Why Did I Go Mad? Horizon


Why Did I Go Mad?

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This programme contains some strong language.

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Our brains have an astonishing ability to interpret

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

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between fact and fantasy.

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Between real and imagined danger.

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We learn to recognise voices, and understand meaning.

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But for some, the normal, benign business

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of interpreting reality has broken down.

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

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and eat me alive from the inside.

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

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

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I woke up, and the voices were telling me,

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"Kill yourself, kill yourself."

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You have not experienced terror like that...

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..unless you've had a psychotic episode.

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They are...beyond any imaginable terror

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that a normal person can experience.

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For years, these disturbing psychotic experiences

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have been given a name - schizophrenia.

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In this film, we'll discover first-hand

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what this condition is really like.

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The floor started buckling,

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like that, on either side where my feet were.

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

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The bloody floor was going to eat me.

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We'll explore the research that is throwing new light

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on what is happening to the brain.

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If you have too much dopamine,

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then things which normally are not important in your environment may

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suddenly acquire importance to you.

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I see all these people looking at me,

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

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

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

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Growing up in an urban environment increases your risk of developing

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psychosis later on.

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

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You're in for it now.

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But most importantly,

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

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All the crew around me are...

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..plotting to kill me.

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You're in on it too.

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CHOIR SINGS

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For decades, people with severe mental conditions

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have been called mad.

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But is there really such a thing as madness?

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Dr David Strange is a former Oxford scholar.

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

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And his work was award-winning.

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

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..his world changed forever.

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MUSIC: Elephant by Tame Impala

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# Bet he feels like an elephant

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# Shaking his big grey trunk for the hell of it

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

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

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And suddenly I could hear five voices

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screaming at me from positions, strangely, around me.

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And there were lots of rats, hairy,

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

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

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to come and eat me alive from the inside.

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It's frightening beyond belief.

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

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and they are apparently not noticing these things.

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

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

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# I hear voices in my head

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# It gets dark and dangerous... #

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

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Now 39, she experienced her first

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terrifying hallucination aged just seven.

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# Catch me when I fall... #

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I remember being at my friend's house,

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

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staring back at me where I should have been.

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It was...kind of ugly.

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It was dark coloured.

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It wasn't human.

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It's just looked terrifying.

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

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including the most notorious of all - schizophrenia.

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Each person's experience of psychosis is unique.

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But there are three key symptoms that generally define it.

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Voice-hearing, paranoia and hallucinations.

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There's a rat just on your knee.

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

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

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Oh, yeah.

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While hallucinations can be terrifying,

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they are often accompanied by deep paranoia.

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

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I can hear your thoughts now.

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And you don't like me very much.

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You think I should do something horrible to myself.

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

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I remember being about 13, 14,

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

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

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

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I could feel the sensation of being watched,

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and the only way I could make sense of it

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is that there must be cameras installed in my flat.

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

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

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

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they...

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

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or even speaking to them will put them in danger.

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ELECTRONIC DRUMBEAT

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

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effects of his psychosis.

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I quite like ambient

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and electronic music.

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And I wanted to make something quite hallucinogenic, quite weird,

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quite mind-altered state.

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And I think I've done it quite well with this piece.

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It's quite hallucinogenic.

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At times, the paranoia and hallucinations

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have become too much for David.

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He's been driven to numerous suicide attempts,

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

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His music reflects some of these experiences.

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I wrote this piece of music to capture the experience

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of coming around after an overdose

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and finding all kinds of electronic equipment and tubes

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poking out of you.

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And I had some horrible experience

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of big metal pipes coming out of my throat.

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And machines all around me.

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And this is that experience.

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ELECTRONIC BEEPING

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Rachel lives with another key element of psychosis.

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Voice hearing.

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

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Rachel hears many voices,

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with different characters, different personalities,

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but each behave differently to her.

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So, Blue is a little girl.

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She's one of my youngest voices.

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She's about three.

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I think she's frightened of other people.

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She is frightened of being hurt.

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

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who was upset and crying.

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

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

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A breakthrough kind of came when I found Bunny.

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Bunny is this lovely little toy, just this beautiful little toy.

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And for the first time, I kind of felt...like this curiosity in her.

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And it felt like I'd reached her,

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which was a pretty powerful moment, really.

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But not all Rachel's voices are so benign.

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

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These guys were paid to watch me, hated me.

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And they just

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report to the government, report to the aliens.

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They never talk directly to me.

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

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The voices are even able to cause Rachel physical pain.

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So I'm going to draw Elfie now.

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

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And that's what I saw in the mirror.

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

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because I feel burning on my skin.

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

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with a hot iron or something like that.

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And I know it's not "happening" happening

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because I can't see any flames,

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

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I was terrified of Elf, and then something changed.

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

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

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scary monster that she appeared to me as.

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

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GENTLE CHILDLIKE MUSIC

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

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scientists have now largely agreed

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on the biological process going on in the brain.

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Research suggests that people with psychosis

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

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Dopamine is a chemical that is naturally produced

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in all our brains,

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

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Our brains are constantly being bombarded by information

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

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

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unimportant, the kind of regular things,

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from those that are unusual or potentially really

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

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Dopamine starts...

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those nerve cells start firing and signalling

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when they detect something unusual, and they then focus attention

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and the brain's resources on trying to

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make sense of those particular stimuli,

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rather than other things that are unimportant.

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

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In the real world, dopamine helps us avoid danger

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

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The visually packed world of a funfair

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

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A fast-moving machine or a suspicious character.

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Michelle Kokkinou is part of Professor Howe's team,

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

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Dopamine fires and tells me to pay attention,

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

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But if the brain becomes too flooded with dopamine,

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things can start to go wrong.

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And this is exactly what is thought to happen

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in the brains of those with psychosis.

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If you have too much dopamine in your brain,

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so if there's an excess of dopamine,

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then things which normally are not important

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in your environment - for your survival, for example -

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may suddenly acquire importance to you.

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Everyday objects take on new meaning.

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The benign and harmless become terrifying.

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

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

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

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

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

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Or by the aliens to spy on me.

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

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instead of being enjoyable.

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Doctors struggled for years to find medication to treat psychosis

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

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originally used as anaesthetics, that reduce symptoms.

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A mainstay of our treatment for people with schizophrenia are

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anti-psychotic medications.

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

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released. So they dampen down the effects

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of the dopamine overactivity,

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

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this gradually means that the psychosis -

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the paranoia, the hallucinations -

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subsides and goes away.

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OK, this is my medication cupboard.

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And I have rather a lot.

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Risperidone, that is my anti-psychotic,

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

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

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

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

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You are crazily hungry when you take anti-psychotics.

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And Risperidone is one of the worst.

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

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

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These deal with my anxiety.

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The other anti-psychotic I take is Quetiapine,

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which is a very sedating anti-psychotic.

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

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and they stop you pooing your pants.

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

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

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so we need a procyclidine.

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

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

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

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And that's my medication for tonight.

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

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are anti-psychotic drugs.

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They are not actually curing, if you like,

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

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So, unfortunately, with our current medications,

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

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but doesn't cure the underlying problem.

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While drugs can't cure psychosis,

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a series of new therapies have been developed.

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Treatment that could revolutionise how we deal with it.

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This is Professor Richard Bentall.

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He has been using a treatment for psychosis

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that doesn't use any drugs.

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It's called experience sampling.

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

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

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look at the way that people feel in everyday life.

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

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We get a kind of snapshot about them.

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What they are like at a particular moment.

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And in the case of psychosis,

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

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for example, hear their voices,

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or in what circumstances do they feel paranoid?

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And experience sampling can pick that up.

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

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The app bleeps four times a day,

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and when it bleeps, the patient answers questions.

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The questions are about whether the patient is hearing voices

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and how severe they are,

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whether they feel paranoid, what their mood is.

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We can look at how, for example,

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exposure to stressful events leads to an exasperation of senses.

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

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help him discover what triggers his hallucinations.

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Hello, I'm David Strange.

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-You must be Richard.

-I'm Richard, yes. Hi.

-Any chance of an espresso?

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The way it works is it uploads your answers,

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whenever it's in contact with the web.

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

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and see how they're doing.

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And big Brother is watching you!

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

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

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

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

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just so that I can set this up properly.

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Uh... There is something next to you.

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There's something next to me?

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Is this something you...?

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

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And you can see it right now?

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-Yeah.

-OK.

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And I'm rather scared of it.

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OK.

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So, what's it doing?

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

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-OK, it's gone.

-OK.

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So...

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Are you OK?

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-Yeah, fine.

-OK.

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How big was it?

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About 18 inches long.

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Crab-like claws, spikes on its back.

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Wow.

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Poisonous spikes at the front.

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

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Right, OK.

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

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of the hallucinations,

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such as the one David just had.

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-All right.

-Thank you very much.

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I wonder how much I could get for this!

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

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experiences on his iPad,

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

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I had a really...

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..difficult night last night.

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

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And there were large, scorpion-type things

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scampering around on the floor.

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Two or three.

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And I thought...

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

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

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

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David may gain an insight into what triggers

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his voices and hallucinations.

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Like David, Rachel also spent years in and out

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of the psychiatric system.

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

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

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with no hope of recovery.

0:23:330:23:34

I was diagnosed with schizophrenia, borderline personality disorder,

0:23:340:23:38

schizoaffective disorder, dissociative identity disorder,

0:23:380:23:41

complex post-traumatic stress disorder

0:23:410:23:44

with psychosis, amongst others.

0:23:440:23:46

Rachel turned her back on the psychiatric system,

0:23:460:23:50

and looked for alternative support.

0:23:500:23:52

A key moment was joining a group

0:23:520:23:54

with other people who also hear voices.

0:23:540:23:57

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

0:23:570:23:59

was the huge turning point for me.

0:23:590:24:01

I had no fight left in me.

0:24:010:24:03

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

0:24:030:24:10

So, for me,

0:24:100:24:12

the first step on my journey back

0:24:120:24:14

was realising that I was a human being.

0:24:140:24:16

And that took connections.

0:24:160:24:18

People connected with me. I connected with them.

0:24:180:24:21

And that allowed me to realise I had stories

0:24:210:24:24

before the story of schizophrenia.

0:24:240:24:26

With peer support and therapy,

0:24:310:24:33

Rachel came off medication and has forged a career

0:24:330:24:35

as a mental health consultant and practitioner.

0:24:350:24:38

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

0:24:410:24:46

she struggles with.

0:24:460:24:47

The Not Yets.

0:24:470:24:49

They are only called the Not Yets

0:24:510:24:52

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

0:24:520:24:55

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

0:24:550:24:57

a question about them.

0:24:570:24:59

I actually feel physically sick just thinking about them.

0:24:590:25:02

And actually just drawing this makes me feel slightly frightened.

0:25:020:25:08

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

0:25:090:25:12

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

0:25:130:25:18

that people are waiting for me. Um...

0:25:180:25:21

It's...

0:25:220:25:23

..it can get really graphic.

0:25:240:25:25

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

0:25:270:25:30

Not Yets, called Avatar therapy.

0:25:300:25:32

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

0:25:340:25:38

Professor Tom Craig has been pioneering this new technique.

0:25:410:25:45

It involves creating a computer-generated face

0:25:450:25:48

that Rachel will then have to interact with.

0:25:480:25:50

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

0:25:520:25:56

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

0:25:560:26:01

-MALE VOICE:

-You could never learn to make a choice.

0:26:010:26:03

That's a bit high.

0:26:030:26:04

-LOWER:

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

0:26:040:26:07

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

0:26:070:26:09

-Yes.

-Yeah?

-I think so.

0:26:090:26:12

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

0:26:120:26:15

I imagine, probably, that one.

0:26:160:26:18

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

0:26:180:26:21

Yeah. That kind of works better, I think,

0:26:210:26:23

cos it just looks a little bit more aggressive.

0:26:230:26:26

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

0:26:300:26:33

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

0:26:330:26:37

So I feel a little nervous.

0:26:370:26:39

I can feel my heart beating a little bit.

0:26:390:26:42

And I'm not entirely sure what to expect.

0:26:420:26:45

Professor Craig will take the role of the voice.

0:26:460:26:50

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

0:26:500:26:54

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

0:26:550:26:58

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

0:26:580:27:02

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

0:27:020:27:05

"Go away! Leave me alone."

0:27:050:27:07

-OK?

-Mm-hm.

0:27:070:27:09

So, here he comes.

0:27:090:27:11

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

0:27:130:27:16

I'm not going to listen to you.

0:27:170:27:19

You know you're in for it.

0:27:190:27:21

They're waiting for you.

0:27:210:27:23

They're going to cut you up.

0:27:230:27:25

-You know it.

-That's not true.

0:27:250:27:28

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

0:27:280:27:32

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

0:27:320:27:34

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

0:27:350:27:37

Of course I'm scared of you.

0:27:370:27:39

But you don't speak the truth.

0:27:390:27:42

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

0:27:430:27:46

Why do you want that to be fun?

0:27:460:27:48

You know, is it that boring - your life?

0:27:480:27:51

You are in for it now.

0:27:510:27:53

You know they're waiting outside for you.

0:27:540:27:57

They're not waiting outside.

0:27:570:27:59

You said this before.

0:27:590:28:01

It's not happening.

0:28:010:28:02

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

0:28:040:28:08

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

0:28:080:28:12

A little shaky,

0:28:120:28:14

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

0:28:140:28:17

-kind of chiming in at the moment.

-Right.

0:28:170:28:21

But certainly, at times, it felt very intense.

0:28:210:28:24

By asking Rachel to confront her voice in this way,

0:28:260:28:30

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

0:28:300:28:33

better equipped to deal with it.

0:28:330:28:35

Talking therapies like this are offering a path to recovery,

0:28:360:28:40

and a chance to learn to live with voices.

0:28:400:28:43

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

0:28:510:28:55

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

0:28:590:29:03

doing an event in New York.

0:29:030:29:05

And then I'm off to Atlanta.

0:29:050:29:08

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

0:29:080:29:12

Jackie has a busy career as an

0:29:140:29:16

academic and consultant in mental health.

0:29:160:29:19

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

0:29:190:29:22

with her own voices.

0:29:220:29:24

So, toast is ready.

0:29:240:29:27

One of my voices is just reminding me to

0:29:270:29:29

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

0:29:290:29:33

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

0:29:340:29:38

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

0:29:380:29:41

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

0:29:410:29:44

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

0:29:440:29:47

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

0:29:470:29:50

They, sort of, chip in.

0:29:500:29:52

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

0:29:520:29:55

Get my bag.

0:29:550:29:57

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

0:29:570:30:00

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

0:30:000:30:04

"Have you got a banana?"

0:30:040:30:06

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

0:30:060:30:10

Oh, yeah, and my phone and my shades.

0:30:100:30:12

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

0:30:120:30:16

I'm feeling slightly anxious.

0:30:170:30:19

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

0:30:190:30:22

I know I should have, you're right.

0:30:220:30:24

I hear a lot of voices.

0:30:260:30:28

You know, probably well over 100 voices.

0:30:280:30:34

Obviously, we travel as a crew.

0:30:340:30:36

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

0:30:360:30:41

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

0:30:410:30:45

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

0:30:450:30:50

company, if I want it.

0:30:500:30:53

I'm so sorry, everyone.

0:30:560:30:58

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

0:30:580:31:03

Just to remind you that there are

0:31:030:31:05

more people living in the general population who hear voices

0:31:050:31:09

who have never, ever had contact with psychiatric services.

0:31:090:31:13

Jackie's life is in control now.

0:31:130:31:15

But it hasn't always been like this.

0:31:150:31:17

She first started hearing voices aged three.

0:31:220:31:25

I remember playing in the playgrounds of my primary school,

0:31:280:31:31

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

0:31:310:31:34

"those voices that you hear."

0:31:340:31:35

And her looking at me like, "Huh?"

0:31:350:31:39

And I picked up, ah,

0:31:390:31:41

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

0:31:410:31:46

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

0:31:460:31:49

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

0:31:520:31:56

Things hit a crisis point in her 20s,

0:31:560:31:59

with the birth of her first daughter.

0:31:590:32:01

When my daughter was a couple of days old,

0:32:030:32:05

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

0:32:050:32:10

and suddenly, when I looked back,

0:32:100:32:12

she was covered in blood...

0:32:120:32:14

..which was absolutely horrifying.

0:32:160:32:18

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

0:32:180:32:22

I lived in this kind of nightmarish world,

0:32:220:32:25

where I was just having these terrifying voices,

0:32:250:32:30

saying that my daughter's life was at risk,

0:32:300:32:34

that people might kidnap her.

0:32:340:32:36

And the voices began to say, increasingly,

0:32:360:32:39

"Your daughter would be better off without you."

0:32:390:32:42

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

0:32:440:32:48

I worked with a very gifted therapist,

0:32:490:32:52

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

0:32:520:32:55

and actually engaging with them more.

0:32:550:32:58

So with his support I began to ask them questions.

0:32:580:33:02

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

0:33:020:33:07

lucid and helpful responses.

0:33:070:33:09

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

0:33:090:33:14

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

0:33:140:33:19

Today Jackie lectures on mental health issues,

0:33:260:33:29

and is constantly seeking new research

0:33:290:33:31

about schizophrenia and psychosis,

0:33:310:33:33

so often meets experts across the country,

0:33:330:33:36

trying to discover the root causes of the condition.

0:33:360:33:39

Professor Charles Fernyhough is interested

0:33:420:33:44

in the source of the voices

0:33:440:33:45

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

0:33:450:33:49

Show me your boat.

0:33:520:33:54

I'm doing a boat as well.

0:33:550:33:57

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

0:33:570:34:01

and see typically developing kids,

0:34:010:34:04

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

0:34:040:34:06

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

0:34:060:34:09

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

0:34:090:34:13

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

0:34:130:34:16

they are talking to each other,

0:34:160:34:18

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

0:34:180:34:21

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

0:34:210:34:25

This train is running away.

0:34:270:34:29

This is called private speech.

0:34:290:34:31

He is talking to himself.

0:34:340:34:36

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

0:34:360:34:38

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

0:34:380:34:42

This kind of speech in childhood helps children

0:34:450:34:47

to think through what they are doing.

0:34:470:34:50

The cars on the road.

0:34:500:34:53

Private speech is an important part of healthy child development.

0:34:530:34:57

And this, this train...

0:34:570:35:01

The children who are doing private speech

0:35:010:35:03

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

0:35:030:35:06

They're trying to help themselves think through strategies

0:35:060:35:10

and ways of kind of working the problem out.

0:35:100:35:12

Exactly. There's something about

0:35:120:35:14

putting it into words that is helpful.

0:35:140:35:16

As we get older, this private speech becomes internal.

0:35:170:35:21

But for people with psychosis, in stressful situations,

0:35:210:35:25

it's thought that this private speech

0:35:250:35:28

can appear as an external voice.

0:35:280:35:30

Put your car on the road...

0:35:320:35:36

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

0:35:360:35:39

And therefore, you hear it as a voice.

0:35:390:35:42

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

0:35:420:35:45

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

0:35:450:35:49

about different kinds of inner speech.

0:35:490:35:51

This research is at an early stage.

0:35:540:35:57

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

0:35:570:36:01

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

0:36:050:36:10

it's no longer correctly identifying

0:36:100:36:13

information as either coming from

0:36:130:36:15

outside, or internally generated.

0:36:150:36:19

So, inner speech might start sounding like a voice

0:36:190:36:23

outside of your head.

0:36:230:36:24

This increase in dopamine is heavily involved

0:36:280:36:31

in another central element of psychosis.

0:36:310:36:33

Fear.

0:36:400:36:42

Professor Paul Fletcher has been researching how the brain reacts

0:36:460:36:51

when it's frightened and scared,

0:36:510:36:53

and thinks there are useful comparisons

0:36:530:36:55

when likened to people with psychosis.

0:36:550:36:57

We can think of experiencing psychosis

0:36:580:37:01

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

0:37:010:37:05

When you have very little sensory input,

0:37:070:37:09

just vague-shaped shadows, flickering lights,

0:37:090:37:13

you start to allow your imagination to create the world,

0:37:130:37:17

rather than to base it entirely on reality.

0:37:170:37:21

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

0:37:210:37:26

-now it becomes something more frightening.

-Yes.

-Maybe an intruder.

0:37:260:37:30

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

0:37:300:37:35

but for people with psychosis,

0:37:350:37:37

their elevated levels of dopamine

0:37:370:37:38

mean they can feel frightened all the time.

0:37:380:37:42

Some people have suggested that dopamine is associated with the

0:37:420:37:47

importance of what's around you. So that you can pay attention to it,

0:37:470:37:50

and focus on what it's going to do next.

0:37:500:37:52

Now, imagine that dopamine was misfiring.

0:37:530:37:56

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

0:37:570:38:01

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

0:38:010:38:06

until everything becomes a threat.

0:38:060:38:08

And probably the closest many people can come

0:38:080:38:11

to knowing just what that might be like is when

0:38:110:38:14

they're in a situation like this,

0:38:140:38:17

where there are flickering shadows that they can't really interpret,

0:38:170:38:20

where they've got their fears that are making things up all the time,

0:38:200:38:23

and they quite vividly see a figure or a face.

0:38:230:38:26

Having psychosis can be like this,

0:38:270:38:30

being continually frightened and scared all the time.

0:38:300:38:33

This terror is a daily battle for David.

0:38:360:38:39

It dominates his life.

0:38:390:38:41

Shitting fuck!

0:38:410:38:43

Um, I went for a piss.

0:38:430:38:45

And the floor started buckling like that on either side,

0:38:450:38:49

where my feet were.

0:38:490:38:51

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

0:38:520:38:56

The bloody floor was going to eat me.

0:38:560:38:59

Fucking terrifying!

0:38:590:39:01

And while I was waiting in the...

0:39:010:39:03

in the...

0:39:030:39:04

doctor's surgery, I saw this big,

0:39:040:39:08

great, big armadillo-like thing

0:39:080:39:12

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

0:39:120:39:17

And it was covered in spikes,

0:39:170:39:19

and there was poison dripping off the spikes,

0:39:190:39:21

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

0:39:210:39:25

um, dissolve their way through the carpet.

0:39:250:39:29

I was terrified this was coming towards me, but then

0:39:290:39:33

it sort of curled up.

0:39:330:39:35

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

0:39:350:39:39

Aaargh! ..was not easy.

0:39:420:39:44

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

0:39:520:39:57

And although the fundamental causes are beginning to be understood,

0:39:570:40:01

why some people develop it while others don't,

0:40:010:40:05

still largely remains a mystery.

0:40:050:40:07

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

0:40:100:40:13

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

0:40:130:40:16

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

0:40:170:40:21

Growing up in an urban environment increases your risk of developing

0:40:230:40:27

psychosis later on.

0:40:270:40:29

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

0:40:300:40:33

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

0:40:330:40:36

especially before the age of 15.

0:40:360:40:38

If you compare the relative contribution of genes,

0:40:420:40:47

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

0:40:470:40:53

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

0:40:530:40:58

Beyond urban living,

0:41:000:41:02

research shows that our ethnic background

0:41:020:41:05

affects our chance of developing psychosis.

0:41:050:41:08

But this isn't as simple as race.

0:41:080:41:09

We have known for at least 25 years in this country

0:41:120:41:16

that the rates of psychotic disorders

0:41:160:41:19

are particularly high in some ethnic minority groups.

0:41:190:41:23

So we know... migration, for instance,

0:41:230:41:26

is a very significant causal factor in psychosis.

0:41:260:41:30

All migrant groups, all over the world,

0:41:300:41:33

have higher rates of psychosis than the host population.

0:41:330:41:36

It's not an ethnicity issue.

0:41:370:41:40

It's not a black and white issue.

0:41:400:41:43

It's a migrant versus host issue.

0:41:430:41:46

For instance, some of the highest reported rates of psychosis

0:41:490:41:53

are amongst Greenlanders in Denmark.

0:41:530:41:57

And they are not black.

0:41:570:41:59

What all these groups have in common is

0:41:590:42:02

social discrimination and adversity.

0:42:020:42:05

The higher rates of psychosis in ethnic minorities

0:42:070:42:11

seem to be because these groups are more likely

0:42:110:42:14

to be migrant populations.

0:42:140:42:16

The key issue appears to be dislocation.

0:42:160:42:19

Some people have argued that it is social defeat

0:42:190:42:24

that is related to psychosis.

0:42:240:42:26

By social defeat we mean repeated experiences of marginalisation,

0:42:260:42:32

exclusion, and discrimination.

0:42:320:42:35

You don't even have to leave the country

0:42:390:42:41

for this effect to take hold.

0:42:410:42:43

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

0:42:430:42:47

can be a factor in developing psychosis.

0:42:470:42:50

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

0:42:510:42:57

of developing psychotic symptoms in adolescence.

0:42:570:43:00

Every time you move schools,

0:43:000:43:02

you leave your peer group and your support network.

0:43:020:43:05

And you start again as an outsider.

0:43:050:43:07

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

0:43:090:43:14

related to the development of psychosis.

0:43:140:43:17

This new evidence reveals the

0:43:190:43:21

powerful impact social environment has.

0:43:210:43:24

But there are other aspects of childhood

0:43:260:43:28

that also contribute to psychosis.

0:43:280:43:31

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

0:43:330:43:37

And it's quite weird coming back.

0:43:370:43:39

It made my voices quite noisy.

0:43:390:43:42

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

0:43:420:43:46

feeling quite frightened that

0:43:460:43:47

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

0:43:470:43:52

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

0:43:520:43:54

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

0:43:540:43:57

She's screaming.

0:43:570:43:59

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

0:43:590:44:02

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

0:44:020:44:05

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

0:44:050:44:07

This neighbourhood holds some terrible memories for Jackie.

0:44:090:44:12

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

0:44:150:44:18

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

0:44:180:44:21

very small, up until my teens.

0:44:210:44:24

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

0:44:260:44:30

I went from a whole,

0:44:320:44:34

healthy little girl into a shattered mind.

0:44:340:44:38

My mind literally fragmented

0:44:380:44:40

as a consequence of the things that happened to me.

0:44:400:44:43

Although exact figures vary,

0:44:440:44:47

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

0:44:470:44:50

childhood abuse to a range of mental disorders.

0:44:500:44:53

Including psychosis.

0:44:540:44:56

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

0:45:060:45:10

And Professor Bentall is back to see how it went.

0:45:100:45:13

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

0:45:130:45:16

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

0:45:160:45:18

I'd love a cup of coffee.

0:45:180:45:20

I just went into Boots...

0:45:200:45:22

..and it was...

0:45:230:45:25

..horribly busy, so I was already anxious.

0:45:260:45:29

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

0:45:290:45:33

And it was quite busy.

0:45:330:45:36

So all the tables downstairs were full.

0:45:360:45:40

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

0:45:400:45:42

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

0:45:420:45:45

Both of us clearly not thinking this through.

0:45:450:45:48

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

0:45:480:45:52

rats were teeming around everywhere,

0:45:520:45:55

the voices were screaming, screaming,

0:45:550:45:59

screaming in my head.

0:45:590:46:01

It was terrifying.

0:46:010:46:03

And then...

0:46:030:46:05

You look really quite distressed there.

0:46:060:46:09

Crowded situations are a particular difficulty for you?

0:46:120:46:15

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

0:46:150:46:21

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

0:46:210:46:26

When you get very anxious,

0:46:260:46:28

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

0:46:280:46:31

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

0:46:310:46:34

Dissociation is a way of kind of handling threat.

0:46:350:46:39

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

0:46:390:46:42

Because what happens is your brain kind of goes,

0:46:420:46:45

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

0:46:450:46:48

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

0:46:480:46:51

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

0:46:510:46:53

My mother remarried when I was four or five,

0:46:530:46:56

I can never remember, really.

0:46:560:46:59

And the person she married was a

0:46:590:47:01

sadistic, randomly violent psychopath.

0:47:010:47:07

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

0:47:070:47:09

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

0:47:120:47:14

if you said the wrong thing,

0:47:140:47:16

it could be anything that could trigger off

0:47:160:47:19

you getting...getting beaten to a pulp.

0:47:190:47:25

How old were you at the time?

0:47:250:47:27

From 4 or 5, to 13.

0:47:270:47:30

Jesus! So from four or five,

0:47:300:47:33

to 13, you lived in the constant fear

0:47:330:47:36

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

0:47:360:47:40

who was supposed to be caring for you,

0:47:400:47:42

would launch a brutal attack on you.

0:47:420:47:45

Yes. The atmosphere at home was terrifying.

0:47:450:47:49

Frightening beyond belief.

0:47:490:47:51

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

0:47:510:47:54

If it was a particularly savage beating,

0:47:540:47:57

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

0:47:570:48:01

..pretend not to be there.

0:48:030:48:05

Right. What you're describing there

0:48:050:48:07

is what we sometimes call peri-traumatic dissociation.

0:48:070:48:10

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

0:48:100:48:13

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

0:48:130:48:16

your brain does this trick where it kind of goes,

0:48:160:48:19

"I'm not really there."

0:48:190:48:21

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

0:48:210:48:25

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

0:48:250:48:28

And you carry forward that as your...

0:48:280:48:31

one of your survival strategies to adulthood.

0:48:310:48:35

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

0:48:350:48:39

hallucinatory experiences.

0:48:390:48:41

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

0:48:460:48:50

childhood trauma.

0:48:500:48:51

However, just like Jackie,

0:48:550:48:57

Eleanor Longden has learned to live with her voices,

0:48:570:49:00

and even become a doctor of psychology.

0:49:000:49:02

Darling! Lovely to see you. How are you?

0:49:050:49:08

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

0:49:080:49:10

Eleanor believes that she took a big step

0:49:100:49:12

when she addressed her voices directly.

0:49:120:49:14

You know, the idea of approaching this stuff,

0:49:140:49:18

and confronting it, is so terrifying and horrifying

0:49:180:49:22

that it does feel like it could kill you.

0:49:220:49:25

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

0:49:270:49:32

attacking her, but could potentially help her.

0:49:320:49:36

And this was sort of the big turning point.

0:49:360:49:38

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

0:49:380:49:41

Speaking with one of her most frightening voices

0:49:410:49:43

proved revelatory.

0:49:430:49:46

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

0:49:460:49:48

"You've drawn my attention to all this unresolved

0:49:480:49:51

"emotional problems.

0:49:510:49:54

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

0:49:540:49:56

"and tried to get rid of you.

0:49:560:49:57

"And it must have been really lonely

0:49:570:50:01

"and really demoralising."

0:50:010:50:04

And there was a very long pause.

0:50:040:50:06

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

0:50:060:50:10

It was a really, really powerful moment.

0:50:100:50:13

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

0:50:140:50:19

of restitution between me and another part of myself.

0:50:190:50:23

Voices absolutely can -

0:50:240:50:26

even the sort of really difficult, negative ones -

0:50:260:50:28

can be recruited

0:50:280:50:30

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

0:50:300:50:34

Like Eleanor, Jackie is living proof

0:50:360:50:39

that you can be successful despite having psychosis -

0:50:390:50:43

by using talking therapies.

0:50:430:50:45

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

0:50:480:50:52

voices and hallucinations.

0:50:520:50:55

Of course I lunge for the tranquillisers, and they take

0:50:560:50:59

about 15, 20 minutes to kick in,

0:50:590:51:01

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

0:51:010:51:03

And I am...

0:51:030:51:07

less bothered by it now.

0:51:070:51:09

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

0:51:090:51:13

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

0:51:150:51:17

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

0:51:190:51:22

The, um...

0:51:220:51:23

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

0:51:250:51:29

I don't want to get terrified when

0:51:310:51:33

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

0:51:330:51:37

Terrified, I want to run away.

0:51:400:51:42

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

0:51:440:51:47

Off you go, Kitsu!

0:51:470:51:49

That's a good cat.

0:51:490:51:51

Problem solved.

0:51:530:51:54

David is going to meet Professor Sir Robin Murray -

0:51:570:52:00

one of the country's leading psychiatrists,

0:52:000:52:02

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

0:52:020:52:06

can cause serious side effects.

0:52:060:52:09

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

0:52:090:52:14

Should I have been on them for that long?

0:52:140:52:17

The ideal is to get off the anti-psychotics,

0:52:170:52:20

but it's not always possible.

0:52:200:52:22

And we do know that there are side effects -

0:52:220:52:25

in particular they tend to make people put on weight.

0:52:250:52:29

And that...

0:52:290:52:31

Yes. So that, of course,

0:52:310:52:35

brings an increased risk of diabetes,

0:52:350:52:37

an increased risk of heart disease

0:52:370:52:39

and similar problems.

0:52:390:52:42

If I don't take anti-psychotics,

0:52:420:52:44

I start having extremely florid psychotic episodes where I totally

0:52:440:52:50

disassociate from the real world,

0:52:500:52:52

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

0:52:520:52:56

It may be that for unfortunate reasons

0:52:560:52:59

you are one of the people who has to continue

0:52:590:53:02

to take the anti-psychotics.

0:53:020:53:04

For many people with psychosis,

0:53:070:53:09

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

0:53:090:53:14

The medications that you are taking are much cheaper

0:53:140:53:18

than psychological therapy.

0:53:180:53:20

And, sadly, many psychiatrists are working in services

0:53:200:53:26

where there is very limited psychological or social support.

0:53:260:53:31

And therefore, all that can be done is medication.

0:53:310:53:35

So that is when the service appears to be so limited

0:53:350:53:39

and diminishes people's chances to recover.

0:53:390:53:43

# And older now

0:53:480:53:51

# I am home again

0:53:530:53:57

# Your touch feels like... #

0:53:570:54:01

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

0:54:010:54:06

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

0:54:070:54:11

was that someone sexually abused me.

0:54:110:54:14

And I never told my family.

0:54:140:54:17

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

0:54:170:54:21

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

0:54:210:54:25

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

0:54:250:54:30

could confronting them with therapy help?

0:54:300:54:33

She is meeting with Dr Dirk Corstens.

0:54:430:54:46

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

0:54:460:54:51

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

0:54:540:54:58

and ask what he stands for.

0:54:580:55:01

And the specific question, when he hurts you,

0:55:010:55:06

is that trying to hurt or to communicate?

0:55:060:55:09

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

0:55:090:55:14

Separate from you?

0:55:140:55:16

Separate from me. Yes.

0:55:160:55:18

If he is there, please then connect with me.

0:55:240:55:29

Do you have a name?

0:55:330:55:35

No. Who do you think you are?

0:55:360:55:39

I am someone who wants to support Rachel -

0:55:410:55:46

and you, in a way.

0:55:460:55:48

Are you scared of me?

0:55:480:55:50

No, I'm not scared of you.

0:55:500:55:51

What are the things you are telling to her?

0:55:510:55:54

Tell her that she will get hurt.

0:55:540:55:56

That they will hurt her.

0:55:580:55:59

That it's her fault.

0:56:010:56:03

Does it make her afraid?

0:56:030:56:05

She SHOULD be afraid.

0:56:050:56:07

That you are in?

0:56:070:56:09

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

0:56:090:56:12

-She will be hurt.

-You warn her?

0:56:120:56:15

Is that a warning or...?

0:56:150:56:16

I just tell her what's going to happen.

0:56:180:56:20

And how long do you tell her that?

0:56:200:56:23

As long as I need to.

0:56:250:56:27

I feel that you feel sad, is that true?

0:56:270:56:30

-I don't feel.

-You don't feel at all?

0:56:300:56:33

-No, I see.

-What specific things do you see?

0:56:330:56:37

I see them picking at her.

0:56:380:56:40

You see a lot...

0:56:400:56:41

..things that are dangerous for Rachel?

0:56:430:56:45

Yes.

0:56:470:56:48

Thank you very much.

0:56:500:56:51

Thank you.

0:56:530:56:54

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

0:56:550:56:59

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

0:56:590:57:03

-How do you feel?

-I feel on the edges of emotional.

0:57:090:57:13

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

-No.

0:57:140:57:16

I guess

0:57:190:57:22

that this voice

0:57:220:57:25

means that he has seen something.

0:57:250:57:29

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

0:57:300:57:36

and when you open up that perspective,

0:57:360:57:38

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

0:57:380:57:44

Our experience,

0:57:450:57:47

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

0:57:470:57:52

then they become stronger.

0:57:520:57:54

So, that was pretty intense.

0:57:590:58:02

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

0:58:020:58:05

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

0:58:050:58:08

I thought it meant me harm.

0:58:080:58:10

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

0:58:100:58:13

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

0:58:130:58:16

It IS trying to warn me.

0:58:160:58:18

And just knowing that makes it seems less scary.

0:58:180:58:21

Psychosis has many names

0:58:230:58:26

and was long considered an irreversible condition.

0:58:260:58:29

But research now increasingly suggests

0:58:290:58:31

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

0:58:310:58:36

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

0:58:360:58:40

and that holds out the prospect of recovery.

0:58:400:58:43

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