Ben Guest could never be sure where the sounds were coming from. At night, noises haunted the shadowy corners of his apartment and on the street. When he heard them, he’d record videos of himself detailing theories he had that he was being followed and surveilled. Believing he was likely to be a target of abduction for human trafficking, Guest found himself becoming intensely suspicious of strangers. “I definitely thought people were following me,” he says.
But no one was. Guest had been experiencing psychosis—episodes where he perceived things that, while feeling very real to him, weren’t part of reality for the rest of us.
Psychosis as a term has been around for over a century, initially used to capture a number of mental disorders. Today, it’s been narrowed to describe a specific detachment from reality, often following a period of deprivation of food, water and especially sleep. Initially for Guest, these bouts of psychosis would follow 24-48-hour periods with little food or sleep—a part of the meth sessions he had with his boyfriend at the time.
As the drug binges would end and Guest was able to get some sleep and meals in his system, the paranoia and fear would subside. When he watched his recorded videos back days later, he saw himself on camera, engaged in unintelligible blabber. He could barely make out the words he was saying, let alone the arguments behind them.
Guest isn’t alone in his experience. While there’s little research on the prevalence of psychosis in the queer and trans community, LGBTQ2S+ people are more likely to take the types of stimulant drugs that keep you awake, dehydrated and underfed. In the past year, more than 17 percent of queer and trans people have taken a stimulant drug compared to only 4 percent of straight cis people, according to the most recent Statistics Canada data.
It’s why psychosis has become a priority focus for the Ontario-based Gay Men’s Sexual Alliance (GMSH), which has released two videos and more resources around psychosis—information especially relevant ahead of the summer months. “So many people are partying at Pride,” says Jordan Bond-Gorr, GMSH’s coordinator of Party ’n’ Play and chemsex initiatives (two terms used to describe the mix of sex and drugs). “If you’re using crystal meth or other substances, if you have a lack of sleep, if you’re dehydrated—psychosis can happen.”
One part of GMSH’s messaging is just how common psychosis is in the community. Think about the person at a late-night after-party that suddenly becomes paranoid that everyone is texting about them, despite no phones in sight. Or someone convinced they see an intruder in their apartment, only for it to be the shadow of a tree branch. Or a lover who calls 100 times, demanding answers for an invented affair.
It’s easy to misconstrue these occasions as someone being “fucked up” or too high—and sometimes that is the case: stimulant use can, after all, get adrenaline and aggression up. But what makes psychosis distinct is that prolonged detachment from reality—people aren’t just fighting, they’re fighting against enemies that aren’t there.
“Paranoia can be a first sign, leading to auditory and visual hallucinations for people,” says Bond-Gorr. “They’re seeing people in the shadows, they’re hearing people talking about them when nobody’s talking, or they’re picking up on sounds in the background as threats.”
Psychosis can be dangerous, not only to your health but also your livelihood. As Guest continued taking meth with his then boyfriend, his periods of psychosis continued for days—even when he was sober.
“It was this constant state, almost like life itself was the trigger,” says Guest, who has now been sober from meth for about two years. “I isolated myself in my parents’ basement for the better part of a year. I just couldn’t be around other people, couldn’t handle taking on any responsibility.” He eventually had to take a leave from his job as a nurse, checking into rehab and being prescribed antipsychotics to help manage his audio-hallucinations.
This risk for prolonged psychosis is also why more people should recognize the signs, since dismissing it as “partying” leaves others less likely to intervene, or to try to help in the wrong ways. This is according to Steph Massey—a Toronto-based harm reduction worker. In their two decades of experience with LGBTQ2S+ and substance-using communities, Massey has seen the consequences when people experiencing psychosis are left alone by their friends, or when police are called.
“People will assume that folks are violent or angry when they’re in a prolonged health crisis, so there’s often a fear-based response as opposed to a trauma-informed response,” says Massey. “I think oftentimes when it’s drug related, people think, ‘you did this to yourself, you deserve it, so I’m either going to invite more punishment in, or I’m going to leave you alone and not offer you any support.’”
Massey especially warns against calling the police, who may come with bias and are likely to make matters worse. “That’s the nuclear option. It can be very dehumanizing when you’re in four-point restraints, or chemical restraints.”
That reticence to deal with the police bias was there for Robin, who asked to be referred to by only his first name. Like Guest, Robin would use meth with his partner at the time, typically when they were having sex. Over time, Robin’s partner started acting more erratic—inviting Robin over only to be confronted with strangers, or making calls to Robin’s employers when they fought.
Outside of these outbursts, Robin says his partner was sweet and caring. But when taking drugs, he wouldn’t sleep, wouldn’t balance his life in the same ways Robin had, and would fly into these paranoid, aggressive episodes.
“I was of two minds about it,” says Robin. “On the one hand, I was being abused. At the same time, it’s not like he was not aware of what he was doing and at the time, I was the responsible person to help him through it.” Robin wasn’t sure who to turn to for help.
When you’re faced with someone in active psychosis, you should check in with yourself and your capacity to handle the situation first, says Bond-Gorr.
“Are you prepared to respond to this person? Because you need a level head when you’re responding to somebody who’s in psychosis. You can’t be elevated and amplified yourself.” If you’re not in the right mindset yourself, call for help from other friends or community groups.
If you are able to help, take away as much external stimuli as possible, say Bond-Gorr and Massey. Remove the person from the party, turn off or dim lights, turn off music. Most importantly, don’t try to contradict what they’re experiencing. Rather, try to calm them down, assuring them that everything’s going to be okay and that you’re a trusted friend and ally. “Empathize with them, don’t get into what’s real and what isn’t,” says Massey.
If danger is imminent and police do need to be called, get a community worker to accompany the person experiencing psychosis at every stage of intake to be an advocate. Many people in the queer and trans community do this kind of work, so reach out to your networks to see if there’s someone you can call even late at night or early in the morning.
Yet despite these risks, GMSH refuses to frame psychosis as yet another potential consequence of drug use. Mikiki, a queer artist and community worker who creates psychosis resources in partnership with GMSH, says that playing with our perception of reality may sound scary, but it isn’t necessarily an immediate cause for concern.
“There are people that use meth in ways that are sustainable and that don’t result in psychosis—or when it does, they are able to manage it,” says Mikiki. “But because substance use is stigmatized and then mental health is stigmatized, it’s a double whammy.”
Learning more about psychosis through their community work, Mikiki now makes substance use safer for them, their lovers and their friends. Even simple things like having bowls of fruit at a late-night party, or checking in with people to see when they last slept, can be impactful.
Massey compares this knowledge to other harm reduction steps that the community takes. “Many people have learned and been trained on opioid overdoses—how to recognize it, intervene and respond. This too is a health crisis.”
But unlike an overdose, where the time it takes to get naloxone or an ambulance is critical, responding to psychosis is all about patience and communication. Sitting through the discomfort, the paranoia and the anxiety can make a world of difference when that person does come out of psychosis and the trust they have in friends, lovers and community has not been broken.
“I wish that people in the queer community knew that we can support our friends who are experiencing these things,” says Guest. “There’s a way to be there for each other and help somebody navigate through to a better place.”
