0:00:02 > 0:00:09This programme contains some strong language.
0:00:09 > 0:00:11Our brains have an astonishing ability to interpret
0:00:11 > 0:00:14the world around us. Most of us are able to tell the difference
0:00:14 > 0:00:15between fact and fantasy.
0:00:15 > 0:00:19Between real and imagined danger.
0:00:21 > 0:00:24We learn to recognise voices, and understand meaning.
0:00:26 > 0:00:30But for some, the normal, benign business
0:00:30 > 0:00:33of interpreting reality has broken down.
0:00:35 > 0:00:39And as I sat there, I knew these things were going to come
0:00:39 > 0:00:41and eat me alive from the inside.
0:00:43 > 0:00:48I remember being about 13, 14, and having this real knowledge,
0:00:48 > 0:00:51this true knowledge, that I had an alien inside me.
0:00:52 > 0:00:55I woke up, and the voices were telling me,
0:00:55 > 0:00:57"Kill yourself, kill yourself."
0:00:57 > 0:01:00You have not experienced terror like that...
0:01:02 > 0:01:05..unless you've had a psychotic episode.
0:01:07 > 0:01:12They are...beyond any imaginable terror
0:01:12 > 0:01:14that a normal person can experience.
0:01:16 > 0:01:19For years, these disturbing psychotic experiences
0:01:19 > 0:01:22have been given a name - schizophrenia.
0:01:22 > 0:01:24In this film, we'll discover first-hand
0:01:24 > 0:01:27what this condition is really like.
0:01:27 > 0:01:30The floor started buckling,
0:01:30 > 0:01:32like that, on either side where my feet were.
0:01:35 > 0:01:38And then they opened up, and there were teeth on the inside.
0:01:38 > 0:01:41The bloody floor was going to eat me.
0:01:41 > 0:01:44We'll explore the research that is throwing new light
0:01:44 > 0:01:47on what is happening to the brain.
0:01:47 > 0:01:49If you have too much dopamine,
0:01:49 > 0:01:53then things which normally are not important in your environment may
0:01:53 > 0:01:55suddenly acquire importance to you.
0:01:58 > 0:02:00I see all these people looking at me,
0:02:00 > 0:02:04I can see their eyes looking at me, staring at me very intensely.
0:02:04 > 0:02:09And you can see how an environment like this becomes very threatening.
0:02:09 > 0:02:12We'll search for what causes psychosis in the first place.
0:02:14 > 0:02:18Growing up in an urban environment increases your risk of developing
0:02:18 > 0:02:19psychosis later on.
0:02:21 > 0:02:25And we'll see new and experimental therapies in action.
0:02:25 > 0:02:26You're in for it now.
0:02:28 > 0:02:29But most importantly,
0:02:29 > 0:02:32we'll follow three people who live with the condition.
0:02:34 > 0:02:36All the crew around me are...
0:02:40 > 0:02:42..plotting to kill me.
0:02:44 > 0:02:46You're in on it too.
0:02:58 > 0:03:00CHOIR SINGS
0:03:02 > 0:03:06For decades, people with severe mental conditions
0:03:06 > 0:03:07have been called mad.
0:03:09 > 0:03:11But is there really such a thing as madness?
0:03:14 > 0:03:18Dr David Strange is a former Oxford scholar.
0:03:18 > 0:03:23He has a doctorate in epidemiology, the study of how diseases spread.
0:03:23 > 0:03:24And his work was award-winning.
0:03:28 > 0:03:31But then, on what seemed like a normal day in 1999...
0:03:35 > 0:03:37..his world changed forever.
0:03:38 > 0:03:42MUSIC: Elephant by Tame Impala
0:03:42 > 0:03:44# Bet he feels like an elephant
0:03:44 > 0:03:49# Shaking his big grey trunk for the hell of it
0:03:49 > 0:03:55# You know that you're dreaming about being loved by him... #
0:04:05 > 0:04:09I was in a meeting with my supervisor, sitting in her office.
0:04:09 > 0:04:12And suddenly I could hear five voices
0:04:12 > 0:04:17screaming at me from positions, strangely, around me.
0:04:17 > 0:04:21And there were lots of rats, hairy,
0:04:21 > 0:04:25dirty, rat-like things running around and running over my feet.
0:04:26 > 0:04:30And as I sat there, I knew these things were going
0:04:30 > 0:04:32to come and eat me alive from the inside.
0:04:37 > 0:04:40It's frightening beyond belief.
0:04:41 > 0:04:45Especially when you're with someone who you've known for several years,
0:04:45 > 0:04:48and they are apparently not noticing these things.
0:04:50 > 0:04:53And it was so much, I just said, I...
0:04:53 > 0:04:57I made a quick excuse, and ran home, and hid under my bed.
0:05:14 > 0:05:17# I hear voices in my head
0:05:17 > 0:05:20# It gets dark and dangerous... #
0:05:20 > 0:05:24Like David, Rachel Woddingham is accompanied by voices and paranoia.
0:05:24 > 0:05:27Now 39, she experienced her first
0:05:27 > 0:05:31terrifying hallucination aged just seven.
0:05:31 > 0:05:34# Catch me when I fall... #
0:05:34 > 0:05:36I remember being at my friend's house,
0:05:36 > 0:05:42and I was looking in her dressing table mirror and saw this monster
0:05:42 > 0:05:45staring back at me where I should have been.
0:05:45 > 0:05:48It was...kind of ugly.
0:05:48 > 0:05:49It was dark coloured.
0:05:49 > 0:05:51It wasn't human.
0:05:51 > 0:05:53It's just looked terrifying.
0:05:55 > 0:06:01Psychosis is a term used to describe a range of different diagnoses,
0:06:01 > 0:06:04including the most notorious of all - schizophrenia.
0:06:06 > 0:06:10Each person's experience of psychosis is unique.
0:06:10 > 0:06:13But there are three key symptoms that generally define it.
0:06:14 > 0:06:18Voice-hearing, paranoia and hallucinations.
0:06:23 > 0:06:25There's a rat just on your knee.
0:06:25 > 0:06:30There are a few running up and down onto those benches there.
0:06:33 > 0:06:39And there's one on that table which is a bit close.
0:06:39 > 0:06:40Oh, yeah.
0:06:43 > 0:06:46While hallucinations can be terrifying,
0:06:46 > 0:06:49they are often accompanied by deep paranoia.
0:06:51 > 0:06:55For David, he feels his life is constantly under threat.
0:06:56 > 0:06:59I can hear your thoughts now.
0:06:59 > 0:07:01And you don't like me very much.
0:07:01 > 0:07:04You think I should do something horrible to myself.
0:07:09 > 0:07:13Paranoid thoughts have also plagued Rachel for much of her life.
0:07:18 > 0:07:21I remember being about 13, 14,
0:07:21 > 0:07:25and having this real knowledge that I had an alien inside me.
0:07:25 > 0:07:28One night I started to hear these voices talking about me.
0:07:28 > 0:07:32I started to believe that they were part of this conspiracy.
0:07:33 > 0:07:36I could feel the sensation of being watched,
0:07:36 > 0:07:38and the only way I could make sense of it
0:07:38 > 0:07:41is that there must be cameras installed in my flat.
0:07:42 > 0:07:45It's similar to being in one of those conspiracy movies,
0:07:45 > 0:07:49where just something's going on, and no-one else knows,
0:07:49 > 0:07:52and no matter who you turn to, who you speak to,
0:07:52 > 0:07:54they...
0:07:54 > 0:07:58they either won't believe you, they'll think you're crazy,
0:07:58 > 0:08:02or even speaking to them will put them in danger.
0:08:05 > 0:08:09ELECTRONIC DRUMBEAT
0:08:12 > 0:08:16David uses music to express some of the emotions he feels about the
0:08:16 > 0:08:18effects of his psychosis.
0:08:21 > 0:08:23I quite like ambient
0:08:23 > 0:08:25and electronic music.
0:08:25 > 0:08:29And I wanted to make something quite hallucinogenic, quite weird,
0:08:29 > 0:08:31quite mind-altered state.
0:08:31 > 0:08:35And I think I've done it quite well with this piece.
0:08:35 > 0:08:36It's quite hallucinogenic.
0:08:39 > 0:08:43At times, the paranoia and hallucinations
0:08:43 > 0:08:45have become too much for David.
0:08:45 > 0:08:47He's been driven to numerous suicide attempts,
0:08:47 > 0:08:51and been in and out of psychiatric units for much of his adult life.
0:08:52 > 0:08:55His music reflects some of these experiences.
0:08:59 > 0:09:02I wrote this piece of music to capture the experience
0:09:02 > 0:09:05of coming around after an overdose
0:09:05 > 0:09:08and finding all kinds of electronic equipment and tubes
0:09:08 > 0:09:10poking out of you.
0:09:10 > 0:09:13And I had some horrible experience
0:09:13 > 0:09:17of big metal pipes coming out of my throat.
0:09:17 > 0:09:18And machines all around me.
0:09:18 > 0:09:21And this is that experience.
0:09:21 > 0:09:24ELECTRONIC BEEPING
0:09:34 > 0:09:37Rachel lives with another key element of psychosis.
0:09:37 > 0:09:38Voice hearing.
0:09:39 > 0:09:43She creates images of her voices to help her try and understand them.
0:09:44 > 0:09:46Rachel hears many voices,
0:09:46 > 0:09:49with different characters, different personalities,
0:09:49 > 0:09:51but each behave differently to her.
0:09:52 > 0:09:54So, Blue is a little girl.
0:09:55 > 0:09:57She's one of my youngest voices.
0:09:57 > 0:10:00She's about three.
0:10:00 > 0:10:02I think she's frightened of other people.
0:10:02 > 0:10:03She is frightened of being hurt.
0:10:03 > 0:10:08I felt really sad, because there was a young voice, a child,
0:10:08 > 0:10:10who was upset and crying.
0:10:10 > 0:10:13I felt like I was abandoning her. A little one.
0:10:13 > 0:10:16And it felt like it was my fault that I couldn't reach her.
0:10:17 > 0:10:21A breakthrough kind of came when I found Bunny.
0:10:21 > 0:10:26Bunny is this lovely little toy, just this beautiful little toy.
0:10:26 > 0:10:30And for the first time, I kind of felt...like this curiosity in her.
0:10:30 > 0:10:32And it felt like I'd reached her,
0:10:32 > 0:10:36which was a pretty powerful moment, really.
0:10:36 > 0:10:39But not all Rachel's voices are so benign.
0:10:42 > 0:10:45So the next ones I'm going to draw is The Three.
0:10:47 > 0:10:50These guys were paid to watch me, hated me.
0:10:50 > 0:10:54And they just
0:10:54 > 0:10:56report to the government, report to the aliens.
0:10:56 > 0:10:58They never talk directly to me.
0:10:58 > 0:11:02They always talk about me, and about the people that are around me.
0:11:03 > 0:11:07The voices are even able to cause Rachel physical pain.
0:11:08 > 0:11:11So I'm going to draw Elfie now.
0:11:11 > 0:11:14When I first started to hear her, she called herself Monster.
0:11:14 > 0:11:16And that's what I saw in the mirror.
0:11:16 > 0:11:22The monster. Sometimes I can tell that Elfie's upset...
0:11:22 > 0:11:25because I feel burning on my skin.
0:11:28 > 0:11:31It's kind of like someone's searing my skin with...
0:11:31 > 0:11:34with a hot iron or something like that.
0:11:35 > 0:11:38And I know it's not "happening" happening
0:11:38 > 0:11:40because I can't see any flames,
0:11:40 > 0:11:42there's no marks, but I feel it as intensely.
0:11:45 > 0:11:49I was terrified of Elf, and then something changed.
0:11:49 > 0:11:52Over time it kind of emerged that she'd been trying to tell me that I
0:11:52 > 0:11:56wasn't safe. So what kind of emerged is that Elfie is not this big,
0:11:56 > 0:11:59scary monster that she appeared to me as.
0:11:59 > 0:12:01She's actually just an 11-year-old girl.
0:12:03 > 0:12:06GENTLE CHILDLIKE MUSIC
0:12:17 > 0:12:21While there has long been difficulty in the diagnosis of psychosis,
0:12:21 > 0:12:23scientists have now largely agreed
0:12:23 > 0:12:25on the biological process going on in the brain.
0:12:27 > 0:12:30Research suggests that people with psychosis
0:12:30 > 0:12:34seem to produce too much of the brain chemical called dopamine.
0:12:37 > 0:12:40Dopamine is a chemical that is naturally produced
0:12:40 > 0:12:41in all our brains,
0:12:41 > 0:12:44and it's absolutely essential to how our brains work.
0:12:46 > 0:12:50Our brains are constantly being bombarded by information
0:12:50 > 0:12:54from our senses, we are always hearing or seeing things,
0:12:54 > 0:12:57and we've got to filter out the things that are
0:12:57 > 0:13:00unimportant, the kind of regular things,
0:13:00 > 0:13:04from those that are unusual or potentially really
0:13:04 > 0:13:07important, either a danger or something that might be a reward.
0:13:07 > 0:13:10Dopamine starts...
0:13:10 > 0:13:13those nerve cells start firing and signalling
0:13:13 > 0:13:17when they detect something unusual, and they then focus attention
0:13:17 > 0:13:20and the brain's resources on trying to
0:13:20 > 0:13:24make sense of those particular stimuli,
0:13:24 > 0:13:27rather than other things that are unimportant.
0:13:27 > 0:13:30So they filter out the other things, by saying, "Focus on this."
0:13:37 > 0:13:40In the real world, dopamine helps us avoid danger
0:13:40 > 0:13:44by allowing us to recognise what could be an actual threat.
0:13:45 > 0:13:47The visually packed world of a funfair
0:13:47 > 0:13:50is filled with objects that could pose real danger to us.
0:13:51 > 0:13:55A fast-moving machine or a suspicious character.
0:13:58 > 0:14:02Michelle Kokkinou is part of Professor Howe's team,
0:14:02 > 0:14:06and has been researching the effects of dopamine on the brain.
0:14:06 > 0:14:09Dopamine fires and tells me to pay attention,
0:14:09 > 0:14:12and maybe not go too near it, because it's dangerous.
0:14:14 > 0:14:18But if the brain becomes too flooded with dopamine,
0:14:18 > 0:14:20things can start to go wrong.
0:14:20 > 0:14:22And this is exactly what is thought to happen
0:14:22 > 0:14:24in the brains of those with psychosis.
0:14:27 > 0:14:30If you have too much dopamine in your brain,
0:14:30 > 0:14:32so if there's an excess of dopamine,
0:14:32 > 0:14:35then things which normally are not important
0:14:35 > 0:14:37in your environment - for your survival, for example -
0:14:37 > 0:14:41may suddenly acquire importance to you.
0:14:41 > 0:14:44Everyday objects take on new meaning.
0:14:44 > 0:14:48The benign and harmless become terrifying.
0:14:49 > 0:14:52For example, I see all these people looking at me.
0:14:52 > 0:14:57I can see their eyes looking at me, staring at me, very intensely.
0:14:57 > 0:15:01And then I have this inherent drive to make sense of it.
0:15:01 > 0:15:06And so, depending on my experiences, for example, or my personality,
0:15:06 > 0:15:10I may think that they have been sent by the FBI to follow me.
0:15:11 > 0:15:13Or by the aliens to spy on me.
0:15:13 > 0:15:19And you can see how an environment like this becomes very threatening,
0:15:19 > 0:15:20instead of being enjoyable.
0:15:26 > 0:15:30Doctors struggled for years to find medication to treat psychosis
0:15:30 > 0:15:33but, in the 1950s, found a class of drugs,
0:15:33 > 0:15:37originally used as anaesthetics, that reduce symptoms.
0:15:38 > 0:15:42A mainstay of our treatment for people with schizophrenia are
0:15:42 > 0:15:44anti-psychotic medications.
0:15:44 > 0:15:48And these work by blocking the action of dopamine after it's been
0:15:48 > 0:15:52released. So they dampen down the effects
0:15:52 > 0:15:54of the dopamine overactivity,
0:15:54 > 0:15:58and over a few days, or maybe a week or two,
0:15:58 > 0:16:01this gradually means that the psychosis -
0:16:01 > 0:16:04the paranoia, the hallucinations -
0:16:04 > 0:16:06subsides and goes away.
0:16:10 > 0:16:12OK, this is my medication cupboard.
0:16:12 > 0:16:15And I have rather a lot.
0:16:18 > 0:16:21Risperidone, that is my anti-psychotic,
0:16:21 > 0:16:24this is the main thing I need to keep me sane.
0:16:24 > 0:16:26My dose isn't very high at the moment, but it's been...
0:16:26 > 0:16:32it has in the past been so high that about once a day I would have a fit.
0:16:32 > 0:16:37It also makes you more hungry than the imagination can handle.
0:16:37 > 0:16:41You are crazily hungry when you take anti-psychotics.
0:16:41 > 0:16:43And Risperidone is one of the worst.
0:16:43 > 0:16:48So I've gone from a 32-inch waist to a 42-inch waist.
0:16:48 > 0:16:52Then there's Pregabalin, which is an anti-convulsant.
0:16:52 > 0:16:54These deal with my anxiety.
0:16:55 > 0:16:59The other anti-psychotic I take is Quetiapine,
0:16:59 > 0:17:03which is a very sedating anti-psychotic.
0:17:03 > 0:17:08The only other ones that I have that are lunacy-related are Loperamide,
0:17:08 > 0:17:11and they stop you pooing your pants.
0:17:11 > 0:17:16I need something to cork me up, so I will have two, I think.
0:17:16 > 0:17:20I think I will have a couple of the benzodiazepine tranquillisers,
0:17:20 > 0:17:23so we need a procyclidine.
0:17:23 > 0:17:29This is to deal with the side-effects of the anti-psychotic.
0:17:29 > 0:17:32Ranitidine is just for my stomach, I have acid reflux.
0:17:32 > 0:17:37And so is the Esomeprazole, that's for my stomach as well.
0:17:37 > 0:17:39And that's my medication for tonight.
0:17:43 > 0:17:47Today, the primary treatment for people with psychosis, like David,
0:17:47 > 0:17:49are anti-psychotic drugs.
0:17:53 > 0:17:56They are not actually curing, if you like,
0:17:56 > 0:18:00the dopamine overactivity that was the problem in the first place.
0:18:00 > 0:18:03So, unfortunately, with our current medications,
0:18:03 > 0:18:07we've got something that works very well to dampen down dopamine,
0:18:07 > 0:18:10but doesn't cure the underlying problem.
0:18:14 > 0:18:17While drugs can't cure psychosis,
0:18:17 > 0:18:20a series of new therapies have been developed.
0:18:20 > 0:18:22Treatment that could revolutionise how we deal with it.
0:18:37 > 0:18:40This is Professor Richard Bentall.
0:18:40 > 0:18:42He has been using a treatment for psychosis
0:18:42 > 0:18:44that doesn't use any drugs.
0:18:44 > 0:18:46It's called experience sampling.
0:18:46 > 0:18:49And it's a form of electronic diary-keeping.
0:18:51 > 0:18:56So, experience sampling is a method which we've used for many years to
0:18:56 > 0:18:59look at the way that people feel in everyday life.
0:19:00 > 0:19:04What we do is, we ask people to fill in questionnaires.
0:19:04 > 0:19:06We get a kind of snapshot about them.
0:19:06 > 0:19:09What they are like at a particular moment.
0:19:09 > 0:19:11And in the case of psychosis,
0:19:11 > 0:19:14what we're really interested in is what circumstances do people,
0:19:14 > 0:19:16for example, hear their voices,
0:19:16 > 0:19:19or in what circumstances do they feel paranoid?
0:19:19 > 0:19:22And experience sampling can pick that up.
0:19:22 > 0:19:26The therapy uses an app which can be installed into a mobile device.
0:19:26 > 0:19:28The app bleeps four times a day,
0:19:28 > 0:19:32and when it bleeps, the patient answers questions.
0:19:32 > 0:19:36The questions are about whether the patient is hearing voices
0:19:36 > 0:19:37and how severe they are,
0:19:37 > 0:19:40whether they feel paranoid, what their mood is.
0:19:40 > 0:19:42We can look at how, for example,
0:19:42 > 0:19:46exposure to stressful events leads to an exasperation of senses.
0:19:49 > 0:19:54Today Professor Bentall is meeting David to see whether this method can
0:19:54 > 0:19:57help him discover what triggers his hallucinations.
0:20:01 > 0:20:02Hello, I'm David Strange.
0:20:02 > 0:20:06- You must be Richard.- I'm Richard, yes. Hi.- Any chance of an espresso?
0:20:08 > 0:20:10The way it works is it uploads your answers,
0:20:10 > 0:20:13whenever it's in contact with the web.
0:20:13 > 0:20:19So psychiatrists and psychologists can keep an eye on their patients,
0:20:19 > 0:20:20and see how they're doing.
0:20:20 > 0:20:22And big Brother is watching you!
0:20:22 > 0:20:24Well... You could look at it that way,
0:20:24 > 0:20:28but on the other hand what it means is that they can...
0:20:28 > 0:20:32It's a more reliable picture of how your life is.
0:20:32 > 0:20:35Yes. I'm just going to get on my computer,
0:20:35 > 0:20:37just so that I can set this up properly.
0:20:44 > 0:20:47Uh... There is something next to you.
0:20:49 > 0:20:50There's something next to me?
0:20:52 > 0:20:53Is this something you...?
0:20:53 > 0:20:59Yes, it's a large crab, pointy, spiky...like, thing.
0:21:03 > 0:21:05And you can see it right now?
0:21:06 > 0:21:08- Yeah.- OK.
0:21:09 > 0:21:11And I'm rather scared of it.
0:21:11 > 0:21:12OK.
0:21:14 > 0:21:15So, what's it doing?
0:21:20 > 0:21:22Can you tell me what it's doing, David?
0:21:25 > 0:21:28- OK, it's gone.- OK.
0:21:28 > 0:21:30So...
0:21:30 > 0:21:32Are you OK?
0:21:32 > 0:21:34- Yeah, fine.- OK.
0:21:34 > 0:21:36How big was it?
0:21:38 > 0:21:40About 18 inches long.
0:21:40 > 0:21:44Crab-like claws, spikes on its back.
0:21:44 > 0:21:45Wow.
0:21:47 > 0:21:49Poisonous spikes at the front.
0:21:49 > 0:21:53It was a rather grim vision of...Winchester.
0:21:53 > 0:21:56Right, OK.
0:21:56 > 0:22:00Using the diary technique, Professor Bentall hopes to establish the cause
0:22:00 > 0:22:02of the hallucinations,
0:22:02 > 0:22:03such as the one David just had.
0:22:05 > 0:22:08- All right.- Thank you very much.
0:22:08 > 0:22:10I wonder how much I could get for this!
0:22:11 > 0:22:15As well as using the app on his phone, David will also record his
0:22:15 > 0:22:18experiences on his iPad,
0:22:18 > 0:22:22to give a real insight of what it's like living with psychosis.
0:22:22 > 0:22:24I had a really...
0:22:26 > 0:22:28..difficult night last night.
0:22:29 > 0:22:32I woke up, I don't know what time it was.
0:22:32 > 0:22:38And there were large, scorpion-type things
0:22:38 > 0:22:41scampering around on the floor.
0:22:41 > 0:22:42Two or three.
0:22:42 > 0:22:45And I thought...
0:22:47 > 0:22:52"Bloody hell, I don't want to have all these experiences,"
0:22:52 > 0:22:56and I got out of bed and I enthusiastically jumped on them.
0:23:00 > 0:23:04It's hoped that by recording his experiences in this way,
0:23:04 > 0:23:06David may gain an insight into what triggers
0:23:06 > 0:23:08his voices and hallucinations.
0:23:17 > 0:23:21Like David, Rachel also spent years in and out
0:23:21 > 0:23:22of the psychiatric system.
0:23:27 > 0:23:30When I was a patient of the mental-health system,
0:23:30 > 0:23:33I felt like I was written off as severely mentally ill,
0:23:33 > 0:23:34with no hope of recovery.
0:23:34 > 0:23:38I was diagnosed with schizophrenia, borderline personality disorder,
0:23:38 > 0:23:41schizoaffective disorder, dissociative identity disorder,
0:23:41 > 0:23:44complex post-traumatic stress disorder
0:23:44 > 0:23:46with psychosis, amongst others.
0:23:46 > 0:23:50Rachel turned her back on the psychiatric system,
0:23:50 > 0:23:52and looked for alternative support.
0:23:52 > 0:23:54A key moment was joining a group
0:23:54 > 0:23:57with other people who also hear voices.
0:23:57 > 0:23:59I went to the group. And that, I think,
0:23:59 > 0:24:01was the huge turning point for me.
0:24:01 > 0:24:03I had no fight left in me.
0:24:03 > 0:24:10And no belief that I could ever live outside of the psychiatric system.
0:24:10 > 0:24:12So, for me,
0:24:12 > 0:24:14the first step on my journey back
0:24:14 > 0:24:16was realising that I was a human being.
0:24:16 > 0:24:18And that took connections.
0:24:18 > 0:24:21People connected with me. I connected with them.
0:24:21 > 0:24:24And that allowed me to realise I had stories
0:24:24 > 0:24:26before the story of schizophrenia.
0:24:31 > 0:24:33With peer support and therapy,
0:24:33 > 0:24:35Rachel came off medication and has forged a career
0:24:35 > 0:24:38as a mental health consultant and practitioner.
0:24:41 > 0:24:46However, there is still one group of aggressive, frightening voices that
0:24:46 > 0:24:47she struggles with.
0:24:47 > 0:24:49The Not Yets.
0:24:51 > 0:24:52They are only called the Not Yets
0:24:52 > 0:24:55because I didn't want to talk about them in therapy.
0:24:55 > 0:24:57So it was the best way of getting the therapist not to ask
0:24:57 > 0:24:59a question about them.
0:24:59 > 0:25:02I actually feel physically sick just thinking about them.
0:25:02 > 0:25:08And actually just drawing this makes me feel slightly frightened.
0:25:09 > 0:25:12It's as if, by drawing it, I'm making it real.
0:25:13 > 0:25:18Sometimes one of them will talk in depth about me being tortured,
0:25:18 > 0:25:21that people are waiting for me. Um...
0:25:22 > 0:25:23It's...
0:25:24 > 0:25:25..it can get really graphic.
0:25:27 > 0:25:30Rachel is going to try a different kind of treatment to deal with the
0:25:30 > 0:25:32Not Yets, called Avatar therapy.
0:25:34 > 0:25:38She's going to try and put a face to one of them for the first time.
0:25:41 > 0:25:45Professor Tom Craig has been pioneering this new technique.
0:25:45 > 0:25:48It involves creating a computer-generated face
0:25:48 > 0:25:50that Rachel will then have to interact with.
0:25:52 > 0:25:56The first stage in the process is to create the voice.
0:25:56 > 0:26:01So the first thing we need to do is to find the best approximate voice.
0:26:01 > 0:26:03- MALE VOICE:- You could never learn to make a choice.
0:26:03 > 0:26:04That's a bit high.
0:26:04 > 0:26:07- LOWER:- Whenever his friends asked him if he would like to go
0:26:07 > 0:26:09out with them, he would only answer, "I don't know."
0:26:09 > 0:26:12- Yes.- Yeah?- I think so.
0:26:12 > 0:26:15Next, they move onto the physical features of the face.
0:26:16 > 0:26:18I imagine, probably, that one.
0:26:18 > 0:26:21Brow - we'll just make him frown a bit?
0:26:21 > 0:26:23Yeah. That kind of works better, I think,
0:26:23 > 0:26:26cos it just looks a little bit more aggressive.
0:26:30 > 0:26:33So, kind of, looking at the depiction of the voice
0:26:33 > 0:26:37on the screen, its eyes are pretty piercing and strange-looking.
0:26:37 > 0:26:39So I feel a little nervous.
0:26:39 > 0:26:42I can feel my heart beating a little bit.
0:26:42 > 0:26:45And I'm not entirely sure what to expect.
0:26:46 > 0:26:50Professor Craig will take the role of the voice.
0:26:50 > 0:26:54Rachel must overcome her fears and attempt to be assertive with it.
0:26:55 > 0:26:58He's going to say some of the usual things he says to you,
0:26:58 > 0:27:02and when he does, I want you to just say to him, really firmly,
0:27:02 > 0:27:05"I don't want to hear this any more.
0:27:05 > 0:27:07"Go away! Leave me alone."
0:27:07 > 0:27:09- OK?- Mm-hm.
0:27:09 > 0:27:11So, here he comes.
0:27:13 > 0:27:16You're stupid. You're in for it now.
0:27:17 > 0:27:19I'm not going to listen to you.
0:27:19 > 0:27:21You know you're in for it.
0:27:21 > 0:27:23They're waiting for you.
0:27:23 > 0:27:25They're going to cut you up.
0:27:25 > 0:27:28- You know it.- That's not true.
0:27:28 > 0:27:32You're just talking crap. You're trying to frighten me.
0:27:32 > 0:27:34That's not here, that's not now.
0:27:35 > 0:27:37Are you telling me you're not scared of me?
0:27:37 > 0:27:39Of course I'm scared of you.
0:27:39 > 0:27:42But you don't speak the truth.
0:27:43 > 0:27:46I wouldn't get much fun if I didn't threaten you.
0:27:46 > 0:27:48Why do you want that to be fun?
0:27:48 > 0:27:51You know, is it that boring - your life?
0:27:51 > 0:27:53You are in for it now.
0:27:54 > 0:27:57You know they're waiting outside for you.
0:27:57 > 0:27:59They're not waiting outside.
0:27:59 > 0:28:01You said this before.
0:28:01 > 0:28:02It's not happening.
0:28:04 > 0:28:08That's really, really good, excellent, good, good work.
0:28:08 > 0:28:12So let's wrap up, I think. How are you feeling?
0:28:12 > 0:28:14A little shaky,
0:28:14 > 0:28:17kind of, yeah... I've got a few of my voices
0:28:17 > 0:28:21- kind of chiming in at the moment. - Right.
0:28:21 > 0:28:24But certainly, at times, it felt very intense.
0:28:26 > 0:28:30By asking Rachel to confront her voice in this way,
0:28:30 > 0:28:33it is hoped that she'll become less frightened, and therefore
0:28:33 > 0:28:35better equipped to deal with it.
0:28:36 > 0:28:40Talking therapies like this are offering a path to recovery,
0:28:40 > 0:28:43and a chance to learn to live with voices.
0:28:51 > 0:28:55And this is exactly what Jackie Dillon has managed to do.
0:28:59 > 0:29:03I'm off to the States next week, I'm doing some...
0:29:03 > 0:29:05doing an event in New York.
0:29:05 > 0:29:08And then I'm off to Atlanta.
0:29:08 > 0:29:12I've got a big project in America that I'm co-directing.
0:29:14 > 0:29:16Jackie has a busy career as an
0:29:16 > 0:29:19academic and consultant in mental health.
0:29:19 > 0:29:22Over the years, she's developed a positive working relationship
0:29:22 > 0:29:24with her own voices.
0:29:24 > 0:29:27So, toast is ready.
0:29:27 > 0:29:29One of my voices is just reminding me to
0:29:29 > 0:29:33make sure I leave some money out for my daughter, for college today.
0:29:34 > 0:29:38Rather than attack her, Jackie's voices now actually help her.
0:29:38 > 0:29:41So, yeah, I guess, like a lot of working mums,
0:29:41 > 0:29:44my head's quite busy at this time of the morning,
0:29:44 > 0:29:47trying to think about all the stuff that has to happen.
0:29:47 > 0:29:50Maybe the difference for me is my voices are helping me.
0:29:50 > 0:29:52They, sort of, chip in.
0:29:52 > 0:29:55You know, it's quite good teamwork, really.
0:29:55 > 0:29:57Get my bag.
0:29:57 > 0:30:00So this is where my voices become very helpful, actually,
0:30:00 > 0:30:04because they start saying, "Right, have you got a bottle of water?"
0:30:04 > 0:30:06"Have you got a banana?"
0:30:06 > 0:30:10"Do you need to do anything for the kids before you leave?"
0:30:10 > 0:30:12Oh, yeah, and my phone and my shades.
0:30:12 > 0:30:16That's it. OK, thanks, guys. I've got everything.
0:30:17 > 0:30:19I'm feeling slightly anxious.
0:30:19 > 0:30:22My voices are kind of saying, "Oh, you should have left a bit earlier."
0:30:22 > 0:30:24I know I should have, you're right.
0:30:26 > 0:30:28I hear a lot of voices.
0:30:28 > 0:30:34You know, probably well over 100 voices.
0:30:34 > 0:30:36Obviously, we travel as a crew.
0:30:36 > 0:30:41And because I've got younger voices and, you know,
0:30:41 > 0:30:45quite a lot of cockney geezers who...we have quite a laugh, and
0:30:45 > 0:30:50I guess, you know, I've kind of got 24/7
0:30:50 > 0:30:53company, if I want it.
0:30:56 > 0:30:58I'm so sorry, everyone.
0:30:58 > 0:31:03Today, Jackie is teaching a course to a group of mental-health workers.
0:31:03 > 0:31:05Just to remind you that there are
0:31:05 > 0:31:09more people living in the general population who hear voices
0:31:09 > 0:31:13who have never, ever had contact with psychiatric services.
0:31:13 > 0:31:15Jackie's life is in control now.
0:31:15 > 0:31:17But it hasn't always been like this.
0:31:22 > 0:31:25She first started hearing voices aged three.
0:31:28 > 0:31:31I remember playing in the playgrounds of my primary school,
0:31:31 > 0:31:34and saying to this other little girl, "You know,
0:31:34 > 0:31:35"those voices that you hear."
0:31:35 > 0:31:39And her looking at me like, "Huh?"
0:31:39 > 0:31:41And I picked up, ah,
0:31:41 > 0:31:46this isn't something that, A) other people necessarily experience, and
0:31:46 > 0:31:49B) that it isn't necessarily cool to talk about it.
0:31:52 > 0:31:56Jackie's voices became more and more aggressive as she grew older.
0:31:56 > 0:31:59Things hit a crisis point in her 20s,
0:31:59 > 0:32:01with the birth of her first daughter.
0:32:03 > 0:32:05When my daughter was a couple of days old,
0:32:05 > 0:32:10I remember turning to get some cotton wool to wash her with,
0:32:10 > 0:32:12and suddenly, when I looked back,
0:32:12 > 0:32:14she was covered in blood...
0:32:16 > 0:32:18..which was absolutely horrifying.
0:32:18 > 0:32:22And I remember shaking my head and blinking, and that disappeared.
0:32:22 > 0:32:25I lived in this kind of nightmarish world,
0:32:25 > 0:32:30where I was just having these terrifying voices,
0:32:30 > 0:32:34saying that my daughter's life was at risk,
0:32:34 > 0:32:36that people might kidnap her.
0:32:36 > 0:32:39And the voices began to say, increasingly,
0:32:39 > 0:32:42"Your daughter would be better off without you."
0:32:44 > 0:32:48Jackie found that talking therapies were the key to helping her.
0:32:49 > 0:32:52I worked with a very gifted therapist,
0:32:52 > 0:32:55he actually began to encourage me to start listening to the voices,
0:32:55 > 0:32:58and actually engaging with them more.
0:32:58 > 0:33:02So with his support I began to ask them questions.
0:33:02 > 0:33:07And I was astonished to find that they could answer me with really
0:33:07 > 0:33:09lucid and helpful responses.
0:33:09 > 0:33:14So if I spoke to them with more kindness, and with more respect,
0:33:14 > 0:33:19in turn, they would speak to me with more kindness and respect.
0:33:26 > 0:33:29Today Jackie lectures on mental health issues,
0:33:29 > 0:33:31and is constantly seeking new research
0:33:31 > 0:33:33about schizophrenia and psychosis,
0:33:33 > 0:33:36so often meets experts across the country,
0:33:36 > 0:33:39trying to discover the root causes of the condition.
0:33:42 > 0:33:44Professor Charles Fernyhough is interested
0:33:44 > 0:33:45in the source of the voices
0:33:45 > 0:33:49some people with psychosis hear, and thinks it starts in childhood.
0:33:52 > 0:33:54Show me your boat.
0:33:55 > 0:33:57I'm doing a boat as well.
0:33:57 > 0:34:01What you find, if you walk into any nursery, anywhere in the world,
0:34:01 > 0:34:04and see typically developing kids,
0:34:04 > 0:34:06in this case, they're about three years old,
0:34:06 > 0:34:09playing with some Lego, playing with any sort of toys,
0:34:09 > 0:34:13you'll find an awful lot of talking going on.
0:34:13 > 0:34:16Now, some of the times the children are talking to other people,
0:34:16 > 0:34:18they are talking to each other,
0:34:18 > 0:34:21they are talking to teachers or other adults who might be around.
0:34:21 > 0:34:25But some of the times, you'll see children talking to themselves.
0:34:27 > 0:34:29This train is running away.
0:34:29 > 0:34:31This is called private speech.
0:34:34 > 0:34:36He is talking to himself.
0:34:36 > 0:34:38He's using words directed at himself, and he is kind of
0:34:38 > 0:34:42thinking out loud about what's going on in that passage of play.
0:34:45 > 0:34:47This kind of speech in childhood helps children
0:34:47 > 0:34:50to think through what they are doing.
0:34:50 > 0:34:53The cars on the road.
0:34:53 > 0:34:57Private speech is an important part of healthy child development.
0:34:57 > 0:35:01And this, this train...
0:35:01 > 0:35:03The children who are doing private speech
0:35:03 > 0:35:06also tend to do more of it when the task is difficult.
0:35:06 > 0:35:10They're trying to help themselves think through strategies
0:35:10 > 0:35:12and ways of kind of working the problem out.
0:35:12 > 0:35:14Exactly. There's something about
0:35:14 > 0:35:16putting it into words that is helpful.
0:35:17 > 0:35:21As we get older, this private speech becomes internal.
0:35:21 > 0:35:25But for people with psychosis, in stressful situations,
0:35:25 > 0:35:28it's thought that this private speech
0:35:28 > 0:35:30can appear as an external voice.
0:35:32 > 0:35:36Put your car on the road...
0:35:36 > 0:35:39You no longer recognise part of the dialogue as being your own.
0:35:39 > 0:35:42And therefore, you hear it as a voice.
0:35:42 > 0:35:45Now, this is still in the realms of speculation until we can get more
0:35:45 > 0:35:49evidence on this. We've only really just started to ask these questions
0:35:49 > 0:35:51about different kinds of inner speech.
0:35:54 > 0:35:57This research is at an early stage.
0:35:57 > 0:36:01But it's also thought dopamine plays a part in causing the voices.
0:36:05 > 0:36:10In people developing a psychosis, as the dopamine is overactive,
0:36:10 > 0:36:13it's no longer correctly identifying
0:36:13 > 0:36:15information as either coming from
0:36:15 > 0:36:19outside, or internally generated.
0:36:19 > 0:36:23So, inner speech might start sounding like a voice
0:36:23 > 0:36:24outside of your head.
0:36:28 > 0:36:31This increase in dopamine is heavily involved
0:36:31 > 0:36:33in another central element of psychosis.
0:36:40 > 0:36:42Fear.
0:36:46 > 0:36:51Professor Paul Fletcher has been researching how the brain reacts
0:36:51 > 0:36:53when it's frightened and scared,
0:36:53 > 0:36:55and thinks there are useful comparisons
0:36:55 > 0:36:57when likened to people with psychosis.
0:36:58 > 0:37:01We can think of experiencing psychosis
0:37:01 > 0:37:05as being a little bit like being in a terrifying wood like this.
0:37:07 > 0:37:09When you have very little sensory input,
0:37:09 > 0:37:13just vague-shaped shadows, flickering lights,
0:37:13 > 0:37:17you start to allow your imagination to create the world,
0:37:17 > 0:37:21rather than to base it entirely on reality.
0:37:21 > 0:37:26So a snapping twig, instead of being interpreted just as the fire,
0:37:26 > 0:37:30- now it becomes something more frightening.- Yes.- Maybe an intruder.
0:37:30 > 0:37:35For most of us, this state only lasts a few moments,
0:37:35 > 0:37:37but for people with psychosis,
0:37:37 > 0:37:38their elevated levels of dopamine
0:37:38 > 0:37:42mean they can feel frightened all the time.
0:37:42 > 0:37:47Some people have suggested that dopamine is associated with the
0:37:47 > 0:37:50importance of what's around you. So that you can pay attention to it,
0:37:50 > 0:37:52and focus on what it's going to do next.
0:37:53 > 0:37:56Now, imagine that dopamine was misfiring.
0:37:57 > 0:38:01There, you might have a situation where everything seemed important.
0:38:01 > 0:38:06You can see how that vigilance for danger could spiral out of control
0:38:06 > 0:38:08until everything becomes a threat.
0:38:08 > 0:38:11And probably the closest many people can come
0:38:11 > 0:38:14to knowing just what that might be like is when
0:38:14 > 0:38:17they're in a situation like this,
0:38:17 > 0:38:20where there are flickering shadows that they can't really interpret,
0:38:20 > 0:38:23where they've got their fears that are making things up all the time,
0:38:23 > 0:38:26and they quite vividly see a figure or a face.
0:38:27 > 0:38:30Having psychosis can be like this,
0:38:30 > 0:38:33being continually frightened and scared all the time.
0:38:36 > 0:38:39This terror is a daily battle for David.
0:38:39 > 0:38:41It dominates his life.
0:38:41 > 0:38:43Shitting fuck!
0:38:43 > 0:38:45Um, I went for a piss.
0:38:45 > 0:38:49And the floor started buckling like that on either side,
0:38:49 > 0:38:51where my feet were.
0:38:52 > 0:38:56And then they opened up, and there were teeth on the inside.
0:38:56 > 0:38:59The bloody floor was going to eat me.
0:38:59 > 0:39:01Fucking terrifying!
0:39:01 > 0:39:03And while I was waiting in the...
0:39:03 > 0:39:04in the...
0:39:04 > 0:39:08doctor's surgery, I saw this big,
0:39:08 > 0:39:12great, big armadillo-like thing
0:39:12 > 0:39:17crawling along one of the beams in the top of the building.
0:39:17 > 0:39:19And it was covered in spikes,
0:39:19 > 0:39:21and there was poison dripping off the spikes,
0:39:21 > 0:39:25and when the poison hit the ground, they would fizz and...
0:39:25 > 0:39:29um, dissolve their way through the carpet.
0:39:29 > 0:39:33I was terrified this was coming towards me, but then
0:39:33 > 0:39:35it sort of curled up.
0:39:35 > 0:39:39But it curled up on the route to see the doctor, which...
0:39:42 > 0:39:44Aaargh! ..was not easy.
0:39:52 > 0:39:57For many people, living with psychosis is a daily struggle.
0:39:57 > 0:40:01And although the fundamental causes are beginning to be understood,
0:40:01 > 0:40:05why some people develop it while others don't,
0:40:05 > 0:40:07still largely remains a mystery.
0:40:10 > 0:40:13It's thought there is a genetic component to psychosis.
0:40:13 > 0:40:16But it doesn't seem to be the most-important factor.
0:40:17 > 0:40:21Professor Swaran Singh believes where you live has a big impact.
0:40:23 > 0:40:27Growing up in an urban environment increases your risk of developing
0:40:27 > 0:40:29psychosis later on.
0:40:30 > 0:40:33It is not to do with being born in a city.
0:40:33 > 0:40:36It's living in a city, growing up in a city,
0:40:36 > 0:40:38especially before the age of 15.
0:40:42 > 0:40:47If you compare the relative contribution of genes,
0:40:47 > 0:40:53genes contribute about 10%, but urban upbringing, 35%.
0:40:53 > 0:40:58So it's a three-times stronger effect than genetics.
0:41:00 > 0:41:02Beyond urban living,
0:41:02 > 0:41:05research shows that our ethnic background
0:41:05 > 0:41:08affects our chance of developing psychosis.
0:41:08 > 0:41:09But this isn't as simple as race.
0:41:12 > 0:41:16We have known for at least 25 years in this country
0:41:16 > 0:41:19that the rates of psychotic disorders
0:41:19 > 0:41:23are particularly high in some ethnic minority groups.
0:41:23 > 0:41:26So we know... migration, for instance,
0:41:26 > 0:41:30is a very significant causal factor in psychosis.
0:41:30 > 0:41:33All migrant groups, all over the world,
0:41:33 > 0:41:36have higher rates of psychosis than the host population.
0:41:37 > 0:41:40It's not an ethnicity issue.
0:41:40 > 0:41:43It's not a black and white issue.
0:41:43 > 0:41:46It's a migrant versus host issue.
0:41:49 > 0:41:53For instance, some of the highest reported rates of psychosis
0:41:53 > 0:41:57are amongst Greenlanders in Denmark.
0:41:57 > 0:41:59And they are not black.
0:41:59 > 0:42:02What all these groups have in common is
0:42:02 > 0:42:05social discrimination and adversity.
0:42:07 > 0:42:11The higher rates of psychosis in ethnic minorities
0:42:11 > 0:42:14seem to be because these groups are more likely
0:42:14 > 0:42:16to be migrant populations.
0:42:16 > 0:42:19The key issue appears to be dislocation.
0:42:19 > 0:42:24Some people have argued that it is social defeat
0:42:24 > 0:42:26that is related to psychosis.
0:42:26 > 0:42:32By social defeat we mean repeated experiences of marginalisation,
0:42:32 > 0:42:35exclusion, and discrimination.
0:42:39 > 0:42:41You don't even have to leave the country
0:42:41 > 0:42:43for this effect to take hold.
0:42:43 > 0:42:47Simply moving to a new school, and the social upheaval that brings,
0:42:47 > 0:42:50can be a factor in developing psychosis.
0:42:51 > 0:42:57And we found that the greater number of school moves increased your risk
0:42:57 > 0:43:00of developing psychotic symptoms in adolescence.
0:43:00 > 0:43:02Every time you move schools,
0:43:02 > 0:43:05you leave your peer group and your support network.
0:43:05 > 0:43:07And you start again as an outsider.
0:43:09 > 0:43:14So it's that chronic experience of being an outsider which we think is
0:43:14 > 0:43:17related to the development of psychosis.
0:43:19 > 0:43:21This new evidence reveals the
0:43:21 > 0:43:24powerful impact social environment has.
0:43:26 > 0:43:28But there are other aspects of childhood
0:43:28 > 0:43:31that also contribute to psychosis.
0:43:33 > 0:43:37So this is the area in which I grew up, round here.
0:43:37 > 0:43:39And it's quite weird coming back.
0:43:39 > 0:43:42It made my voices quite noisy.
0:43:42 > 0:43:46Um, so I've got quite a young voice at the moment,
0:43:46 > 0:43:47feeling quite frightened that
0:43:47 > 0:43:52somebody's going to drag her off and do bad things to her.
0:43:52 > 0:43:54So she's there saying, "Don't hurt me,
0:43:54 > 0:43:57"don't let anyone do anything to me."
0:43:57 > 0:43:59She's screaming.
0:43:59 > 0:44:02She's begging me to "please stop him hurting me.
0:44:02 > 0:44:05"Don't let him do any more bad things to me.
0:44:05 > 0:44:07"I'm sorry, I'm sorry I'm such a bad girl."
0:44:09 > 0:44:12This neighbourhood holds some terrible memories for Jackie.
0:44:15 > 0:44:18I think the reason that I began hearing voices when I was so little
0:44:18 > 0:44:21is because of the abuse and trauma I experienced from when I was very,
0:44:21 > 0:44:24very small, up until my teens.
0:44:26 > 0:44:30There was a paedophile that abused me and many other children.
0:44:32 > 0:44:34I went from a whole,
0:44:34 > 0:44:38healthy little girl into a shattered mind.
0:44:38 > 0:44:40My mind literally fragmented
0:44:40 > 0:44:43as a consequence of the things that happened to me.
0:44:44 > 0:44:47Although exact figures vary,
0:44:47 > 0:44:50there is now a strong and consistent body of evidence that links
0:44:50 > 0:44:53childhood abuse to a range of mental disorders.
0:44:54 > 0:44:56Including psychosis.
0:45:06 > 0:45:10It's been a week since David's experimental therapy began.
0:45:10 > 0:45:13And Professor Bentall is back to see how it went.
0:45:13 > 0:45:16I'm dropping the laptop while I'm at it. Sorry.
0:45:16 > 0:45:18Go straight through to the end. Would you like a cup of coffee?
0:45:18 > 0:45:20I'd love a cup of coffee.
0:45:20 > 0:45:22I just went into Boots...
0:45:23 > 0:45:25..and it was...
0:45:26 > 0:45:29..horribly busy, so I was already anxious.
0:45:29 > 0:45:33And then we went into McDonald's, which is strange for us.
0:45:33 > 0:45:36And it was quite busy.
0:45:36 > 0:45:40So all the tables downstairs were full.
0:45:40 > 0:45:42And that began to wind me up, and then Downey said,
0:45:42 > 0:45:45"Can you pop upstairs and have a look if there are any tables free?"
0:45:45 > 0:45:48Both of us clearly not thinking this through.
0:45:48 > 0:45:52So by the time I made it most of the way downstairs,
0:45:52 > 0:45:55rats were teeming around everywhere,
0:45:55 > 0:45:59the voices were screaming, screaming,
0:45:59 > 0:46:01screaming in my head.
0:46:01 > 0:46:03It was terrifying.
0:46:03 > 0:46:05And then...
0:46:06 > 0:46:09You look really quite distressed there.
0:46:12 > 0:46:15Crowded situations are a particular difficulty for you?
0:46:15 > 0:46:21Yes. As the stress level of being with strangers rises,
0:46:21 > 0:46:26the hallucinations, visual and aural, go through the roof.
0:46:26 > 0:46:28When you get very anxious,
0:46:28 > 0:46:31one of the things which SEEMS to happen is that you get this...
0:46:31 > 0:46:34kind of what we've described as a dissociative state.
0:46:35 > 0:46:39Dissociation is a way of kind of handling threat.
0:46:39 > 0:46:42In a situation where you can't escape, it's a way of escaping.
0:46:42 > 0:46:45Because what happens is your brain kind of goes,
0:46:45 > 0:46:48"Well, I'll just pretend that it's not real."
0:46:48 > 0:46:51I'm sort of wondering whether that makes sense to you
0:46:51 > 0:46:53in terms of experiences you've had in the past?
0:46:53 > 0:46:56My mother remarried when I was four or five,
0:46:56 > 0:46:59I can never remember, really.
0:46:59 > 0:47:01And the person she married was a
0:47:01 > 0:47:07sadistic, randomly violent psychopath.
0:47:07 > 0:47:09He was just horrible. If you walked into a room...
0:47:12 > 0:47:14..if you walked into the room the wrong way,
0:47:14 > 0:47:16if you said the wrong thing,
0:47:16 > 0:47:19it could be anything that could trigger off
0:47:19 > 0:47:25you getting...getting beaten to a pulp.
0:47:25 > 0:47:27How old were you at the time?
0:47:27 > 0:47:30From 4 or 5, to 13.
0:47:30 > 0:47:33Jesus! So from four or five,
0:47:33 > 0:47:36to 13, you lived in the constant fear
0:47:36 > 0:47:40that at any unpredictable moment, the adult, one of the adults
0:47:40 > 0:47:42who was supposed to be caring for you,
0:47:42 > 0:47:45would launch a brutal attack on you.
0:47:45 > 0:47:49Yes. The atmosphere at home was terrifying.
0:47:49 > 0:47:51Frightening beyond belief.
0:47:51 > 0:47:54The question then is, how do you tolerate the intolerable?
0:47:54 > 0:47:57If it was a particularly savage beating,
0:47:57 > 0:48:01if it started suddenly and it went on for a long time, I would...
0:48:03 > 0:48:05..pretend not to be there.
0:48:05 > 0:48:07Right. What you're describing there
0:48:07 > 0:48:10is what we sometimes call peri-traumatic dissociation.
0:48:10 > 0:48:13When you're in mortal danger, in mortal terror,
0:48:13 > 0:48:16and there is no way out, you just have to endure it,
0:48:16 > 0:48:19your brain does this trick where it kind of goes,
0:48:19 > 0:48:21"I'm not really there."
0:48:21 > 0:48:25The problem is that, particularly when you have repeated trauma,
0:48:25 > 0:48:28such as you have, you kind of learn just to do that.
0:48:28 > 0:48:31And you carry forward that as your...
0:48:31 > 0:48:35one of your survival strategies to adulthood.
0:48:35 > 0:48:39This is all piling on the likelihood of you then starting to have
0:48:39 > 0:48:41hallucinatory experiences.
0:48:46 > 0:48:50Jackie is going to see a friend whose psychosis was also caused by
0:48:50 > 0:48:51childhood trauma.
0:48:55 > 0:48:57However, just like Jackie,
0:48:57 > 0:49:00Eleanor Longden has learned to live with her voices,
0:49:00 > 0:49:02and even become a doctor of psychology.
0:49:05 > 0:49:08Darling! Lovely to see you. How are you?
0:49:08 > 0:49:10You too. Good, thank you, how are you?
0:49:10 > 0:49:12Eleanor believes that she took a big step
0:49:12 > 0:49:14when she addressed her voices directly.
0:49:14 > 0:49:18You know, the idea of approaching this stuff,
0:49:18 > 0:49:22and confronting it, is so terrifying and horrifying
0:49:22 > 0:49:25that it does feel like it could kill you.
0:49:27 > 0:49:32She thinks her recovery began when she realised her voices weren't just
0:49:32 > 0:49:36attacking her, but could potentially help her.
0:49:36 > 0:49:38And this was sort of the big turning point.
0:49:38 > 0:49:41Realising, actually, the voices weren't my enemies.
0:49:41 > 0:49:43Speaking with one of her most frightening voices
0:49:43 > 0:49:46proved revelatory.
0:49:46 > 0:49:48And I remember, actually, one day saying to that him,
0:49:48 > 0:49:51"You've drawn my attention to all this unresolved
0:49:51 > 0:49:54"emotional problems.
0:49:54 > 0:49:56"And all I've ever done is attack you for it
0:49:56 > 0:49:57"and tried to get rid of you.
0:49:57 > 0:50:01"And it must have been really lonely
0:50:01 > 0:50:04"and really demoralising."
0:50:04 > 0:50:06And there was a very long pause.
0:50:06 > 0:50:10And then he finally said, "That's right. Thank you."
0:50:10 > 0:50:13It was a really, really powerful moment.
0:50:14 > 0:50:19And, again, this sort of, absolute sense of reconciliation,
0:50:19 > 0:50:23of restitution between me and another part of myself.
0:50:24 > 0:50:26Voices absolutely can -
0:50:26 > 0:50:28even the sort of really difficult, negative ones -
0:50:28 > 0:50:30can be recruited
0:50:30 > 0:50:34as a part of the healing process and of the healing journey.
0:50:36 > 0:50:39Like Eleanor, Jackie is living proof
0:50:39 > 0:50:43that you can be successful despite having psychosis -
0:50:43 > 0:50:45by using talking therapies.
0:50:48 > 0:50:52However, David still has to rely on medication to deal with terrifying
0:50:52 > 0:50:55voices and hallucinations.
0:50:56 > 0:50:59Of course I lunge for the tranquillisers, and they take
0:50:59 > 0:51:01about 15, 20 minutes to kick in,
0:51:01 > 0:51:03so I have all of this going on for 15, 20 minutes.
0:51:03 > 0:51:07And I am...
0:51:07 > 0:51:09less bothered by it now.
0:51:09 > 0:51:13But "less bothered" means I wouldn't mind dying when I go to sleep.
0:51:15 > 0:51:17I don't want any more chest pains...
0:51:19 > 0:51:22..given to me by an anti-psychotic I took.
0:51:22 > 0:51:23The, um...
0:51:25 > 0:51:29..cardiologist said I'll be lucky to live until I'm 50.
0:51:31 > 0:51:33I don't want to get terrified when
0:51:33 > 0:51:37I'm in a group of more than about five people, me included.
0:51:40 > 0:51:42Terrified, I want to run away.
0:51:44 > 0:51:47Come on, Kitsu, off you go, off you go.
0:51:47 > 0:51:49Off you go, Kitsu!
0:51:49 > 0:51:51That's a good cat.
0:51:53 > 0:51:54Problem solved.
0:51:57 > 0:52:00David is going to meet Professor Sir Robin Murray -
0:52:00 > 0:52:02one of the country's leading psychiatrists,
0:52:02 > 0:52:06who's warned that long-term use of anti-psychotic medication
0:52:06 > 0:52:09can cause serious side effects.
0:52:09 > 0:52:14So, as I said, I've been on anti-psychotics since 1999.
0:52:14 > 0:52:17Should I have been on them for that long?
0:52:17 > 0:52:20The ideal is to get off the anti-psychotics,
0:52:20 > 0:52:22but it's not always possible.
0:52:22 > 0:52:25And we do know that there are side effects -
0:52:25 > 0:52:29in particular they tend to make people put on weight.
0:52:29 > 0:52:31And that...
0:52:31 > 0:52:35Yes. So that, of course,
0:52:35 > 0:52:37brings an increased risk of diabetes,
0:52:37 > 0:52:39an increased risk of heart disease
0:52:39 > 0:52:42and similar problems.
0:52:42 > 0:52:44If I don't take anti-psychotics,
0:52:44 > 0:52:50I start having extremely florid psychotic episodes where I totally
0:52:50 > 0:52:52disassociate from the real world,
0:52:52 > 0:52:56and I'm running into walls and things, screaming...
0:52:56 > 0:52:59It may be that for unfortunate reasons
0:52:59 > 0:53:02you are one of the people who has to continue
0:53:02 > 0:53:04to take the anti-psychotics.
0:53:07 > 0:53:09For many people with psychosis,
0:53:09 > 0:53:14anti-psychotics are still the primary treatment they can access.
0:53:14 > 0:53:18The medications that you are taking are much cheaper
0:53:18 > 0:53:20than psychological therapy.
0:53:20 > 0:53:26And, sadly, many psychiatrists are working in services
0:53:26 > 0:53:31where there is very limited psychological or social support.
0:53:31 > 0:53:35And therefore, all that can be done is medication.
0:53:35 > 0:53:39So that is when the service appears to be so limited
0:53:39 > 0:53:43and diminishes people's chances to recover.
0:53:48 > 0:53:51# And older now
0:53:53 > 0:53:57# I am home again
0:53:57 > 0:54:01# Your touch feels like... #
0:54:01 > 0:54:06As a child, I believed I was a monster because I was abused.
0:54:07 > 0:54:11I had a lovely family. What I kept hidden, what I kept inside
0:54:11 > 0:54:14was that someone sexually abused me.
0:54:14 > 0:54:17And I never told my family.
0:54:17 > 0:54:21I just...pushed it down so far, yet it was there.
0:54:21 > 0:54:25And when I looked in the mirror, that's what I saw.
0:54:25 > 0:54:30If this trauma caused Rachel's hostile voices, like the Not Yets,
0:54:30 > 0:54:33could confronting them with therapy help?
0:54:43 > 0:54:46She is meeting with Dr Dirk Corstens.
0:54:46 > 0:54:51In the session, he will talk directly to one of the Not Yets.
0:54:54 > 0:54:58My intention is to engage with him, and talk with him,
0:54:58 > 0:55:01and ask what he stands for.
0:55:01 > 0:55:06And the specific question, when he hurts you,
0:55:06 > 0:55:09is that trying to hurt or to communicate?
0:55:09 > 0:55:14Where do you think he would like to sit in the room?
0:55:14 > 0:55:16Separate from you?
0:55:16 > 0:55:18Separate from me. Yes.
0:55:24 > 0:55:29If he is there, please then connect with me.
0:55:33 > 0:55:35Do you have a name?
0:55:36 > 0:55:39No. Who do you think you are?
0:55:41 > 0:55:46I am someone who wants to support Rachel -
0:55:46 > 0:55:48and you, in a way.
0:55:48 > 0:55:50Are you scared of me?
0:55:50 > 0:55:51No, I'm not scared of you.
0:55:51 > 0:55:54What are the things you are telling to her?
0:55:54 > 0:55:56Tell her that she will get hurt.
0:55:58 > 0:55:59That they will hurt her.
0:56:01 > 0:56:03That it's her fault.
0:56:03 > 0:56:05Does it make her afraid?
0:56:05 > 0:56:07She SHOULD be afraid.
0:56:07 > 0:56:09That you are in?
0:56:09 > 0:56:12And what's the reason that she should be afraid?
0:56:12 > 0:56:15- She will be hurt.- You warn her?
0:56:15 > 0:56:16Is that a warning or...?
0:56:18 > 0:56:20I just tell her what's going to happen.
0:56:20 > 0:56:23And how long do you tell her that?
0:56:25 > 0:56:27As long as I need to.
0:56:27 > 0:56:30I feel that you feel sad, is that true?
0:56:30 > 0:56:33- I don't feel.- You don't feel at all?
0:56:33 > 0:56:37- No, I see.- What specific things do you see?
0:56:38 > 0:56:40I see them picking at her.
0:56:40 > 0:56:41You see a lot...
0:56:43 > 0:56:45..things that are dangerous for Rachel?
0:56:47 > 0:56:48Yes.
0:56:50 > 0:56:51Thank you very much.
0:56:53 > 0:56:54Thank you.
0:56:55 > 0:56:59By trying to understand the viewpoint of the Not Yet voice,
0:56:59 > 0:57:03Dirk hopes he can improve the relationship it has with Rachel.
0:57:09 > 0:57:13- How do you feel?- I feel on the edges of emotional.
0:57:14 > 0:57:16- He wasn't as aggressive as he usually is to me.- No.
0:57:19 > 0:57:22I guess
0:57:22 > 0:57:25that this voice
0:57:25 > 0:57:29means that he has seen something.
0:57:30 > 0:57:36Sometimes, voices are fed up with what they are doing,
0:57:36 > 0:57:38and when you open up that perspective,
0:57:38 > 0:57:44then you can help the voice to reach their goal in a more fruitful way.
0:57:45 > 0:57:47Our experience,
0:57:47 > 0:57:52and there is also research that says if you only suppress your voices,
0:57:52 > 0:57:54then they become stronger.
0:57:59 > 0:58:02So, that was pretty intense.
0:58:02 > 0:58:05When I went in to it, I really wanted to know,
0:58:05 > 0:58:08I thought the voice was powerful, that it was threatening me.
0:58:08 > 0:58:10I thought it meant me harm.
0:58:10 > 0:58:13I was just wondering, could it have been trying to warn me?
0:58:13 > 0:58:16I think what I've learned is, yes, it WAS trying to warn me.
0:58:16 > 0:58:18It IS trying to warn me.
0:58:18 > 0:58:21And just knowing that makes it seems less scary.
0:58:23 > 0:58:26Psychosis has many names
0:58:26 > 0:58:29and was long considered an irreversible condition.
0:58:29 > 0:58:31But research now increasingly suggests
0:58:31 > 0:58:36that it's primarily the brain's response to traumatic events.
0:58:36 > 0:58:40And perhaps if we can identify the cause, we can address it,
0:58:40 > 0:58:43and that holds out the prospect of recovery.