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Documentary, Horizon - Why Did I Go Mad
#Documentary #Horizon #WhyDidIGoMad
#Documentary #Horizon #WhyDidIGoMad
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00:00Our brains have an astonishing ability to interpret the world around us.
00:07Most of us are able to tell the difference between fact and fantasy,
00:15between real and imagined danger.
00:21We learn to recognize voices and understand meaning.
00:26But for some, the normal benign business of interpreting reality has broken down.
00:35And as I sat there, I knew these things were going to come and eat me alive from the inside.
00:43I remember being about 13, 14 and having this real knowledge, this true knowledge,
00:49that I had an alien inside me.
00:52I woke up and the voices were telling me, kill yourself, kill yourself, kill yourself.
00:57You have not experienced terror like that unless you've had a psychotic episode.
01:06They are utterly beyond any imaginable terror that a normal person can experience.
01:15For years, these disturbing psychotic experiences have been given a name. Schizophrenia.
01:23In this film, we'll discover first hand what this condition is really like.
01:28The floor started buckling like that on either side where my feet were.
01:33And then they opened up and there were teeth on the inside.
01:39The bloody floor was going to eat you.
01:42We'll explore the research that is throwing new light on what is happening to the brain.
01:47If you have too much dopamine, then things which normally are not important in your environment may suddenly acquire importance to you.
01:58I see all these people looking at me. I can see their eyes looking at me, staring at me very intensely.
02:04And you can see how an environment like this becomes very threatening.
02:09We'll search for what causes psychosis in the first place.
02:14Growing up in an urban environment increases your risk of developing psychosis later on.
02:21And we'll see new and experimental therapies in action.
02:25You're in for it now.
02:28But most importantly, we'll follow three people who live with the condition.
02:34All the crew around me are...
02:40...plotting to kill me.
02:44You're in on it too.
02:46For decades, people with severe mental conditions have been called mad.
03:07But is there really such a thing as madness?
03:11Dr David Strange is a former Oxford scholar.
03:18He has a doctorate in epidemiology, the study of how diseases spread.
03:23And his work was award-winning.
03:28But then, on what seemed like a normal day in 1999...
03:32...his world changed forever.
03:37But it feels like an elephant shaking its beak tear
03:59People reflect with all that's ugly.
04:00I was in a meeting with my supervisor sitting in her office and suddenly I could hear five voices
04:12screaming at me from positions strangely around me and there were lots of rat hairy dirty rat
04:22like things running around and running over my feet and as I sat there I knew these things
04:29were going to come and eat me alive from the inside it's frightening beyond belief and especially
04:42when you're with someone who you've known for several years and they're not apparently not
04:47noticing these things and it was so much I just said I made a quick excuse and ran home
04:56and hid under my bed
04:57I hear voices in my head it gets dark and dangerous
05:19like David Rachel Waddingham is accompanied by voices in paranoia now 39 she experienced her
05:27first terrifying hallucination aged just seven
05:30I remember being at my friend's house and I was looking in her dressing table mirror
05:40and saw this monster staring back at me where I should have been it was kind of ugly it was dark
05:49colored it was wasn't human it just looked terrifying psychosis is a term used to describe a range of
05:59different diagnoses including the most notorious of all schizophrenia each person's experience
06:07of psychosis is unique but there are three key symptoms that generally define it voice hearing
06:15paranoia and hallucinations
06:18there's a rat just on your knee there are a few running up and down onto those benches there
06:30and there's one on that table which is a bit close oh yeah
06:40while hallucinations can be terrifying they are often accompanied by deep paranoia
06:49for David he feels his life is constantly under threat
06:55I can hear your thoughts now and you don't like me very much you think I should do something horrible
07:04to myself paranoid thoughts have also plagued Rachel for much of her life
07:13I remember being about 13 14 and having this real knowledge that I had an alien inside me one night
07:26I started to hear these voices talking about me I started to believe that they were part of this
07:31conspiracy I could feel the sensation of being watched and the only way I could make sense of it
07:38is there must be cameras installed in my flat it's similar to being in one of those conspiracy movies where
07:45just something's going on and no one else knows and no matter who you turn to who you speak to
07:51they they they either won't believe you they'll think you're crazy or even speaking to them will put them in danger
07:59David uses music to express some of the emotions he feels about the effects of his psychosis
08:18I quite like ambient and electronic music and I wanted to make something quite hallucinogenic quite weird quite mind altered state and I think I've done it quite well with this piece it's quite hallucinogenic
08:36at times the paranoia and hallucinations have become too much for David he's been driven to numerous
08:46suicide attempts and been in and out of psychiatric units for much of his adult life his music reflects
08:53some of these experiences I wrote this piece of music to capture the experience of coming around
09:03after an overdose and finding all kinds of electronic equipment and tubes poking out of you and
09:09that's a horrible experience with big metal pipes coming out of my throat and machines all around me and this is that experience
09:33Rachel lives with another key element of psychosis voice hearing she creates images of her voices to
09:41help her try and understand them Rachel hears many voices with different characters different personalities
09:49that each behave differently to her so blue is a little girl she's one of my youngest voices she's about three I
09:59I think she's frightened of other people she's frightened of being hurt I felt really sad because
10:05there was a young voice child who was upset and crying I felt like I was abandoning a little one and it felt
10:14like it was my fault that I couldn't reach her a breakthrough kind of came when I found bunny bunny is this lovely little
10:23toy just this beautiful little toy and for the first time I kind of felt like this curiosity in her and it felt like I'd
10:30reached her which was a pretty powerful moment really but not all Rachel's voices are so benign
10:38so the next ones I'm going to draw is the three
10:45these guys were paid to watch me hated me and they just report to the government report to the aliens
10:56they never talk directly to me they always talk about me about the people that are around me the voices
11:04are even able to cause Rachel physical pain so I'm gonna draw Elfie now when I first started to hear her
11:12she called herself monster and that's what I saw in the mirror the monster sometimes I can tell that Elfie's
11:20upset because I feel burning on my skin kind of like someone's searing my skin with with a hot iron or something
11:33like that and I know it's not happening happening because I can't see any flames there's no marks
11:40but I feel it as intensely I was terrified of Elf and then something changed over time it kind of emerged
11:50that she'd been trying to tell me that I wasn't safe so what kind of emerged is that Elfie is not this big
11:56scary monster that she appeared to me as she's actually just an 11 year old girl
12:03while there has long been difficulty in the diagnosis of psychosis scientists have now largely agreed on the biological process going on in the brain
12:25research suggests that people with psychosis seem to produce too much of a brain chemical called dopamine
12:34dopamine is a chemical that's naturally produced in all our brains and it's absolutely essential to how our brains work
12:44our brains are constantly being bombarded by information from our senses
12:51we're always hearing or seeing things and we've got to filter out the things that are unimportant
12:58the kind of regular things from those that are unusual or potentially really important
13:04either a danger or something that might be a reward
13:07and dopamine starts those nerve cells start firing and signaling when they detect something unusual
13:15and they then focus attention and the brain's resources on trying to make sense of those particular stimuli
13:23rather than other things that are unimportant so they filter out the other things by saying focus on this
13:30in the real world dopamine helps us avoid danger by allowing us to recognize what could be an actual threat
13:45the visually packed world of a funfair is filled with objects that could pose real danger to us
13:51a fast-moving machine or a suspicious character
13:55Michelle Cockennew is part of Professor Howell's team and has been researching the effects of dopamine on the brain
14:04dopamine fires and tells me to pay attention and maybe not go too near it because it's dangerous
14:12but if the brain becomes too flooded with dopamine things can start to go wrong
14:18and this is exactly what's thought to happen in the brains of those with psychosis
14:23if you have too much dopamine in your brain so if there is a nexus of dopamine then things which normally
14:33are not important in your environment for your survival for example may suddenly acquire importance to you
14:40everyday objects take on new meaning the benign and harmless become terrifying
14:47for example I see all these people looking at me I can see their eyes looking at me staring at me very intensely
14:56and then I have this inherent drive to make sense of it and so depending on my experiences for example
15:04or my personality I may think that they have been sent by the FBI to follow me and or by the aliens to spy on me
15:12and you can see how an environment like this becomes very threatening instead of being enjoyable
15:25Doctors struggled for years to find medication to treat psychosis
15:29but in the 1950s found a class of drugs originally used as anaesthetics that reduce symptoms
15:36A mainstay of our treatment for people with schizophrenia are anti-psychotic medications
15:43and these work by blocking the action of dopamine after it's been released
15:49so they dampen down the effects of the dopamine over activity
15:53and over a few days or maybe a week or two
15:58this gradually means that the psychosis the paranoia the hallucinations subsides and goes away
16:06Okay, this is my medication cupboard and I have rather a lot
16:18Risperidone that is my anti-psychotic
16:21This is the main things I need to keep me sane
16:23My dose isn't very high at the moment but it's been
16:26It has in the past been so high that about once a day I would have a fit
16:31It also makes you more hungry than the imagination can handle
16:36You are crazily hungry when you take anti-psychotics
16:40and Risperidone is one of the worst
16:42So I have gone from a 32 inch waist to a 42 inch waist
16:47Then there's pregabalin which is an anti-convulsant
16:51These deal with my anxiety
16:54The other anti-psychotic I take is quetiabin
16:58Which is a very sedating anti-psychotic
17:02The only other ones that I have that are lunacy related are lopramide
17:08And they stop you pooing your pants
17:11I need something to cork me up
17:14So I will have two I think
17:16I think I will have a couple of the benzodiazepine shragnalizers
17:20So we need a procycline
17:23This is to deal with the side effects of the anti-psychotic
17:29Drenitidine
17:30This is just my stomach
17:31I have acid reflux
17:32And so is the ezomacrozole
17:35That's my stomach as well
17:37And that's my medication for tonight
17:39Today the primary treatment for people with psychosis like David
17:48Are anti-psychotic drugs
17:52They're not actually curing if you like
17:56The dopamine over activity that was the problem in the first place
18:00So unfortunately with our current medications
18:03We've got something that works very well to dampen down dopamine
18:07But doesn't cure the underlying problem
18:10While drugs can't cure psychosis
18:16A series of new therapies have been developed
18:19Treatments that could revolutionize how we deal with it
18:22This is Professor Richard Benton
18:39He has been using a treatment for psychosis that doesn't use any drugs
18:43It's called experience sampling
18:46And it's a form of electronic diary keeping
18:49So experience sampling is a method which we've used over many years
18:56To look at the way that people feel in everyday life
18:59What we do is we ask people to fill in questionnaires
19:04We get a kind of snapshot about what they're like at a particular moment
19:08In the case of psychosis what we're really interested in is
19:12What circumstances do people for example hear their voices
19:15Or what circumstances do they feel paranoid
19:18And experiencing sampling can pick that up
19:21The therapy uses an app which can be installed onto a mobile device
19:25The app bleats four times a day
19:28When it bleats the patient answers questions
19:31The questions are about whether the patient is hearing voices
19:35And how severe they are
19:36Whether they feel paranoid
19:38What their mood is
19:39We can look at how for example
19:41Exposure to stressful events leads to an exacerbation of symptoms
19:46Today Professor Bentle is meeting David
19:52To see whether this method can help him discover what triggers his hallucinations
19:57The way it works is it uploads your answers whenever it's in contact with the web
20:12So psychiatrists and psychologists can keep an eye on their patients and see how they're doing
20:19And think a brother is watching you
20:22Well
20:23Yeah you could look at it that way
20:24But on the other hand what it means is that they can
20:27Get a more reliable picture of how your life is
20:32Yeah
20:33So I'm just gonna get on my computer just so that I can set this up properly
20:37Ah
20:45There's something next to you
20:47There's something next to me
20:49Is this something you
20:53Yeah
20:54Yeah it's a large
20:55Crab
20:56Pointy
20:57Spiky
20:58Like
20:59Thing
21:00And you can see it right now
21:05Yeah
21:06Okay
21:07And I'm rather scared of it
21:10Okay
21:11So what's it doing?
21:15Can you tell me what it's doing David?
21:20Can you tell me what it's doing David?
21:21Oh
21:22Okay it's cool
21:26Okay
21:27So did
21:29Did
21:30Are you okay?
21:31Yeah fine
21:32Okay
21:33How big was it?
21:35About 18 inches long
21:39Big
21:40Crab like claws spikes on its back
21:44Wow
21:45Pints, poison spikes at the front
21:49It was a rather grim vision of Winchester
21:53Right
21:54Okay
21:55Using the diary technique
21:57Professor Bentle hopes to establish the cause of the hallucinations
22:01Such as the one David just had
22:03All right
22:05Thank you very much
22:06I wonder how much I can get from this
22:09As well as using the app on his phone
22:13David will also record his experiences on his iPad
22:17To give a real insight into what it's like living with psychosis
22:22I had a really difficult night last night
22:29I woke up I didn't know what time it was
22:32And there were a large scorpion type things scampering around on the floor
22:40It was two or three
22:42And I thought
22:44Bloody hell
22:47I don't want to
22:49Have all these experiences
22:52I got out of bed and I enthusiastically jumped on them
22:56It's hoped that by recording his experiences in this way
23:03David may gain an insight into what triggers his voices and hallucinations
23:08Like David, Rachel also spent years in and out of the psychiatric system
23:22When I was a patient of the mental health system
23:27When I was a patient of the mental health system
23:29I felt like I was written off as severely mentally ill with no hope of recovery
23:34I was diagnosed with schizophrenia
23:36Borderline personality disorder
23:38Schizoaffective disorder
23:39Dissociative identity disorder
23:41Complex post-traumatic stress disorder
23:43With psychosis amongst others
23:45Rachel turned her back on the psychiatric system
23:49And looked for alternative support
23:51A key moment was joining a group with other people who also hear voices
23:56I went to the group
23:58And that I think was the huge turning point for me
24:01I had no fight left in me
24:03And no belief that I could ever live outside of the psychiatric system
24:10So for me the first step on my journey back
24:14Was realising that I was a human being
24:16And that took connections
24:18People connected with me
24:19I connected with them
24:22And that allowed me to realise I had stories
24:24Before the story of schizophrenia
24:30With peer support and therapy
24:33Rachel came off medication
24:35And has forged a career as a mental health consultant and practitioner
24:40However, there is still one group of aggressive, frightening voices
24:45That she struggles with
24:47The not-yets
24:51They're only called the not-yets
24:52Because I didn't want to talk about them in therapy
24:55So it was the best way of getting the therapist not to ask a question about them
24:59I actually feel physically sick just thinking about them
25:03And actually just drawing this makes me feel slightly frightened
25:08It's as if by drawing it I'm making it real
25:13Sometimes one of them will talk in depth about me being tortured
25:18That people are waiting for me
25:20It's...
25:24It can get really graphic
25:27Rachel is going to try a different kind of treatment
25:29To deal with the not-yets
25:31Called avatar therapy
25:32She's going to try and put a face to one of them
25:36For the first time
25:38Professor Tom Craig has been pioneering this new technique
25:44It involves creating a computer-generated face
25:47That Rachel will then have to interact with
25:51The first stage in the process is to create the voice
25:54So the first thing we need to do is to find the best approximate voice
26:01He could never learn to make a chop
26:03That's a bit high
26:05Whenever his friends asked him if he would like to go out with them
26:08He would only answer, I don't know
26:10Yeah, I think so
26:12Next, they move on to the physical features of the face
26:14I imagine probably that one
26:19Brow ridges, make him frown a bit
26:21Yeah, that kind of works better I think
26:23Because it just looks a little bit more aggressive
26:24Yeah, yeah
26:31So kind of looking at the depiction of the voice on the screen
26:34It's always a pretty piercing and strange looking
26:37So I feel a little nervous
26:39I can feel my heart beating a little bit
26:41And I'm not entirely sure what to expect
26:46Professor Craig will take the role of the voice
26:50Rachel must overcome her fears
26:52And attempt to be assertive with it
26:54He's going to say some of the usual things that he says to you
26:58And when he does, I want you to just say to him really firmly
27:02I don't want to hear this anymore
27:05Go away, leave me alone
27:07OK?
27:08Yeah
27:10So, here he comes
27:14You're stupid
27:16You're in for it now
27:18I'm not going to listen to you
27:20You know, you're in for it
27:22They're waiting for you
27:24They're going to cut you up
27:26You know it
27:28That's not true
27:30You're just talking crap
27:31You're trying to frighten me
27:33That's not here, that's not now
27:35Are you telling me you're not scared of me?
27:37Of course I'm scared of you
27:39But
27:41You don't speak the truth
27:43I wouldn't get much fun if I didn't threaten you
27:46Why do you want that to be fun?
27:48You know, is it that boring your life?
27:51You're in for it now
27:53You know they're waiting outside for you
27:56They're not waiting outside
27:58You've said this before
28:00It's not happening
28:01It's not happening
28:05That's really, really good, Ray
28:06Excellent
28:07Good, good work
28:09So, let's wrap up
28:11How are you feeling?
28:13A little shaky
28:15Kind of
28:17Yeah, I've got a few of my voices
28:19Are kind of chiming in at the moment
28:20But
28:21Right
28:22It certainly at times felt very intense
28:24By asking Rachel to confront her voice in this way
28:29It is hoped that she will become less frightened
28:32And therefore better equipped to deal with it
28:35Talking therapies like this
28:38Are offering a path to recovery
28:40And a chance to learn to live with voices
28:42And this is exactly what Jackie Dillon has managed to do
28:59I'm off to the States next week
29:01I'm doing some
29:03Doing an event in New York
29:05And then I'm off to Atlanta
29:07I've got a big project in America that I'm co-directing
29:13Jackie has a busy career
29:15As an academic and consultant in mental health
29:18Over the years
29:20She's developed a positive working relationship with her own voices
29:24So, toast is ready
29:26One of my voices is just reminding me to make sure I leave some money out for my daughter for college today
29:33Rather than attack her
29:35Jackie's voices now actually help her
29:38So, yeah, I guess like a lot of working mums
29:41My head's quite busy at this time in the morning trying to think about all the stuff
29:45That has to happen, I guess
29:47Maybe the difference for me is my voices are helping me
29:50They sort of chip in
29:52You know, it's quite good teamwork really
29:55Get my bag
29:57So, this is where my voices become very helpful actually
30:00Because they start saying
30:02Right, have you got a bottle of water?
30:04Have you got a banana?
30:06Do you need to do anything for the kids before you leave?
30:10Oh yeah, and my phone and my shades
30:13That's it
30:15Okay, thanks guys, I've got everything
30:17I'm feeling slightly anxious
30:19My voices are kind of saying
30:21Oh, you should have left a bit earlier
30:22I know, I should have
30:23You're right
30:26I hear a lot of voices
30:28You know, probably well over a hundred voices
30:34Obviously we travel as a crew
30:36And because I've got younger voices
30:39And you know, quite a lot of Cockney geezers
30:42We have quite a laugh
30:43And I guess, you know, I've kind of got 24-7 company if I want it
30:56So sorry everyone
30:58Today, Jackie is teaching a course to a group of mental health workers
31:03Just to remind you that there are more people living in the general population
31:09Who hear voices who have never ever had contact with psychiatric services
31:13Jackie's life is in control now
31:15But it hasn't always been like this
31:22She first started hearing voices aged three
31:28I remember then playing in the playgrounds of my primary school
31:32And saying to this other little girl
31:34You know, those voices that you hear
31:36And her looking at me like
31:38And I picked up, ah, this isn't something that A, other people necessarily experience
31:45And B, that it isn't necessarily cool to talk about it
31:49Jackie's voices became more and more aggressive as she grew older
31:56Things hit a crisis point in her twenties with the birth of her first daughter
32:01When my daughter was a couple of days old, I remember turning to get some cotton wool to wash her with
32:10And suddenly when I look back, she was covered in blood
32:13Which was absolutely horrifying
32:17And I remember sort of shaking my head and blinking and that disappeared
32:22I lived in this kind of nightmarish world
32:25Um, where I was just having these terrifying voices
32:29Um, saying that my daughter's life was at risk
32:33That people might kidnap her
32:36And the voices began to say increasingly your daughter would be better off without you
32:41Jackie found that talking therapies were the key to helping her
32:48I worked with a very gifted therapist
32:52He actually began to encourage me to start listening to the voices
32:56And actually engaging with them more
32:58So with his support, I began to ask them questions
33:02And I was astonished to find that they could answer me with really lucid and helpful responses
33:08So if I spoke to them with more kindness and with more respect
33:14In turn, they would speak to me with more kindness and respect
33:26Today, Jackie lectures on mental health issues
33:29And is constantly seeking new research about schizophrenia and psychosis
33:32So often meets experts across the country
33:36Trying to discover the root causes of the condition
33:41Professor Charles Fernyhoe is interested in the source of the voices some people with psychosis hear
33:47And thinks it starts in childhood
33:50Show me, show me your boat
33:54I'm doing the boat as well
33:56What you find if you walk into any nursery anywhere in the world
34:01And see typically developing kids
34:04In this case they're about three years old
34:07Playing with some Lego, playing with any sort of toys
34:10You'll find an awful lot of talking going on
34:13Now some of the times the children are talking to other people
34:17They're talking to each other, they're talking to teachers or other adults who might be around
34:20But some of the times you'll see children talking to themselves
34:25This is called private speech
34:31He's talking to himself, he's using words directed at himself
34:38And he's kind of thinking out loud about what's going on in that passage of play
34:43This kind of speech in childhood helps children to think through what they're doing
34:49Private speech is an important part of healthy child development
34:57And this book, this thing
35:01The children who are doing private speech also tend to do more of it
35:05When the task is difficult
35:07So trying to help themselves think through strategies and ways of kind of working the problem out
35:12Exactly, there's something about putting it into words that is helpful
35:15As we get older, this private speech becomes internal
35:21But for people with psychosis, in stressful situations, it's thought that this private speech can appear as an external voice
35:29You're no longer recognise part of the dialogue as being your own, and therefore you hear it as a voice
35:42Now this is still in the realms of speculation until we can get more evidence on this
35:46We've only really just started to ask these questions about different kinds of inner speech
35:50This research is at an early stage, but it's also thought dopamine plays a part in causing the voices
36:05In people developing a psychosis, as the dopamine is overactive, it's no longer correctly identifying information as either coming from outside or internally generated
36:17So, inner speech might start sounding like a voice outside of your head
36:28This increase in dopamine is heavily involved in another central element of psychosis
36:40Fear
36:41Professor Paul Fletcher has been researching how the brain reacts when it's frightened and scared
36:52And thinks there are useful comparisons when likened to people with psychosis
36:58We can think of the experience of psychosis as being a little bit like being in a terrifying wood like this
37:03When you have very little sensory input, just vague shapes, shadows, flickering lights, you start to allow your imagination to create your world rather than to base it entirely on reality
37:20So, a snapping twig, instead of being interpreted just as the fire, now it becomes something more frightening, maybe an intruder
37:27Yes
37:28For most of us, this state only lasts a few moments, but for people with psychosis, their elevated levels of dopamine means they can feel frightened all the time
37:42Some people have suggested that dopamine is associated with the importance of what's around you, so that you can pay attention to it and focus on what it's going to do next
37:51Now imagine that dopamine was misfiring, there you might have a situation where everything seemed important, and you can see how that vigilance for danger could spiral out of control until everything becomes a threat
38:08I'm probably the closest many people can come to knowing just what that might be like
38:14Is when they're in a situation like this, where there are flickering shadows that they can't really interpret, where they've got their fears that are making things up all the time and they quite vividly see a figure or a face
38:27Having psychosis can be like this, being continually frightened and scared all the time
38:36This terror is a daily battle for David, it dominates his life
38:40Shitty fuck
38:43Um, I went for a piss
38:45And the floor started buckling like that on either side where my feet were
38:50It's...
38:52And then they opened up and there were teeth on the inside
38:56The bloody floor was going to eat me
38:59It's fucking terrifying
39:01While I was waiting in the, in the, um, doctor's surgery
39:05I saw this big armadillo
39:09Great big armadillo like thing
39:12Crawling along one of the beams in the top of the building
39:16And it was covered in spikes and there was poison dripping off the spikes
39:21And when the poison hit the ground
39:23They would fizz and, um, dissolve their way through the carpet
39:28And I was terrified this was coming towards me
39:32But then, uh, it sort of curled up
39:35But it curled up on the route to see the doctor
39:39Which...
39:42Ah, was not easy
39:44For many people living with psychosis is a daily struggle
39:57And although the fundamental causes are beginning to be understood
40:01Why some people develop it while others don't
40:05Still largely remains a mystery
40:09It's thought there is a genetic component to psychosis
40:12But it doesn't seem to be the most important factor
40:16Professor Swaran Singh believes where you live has a big impact
40:21Growing up in an urban environment increases your risk of developing psychosis later on
40:29It is not to do with being born in a city
40:33It's living in a city, growing up in a city, especially before the age of 15
40:38If you compare the relative contribution of these
40:47Genes contribute about 10%
40:50But urban upbringing, 35%
40:53So it's a three times stronger effect
40:56Than genetics
41:00Beyond urban living
41:02Research shows that our ethnic background affects our chance of developing psychosis
41:06But this isn't as simple as race
41:09We have known for at least 25 years in this country
41:16That the rates of psychotic disorders are particularly high in some ethnic minority groups
41:23So we know migration, for instance, is a very significant causal factor in psychosis
41:29So all migrant groups all over the world have higher rates of psychosis than the host population
41:36It's not an ethnicity issue
41:40It's not a black and white issue
41:42It is a migrant versus host issue
41:46For instance, some of the highest reported rates of psychosis
41:51are amongst Greenlanders in Denmark
41:56And they are not black
41:58What all these groups have in common is social discrimination and adversity
42:05The higher rates of psychosis in ethnic minorities seem to be because these groups are more likely to be migrant populations
42:13The key issue appears to be dislocation
42:19Some people have argued that it is social defeat that is related to psychosis
42:26By social defeat, we mean repeated experiences of marginalisation, exclusion and discrimination
42:35You don't even have to leave the country for this effect to take hold
42:43Simply moving to a new school and the social upheaval that brings can be a factor in developing psychosis
42:50And we found that greater number of school moves increased your risk of developing psychotic symptoms in adolescence
42:59Every time you move schools, you leave your peer group and your support network
43:06And you start again as an outsider
43:09So it's that chronic experience of being an outsider
43:13Which we think is related to the development of psychosis
43:19This new evidence reveals the powerful impact social environment has
43:24But there are other aspects of childhood that also contribute to psychosis
43:33So this is the area in which I grew up, around here
43:37And it's quite weird coming back
43:39It made my voices quite noisy
43:42So I've got quite a young voice at the moment
43:46Feeling quite frightened that somebody's going to drag her off and do bad things to her
43:50So she's there saying, don't hurt me, don't let anyone do anything to me
43:56She's screaming, she's begging me to please stop him hurting me
44:02Don't let him do any more bad things to me
44:05I'm sorry, I'm sorry, I'm such a bad girl
44:08This neighbourhood holds some terrible memories for Jackie
44:12I think the reason that I began hearing voices when I was so little is because of the abuse and the trauma I experienced from when I was very, very small up until my teens
44:24There was a paedophile that abused me and many other children
44:29I went from a whole healthy little girl into a shattered mind
44:38My mind literally fragmented as a consequence of the things that happened to me
44:43Although exact figures vary
44:46There is now a strong and consistent body of evidence that links childhood abuse to a range of mental disorders
44:52Including psychosis
45:06It's been a week since Davy's experimental therapy began
45:10And Professor Bentle is back to see how it went
45:13I'm dropping my laptop while I'm at it
45:15So I go straight through to the end
45:17Would you like a cup of coffee?
45:19I'd love a cup of coffee
45:21I just went into Boots
45:23And it was...
45:25Horribly busy so I was already anxious
45:29And then we went into McDonalds, which is straight for us
45:33And...er...
45:35It was quite busy
45:37So all the tables downstairs were full
45:40And that began to wind me up
45:41And then Darren Lee said
45:42Can you pull up ourselves and have a look and see if...
45:44They're in table three
45:46Both of us clearly not thinking this through
45:48So about the time I made most of the way downstairs
45:52Rats were teeming around everywhere
45:55The voices were screaming, screaming, screaming in my head
46:01It was terrifying
46:04And then...
46:06You look really quite distressed then
46:08I have to remember
46:12Crowded situations are a particular difficulty for you in that?
46:15Yes
46:17As the stress level of being with strangers rises
46:21The hallucinations, visual and awe go through the roof
46:27When you get very anxious, one of the things that seems to happen
46:29Is that you get this kind of...
46:32What we've described as a dissociative state
46:35Dissociation is a way of kind of handling threat
46:39In that situation where you can't escape, it's a way of escaping
46:42Because what happens is your kind of brain kind of goes
46:45Well, I'll sort of just pretend that it's not real
46:48I'm sort of wondering whether that makes sense to you in terms of experiences you've had in the past
46:51My mother remarried when I was four or five, I can't remember what I was
46:58Really?
47:00And the person she married was a sadistic, randomly violent psychopath
47:06He was horrible
47:07Right
47:08If you walked into a room
47:12If you walked into the room in the wrong way, if you said the wrong thing
47:16It could be anything that could trigger off
47:19You getting...
47:21Me getting...
47:23Beaten to a pulp
47:25How old were you at that time?
47:27From four or five to...
47:29Thirteen
47:30Jesus
47:31So, from four to five at thirteen, you lived in the constant fear
47:36That at any unpredictable moment, the adult, one of the adults who's supposed to be caring for you
47:42Would launch a brutal attack on you
47:45Yes, the atmosphere at home was terrifying
47:49Right, okay
47:50The question then is how do you tolerate the intolerable?
47:54If it was a particularly savage beating, if it started suddenly and it went on for a long time
48:00I would...
48:03Pretend not to be there
48:05Right, what you're describing there is what we sometimes call peritraumatic dissociation
48:10When you're in mortal danger, in mortal terror, and there is no way out, you just have to endure it
48:16Your brain does this trick, where it kind of goes, I'm not really there
48:20The problem is that, particularly when you have repeated trauma, such as you have
48:26You kind of learn just to do that
48:28And you carry forward that as one of your survival strategies to adulthood
48:34This is all piling on the likelihood of you then starting to have hallucinatory experiences
48:40Jackie is going to see a friend, whose psychosis was also caused by childhood trauma
48:54However, just like Jackie, Eleanor Longden has learned to live with her voices
49:00And even become a doctor of psychology
49:01Darlene
49:07How are you?
49:10Eleanor believes that she took a big step when she addressed her voices directly
49:14You know, the idea of approaching this stuff and confronting it is so terrifying and horrifying
49:23That it does feel like it could kill you
49:24She thinks her recovery began when she realised her voices weren't just attacking her, but could potentially help her
49:35And this was sort of the big turning point, was realising that actually voices weren't my enemies
49:40Speaking with one of her most frightening voices proved revelatory
49:44And I remember actually sort of one day saying that to him, you've drawn my attention to all this unresolved emotional problems
49:54And all I've ever done is attack you for it and, you know, try to get rid of you
49:58And it must have been really lonely
50:01And really demoralising
50:04And there was a very long pause
50:06And then he finally said, that's right
50:08Thank you
50:09It was a really, really powerful moment
50:13And again, this sort of absolute sense of reconciliation, of restitution between me and another part of myself
50:24Voices absolutely can, even the sort of very difficult negative ones, can be recruited as, you know, as a part of the healing process and of the healing journey
50:34Like Eleanor, Jackie is living proof that you can be successful, despite having psychosis, by using talking therapies
50:45However, David still has to rely on medication, to deal with terrifying voices and hallucinations
50:54And, of course, I lunge for the tranquilizers and they take about 15-20 minutes to kick in, so I have all of this going on for 15-20 minutes
51:04And, I'm less bothered by now
51:09But less bothered means I wouldn't mind dying when I go to sleep
51:14I don't want any more chest pains
51:17Given to me by an anti-psychotic I took, the, um
51:25Cardioid said
51:27I'll be lucky to live until I'm 50
51:30I don't want to get terrified when I'm in a group of more than about 5 people
51:36Me included
51:40Terrified I want to run away
51:43Come on, Kisu, off you go, off you go
51:47Off you go, Kisu
51:50That's a good cat
51:52Problem solved
51:57David is going to meet Professor Sir Robin Murray
52:01One of the country's leading psychiatrists
52:03Who's warned that long-term use of anti-psychotic medication can cause serious side effects
52:09As far as I said, I've been on anti-psychotics since 1999
52:14Should I have been on them for that long?
52:17The ideal is to get off the anti-psychotics, but it is not always possible
52:22And we do know that there are side effects, in particular they tend to make people put on weight
52:29And that, yes, so that, of course, brings an increased risk of diabetes, an increased risk of heart disease
52:40And similar problems
52:42If I don't take anti-psychotics, I start having extremely florid psychotic episodes
52:48Where I totally disassociate from the real world
52:52And I sort of run around and running into walls and things, screaming
52:56It may be that, for unfortunate reasons, you're one of the people who has to continue to take the anti-psychotics
53:04For many people with psychosis, anti-psychotics are still the primary treatment they can access
53:14The medications that you are taking are much cheaper than psychological therapy
53:20And, sadly, many psychiatrists are working in services where there is very limited psychological or social support
53:31And, therefore, all that can be done is medication
53:35So that is when the service appears to be so limited and diminishes people's chances to recover
53:43As a child, I believed I was a monster because I was abused
54:06I had a lovely family
54:08What I kept hidden, what I kept inside, was that someone sexually abused me
54:14And I never told my family
54:17I just pushed it down so far
54:21Yet it was there, and when I looked in the mirror, that's what I saw
54:24If this trauma caused Rachel's hostile voices, like the not-yets
54:30Could confronting them with therapy help?
54:38She is meeting with Dr. Dirk Caustens
54:39In the session, he will talk directly to one of the not-yets
54:53My intention is to engage with him and talk with him and ask what he stands for
55:00And the specific question, when he hurts you, is that trying to hurt or to communicate?
55:10Where do you think he would like to sit in the room?
55:15Separate from you?
55:16Separate from me
55:17Yeah
55:18If he is there, please then connect with me
55:29And do you have a name?
55:35No
55:37Who do you think you are?
55:39I am someone who wants to support Rachel and you in a way
55:48Are you scared of me?
55:50No, I am not scared of you
55:52What are the things you are telling to her?
55:54Tell her that she will get hurt
55:57That they will hurt her
56:00That it's her fault
56:03Does it make her afraid?
56:05She should be afraid
56:06That's your aim?
56:08Hmm
56:09And what's the reason that she should be afraid?
56:12She will be hurt
56:14You warn her, is that a warning or?
56:17I just tell her what's going to happen
56:20And how long do you tell her that?
56:25As long as I need to
56:27I feel that you feel sad, is that true?
56:30I don't feel
56:31You don't feel at all?
56:33I see
56:35What specific things do you see?
56:38I see them picking at her
56:40You see a lot
56:42That things that are dangerous for Rachel?
56:47Yes
56:50Thank you very much
56:53Thank you
56:55By trying to understand the viewpoint of the not yet voice
56:59Dirk hopes he can improve the relationship it has with Rachel
57:02How do you feel?
57:03I feel on the edges of emotional
57:13And he wasn't as aggressive as he usually is to me
57:17No
57:18I guess
57:21And that this voice means that he has seen something
57:30Sometimes voices are fed up with what they are doing
57:36And when you open up that perspective then you can help the voice to reach their goal in a more fruitful way
57:43Our experience and there is also research that says that if you only suppress your voices then they become stronger
57:53So that was pretty intense
58:01When I went into it I really wanted to know
58:04I thought the voice was powerful that it was threatening me
58:08I thought it meant me harm
58:10And I was just wondering could it have been trying to warn me
58:12And I think what I have learnt is yes it was trying to warn me
58:16It is trying to warn me
58:18And just knowing that makes it seem less scary
58:23Psychosis has many names
58:26And was long considered an irreversible condition
58:29But research now increasingly suggests that it is primarily the brain's response to traumatic events
58:35And perhaps if we can identify the cause we can address it
58:40And that holds out the prospect of recovery
58:43Details of organisations offering information and support with mental health are available at bbc.co.uk forward slash action line
58:59Or you can call for free at any time to hear recorded information on 08000 839 839
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