Why Did I Go Mad? Horizon

This programme contains some strong language.

Our brains have an astonishing ability to interpret

the world around us. Most of us are able to tell the difference

between fact and fantasy.

Between real and imagined danger.

We learn to recognise voices, and understand meaning.

But for some, the normal, benign business

of interpreting reality has broken down.

And as I sat there, I knew these things were going to come

and eat me alive from the inside.

I remember being about 13, 14, and having this real knowledge,

this true knowledge, that I had an alien inside me.

I woke up, and the voices were telling me,

"Kill yourself, kill yourself."

You have not experienced terror like that...

..unless you've had a psychotic episode.

They are...beyond any imaginable terror

that a normal person can experience.

For years, these disturbing psychotic experiences

have been given a name - schizophrenia.

In this film, we'll discover first-hand

what this condition is really like.

The floor started buckling,

like that, on either side where my feet were.

And then they opened up, and there were teeth on the inside.

The bloody floor was going to eat me.

We'll explore the research that is throwing new light

on what is happening to the brain.

If you have too much dopamine,

then things which normally are not important in your environment may

suddenly acquire importance to you.

I see all these people looking at me,

I can see their eyes looking at me, staring at me very intensely.

And you can see how an environment like this becomes very threatening.

We'll search for what causes psychosis in the first place.

Growing up in an urban environment increases your risk of developing

psychosis later on.

And we'll see new and experimental therapies in action.

You're in for it now.

But most importantly,

we'll follow three people who live with the condition.

All the crew around me are...

..plotting to kill me.

You're in on it too.

CHOIR SINGS

For decades, people with severe mental conditions

have been called mad.

But is there really such a thing as madness?

Dr David Strange is a former Oxford scholar.

He has a doctorate in epidemiology, the study of how diseases spread.

And his work was award-winning.

But then, on what seemed like a normal day in 1999...

..his world changed forever.

MUSIC: Elephant by Tame Impala

# Bet he feels like an elephant

# Shaking his big grey trunk for the hell of it

# You know that you're dreaming about being loved by him... #

I was in a meeting with my supervisor, sitting in her office.

And suddenly I could hear five voices

screaming at me from positions, strangely, around me.

And there were lots of rats, hairy,

dirty, rat-like things running around and running over my feet.

And as I sat there, I knew these things were going

to come and eat me alive from the inside.

It's frightening beyond belief.

Especially when you're with someone who you've known for several years,

and they are apparently not noticing these things.

And it was so much, I just said, I...

I made a quick excuse, and ran home, and hid under my bed.

# I hear voices in my head

# It gets dark and dangerous... #

Like David, Rachel Woddingham is accompanied by voices and paranoia.

Now 39, she experienced her first

terrifying hallucination aged just seven.

# Catch me when I fall... #

I remember being at my friend's house,

and I was looking in her dressing table mirror and saw this monster

staring back at me where I should have been.

It was...kind of ugly.

It was dark coloured.

It wasn't human.

It's just looked terrifying.

Psychosis is a term used to describe a range of different diagnoses,

including the most notorious of all - schizophrenia.

Each person's experience of psychosis is unique.

But there are three key symptoms that generally define it.

Voice-hearing, paranoia and hallucinations.

There's a rat just on your knee.

There are a few running up and down onto those benches there.

And there's one on that table which is a bit close.

Oh, yeah.

While hallucinations can be terrifying,

they are often accompanied by deep paranoia.

For David, he feels his life is constantly under threat.

I can hear your thoughts now.

And you don't like me very much.

You think I should do something horrible to myself.

Paranoid thoughts have also plagued Rachel for much of her life.

I remember being about 13, 14,

and having this real knowledge that I had an alien inside me.

One night I started to hear these voices talking about me.

I started to believe that they were part of this conspiracy.

I could feel the sensation of being watched,

and the only way I could make sense of it

is that there must be cameras installed in my flat.

It's similar to being in one of those conspiracy movies,

where just something's going on, and no-one else knows,

and no matter who you turn to, who you speak to,

they...

they either won't believe you, they'll think you're crazy,

or even speaking to them will put them in danger.

ELECTRONIC DRUMBEAT

David uses music to express some of the emotions he feels about the

effects of his psychosis.

I 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.

At times, the paranoia and hallucinations

have become too much for David.

He's been driven to numerous suicide attempts,

and been in and out of psychiatric units for much of his adult life.

His music reflects some of these experiences.

I wrote this piece of music to capture the experience

of coming around after an overdose

and finding all kinds of electronic equipment and tubes

poking out of you.

And I had some horrible experience

of big metal pipes coming out of my throat.

And machines all around me.

And this is that experience.

ELECTRONIC BEEPING

Rachel lives with another key element of psychosis.

Voice hearing.

She creates images of her voices to help her try and understand them.

Rachel hears many voices,

with different characters, different personalities,

but each behave differently to her.

So, Blue is a little girl.

She's one of my youngest voices.

She's about three.

I think she's frightened of other people.

She is frightened of being hurt.

I felt really sad, because there was a young voice, a child,

who was upset and crying.

I felt like I was abandoning her. A little one.

And it felt like it was my fault that I couldn't reach her.

A breakthrough kind of came when I found Bunny.

Bunny is this lovely little toy, 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 reached her,

which was a pretty powerful moment, really.

But not all Rachel's voices are so benign.

So the next ones I'm going to draw is The Three.

These guys were paid to watch me, hated me.

And they just

report to the government, report to the aliens.

They never talk directly to me.

They always talk about me, and about the people that are around me.

The voices are even able to cause Rachel physical pain.

So I'm going to draw Elfie now.

When I first started to hear her, she called herself Monster.

And that's what I saw in the mirror.

The monster. Sometimes I can tell that Elfie's upset...

because I feel burning on my skin.

It's kind of like someone's searing my skin with...

with a hot iron or something like that.

And I know it's not "happening" happening

because I can't see any flames,

there's no marks, but I feel it as intensely.

I was terrified of Elf, and then something changed.

Over time it kind of emerged that she'd been trying to tell me that I

wasn't safe. So what kind of emerged is that Elfie is not this big,

scary monster that she appeared to me as.

She's actually just an 11-year-old girl.

GENTLE CHILDLIKE MUSIC

While there has long been difficulty in the diagnosis of psychosis,

scientists have now largely agreed

on the biological process going on in the brain.

Research suggests that people with psychosis

seem to produce too much of the brain chemical called dopamine.

Dopamine is a chemical that is naturally produced

in all our brains,

and it's absolutely essential to how our brains work.

Our brains are constantly being bombarded by information

from our senses, we are always hearing or seeing things,

and we've got to filter out the things that are

unimportant, the kind of regular things,

from those that are unusual or potentially really

important, either a danger or something that might be a reward.

Dopamine starts...

those nerve cells start firing and signalling

when they detect something unusual, and they then focus attention

and the brain's resources on trying to

make sense of those particular stimuli,

rather than other things that are unimportant.

So they filter out the other things, by saying, "Focus on this."

In the real world, dopamine helps us avoid danger

by allowing us to recognise what could be an actual threat.

The visually packed world of a funfair

is filled with objects that could pose real danger to us.

A fast-moving machine or a suspicious character.

Michelle Kokkinou is part of Professor Howe's team,

and has been researching the effects of dopamine on the brain.

Dopamine fires and tells me to pay attention,

and maybe not go too near it, because it's dangerous.

But if the brain becomes too flooded with dopamine,

things can start to go wrong.

And this is exactly what is thought to happen

in the brains of those with psychosis.

If you have too much dopamine in your brain,

so if there's an excess of dopamine,

then things which normally are not important

in your environment - for your survival, for example -

may suddenly acquire importance to you.

Everyday objects take on new meaning.

The benign and harmless become terrifying.

For example, I see all these people looking at me.

I can see their eyes looking at me, staring at me, very intensely.

And then I have this inherent drive to make sense of it.

And so, depending on my experiences, for example, or my personality,

I may think that they have been sent by the FBI to follow me.

Or by the aliens to spy on me.

And you can see how an environment like this becomes very threatening,

instead of being enjoyable.

Doctors struggled for years to find medication to treat psychosis

but, in the 1950s, found a class of drugs,

originally used as anaesthetics, that reduce symptoms.

A mainstay of our treatment for people with schizophrenia are

anti-psychotic medications.

And these work by blocking the action of dopamine after it's been

released. So they dampen down the effects

of the dopamine overactivity,

and over a few days, or maybe a week or two,

this gradually means that the psychosis -

the paranoia, the hallucinations -

subsides and goes away.

OK, this is my medication cupboard.

And I have rather a lot.

Risperidone, that is my anti-psychotic,

this is the main thing I need to keep me sane.

My dose isn't very high at the moment, but it's been...

it has in the past been so high that about once a day I would have a fit.

It also makes you more hungry than the imagination can handle.

You are crazily hungry when you take anti-psychotics.

And Risperidone is one of the worst.

So I've gone from a 32-inch waist to a 42-inch waist.

Then there's Pregabalin, which is an anti-convulsant.

These deal with my anxiety.

The other anti-psychotic I take is Quetiapine,

which is a very sedating anti-psychotic.

The only other ones that I have that are lunacy-related are Loperamide,

and they stop you pooing your pants.

I need something to cork me up, so I will have two, I think.

I think I will have a couple of the benzodiazepine tranquillisers,

so we need a procyclidine.

This is to deal with the side-effects of the anti-psychotic.

Ranitidine is just for my stomach, I have acid reflux.

And so is the Esomeprazole, that's for my stomach as well.

And that's my medication for tonight.

Today, the primary treatment for people with psychosis, like David,

are anti-psychotic drugs.

They are not actually curing, if you like,

the dopamine overactivity that was the problem in the first place.

So, unfortunately, with our current medications,

we've got something that works very well to dampen down dopamine,

but doesn't cure the underlying problem.

While drugs can't cure psychosis,

a series of new therapies have been developed.

Treatment that could revolutionise how we deal with it.

This is Professor Richard Bentall.

He has been using a treatment for psychosis

that doesn't use any drugs.

It's called experience sampling.

And it's a form of electronic diary-keeping.

So, experience sampling is a method which we've used for many years to

look at the way that people feel in everyday life.

What we do is, we ask people to fill in questionnaires.

We get a kind of snapshot about them.

What they are like at a particular moment.

And in the case of psychosis,

what we're really interested in is what circumstances do people,

for example, hear their voices,

or in what circumstances do they feel paranoid?

And experience sampling can pick that up.

The therapy uses an app which can be installed into a mobile device.

The app bleeps four times a day,

and when it bleeps, the patient answers questions.

The questions are about whether the patient is hearing voices

and how severe they are,

whether they feel paranoid, what their mood is.

We can look at how, for example,

exposure to stressful events leads to an exasperation of senses.

Today Professor Bentall is meeting David to see whether this method can

help him discover what triggers his hallucinations.

Hello, I'm David Strange.

-You must be Richard.

-I'm Richard, yes. Hi.

-Any chance of an espresso?

The way it works is it uploads your answers,

whenever it's in contact with the web.

So psychiatrists and psychologists can keep an eye on their patients,

and see how they're doing.

And big Brother is watching you!

Well... You could look at it that way,

but on the other hand what it means is that they can...

It's a more reliable picture of how your life is.

Yes. I'm just going to get on my computer,

just so that I can set this up properly.

Uh... There is something next to you.

There's something next to me?

Is this something you...?

Yes, it's a large crab, pointy, spiky...like, thing.

And you can see it right now?

-Yeah.

-OK.

And I'm rather scared of it.

OK.

So, what's it doing?

Can you tell me what it's doing, David?

-OK, it's gone.

-OK.

So...

Are you OK?

-Yeah, fine.

-OK.

How big was it?

About 18 inches long.

Crab-like claws, spikes on its back.

Wow.

Poisonous spikes at the front.

It was a rather grim vision of...Winchester.

Right, OK.

Using the diary technique, Professor Bentall hopes to establish the cause

of the hallucinations,

such as the one David just had.

-All right.

-Thank you very much.

I wonder how much I could get for this!

As well as using the app on his phone, David will also record his

experiences on his iPad,

to give a real insight of what it's like living with psychosis.

I had a really...

..difficult night last night.

I woke up, I don't know what time it was.

And there were large, scorpion-type things

scampering around on the floor.

Two or three.

And I thought...

"Bloody hell, I don't want to have all these experiences,"

and I got out of bed and I enthusiastically jumped on them.

It's hoped that by recording his experiences in this way,

David may gain an insight into what triggers

his voices and hallucinations.

Like David, Rachel also spent years in and out

of the psychiatric system.

When I was a patient of the mental-health system,

I felt like I was written off as severely mentally ill,

with no hope of recovery.

I was diagnosed with schizophrenia, borderline personality disorder,

schizoaffective disorder, dissociative identity disorder,

complex post-traumatic stress disorder

with psychosis, amongst others.

Rachel turned her back on the psychiatric system,

and looked for alternative support.

A key moment was joining a group

with other people who also hear voices.

I went to the group. And that, I think,

was the huge turning point for me.

I had no fight left in me.

And no belief that I could ever live outside of the psychiatric system.

So, for me,

the first step on my journey back

was realising that I was a human being.

And that took connections.

People connected with me. I connected with them.

And that allowed me to realise I had stories

before the story of schizophrenia.

With peer support and therapy,

Rachel came off medication and has forged a career

as a mental health consultant and practitioner.

However, there is still one group of aggressive, frightening voices that

she struggles with.

The Not Yets.

They are only called the Not Yets

because I didn't want to talk about them in therapy.

So it was the best way of getting the therapist not to ask

a question about them.

I actually feel physically sick just thinking about them.

And actually just drawing this makes me feel slightly frightened.

It's as if, by drawing it, I'm making it real.

Sometimes one of them will talk in depth about me being tortured,

that people are waiting for me. Um...

It's...

..it can get really graphic.

Rachel is going to try a different kind of treatment to deal with the

Not Yets, called Avatar therapy.

She's going to try and put a face to one of them for the first time.

Professor Tom Craig has been pioneering this new technique.

It involves creating a computer-generated face

that Rachel will then have to interact with.

The first stage in the process is to create the voice.

So the first thing we need to do is to find the best approximate voice.

-MALE VOICE:

-You could never learn to make a choice.

That's a bit high.

-LOWER:

-Whenever his friends asked him if he would like to go

out with them, he would only answer, "I don't know."

-Yes.

-Yeah?

-I think so.

Next, they move onto the physical features of the face.

I imagine, probably, that one.

Brow - we'll just make him frown a bit?

Yeah. That kind of works better, I think,

cos it just looks a little bit more aggressive.

So, kind of, looking at the depiction of the voice

on the screen, its eyes are pretty piercing and strange-looking.

So I feel a little nervous.

I can feel my heart beating a little bit.

And I'm not entirely sure what to expect.

Professor Craig will take the role of the voice.

Rachel must overcome her fears and attempt to be assertive with it.

He's going to say some of the usual things he says to you,

and when he does, I want you to just say to him, really firmly,

"I don't want to hear this any more.

"Go away! Leave me alone."

-OK?

-Mm-hm.

So, here he comes.

You're stupid. You're in for it now.

I'm not going to listen to you.

You know you're in for it.

They're waiting for you.

They're going to cut you up.

-You know it.

-That's not true.

You're just talking crap. You're trying to frighten me.

That's not here, that's not now.

Are you telling me you're not scared of me?

Of course I'm scared of you.

But you don't speak the truth.

I wouldn't get much fun if I didn't threaten you.

Why do you want that to be fun?

You know, is it that boring - your life?

You are in for it now.

You know they're waiting outside for you.

They're not waiting outside.

You said this before.

It's not happening.

That's really, really good, excellent, good, good work.

So let's wrap up, I think. How are you feeling?

A little shaky,

kind of, yeah... I've got a few of my voices

-kind of chiming in at the moment.

-Right.

But certainly, at times, it felt very intense.

By asking Rachel to confront her voice in this way,

it is hoped that she'll become less frightened, and therefore

better equipped to deal with it.

Talking therapies like this are offering a path to recovery,

and a chance to learn to live with voices.

And this is exactly what Jackie Dillon has managed to do.

I'm off to the States next week, I'm doing some...

doing an event in New York.

And then I'm off to Atlanta.

I've got a big project in America that I'm co-directing.

Jackie has a busy career as an

academic and consultant in mental health.

Over the years, she's developed a positive working relationship

with her own voices.

So, toast is ready.

One of my voices is just reminding me to

make sure I leave some money out for my daughter, for college today.

Rather than attack her, Jackie's voices now actually help her.

So, yeah, I guess, like a lot of working mums,

my head's quite busy at this time of the morning,

trying to think about all the stuff that has to happen.

Maybe the difference for me is my voices are helping me.

They, sort of, chip in.

You know, it's quite good teamwork, really.

Get my bag.

So this is where my voices become very helpful, actually,

because they start saying, "Right, have you got a bottle of water?"

"Have you got a banana?"

"Do you need to do anything for the kids before you leave?"

Oh, yeah, and my phone and my shades.

That's it. OK, thanks, guys. I've got everything.

I'm feeling slightly anxious.

My voices are kind of saying, "Oh, you should have left a bit earlier."

I know I should have, you're right.

I hear a lot of voices.

You know, probably well over 100 voices.

Obviously, we travel as a crew.

And because I've got younger voices and, you know,

quite a lot of cockney geezers who...we have quite a laugh, and

I guess, you know, I've kind of got 24/7

company, if I want it.

I'm so sorry, everyone.

Today, Jackie is teaching a course to a group of mental-health workers.

Just to remind you that there are

more people living in the general population who hear voices

who have never, ever had contact with psychiatric services.

Jackie's life is in control now.

But it hasn't always been like this.

She first started hearing voices aged three.

I remember playing in the playgrounds of my primary school,

and saying to this other little girl, "You know,

"those voices that you hear."

And her looking at me like, "Huh?"

And I picked up, ah,

this isn't something that, A) other people necessarily experience, and

B) that it isn't necessarily cool to talk about it.

Jackie's voices became more and more aggressive as she grew older.

Things hit a crisis point in her 20s,

with the birth of her first daughter.

When my daughter was a couple of days old,

I remember turning to get some cotton wool to wash her with,

and suddenly, when I looked back,

she was covered in blood...

..which was absolutely horrifying.

And I remember shaking my head and blinking, and that disappeared.

I lived in this kind of nightmarish world,

where I was just having these terrifying voices,

saying that my daughter's life was at risk,

that people might kidnap her.

And the voices began to say, increasingly,

"Your daughter would be better off without you."

Jackie found that talking therapies were the key to helping her.

I worked with a very gifted therapist,

he actually began to encourage me to start listening to the voices,

and actually engaging with them more.

So with his support I began to ask them questions.

And I was astonished to find that they could answer me with really

lucid and helpful responses.

So if I spoke to them with more kindness, and with more respect,

in turn, they would speak to me with more kindness and respect.

Today Jackie lectures on mental health issues,

and is constantly seeking new research

about schizophrenia and psychosis,

so often meets experts across the country,

trying to discover the root causes of the condition.

Professor Charles Fernyhough is interested

in the source of the voices

some people with psychosis hear, and thinks it starts in childhood.

Show me your boat.

I'm doing a boat as well.

What you find, if you walk into any nursery, anywhere in the world,

and see typically developing kids,

in this case, they're about three years old,

playing with some Lego, playing with any sort of toys,

you'll find an awful lot of talking going on.

Now, some of the times the children are talking to other people,

they are talking to each other,

they are talking to teachers or other adults who might be around.

But some of the times, you'll see children talking to themselves.

This train is running away.

This is called private speech.

He is talking to himself.

He's using words directed at himself, and he is kind of

thinking out loud about what's going on in that passage of play.

This kind of speech in childhood helps children

to think through what they are doing.

The cars on the road.

Private speech is an important part of healthy child development.

And this, this train...

The children who are doing private speech

also tend to do more of it when the task is difficult.

They're trying to help themselves think through strategies

and ways of kind of working the problem out.

Exactly. There's something about

putting it into words that is helpful.

As we get older, this private speech becomes internal.

But for people with psychosis, in stressful situations,

it's thought that this private speech

can appear as an external voice.

Put your car on the road...

You no longer recognise part of the dialogue as being your own.

And therefore, you hear it as a voice.

Now, this is still in the realms of speculation until we can get more

evidence on this. We've only really just started to ask these questions

about different kinds of inner speech.

This research is at an early stage.

But it's also thought dopamine plays a part in causing the voices.

In people developing a psychosis, as the dopamine is overactive,

it's no longer correctly identifying

information as either coming from

outside, or internally generated.

So, inner speech might start sounding like a voice

outside of your head.

This increase in dopamine is heavily involved

in another central element of psychosis.

Fear.

Professor Paul Fletcher has been researching how the brain reacts

when it's frightened and scared,

and thinks there are useful comparisons

when likened to people with psychosis.

We can think of experiencing psychosis

as being a little bit like being in a terrifying wood like this.

When you have very little sensory input,

just vague-shaped shadows, flickering lights,

you start to allow your imagination to create the world,

rather than to base it entirely on reality.

So a snapping twig, instead of being interpreted just as the fire,

-now it becomes something more frightening.

-Yes.

-Maybe an intruder.

For most of us, this state only lasts a few moments,

but for people with psychosis,

their elevated levels of dopamine

mean they can feel frightened all the time.

Some 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.

Now, imagine that dopamine was misfiring.

There, you might have a situation where everything seemed important.

You can see how that vigilance for danger could spiral out of control

until everything becomes a threat.

And probably the closest many people can come

to knowing just what that might be like is 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.

Having psychosis can be like this,

being continually frightened and scared all the time.

This terror is a daily battle for David.

It dominates his life.

Shitting fuck!

Um, I went for a piss.

And the floor started buckling like that on either side,

where my feet were.

And then they opened up, and there were teeth on the inside.

The bloody floor was going to eat me.

Fucking terrifying!

And while I was waiting in the...

in the...

doctor's surgery, I saw this big,

great, big armadillo-like thing

crawling along one of the beams in the top of the building.

And it was covered in spikes,

and there was poison dripping off the spikes,

and when the poison hit the ground, they would fizz and...

um, dissolve their way through the carpet.

I was terrified this was coming towards me, but then

it sort of curled up.

But it curled up on the route to see the doctor, which...

Aaargh! ..was not easy.

For many people, living with psychosis is a daily struggle.

And although the fundamental causes are beginning to be understood,

why some people develop it while others don't,

still largely remains a mystery.

It's thought there is a genetic component to psychosis.

But it doesn't seem to be the most-important factor.

Professor Swaran Singh believes where you live has a big impact.

Growing up in an urban environment increases your risk of developing

psychosis later on.

It is not to do with being born in a city.

It's living in a city, growing up in a city,

especially before the age of 15.

If you compare the relative contribution of genes,

genes contribute about 10%, but urban upbringing, 35%.

So it's a three-times stronger effect than genetics.

Beyond urban living,

research shows that our ethnic background

affects our chance of developing psychosis.

But this isn't as simple as race.

We have known for at least 25 years in this country

that the rates of psychotic disorders

are particularly high in some ethnic minority groups.

So we know... migration, for instance,

is a very significant causal factor in psychosis.

All migrant groups, all over the world,

have higher rates of psychosis than the host population.

It's not an ethnicity issue.

It's not a black and white issue.

It's a migrant versus host issue.

For instance, some of the highest reported rates of psychosis

are amongst Greenlanders in Denmark.

And they are not black.

What all these groups have in common is

social discrimination and adversity.

The higher rates of psychosis in ethnic minorities

seem to be because these groups are more likely

to be migrant populations.

The key issue appears to be dislocation.

Some people have argued that it is social defeat

that is related to psychosis.

By social defeat we mean repeated experiences of marginalisation,

exclusion, and discrimination.

You don't even have to leave the country

for this effect to take hold.

Simply moving to a new school, and the social upheaval that brings,

can be a factor in developing psychosis.

And we found that the greater number of school moves increased your risk

of developing psychotic symptoms in adolescence.

Every time you move schools,

you leave your peer group and your support network.

And you start again as an outsider.

So it's that chronic experience of being an outsider which we think is

related to the development of psychosis.

This new evidence reveals the

powerful impact social environment has.

But there are other aspects of childhood

that also contribute to psychosis.

So this is the area in which I grew up, round here.

And it's quite weird coming back.

It made my voices quite noisy.

Um, so I've got quite a young voice at the moment,

feeling quite frightened that

somebody's going to drag her off and do bad things to her.

So she's there saying, "Don't hurt me,

"don't let anyone do anything to me."

She's screaming.

She's begging me to "please stop him hurting me.

"Don't let him do any more bad things to me.

"I'm sorry, I'm sorry I'm such a bad girl."

This neighbourhood holds some terrible memories for Jackie.

I think the reason that I began hearing voices when I was so little

is because of the abuse and trauma I experienced from when I was very,

very small, up until my teens.

There was a paedophile that abused me and many other children.

I went from a whole,

healthy little girl into a shattered mind.

My mind literally fragmented

as a consequence of the things that happened to me.

Although exact figures vary,

there is now a strong and consistent body of evidence that links

childhood abuse to a range of mental disorders.

Including psychosis.

It's been a week since David's experimental therapy began.

And Professor Bentall is back to see how it went.

I'm dropping the laptop while I'm at it. Sorry.

Go straight through to the end. Would you like a cup of coffee?

I'd love a cup of coffee.

I just went into Boots...

..and it was...

..horribly busy, so I was already anxious.

And then we went into McDonald's, which is strange for us.

And it was quite busy.

So all the tables downstairs were full.

And that began to wind me up, and then Downey said,

"Can you pop upstairs and have a look if there are any tables free?"

Both of us clearly not thinking this through.

So by the time I made it most of the way downstairs,

rats were teeming around everywhere,

the voices were screaming, screaming,

screaming in my head.

It was terrifying.

And then...

You look really quite distressed there.

Crowded situations are a particular difficulty for you?

Yes. As the stress level of being with strangers rises,

the hallucinations, visual and aural, go through the roof.

When you get very anxious,

one of the things which SEEMS to happen is that you get this...

kind of what we've described as a dissociative state.

Dissociation is a way of kind of handling threat.

In a situation where you can't escape, it's a way of escaping.

Because what happens is your brain kind of goes,

"Well, I'll just pretend that it's not real."

I'm sort of wondering whether that makes sense to you

in terms of experiences you've had in the past?

My mother remarried when I was four or five,

I can never remember, really.

And the person she married was a

sadistic, randomly violent psychopath.

He was just horrible. If you walked into a room...

..if you walked into the room the wrong way,

if you said the wrong thing,

it could be anything that could trigger off

you getting...getting beaten to a pulp.

How old were you at the time?

From 4 or 5, to 13.

Jesus! So from four or five,

to 13, you lived in the constant fear

that at any unpredictable moment, the adult, one of the adults

who was supposed to be caring for you,

would launch a brutal attack on you.

Yes. The atmosphere at home was terrifying.

Frightening beyond belief.

The question then is, how do you tolerate the intolerable?

If it was a particularly savage beating,

if it started suddenly and it went on for a long time, I would...

..pretend not to be there.

Right. What you're describing there

is what we sometimes call peri-traumatic dissociation.

When you're in mortal danger, in mortal terror,

and there is no way out, you just have to endure it,

your brain does this trick where it kind of goes,

"I'm not really there."

The problem is that, particularly when you have repeated trauma,

such as you have, you kind of learn just to do that.

And you carry forward that as your...

one of your survival strategies to adulthood.

This is all piling on the likelihood of you then starting to have

hallucinatory experiences.

Jackie is going to see a friend whose psychosis was also caused by

childhood trauma.

However, just like Jackie,

Eleanor Longden has learned to live with her voices,

and even become a doctor of psychology.

Darling! Lovely to see you. How are you?

You too. Good, thank you, how are you?

Eleanor believes that she took a big step

when she addressed her voices directly.

You know, the idea of approaching this stuff,

and confronting it, is so terrifying and horrifying

that it does feel like it could kill you.

She thinks her recovery began when she realised her voices weren't just

attacking her, but could potentially help her.

And this was sort of the big turning point.

Realising, actually, the voices weren't my enemies.

Speaking with one of her most frightening voices

proved revelatory.

And I remember, actually, one day saying to that him,

"You've drawn my attention to all this unresolved

"emotional problems.

"And all I've ever done is attack you for it

"and tried to get rid of you.

"And it must have been really lonely

"and really demoralising."

And there was a very long pause.

And then he finally said, "That's right. Thank you."

It was a really, really powerful moment.

And, again, this sort of, absolute sense of reconciliation,

of restitution between me and another part of myself.

Voices absolutely can -

even the sort of really difficult, negative ones -

can be recruited

as a part of the healing process and of the healing journey.

Like Eleanor, Jackie is living proof

that you can be successful despite having psychosis -

by using talking therapies.

However, David still has to rely on medication to deal with terrifying

voices and hallucinations.

Of course I lunge for the tranquillisers, and they take

about 15, 20 minutes to kick in,

so I have all of this going on for 15, 20 minutes.

And I am...

less bothered by it now.

But "less bothered" means I wouldn't mind dying when I go to sleep.

I don't want any more chest pains...

..given to me by an anti-psychotic I took.

The, um...

..cardiologist said I'll be lucky to live until I'm 50.

I don't want to get terrified when

I'm in a group of more than about five people, me included.

Terrified, I want to run away.

Come on, Kitsu, off you go, off you go.

Off you go, Kitsu!

That's a good cat.

Problem solved.

David is going to meet Professor Sir Robin Murray -

one of the country's leading psychiatrists,

who's warned that long-term use of anti-psychotic medication

can cause serious side effects.

So, as I said, I've been on anti-psychotics since 1999.

Should I have been on them for that long?

The ideal is to get off the anti-psychotics,

but it's not always possible.

And we do know that there are side effects -

in particular they tend to make people put on weight.

And that...

Yes. So that, of course,

brings an increased risk of diabetes,

an increased risk of heart disease

and similar problems.

If I don't take anti-psychotics,

I start having extremely florid psychotic episodes where I totally

disassociate from the real world,

and I'm running into walls and things, screaming...

It may be that for unfortunate reasons

you are one of the people who has to continue

to take the anti-psychotics.

For many people with psychosis,

anti-psychotics are still the primary treatment they can access.

The medications that you are taking are much cheaper

than psychological therapy.

And, sadly, many psychiatrists are working in services

where there is very limited psychological or social support.

And therefore, all that can be done is medication.

So that is when the service appears to be so limited

and diminishes people's chances to recover.

# And older now

# I am home again

# Your touch feels like... #

As a child, I believed I was a monster because I was abused.

I had a lovely family. What I kept hidden, what I kept inside

was that someone sexually abused me.

And I never told my family.

I just...pushed it down so far, yet it was there.

And when I looked in the mirror, that's what I saw.

If this trauma caused Rachel's hostile voices, like the Not Yets,

could confronting them with therapy help?

She is meeting with Dr Dirk Corstens.

In the session, he will talk directly to one of the Not Yets.

My intention is to engage with him, and talk with him,

and ask what he stands for.

And the specific question, when he hurts you,

is that trying to hurt or to communicate?

Where do you think he would like to sit in the room?

Separate from you?

Separate from me. Yes.

If he is there, please then connect with me.

Do you have a name?

No. Who do you think you are?

I am someone who wants to support Rachel -

and you, in a way.

Are you scared of me?

No, I'm not scared of you.

What are the things you are telling to her?

Tell her that she will get hurt.

That they will hurt her.

That it's her fault.

Does it make her afraid?

She SHOULD be afraid.

That you are in?

And what's the reason that she should be afraid?

-She will be hurt.

-You warn her?

Is that a warning or...?

I just tell her what's going to happen.

And how long do you tell her that?

As long as I need to.

I feel that you feel sad, is that true?

-I don't feel.

-You don't feel at all?

-No, I see.

-What specific things do you see?

I see them picking at her.

You see a lot...

..things that are dangerous for Rachel?

Yes.

Thank you very much.

Thank you.

By trying to understand the viewpoint of the Not Yet voice,

Dirk hopes he can improve the relationship it has with Rachel.

-How do you feel?

-I feel on the edges of emotional.

-He wasn't as aggressive as he usually is to me.

-No.

I guess

that this voice

means that he has seen something.

Sometimes, voices are fed up with what they are doing,

and when you open up that perspective,

then you can help the voice to reach their goal in a more fruitful way.

Our experience,

and there is also research that says if you only suppress your voices,

then they become stronger.

So, that was pretty intense.

When I went in to it, I really wanted to know,

I thought the voice was powerful, that it was threatening me.

I thought it meant me harm.

I was just wondering, could it have been trying to warn me?

I think what I've learned is, yes, it WAS trying to warn me.

It IS trying to warn me.

And just knowing that makes it seems less scary.

Psychosis has many names

and was long considered an irreversible condition.

But research now increasingly suggests

that it's primarily the brain's response to traumatic events.

And perhaps if we can identify the cause, we can address it,

and that holds out the prospect of recovery.