our lives. What we find contributed to the crisis must be eliminated. Whatever supports our recovery, we need that to become part of our new norm. We’ve got to stay in alignment with those things, do those things for the rest of our lives. The changes have to be for good.

I needed a purposeful direction in my life, something that resonated with me. I needed positive, meaningful relationships. I needed to take responsibility for myself and my life, to understand my very thought system and how it goes wrong. I’m still working on this, by the way.


As with addiction, relapse is always a possibility. We’ve got to know our triggers. Early relief can be dangerous as well. I was alarmed by the waves of depression that swept through me during my recovery. That happened when, unaware, I lapsed into old thinking, into those limiting beliefs. It scared me every time. Until I stuck to the practices I found kept me grounded and connected; I was well prepared to respond to potential triggers. A relapse prevention plan, if you will.

How you can help someone you care about

Say something!

If the idea crosses your mind that someone might be in deep trouble with severe depression, tell them. Share what you are noticing without any expectation of the response you might get. Just let them know you see them, you sense something is very wrong, and you want to help.

I’m here. I love you. I don’t care if you need to stay up crying all night long, I will stay with you… There’s nothing you can ever do to lose my love. I will protect you until you die, and after your death I will still protect you. I am stronger than Depression and I am braver than Loneliness and nothing will ever exhaust me.

Elizabeth Gilbert

Give practical love and support

Major depression can be so bad that the person simply no longer cares about anything. If you can care about that person, focus on what that feels like in your heart. That is when they can really feel it from you.

You want to build trust they can feel that will allow you to be supportive.
In my case, believing that I was cared about when I finally let someone know helped me see through my distorted thinking and start reconnecting to the world.

Be safe company

Have companionable conversations. No stress, no trying to fill the space with words or solve their problem. Talk about what you might typically talk about, the everyday stuff. A sense of mundane normalcy is very welcome. In this way, you can be an effortless, safe harbor. Or simply be there. You are just sitting together or going about doing what you do, and they are included. You don’t have to talk.


If the person wants to talk. Listen to help them articulate their experience. Let them find the words, then repeat back what you think you heard.

I may have gotten more precise about it myself if I could have talked to someone, and they listened and let me try to say it out loud. I would have been able to hear myself try and give it a voice. And it would have felt like a miracle not to hold it alone.

What not to say

Stay away from any conversation that will feel like work. Don’t try to get someone to explain what is going on if they aren’t ready. Don’t say anything about your experiences or what may sound like you know what they are talking about. You don’t.

Don’t assume anything

As if you know what they are experiencing, what the problem is, how they got there or what they need. Don’t compare their crisis to sadness or depression you or someone else you know has experienced. That would just feel diminishing. You risk losing their trust in you as a safe person, and you lose your ability to support them.

Validate, don’t judge

Listen to the real pain in their experience. Confirm that their response to it makes sense. It isn’t that there is something wrong with them or this is a problem to fix. It is something devastating that is happening now and has disrupted their whole world. Check any biases you may have about mental illness, mental health, people in psychological or emotional crisis. You may not even know you have them, but a person feeling judged in even a small way feels stigmatizing. And stigma is part of the problem.

Make sure you are not uncomfortable

Check-in with yourself to make sure you can support them, whatever they need, that you’re not trying to ‘fix’ or ‘solve’ the ‘problem.’ Sometimes, all you can do is help a person feel that they are seen and heard, that you care about their pain.

I had a session with a client years ago who lived his own personal hell with auditory hallucinations and paranoid thoughts. He struggled to tell me that he wasn’t sure he should have come that day, that his ‘thoughts’ were telling him that even I was not on his side, that I was trying to ‘hurt him’ too. We just sat together. I held his hand, and we both sat with the cruelness of those paranoid thoughts and the pain and separation they caused him.

‘Get’ the lesson, apply, transform

“If you can see your path laid out in front of you step by step, you know it’s not your path. Your own path you make with every step you take. That’s why it’s your path.”

Joseph Campbell

Thankfully, the stress and isolation of lockdown didn’t lead to the soaring rates of serious mental health challenges and suicide that were predicted in the US. In fact, data tells us that suicide is down. Amazing, since the pandemic was catastrophic for millions that suffered illness and loss. But we have been seeing is a rise in the number of people reaching out for help. That’s good.

We did see this pandemic surface feelings and behaviors that stem from negative core beliefs. We all have them; we’re all vulnerable to them. And we are still seeing those beliefs wreak havoc in people’s lives. The emotional, psychological and behavioral distress they trigger can be extreme. There is no way around it; our life experience comes from the beliefs we cultivate, unwittingly in most of us. That is the nature of a core belief formed in childhood.

There is one grand lie — that we are limited. The only limits we have are the limits we believe.

Wayne Dyer

I saw how my thoughts, those conditioned from experiences of fear and wounding as a child, again and again lead me back into depression. They induced a shutting down in me, an inner retreat. The stronger my belief in those thoughts the greater their impact on me until finally the devastating depression, and that terrifying ‘break with reality.’

This was a huge learning. Unfortunately something immense had to happen to get my attention. It worked, and then some.

My subsequent significant learning? This. Despite the pervasive nature of limiting beliefs, they do not have to be in control of us. They are only ‘permanently fixed’ if we let them stand. And as powerful as these destructive beliefs can be, they pale in comparison to the robust and transformative thinking you can choose to cultivate, beliefs that create what you want in your life, how you want to feel, and who you want to be.

There are stories we take on from our culture, and there are stories based on our own personal history. Some of those stories lock us in limiting beliefs and lead to suffering, and there are others that can move us toward freedom.

Tara Brach

So this is my commitment today, as a professional and a human, to relentlessly ‘out’ the false beliefs that diminish us and replace them with the transformative beliefs that set us free.

And we have a huge leg up. Our false beliefs are hidden in plain sight in the voice in our head. The negative self-talk we allow to run in the background, that we accept automatically. With awareness we can hear these beliefs when they are activated. That’s where we start. Deciding instead what to tell ourselves that will support us, champions us all day long. That changes everything about us.

Who we are today is the result of what we think, and what we think over and over becomes a belief we hold. But that is not who we really are, nor is it our destiny. Because beliefs are formative; we form them by what we continually tell ourselves. And our beliefs are ours to choose. They are for us to use powerfully, not to be used by them.

Link of interest: Characterizing Core Beliefs in Psychosis: A Qualitative Study https://www.researchgate.net/publication/332276940_Characterizing_core_beliefs_in_psychosis_A_qualitative_study



Ginny Cutler, CPCC, LMFT

Transpersonal Coach, creator of LifeMap - The journey from Self Awareness to Transformation. www.ginnycutler.com