On Residual Symptoms After Psychosis: What Daily Life Can Look Like

00:00 – Topic: residual symptoms and how to manage them 00:00:14 – What “residual” means: what doesn’t go away after the acute episode 00:00:27 – Usual pattern vs mine: often negative symptoms; for me it’s positive symptoms 00:00:38 – After first psychosis: everything went except ideas of reference 00:00:54 – How do you manage ideas of reference? 00:00:58 – My theory: not “psychogenic” — primarily linguistic 00:01:13 – Link to pragmatics/social communication impairments in schizophrenia 00:01:28 – How I intervene: I treat it as a linguistic problem 00:01:32 – What it feels like: overhearing others → processed as direct address to me 00:01:49 – Usually as a negative appraisal 00:01:53 – The technique: immediate challenge in inner speech (“that’s not about me”) 00:02:03 – Why it matters: if I don’t, it builds and the referential ideation worsens 00:02:12 – If I respond to each instance: it stays pushed back / contained 00:02:20 – After second episode: a new residual symptom appeared 00:02:28 – Hard to communicate on the ward: psychiatrists framed it as rumination/overthinking 00:02:56 – My label for it: “coprolalia of inner speech” 00:03:06 – Coprolalia normally: Tourette’s (involuntary obscene/other words) 00:03:18 – My version: deeply offensive words intruding into inner speech 00:03:25 – Example: 30-minute drive → ~35 intrusive instances 00:03:47 – Key point: it wasn’t there before the second episode 00:03:58 – Research gap: only 1–2 papers, not very schizophrenia-relevant 00:04:08 – But: lots of anecdotal reports (Reddit) of similar “inner-speech coprolalia” 00:04:20 – Not well studied 00:04:25 – How I manage it: I ride it out 00:04:28 – Reason: you can’t stop inner speech; you can’t prevent it happening 00:04:46 – Biggest fear: that I’ll start verbalising it 00:04:49 – My take: very unlikely 00:05:03 – Leads into prodrome symptoms I call “semantic anxiety” 00:05:15 – First episode prodrome: fear of becoming urinary incontinent in public 00:05:25 – It became obsessional/preoccupied 00:05:40 – Trigger: course leader’s Freud lecture (id/ego/superego) 00:06:01 – Phrase that hooked me: “your id stops you pissing yourself in the street” 00:06:13 – My interpretation: “what if that mechanism fails?” 00:06:22 – Result: preoccupation with “my id will fail” 00:06:38 – Anxiety became physical: urinary symptoms emerged 00:07:03 – Leakage → “it’s real” → anxiety escalated 00:07:16 – Medical checks: GP visits, renal ultrasound, no kidney issues 00:07:34 – Later: during sectioning/acute phase, urinary retention showed up 00:07:47 – Second episode prodrome: semantic anxiety around coprolalia 00:08:02 – Fear: I’ll involuntarily say racist/homophobic/insensitive things out loud 00:08:19 – Grounding: this fear had a basis in past experience 00:08:22 – First episode: passivity phenomenon (speech without inner speech) 00:08:35 – Lying in bed: spoke a full sentence with no volitional process 00:08:56 – I could feel the difference: speech production without intention 00:09:04 – “Aphasia territory” / mechanistic-feeling speech 00:09:13 – Later reframing: could be hypnagogic (waking up + benzos) 00:09:41 – But because it happened in psychosis: it stayed loaded 00:09:43 – So I worried it would happen again off meds 00:09:53 – Off meds, not acutely unwell: moments of thinking I’d spoken involuntarily 00:10:10 – Checking others’ reactions → nobody reacted 00:10:20 – Realisation: maybe I didn’t speak; still scary 00:10:32 – Another residual-ish piece: thinking you spoke when you hadn’t 00:10:36 – Why passivity stuff is terrifying: doing things without intention 00:10:56 – Ties back to trust-after-psychosis: “I could do anything at any moment” 00:11:12 – Example story: flight to Manchester, sitting next to a young woman 00:11:59 – My suspicion: “why does she want to sit here?” 00:12:11 – As I dozed: she dropped paperwork into my lap 00:12:20 – I handed it back; went to sleep 00:12:31 – My interpretation: “did I say something obscene in my sleep?” 00:12:49 – A “polite wake-up” theory — but no evidence 00:13:03 – What this shows: semantic anxiety about residual symptoms socially embarrassing you 00:13:15 – Fear of residuals catching you out in public / new residuals developing 00:13:22 – Close: residual symptoms + some of the more unusual dimensions of my psychosis