Can a Psychiatric Crisis Save Your Life?
Madness as breakdown and breakthrough
What should we make of the idea that a psychiatric crisis can save someone’s life? Depression immobilized Tyler Alterman for over a year, leaving him barely able to get off his mattress. A decade later, he describes feeling “regularly grateful” for that period of severe depression, claiming it saved his life. Jazmine Russell experienced a terrifying psychotic episode in 2015 that she also later credits with saving her life. Both are powerful stories and testimonies. Both challenge conventional psychiatric thinking about mental illness as unambiguously bad events; both raise difficult questions of how we interpret psychiatric crises and their role in people’s lives.
I came across Tyler Alterman’s story on X/Twitter (Oct 24, 2025, discovered thanks to Cooper Davis). I am not reproducing the entire post here, but you should read his story in his own eloquent words. Alterman describes pushing himself into “a life that was terrible for me, like a person smashing themselves into a wall.” He reports that his “self” sent escalating warnings, first a sense of wrongness, then exhaustion, all of which he ignored. When healthy habits like exercise, meditation, and therapy only provided “energy to smash myself against the wall again,” his depression progressed to complete immobilization.
For over a year, he could barely leave his mattress. At the time, believing his only value came from his ability to contribute, he experienced suicidal ideation. He now reinterprets this as “a desire for the self-harming version of myself to die.” His depression eventually lifted without psychiatric intervention, and he credits the immobilization as a necessary step that prevented continued self-destruction and enabled the incredible life he has today.
Alterman distinguishes between depression that responds to lifestyle interventions and depression that resists them because “these healthy habits will only give a person more energy to throw themselves back into an unhealthy job, relationship, identity.” He cautions against judging people for “not wanting to get better,” suggesting their resistance may actually be self-protective.
Jazmine Russell is a mental health educator, host of the Depth Work Podcast, and a co-editor of the 2024 volume Mad Studies Reader. She describes her story in this substack post (Nov 5,2025). Working as a crisis counselor while carrying unprocessed childhood sexual abuse trauma, Russell was chronically ill, sleep-deprived, and overworked. Standing on the Williamsburg Bridge on her birthday, she begged the universe to “get this darkness out of me... at any cost.”
Weeks later, she experienced acute psychosis with hallucinations of shadow figures and delusions requiring ritualistic responses. Despite knowing she was hallucinating, she couldn’t prevent herself from trying to bury herself in her backyard or performing cleansing rituals in the shower.
Russell frames her psychosis as a revelation rather than a breakdown: “it was not my mind, but rather the life that I was living that was fractured and broken.” She describes psychosis as “a sharp clear looking glass, through which I could see all that was already destroyed.” The experience became what she calls “the final warning; keep going like this and you’ll die.”
Russell credits three factors for her survival: avoiding psychiatric hospitalization (which would have stripped her of “the right to own your story”), having a robust community of friends and healers providing alternatives, and receiving appropriate medical investigation that identified autoimmune disease rather than just psychiatric diagnosis. She identifies five converging roots of her psychosis: interpersonal trauma, intergenerational trauma, autoimmunity, structural inequity, and spiritual crisis.
Ten years later, having never experienced another episode, Russell describes her body as refusing to “let me get away with anything other than full integrity of body mind and spirit.” While not calling psychosis itself a gift, she values what she frames as her body’s protective intervention.
Both stories share a basic theme: psychiatric symptoms as protective interventions that forced necessary life changes. Alterman’s “self” sends increasingly urgent warnings. Russell’s “body-mind” reveals truths she had avoided. Both frame their symptoms as emergency measures preventing continued self-destruction.
Justin Garson’s philosophical work distinguishes between “madness-as-dysfunction” (symptoms as broken systems) and “madness-as-design” (symptoms as manifestations of mechanisms doing what they are supposed to do or designed to do). The latter perspective assumes that at least some conditions we call mental disorders represent adaptive, functional, meaningful, goal-directed, or naturally selected responses rather than mechanism failures.
This line of thinking is familiar to folks working in the area of evolutionary psychiatry. It is hypothesized by Randolph Nesse and others that some instances of depressed mood and related behavioral features (withdrawal, loss of motivation, behavioral inhibition) may represent the human mind doing what it is designed by evolution to do in lose-lose unwinnable situations, where low mood can prevent wasted effort. In this view, Alterman’s depressive immobilization could represent the presence of an intact mechanism that prevents continued investment in harmful pursuits.
In Good Reasons for Bad Feelings (2019), Randy Nesse describes the memorable case of a young man of a working-class background who presented with classic depressive symptoms while struggling to stay in school. His primary motivation was to maintain a relationship with his “beautiful and brilliant” girlfriend, who, he was convinced, would leave him if he dropped out of college; the girlfriend was also headed to Vassar in a few months, and the patient was committed to trying to make it work. Despite antidepressant treatment and cognitive behavioral therapy leading to no improvement, months later he was “transformed” after quitting school to work with his father and ending the relationship with his high-status girlfriend for someone who “likes to do all the same kind of things I do.” Nesse believed that his depression lifted primarily because he moved out of an untenable social situation rather than trying to make it work. As a clinician, I’ve had my fair share of patients in similar situations.
Bleuler—who coined the term schizophrenia—was of the view that delusions and hallucinations were responses recruited to help an individual with a malfunctioning brain navigate the world. Anne Harrington described it in Mind Fixers, “There was no point, Bleuler said, in trying to find a biological cause for those symptoms, because they were not caused by brains gone wrong. They were instead caused by patients’ use of psychological mechanisms (especially the kinds identified by Freud) to defend themselves against a world that they experienced through brains that didn’t work right.” At the very origin of our modern concept of schizophrenia is this complex interplay between function and dysfunction. For contemporary versions of such ideas, consider the hypothesis that delusions are a “doxastic shear pin,” a mechanism that errs so as to prevent the destruction of the machine (brain) and permit continued function (in an attenuated capacity) (Fineberg & Corlett, 2016).
Psychodynamic theory has long maintained that psychiatric symptoms carry unconscious meaning and serve psychological purposes. Even when the pathological nature of psychosis is clearer, it is common to observe thematic links between the content of delusions and hallucinations and various conscious-unconscious aspects of their psychological lives, links that can be productively explored in clinical settings and that can serve as sources of psychological insight.
Both Alterman and Russell describe their symptoms as communications from disavowed parts of the psyche. Alterman’s narrative suggests a split between a conscious, striving self pursuing a particular life course and an unconscious, protective self that recognized the path’s destructiveness. The depression represented not a random malfunction but a desperate, albeit maladaptive, solution to an intolerable situation. Russell frames her psychosis as her body “revealing what had made me sick, trapped, and withering away in the first place.” The symbolic content of her hallucinations seemed to connect to her trauma history.
Whether or not symptoms literally “communicate,” constructing such narratives seems to have therapeutic value. They transform seemingly senseless suffering into comprehensible, even purposeful experience. This value cannot be easily discounted.
The Mad Studies perspective, emerging in part from psychiatric survivor movements, also takes the view that “mental illness” often contains elements of meaningful response to oppressive circumstances, identity transformation, or spiritual development. This is the Laingian idea that madness need not be all breakdown, it may also be breakthrough. Russell’s psychosis wasn’t merely a state of impairment but “a necessary process” of death and rebirth. Alterman’s depression enabled the death of his “self-harming version.” The Mad Studies framework also validates resistance to conventional recovery narratives. Both Alterman and Russell warn against pressuring people toward normative functioning (returning to work, maintaining productivity) without questioning whether that functioning serves genuine well-being.
Consider a different scenario: A person is stressed, overworked, sleep-deprived, and developing an alcohol problem. One day while driving home, they get into a serious car accident due to their impaired state. The car is totaled. They end up hospitalized, needing major surgery. While recovering, they see the accident as a wake-up call that their life has become unsustainable. They quit their job, prioritize sleep and exercise, minimize alcohol use, and ultimately have a good life. They say the accident saved their life.
In one sense, this is true; the accident catalyzed necessary changes. But it would be an error to conclude that:
Car accidents are, in some situations, adaptive protective responses to unsustainable lifestyles
The person’s body wisely caused the accident to save them
The accident was “trying to tell them something”
Preventing car accidents might also prevent necessary transformation
The accident was purely “dysfunctional” in mechanism: impaired judgment, substance effects, random chance, and thermodynamics. Nothing about the accident’s mechanism was adaptive, functional, or protective. The crash didn’t occur in order to save the person’s life.
Yet the accident had adaptive consequences: it forced interruption of destructive patterns, created undeniable evidence of unsustainability, provided time for reflection, and generated a crisis point enabling life change.
Or consider someone who receives a cancer diagnosis and successfully recovers but in the process finds a renewed sense of meaning and a renewed engagement with life. The cancer did not occur in order to improve this person’s life or give them a sense of meaning. It merely served as an accidental catalyst for that change.
This distinction between a mechanism that is adaptive in design versus a mechanism that has adaptive consequences but may itself just be pure breakdown seems to me to be missing from Alterman and Russell’s self-narratives.
The car accident analogy also reveals problems with assuming the severity that occurred was necessary or optimal. The person got lucky surviving a major accident. A lesser accident might also have worked as a “wake up” call. A fatal accident would have achieved nothing. The fact that a particular severity achieved change doesn’t mean that severity was optimal.
Alterman and Russell experienced psychiatric crises that seriously jeopardized their well-being. It may be tempting to consider the severity (“dose”) they survived as the dose that was needed, but we can imagine alternatives where they reached transformation without going through a crisis. The crisis wasn’t the best route to change, maybe just the route that actually happened to catalyze it.
There is fundamental uncertainty about such interpretations. We don’t know the counterfactuals. What would have happened with different choices? Would Alterman have changed his life without becoming immobilized? Would Russell have addressed her trauma without psychotic decompensation?
Retrospective narratives exhibit coherence bias, survivorship bias, and outcome-dependent interpretations. The narrative is shaped by knowing the ending, making the path seem more intentional or necessary than it was. These biases don’t automatically make the narratives false or unhelpful, but they should temper confidence in them to some degree.
I can’t help but wonder: Would Alterman have been receptive to his current interpretation while he was acutely depressed? There are reasons to suspect that he may not have been.
Depressed Alterman, lying drained on his mattress, likely couldn’t have entertained the complex metacognitive interpretation that post-depression Alterman articulates. The interpretation requires distance and an existential awareness that is often threatened by severe depression. In the middle of that state, he may have experienced the depression as pure suicidal torment without redemptive meaning.
I also wonder about how the interpretation is offered, by whom, and under what conditions. Coming from a dismissive clinician, the interpretation of symptoms as purposeful could even have been seen as invalidating (“You don’t need medical treatment; nothing is wrong with you; you need to change your whole life”). Maybe Alterman and Russell needed to construct these narratives themselves for them to have the value that they do.
In the process of a psychiatric evaluation, it is important to ask, in addition to symptom severity, duration, and functional impairment: what is this person’s life actually like? What might their symptoms be responding to? Work satisfaction and meaning, relationship quality and authenticity, alignment between stated values and lived choices, chronic stressors or impossible situations the patient feels trapped within.
Alterman’s distinction between depression that responds well over time to healthy habits and depression is a potentially significant one. Some depressed patients need behavioral activation as a priority. Some depressed patients may need a reassessment and reorientation of their goals. As a clinician, however, I fully recognize that this is easier said than done. Real-life presentations are just too tangled and complicated. Still, it is worth asking patients: when you imagine feeling better and having more energy, what would you do with it and what significance does that have for you? I have worked with many patients with inadequate responses to treatments who have been focused on getting well to return to a marriage or a job or a life that even they recognize at some level is unhealthy for them and not sustainable.
We need more clinical space for reflection. The clinician’s goal should be to facilitate the process while avoiding imposing interpretive frameworks. Clinicians can present various interpretive possibilities without demanding patients accept any particular one. Sometimes simply opening up the space of possibilities itself is beneficial.
Kemtrup raised the point on X/Twitter once that sometimes the purpose of psychoanalytic interpretations in psychotherapy contexts is not to demonstrate their absolute truth but to facilitate a pluralistic understanding of oneself:
“Sometimes the pt and analyst/therapist explore things similar to what gets described in science as “underdetermination of theory by evidence” wherein two or more explanations equally fit with the available case history, facts about the pt. And the pt can BENEFIT from understanding that he can be understood in more than one way, and humility is felt as a virtue, which opens up possibilities for new ways of thinking, acting, and feeling. Often, a sign of health in a patient is that they start to understand themselves pluralistically, through multiple lenses. “I suppose one way to think about what I did is this, but another is this. I don’t really know which is true at the moment.”
When patients construct redemptive narratives like Alterman and Russell’s, I am of the view that clinicians should generally respect these without claiming to be in a position to determine their objective accuracy. “It sounds like you’ve found a way of understanding your experience that feels meaningful and has helped your recovery. That’s valuable.” A narrative of recovery can have utility without being true. We should honor the patient’s meaning-making while being mindful of its fallibility.
Even if depression or psychosis might serve protective functions in some situations, these experiences remain distressing, disabling, and disruptive. We should reduce the harms involved without nullifying the prospect for any future adaptive consequences. There are moments as a clinician when I find myself juggling: “What you are experiencing is serious, and we need to address it and ensure your well-being. And we should explore what might be happening in your life that this may be a response to. And it’s possible this difficult period could ultimately lead somewhere important, even if we can’t see that yet.”
When Russell says, “it was not my mind, but rather the life that I was living that was fractured and broken,” I wonder, why couldn’t it be both? Could the fractured and broken life have led to a (transiently) fractured and broken mind?
Just as clinical judgments of “dysfunction” in the DSM sense do not necessarily correspond to dysfunctions in an evolutionary sense, or biostatistical sense, or neurobiological sense, etc., first-person perceptions of an illness experience “saving” one’s life from “self-destruction” also need not correspond to the existence of functional, adaptive mechanisms.
Recall the distinction between a mechanism that is adaptive in design versus a mechanism that has adaptive consequences but may itself just be pure breakdown. (Nesse characterizes two serious errors often made by those looking for evolutionary explanations in medicine: Viewing Symptoms as Diseases and Viewing Diseases as Adaptations.)
Psychiatric crises are dangerous inflection points that can lead to deterioration as well as transformation, perhaps depending on factors such as available support, treatment quality, resources, resilience, timing, insight, and chance. I don’t know if the machinery of any particular crisis inherently contains elements that are adaptive, but transformation is nonetheless possible, and patients may legitimately perceive the episode as putting their life on a better trajectory. Sometimes madness does stop and immobilize, whether by design or by accident, people who are on a self-destructive or unsustainable path. Alterman and Russell found their ways through to meaningful lives. I want to help others find theirs, and I want to encourage people to explore the relationships between their symptoms and their lives, without deciding for them what story they use to make sense of what went wrong and what went right.
See also:
Awais,
This post is quite interesting and challenging. I am going to write a longer reflection on it, because I think it merits a longer response, but that'll take me a week or so (I'm slow). For now a few observations.
It has never been clear (to me) how important it is, for Garson, that there be some sort of purpose-like element in his story. Two candidates for serving that role appear in your account – the ‘subpersonal’ (“My subconscious self is sending me a message”) and evolutionary adaptationism (“mental breakdowns are an evolutionary adaptation”). Garson also mentions those. (A third makes several appearances in Garson’s historical examples, Divine intention.)
Perhaps the idea of ‘madness as strategy’ is more compelling if we get rid of the apparent felt need to tie it to purpose. (Yes, the word ‘strategy’ invites this connection.) Perhaps function is a better concept, not function as in “what is this thing *meant* to do?” but function as in “how does this thing work?” I will suggest (without further discussion, here) that thinking in this way transforms the analogy between mental breakdowns and car accidents.
Adopting this shift from purpose to function (if it is a shift), the contrast to ‘madness as dysfunction’ would still stand. The car accident isn’t a matter of the world functioning incorrectly. That’s how the world functions – when poor decisions are made, car crashes can happen. We have far less clear and general understanding of the analogous antecedent in the case of mental breakdowns, but perhaps the proponents in the two cases that you mention have correctly identified antecedents in their own particular cases.
It’s also important, in fairness to Garson, to remember that he does not think that one or the other of his models is exclusively true. He thinks they are both true. So yes, it would seem that for Garson the depression is a kind of dysfunction. It’s just that at the same time, it can be understood as a kind of strategy, or, as one might put it in light of above, the world functioning as it does. (That’s my spin, not necessarily Garson’s but maybe his.)
There’s a lot more to be said, here, and thanks for giving food for thought. I’m now resisting the temptation to say quite a lot! (I’ll give in to it later...)
Boisen had this idea around 1946