07/08/2013 Dokumenttiprojekti

This year, one in four of us will suffer from mental illness.

I believed that I could heal people just by staring at them.

In this film, we'll meet five young people

who are struggling with some of the most common disorders.

Ffion has anorexia.

At one point, I thought bad things would happen to my family

if I did eat.

Wayne is living with social anxiety disorder.

TOILET FLUSHES

I'm fearful that I'll be shamed in public, you know,

not being able to get to the toilet on time.

And David suffers from OCD.

I'd rather die than ever have to go through that.

With access to cutting edge science and computer graphics,

we'll travel inside the brain to discover what causes

these mental illnesses...

Feeling quite anxious at the moment.

..explore how our bodies react

when we panic or lose touch with reality...

I used to believe that my mum and dad were "energy vampires".

..and reveal some radical new treatments that could improve

the lives of thousands of young people.

This is the inside story of how mental illness works.

For young people, life is often a struggle.

Puberty, exams and relationships can all be stressful.

And it's during these times that mental illness

is most likely to strike.

Among teenagers, depression and anxiety

have rocketed by 70% in the last 25 years.

And 1 in 100 young people can develop an extreme form of anxiety

called obsessive-compulsive disorder.

25-year-old David lives in Luton.

He's been living with OCD since he was 13 -

a common age for the condition to strike in men.

I've been diagnosed with severe obsessive-compulsive disorder

and it's a really horrible mental sensation.

I've lost friends because of it.

It's affected my work, it's affected my health,

my relationships with family.

Everything.

Sufferers experience obsessions that force them to repeat behaviours

which they feel will reduce their anxiety.

But OCD is not only about endlessly washing hands or checking locks.

Many are haunted by intrusive and irrational thoughts.

Today, David is driving to the airport to pick up some relatives.

He's terrified he will do something illegal and be sent to prison.

I feel safe as a driver.

But I just feel anxious about certain aspects of driving -

if I was to break the law whilst driving

or be blamed for injuring somebody.

And the other fear is just hurting somebody.

It's one of the worst things that I can imagine is hurt...

especially a child, like,

if you hit them in a car it would just be terrible.

It's just this irrational fear I can't get over.

Even though I know I'm safe, I don't believe it

and I doubt constantly that other people are safe.

Dr Claire Gillan from the University of Cambridge

studies the neuroscience behind obsessive-compulsive disorder.

Intrusive thoughts are incredibly common in the general population,

we'll all have them at some time during our life.

So you can have thoughts where you may have an urge

to push someone off the railroad tracks

or for yourself to jump off a bridge if you're standing on one.

But you can also have really much more nasty thoughts,

like you might cause harm to somebody in some way.

In OCD, these thoughts linger

and go over and over and over again in their minds,

and what this does is kick-starts a very malicious cycle

of reinforcing the beliefs and reinforcing the behaviours

over and over again, until it just spirals out of control.

David's OCD could be caused by a malfunctioning

of a complex pathway in his brain.

The way we respond to our environment

is by instinctive actions

triggered by the basal ganglia.

These are controlled by the frontal cortex, which helps us think ahead.

And the thalamus, a relay station

that helps regulate the flow of information between the two.

In OCD sufferers, it's thought that the whole circuit is faulty

and the habits and behaviours formed by the basal ganglia

spiral out of control.

This would explain why David is plagued by unwanted thoughts.

During the night, our remote camera

captures David's compulsive behaviour.

Some nights I don't even get to sleep at all, so...

Combination of everything that happens during the day,

like with the speed cameras and different things on the road...

but mostly worries about my dad.

The fear that his dad will die

is another of David's persistent and irrational thoughts.

When he was a boy, his father suffered from heart disease

and this has haunted him ever since.

David is convinced that carrying out compulsive rituals

will help keep his dad safe.

Making things parallel and tapping things...

it makes me feel like I can stop anything bad happening.

But if I don't do that, then there is a big, big, chance that

that will directly cause his death.

And if I lost my dad because I didn't do it,

it would be the worst thing that's ever happened...

and I would feel guilty for it, so I've got to do it.

David's ritualistic behaviour

could be due to another problem with the basal ganglia.

Studies have shown this is often enlarged in sufferers of OCD

which may also explain the desire to repeat actions over and over again.

So we all form habits every day

and it's a way of making our lives a little easier,

so simple tasks can become automatic and easily performed.

So, for example, I swipe this card every day

before coming into the building.

But in OCD what we think happens

is this habit system in the brain is overactive,

so habits are formed more quickly and they are more persistent -

to the point where a patient with OCD will form many, many habits

that can take over their whole life.

David's OCD is so intense

that he's convinced he's going to forget to pay a bill

and be sent to prison.

I can't...

(I can't do it.)

I can't...

I can't...

I just can't imagine what it would be like.

I'd rather die

than ever have to go through that.

And just even the risk of it happening, I'd just...

I'd rather die.

Why someone like David develops OCD is complex

but research shows up to 50% of our risk could be genetic.

While many genes will make someone more vulnerable

to developing the disorder,

scientists have discovered a variation in one particular gene,

SLC1A1, which alters the flow

of certain neurotransmitters in the brain.

And this is only seen in men who develop

the condition at an early age.

While there is no immediate cure for OCD,

several treatments do exist,

with 70% of sufferers showing improvements.

How many times have you washed your hands?

One of most effective is cognitive behavioural therapy,

which helps you change the way you think and behave.

I've tried anti-anxiety medication,

antidepressants.

CBT therapy treatment I have also already done twice now,

and that does have some positive effects.

Dinner is served.

David lives with his partner Nathan

and his OCD can put an enormous strain on them both.

It does test a relationship.

You have to be a very patient person

because sometimes I feel...

like you are doing it deliberately

but I need to obviously not think that because I know you're not.

No, I just wish that I was free of it

but the more I go through life,

the more I realise that this is normal for me.

-Yeah.

-This is me.

It doesn't matter to me because obviously I love Dave

and I'm with him regardless of OCD or whatever.

Thank you.

With the continued support from his partner Nathan,

David is learning to overcome his OCD

and to live a relatively normal life.

Mental illness can strike anyone regardless of age, sex or ethnicity.

In the UK, around one million people are affected by an eating disorder.

Anorexia nervosa is one of the most common

and most at risk are teenage girls.

23-year-old Ffion lives in South Wales.

At 13 she was diagnosed with the mental health condition.

It affects me, like, the majority of every day, really,

to one extent or another,

to varying degrees throughout the last, like, ten years,

it's completely dominated it.

People with anorexia keep their weight as low as possible

by restricting what they eat

but they also have an irrational fear of food.

Over the last ten years,

Ffion has been in and out of hospital for life-saving treatment.

She was last discharged four months ago

but still needs to gain another stone to reach her healthy weight.

And it's not easy.

I am feeling anxious

because today is wanting to make myself a piece of fruit

with my cereal that's bigger than my usual pieces of fruit

so that's making me nervous

because I get really anxious about being, like, too full.

And I'm going to go sit down.

I guess it's the decision making, the portioning,

and the kind of internal battle of, like, of feeling guilty

about having something,

or something that's bigger than I'm allowed to have,

or that I should have, or that I deserve to have.

Then if somebody else is having something

it's, like, worrying I'm having more than them or too much...

because I've kind of been like this for so long

that I don't really know what normal is.

Anorexia is one of the most deadly of all mental illnesses

and as many as 20% of suffers die from it.

It's... It feels like this like demonic, torturous thing

that, like, has just set out to make you miserable.

And it's really tiring.

It's really tiring feeling anxious all the time,

and constantly arguing with your head,

and not being able to do the things that everyone else can do.

Like this one basic thing which is to like eat, really,

and I want it more than anything in the whole world.

Jess McCelland from the Institute of Psychiatry

has been carrying out cutting-edge research

into the illness and busting the myths.

There's a number of misconceptions

about the illness,

such as it's a lifestyle choice, or a diet taken too far,

or brought on by sort of size-zero models. But, in reality,

it can bring on a whole lot of other physical and psychological problems,

things like severe food restriction

and an intense fear of food and gaining weight.

So something sort of as simple as a cappuccino for us would create

quite a lot of anxiety and fear for someone who suffered from anorexia.

Scientists are trying to understand the causes of anorexia.

One possibility is that the condition is triggered by our genes.

It's believed that multiple genes of small effect can increase

the risk of developing the illness.

Additionally, if someone has family members that have been affected

by an eating disorder, or other psychiatric disorders,

this can also render an individual more susceptible

to developing anorexia.

More recently, research has found that the illness

might be rooted in the brain.

Some neural pathways that transmit messages

from one brain cell to another may be dysfunctional

and this could be why sufferers experience such extreme anxiety

when it comes to eating.

Ffion's fear of food began when she was 12 years old.

I wouldn't be around the kitchen in case I inhaled smells,

and I thought you could inhale calories. I wouldn't drink at all.

And I got into real trouble then

because, obviously, you get very ill if you don't drink.

I was really anxious, I used to pick my lips in anxiety

until they started to bleed but I wouldn't put Vaseline on

because I thought that the grease would get absorbed into my lips,

and I'd put on weight through my lips.

People with anorexia also display certain personality traits.

They are often perfectionists, have low self-esteem

and obsessive-compulsive tendencies.

I used to drive myself to exercise in the snow and the rain

and try and keep cold...

anything that I could to burn calories.

At one point

I thought bad things would happen to my family

if I did eat and I'd be punished in some way if I did eat.

By 13, Ffion's weight had dropped to 5 stone

and she stopped eating altogether.

She was admitted to hospital, fed through a drip

and given 24 hour mental health care.

As Ffion starved her body, her bones began to deteriorate.

This is a back support that I had

because I fractured two vertebrae in my spine about six months ago,

so they gave me one of these, which is

something I can wear under my clothes just to help support by back a bit.

The only way it's going to heal is if I don't move it much,

but it's quite hard.

Malnutrition causes levels of oestrogen to drop.

It's thought the hormone helps produce bone cells,

and girls lay down around half of their bone mass in their teens.

But if these hormone levels are too low, fewer cells are produced

and bones become weak and brittle.

I've got full-blown osteoporosis, which has actually got worse

since I was first diagnosed when I was 18.

So that's really scary.

And I may not feel it that much now,

but in another, like, ten years' time,

when I'm in my late 20s, I could be breaking hips and stuff.

So, as much as I hate to admit it, unless you get to a healthy weight,

your body won't work properly and it does bite you on the arse big time.

For most women,

their menstrual cycle is kick-started

by chemical messengers in the brain.

This triggers hormones, which race through the bloodstream

and into the ovaries, where an egg is released.

But when the brain is starved, it can't activate the sex hormones,

so no eggs are released.

Which is why Ffion has stopped having her periods.

Where? Here?

Ffion's mum has been a great support throughout her illness

and weekly trips to the pool have helped them both.

It's a nice thing that we do. We both really enjoy it.

We have a bit of you and me time

and we never invite her father or brother.

It's a bit of time for the two of us.

Another key symptom of anorexia is body dissatisfaction

and, like many sufferers, Ffion is phobic about her looks.

I don't...feel very comfortable in my own skin.

I don't like the way that I look.

I don't like mirrors,

I don't like getting out of baths or showers.

I don't look down, ever, and I don't like people looking at me.

I feel really self-conscious a lot of the time.

One theory is that this distorted body image is related to

a malfunctioning in an area of the brain called the insula.

This part of the brain is like an internet server -

sending and receiving messages.

It monitors anxiety, feelings of disgust, body awareness

and self-image.

But imaging studies have shown that in anorexics the insula

is damaged, making it under fire.

This could explain why many sufferers experience

body image dissatisfaction.

Ffion's illness has also had a huge impact on her family.

They said she should've been dead several times by now.

It's a miracle that she isn't. And there's no logic in it.

She's an intelligent woman so there's no logic in it either.

So you just have to stop looking for it.

It's not something I can let go of.

It drives me crazy when people say, "Why can't you let it go?"

I can't. I would have done it ten years ago.

It's just... It's ingrained.

But you can deal with it a lot more now, you're able to control it.

I have to, really. You just have to.

The worst thing for the family is the absolute helplessness -

we feel completely helpless.

We've been stood alongside Ffion for the whole time, really,

every minute of the way, but you feel totally helpless.

But that's all you can do, really. you can't take it away from her,

you can't do the horrible bit she needs to do or the tough bit now

like trying to gain a stone so she can get to university and be well.

For Ffion, her biggest worry is the future.

I don't know whether I'm going to be able to have kids

and that really frightens me,

but that's something I can't really think about

until I know the facts,

and to know the facts I need to get healthy first.

But that's a huge motivator as I'd really like to have kids one day.

Anorexia is so ruthless that only 50% of people make a full recovery,

so finding new ways to treat the illness is crucial.

Today, Ffion has come to the Institute of Psychiatry

in London to take part in a cutting-edge experiment

run by Jess McClelland.

-Hiya!

-Hi.

-How you doing?

-I'm all right. How are you?

-Good, thank you.

Take a seat.

This trial could result in a new treatment for the disorder.

We are just going to do a couple of tasks first.

Jess and the research team

are trialling transcranial magnetic stimulation, or TMS,

a therapy which fires magnetic pulses into the brain.

First, Ffion is shown images of food and Jess measures her responses.

So we're looking at the effects of the stimulation on some

of the core symptoms of anorexia, things like urge to restrict,

urge to exercise and levels of feeling full,

levels of feeling fat, and anxiety.

-Does that feel secure?

-Yeah, that's fine.

-Perfect.

Then Jess takes some measurements

so she can target a specific part of Ffion's brain with TMS.

She's working on the theory that anorexia

is caused by dysfunctional neural circuits.

So the area of the brain that we are targeting with TMS

is the dorsolateral prefrontal cortex.

This is an area supposed to be involved in self-regulation

and self-control problems

that we see in anorexic patients.

So we are hoping to target these

to try and alter the symptoms and feelings related to eating and food.

Brain scans have shown that sufferers of anorexia have changed

activity in the reward centre - an area that helps us

to feel pleasure or fear about food.

Another circuit in the prefrontal cortex, which plays

an important role in self-control could also be malfunctioning.

Problems with these neural circuits may add to the severe

restriction and intense fear of food felt by suffers of anorexia.

Three, two, one...

RAPID STACCATO CLICKING

The theory is that these critical circuits can be altered

by firing magnetic pulses into the brain.

Knowing there could science behind her disorder gives Ffion hope.

I blamed myself for a really long time for not being able to change

and for getting ill and always thought it was my fault.

I think for there to be some underlying reason

it would help it all make a lot more sense, really.

It's not painful, it's like having a little woodpecker

tap at your skull for five seconds.

Three, two, one.

STACCATO CLICKING

Fabulous. Well done.

When the TMS session is over, Ffion repeats

the questionnaire to record any change in her responses to food.

Great, thank you very much.

And the results are looking good.

Ffion's reactions to food HAVE changed.

Before the TMS, her feelings of fat and full were high.

But after the treatment, they have dropped considerably,

seen here in pink.

There has been a reduction in these scores

after the stimulation session,

so there has been some effect on these two measures

of feeling fat and feeling full.

Ffion is part of a larger study which aims to show that TMS may be

effective in reducing the symptoms of anorexia.

So the research is in very early stages at the moment

but we have had some promising findings so far.

The next step would be to look at these findings in a larger trial

with the hope that TMS may have the potential to be used

with current treatments for anorexia.

For Ffion, the research gives her hope there might be new ways

to treat the illness in the future.

But right now, she's managing to keep her anorexia under control.

I've got a job now, a couple of jobs, and university in September,

and I'm going on my first girlie holiday,

and I'm climbing Snowdon for eating disorders,

and I'm going to do a skydive in a few weeks,

and everything seems to be a bit too good to be true, but I'm going with

it anyway, so it feels really nice.

It was hard... It was hard work but it's really nice.

So as long as I can keep on top of things, I should be OK.

Most of us get stressed out

and sometimes find life hard to cope with.

But for nearly 300,000 young people in the UK,

their anxiety is so constant it rules their life.

Wayne is 24, lives in Southam

and works in his local superstore.

Ten years ago he was diagnosed with social anxiety disorder.

I suffer from anxiety.

I've had it since I was a teenager.

It means I find it hard to travel, maybe go out with friends,

be in certain social situations.

A huge anxiety for Wayne

is that he will lose control of his bodily functions.

I'm fearful that I'll be maybe shamed in public,

not being able to get to the toilet on time and it being

glaringly obvious that I've become incontinent

and having people judge, I suppose.

Today, Wayne's going bowling with his sister Pip and some friends,

but his toilet anxiety is making it hard to leave the house.

Just got 15 minute before we go,

so I'm just making sure I feel all right before I go.

I don't know how many times I need to go,

I don't count or anything like that.

I just... I just go as many times as I need to, really.

Wayne's family have learnt to be patient of his condition.

This is normal, but I don't know how he's going to be today.

He might take 5 minutes, he might take 20 minutes,

but he'll take as long as he needs to take.

He won't be pushed by me, I don't think.

TOILET FLUSHES

Are you ready?

No.

Oh! I was going to say. That was quick.

-OK. I'll just go one more time, then.

-Yeah?

Wayne's anxiety dominates his life.

When I'm out, I spend most of my time anxious.

I didn't go to university because of it.

I pick my jobs around it.

It can be extremely strong,

overwhelming and potent.

It can be really quite, well, terrifying, I suppose.

For all of us, fear and anxiety

are our body's normal response to danger or threat.

If I was going to step out into this road without looking,

then my body's fear response would be triggered.

I might notice that my heart starts to race,

my breathing becomes faster or more shallow, that my muscles tense up,

that my vision becomes more acute

and we might feel we want to empty our bladder or bowel,

make our body as light as possible to run away.

And those would all be useful things because they are our body's

primitive survival mechanism that help to protect us all from danger.

TOILET FLUSHES

But for people like Wayne, the brain system that controls

this mechanism switches on for no apparent reason.

I am feeling very apprehensive.

When we get scared, the amygdala,

or fear centre inside our brain, springs into action.

It sends out messages, which trigger the release of the hormone

adrenaline into the bloodstream.

And it's this that prepares the body to face up to danger.

But in people suffering from anxiety, it's believed the amygdala

is overactive and the part of the brain which helps to control it

is malfunctioning.

-You going to back up and I'll...?

-Yeah?

TOILET FLUSHES

Pip, one second, one second.

TOILET FLUSHES

All right, Wayne?

Now that Wayne's been to the toilet four times,

he's finally ready to leave.

But as he drives further from home, his anxiety rockets.

Are you all right?

Feeling quite anxious at the moment.

Mouth's gone quite dry,

heart's going quite a bit, feel quite tense...

Inside Wayne's brain, his amygdala sets off the release of adrenaline.

As it floods into his bloodstream, it makes his heart beat faster

and his breathing increase.

His body temperature soars,

so glands in the skin release small droplets of sweat to cool him down.

Stress hormones make his muscles contract and his pupils dilate.

The adrenaline also affects Wayne's emotions - he feels terrified.

The instant he reaches the bowling alley, Wayne checks out the toilets.

I just like to have locks on the door working, and...

It's not amazingly clean but it doesn't bother me that much.

Make sure there is loo roll and stuff.

Eventually, as Wayne gets used to his surroundings, he finally relaxes

and can enjoy the evening.

LAUGHTER

It's good start. It's a good start.

Much more relaxed now, much more relaxed, there is no

anxiety any more.

I feel just as comfortable as I would be at home, really.

Wayne's physical symptoms have also calmed down.

The adrenaline is subsiding,

his heart is returning to a normal rhythm

and his breathing is more regular.

Thank God! HE LAUGHS

You can tell he's a bit, like...

twitchy and nervous when he starts

but after a while, he becomes comfortable, and he speaks a lot more

and...yeah, he's a lot more outgoing. I know he does suffer a lot from it

but he tends to control it quite well.

Like all mental illness,

understanding why Wayne suffers from anxiety is not easy.

Some of the factors that we think might influence a person

developing an anxiety disorder could be...um, genetics, or could be

biological factors in the brain, or the person's life experiences

as they're growing up.

One theory is that being fearful can be learned during childhood

through a process known as conditioning.

The idea of conditioning is that a particular stimulus or trigger

might become associated in a person's mind

with a feeling of anxiety, even if that trigger or stimulus

is not actually dangerous.

THEY CHUCKLE

Oh! I AM strong, believe me!

This idea came about at the beginning of the 20th century

when a young psychologist, JB Watson, asked the question,

are we born with fear or do we learn it?

Then he carried out one of the most controversial experiments

in human psychology involving a nine-month-old boy

called Little Albert.

First, Watson presented the baby with various items,

including a white mouse.

Albert was curious

and showed no signs of being scared.

But then, Watson did something

completely unexpected.

And what he did was, he repeatedly

showed Albert a white mouse

whilst at the same time making a loud noise to startle Little Albert

and trigger his fear response.

Finally, he showed Little Albert the mouse again.

This time Albert was terrified, simply by the sight of it.

SUPERIMPOSED BABY SCREAMS

Watson's experiment shows us that we're not necessarily born

with a fear response to everything that we, as adults,

feel fearful of, but that we might have learned that fear response

along the way.

Wayne remembers a fearful event, which he feels

may have contributed to his anxious state of mind.

It started off in Year Six, really. We'd been set some homework

and forgot to take it home, though.

So when the Monday came around, I didn't have any homework

and the teacher was really quite angry about it.

I kind of got a good shouting at.

I felt awful. You know, I was in tears in front of my classmates.

I spent a lot of time off after that.

I ended up being quite reclusive and missing quite a lot of school

and not going at all.

That was the first bout of bad anxiety I got

but it may have been buried in me before that.

The Little Albert experiment proved we can learn to be anxious,

but that also means we can "unlearn" it.

This is the theory behind cognitive behavioural therapy, or CBT -

one of the most effective treatments for anxiety disorders.

-Hi, Wayne.

-Hi, you all right?

-Do you want to come through?

-Yeah.

Wayne is using CBT to help him tackle his fears.

Cognitive behavioural therapy helps people helps people

to look at their thoughts and look at their behaviours

and identify which thoughts or behaviours

might be unhelpful in terms of maintaining their problem.

For Wayne, Jo is using a CBT technique called exposure therapy.

This helps him to keep his anxiety under control

when he's stressed out.

So, any change to what's going on now, or...?

-Yes, I'm getting...getting worse.

-OK. You're doing really well.

Just going for a ten-minute walk will cause Wayne enormous anxiety

because he has no idea where he is going,

or whether there will be a toilet.

-Just...

-What's going on in terms of, um...

-in your tummy?

-Very tight, very tight.

Feels like it's moving a lot.

But Jo's trying to teach Wayne

the more he faces frightening situations,

the less anxious they will become,

and she does this by distracting him.

Shall we have a go at some of our distraction techniques, then,

-and see the effect?

-Yeah, sure.

-OK.

-So you start us off on boys' names.

-Adam...

-Ben...

-Charlie...

David...

HE BREATHES DEEPLY

Er...Edward...

Fred...

As Wayne calms down, his anxiety begins to disappear.

The theory is each time he does this, the less fearful he will be.

-Where's your anxiety at now?

-It's much better now.

OK, well done, well done.

-Thank you.

-I think we were at a point of almost giving up then!

-I was pretty close!

-OK, we'll just loop round and then we'll go...

'I've lived with anxiety for most of my life

'and the rest of my life, I imagine I'll have anxiety

'to a certain degree.'

The key is just managing how bad it is.

I need to make sure that it stays as quiet as possible

and keep on doing my CBT, and, hopefully,

you know, I won't have to think about it so much.

Around 3% of young people in the UK

will experience a one-off psychotic episode.

But if these episodes persist,

it can develop into the mental illness schizophrenia.

27-year-old Ross is a musician.

Five years ago, he was diagnosed with schizophrenia.

'I believed that I could heal people just by staring at them,'

or I believed I could hear aliens talking to me

through the sound of the computer.

One thing I used to believe was that my mum and dad

were "energy vampires" and they were sucking energy out of me.

Schizophrenia usually begins in the early 20s,

and young men are most at risk.

Ross was 21 when his symptoms began.

He became withdrawn and confused, and started to experience psychosis.

The key symptoms are things like hallucinations,

most commonly hearing things that aren't there,

things like hearing voices,

sometimes seeing things that aren't there.

And the other key symptom's delusions.

So having unusual beliefs

that, on closer examination, don't seem to be grounded in reality.

This feeling of absolute power.

I literally thought that I could change the universe.

During one psychotic episode, Ross decided to paint his bedroom

and filmed the whole process.

It's like poo! Poo, I say!

'Poo!'

Poo...eurgh!

You see, I still remember what I was thinking at the time.

I was, like, "this is going to be great, this awesome piece of artwork

'"that I can have on my wall for ever."'

Look at it. No...no sense, no order, no rhyme, nor reason.

But the reason why I was doing it, really,

was cos I was a little bit weird, and odd,

and under the influence of psychosis at the time.

Scientists don't know for sure why people suffer psychosis,

but believe certain chemicals in the brain could play a role.

So we know that people who are experiencing psychotic symptoms

and schizophrenia have disregulated dopamine,

so their dopamine system becomes a bit out of control.

Dopamine is one of the many chemicals

that transfer messages in the brain.

It passes from one nerve cell to another through tiny receptors

at junctions called synapses.

Dopamine is the brain's way of communicating what's important

in the world, like food, sexual attraction,

or that something scary or surprising has happened.

In people with psychosis,

it's thought the levels of dopamine in their brain are too high.

This means that thoughts are distorted

and could explain why they lose a grip on reality.

I think people find seeing people with psychotic symptoms scary

because it seems like a huge departure from

what it is to normally be a human being.

What people need to be made aware of

is that in the vast majority of cases,

these people aren't in any way dangerous.

These people are just quite profoundly distressed.

Thanks very much for listening to me. I'll see you again soon.

Ross's psychotic behaviour had a huge impact on his family.

You were mad. It was mad times.

You lot were all so stressed out

and getting wound up by everything I was doing.

When you were very psychotic,

you had this thing about sleeping rough, wherever.

And you know, your son sleeping on the streets, begging,

it was pretty scary,

because I didn't know anything about mental health issues.

I was learning quickly, I went on courses and stuff.

His dad was so desperate to help his son,

he recorded Ross's behaviour as evidence for the doctors.

ROSS SCREAMS: No, no, no!

I've listened to them a lot

and it still makes the hairs on the back of my neck stand up sometimes.

I mean, how do you feel when you see them back again?

Scary, really. You just think, "God," you know,

I'm capable of that kind of...

Or that happened and I was the one doing it.

It's sort of like, "Was I really like that?" You know.

I mean, that was very scary as a parent.

Ross was finally diagnosed with schizophrenia

and sectioned under the Mental Health Act.

He was put on medication, which he still takes today.

Like all mental illness, the exact cause of schizophrenia is complex.

The current risk factors for psychosis and schizophrenia

that we know about are things like a family history,

so whether one of your relatives has had it,

and also your genetics,

things like whether you've

experienced something traumatic in your childhood

or stressful life events generally,

whether you've grown up in an urban environment,

people who live in urban environments are more likely

to develop psychosis and schizophrenia,

and also things like ethnicity, and on top of that,

and perhaps the most modifiable risk factor, is cannabis use.

Ross enjoyed partying when he was younger,

and started smoking cannabis when he was a teenager.

He was a lot more of a character, I'd say, then you are kind of now.

It was quite strange, though, as well, because

I think it was obvious that something wasn't right.

I think a lot of people were trying to kind of,

"Look, this isn't right," and try and make you get help and stuff.

What do you think caused your psychosis?

I reckon it was probably a combination of

generally feeling insecure about myself and my identity,

and then, oh, yeah, stress at uni,

and smoking weed when I was just a little bit too young,

so when I was about 14 or 15.

So it just kind of all added together, really,

the weed and stress and all these things just going round in my head.

The exact link between cannabis and schizophrenia is still unclear

but ground-breaking research at University College London

suggests that some long-term users are more at risk.

24-year-old Jonathan is one of the volunteers taking part

in an experiment to see how cannabis affects the brain.

-Hi there.

-Hi, Jonathan.

As part of the study, Celia Morgan is giving Jonathan

pure delta-9-tetrahydrocannabinol, or THC.

A relatively deep breath, and then I'm going to time you holding it...

It's the most powerful ingredient in cannabis and causes

many of the feelings people experience when they're stoned.

So just take the kind of breath

-you'd feel comfortable holding in for ten seconds.

-Yeah.

In the experiment today, we're giving people THC

to see how it affects the brain,

and how this might be related to psychosis.

So whenever you're ready, at your own speed.

Jonathan inhales the THC through a vaporiser.

One, two, three...

Just as it does when smoked in a joint,

the THC travels to his lungs and is absorbed into his bloodstream.

Within seconds, it has entered his brain...

..attaches itself to receptors,

and disrupts the flow of brain chemicals like dopamine.

This could be why smoking weed

alters the way we perceive the world.

Eight, nine, ten.

Around one in ten cannabis users will experience hallucinations,

anxiety and paranoia.

Do you want to have a seat? We'll just wait for it to take effect now.

-Mm-hm.

-And, um...

-Feeling OK?

-Yeah. Like, actually, I can't remember being this stoned

-for as far back as I can remember.

-Really?

-Yeah.

Celia wants to see if the THC is affecting Jonathan's mood

and looks for signs of psychotic symptoms.

Do things look different to you? Things in the world at all?

Colours are more vibrant. Bit more sensitive to light.

Do you feel that you're getting kind of insights?

Yeah, just a feeling of presence and a sense of...

them being here now, or...

And that's meaning in itself.

'So what we saw in today's experiment

'were mild delusional thinking, what we call magical thinking,

'and some thought disorder, so some kind of confused thinking,

'inability to keep track of his thoughts.'

So these are the symptoms

people might get in the very early stages of developing psychosis.

Celia and her team think that when THC enters the brain,

it could also be bombarding receptors in the prefrontal cortex,

the part of the brain which controls thoughts and behaviour.

Here, it blocks the brain chemical anandamide, a neurotransmitter

which controls the flow of brain chemicals like dopamine.

With less anandamide keeping the brain in balance,

massive levels of dopamine are released,

and could explain the psychotic-like symptoms Jonathan is experiencing.

But not everyone develops psychosis from getting high.

'The majority of people who smoke cannabis

'will do so without experiencing any long-term harm.'

Even those who become a bit psychotic when they're stoned

will just revert back to normal.

A minority of people, particularly those who are vulnerable

because of things like family history, might go on to develop it.

Estimates are about 2 in every 100 people who smoke cannabis.

And if you smoke under the age of 15, your odds go up even more.

Scientists have also recently discovered

a variation in the gene AKT1

and people who carry this have up to seven times the risk

if they smoke daily.

And people who smoke skunk,

which can contain five times as much THC as ordinary cannabis,

are far more at risk.

What we've shown in our research is

that long-term heavy smoking of THC changes the levels of anandamide

and this might change your brain's ability to regulate other chemicals

in the long term, which might enhance your risk of psychosis

if you are already vulnerable to it.

Ross will never know for certain what caused his schizophrenia,

but today he is fighting his illness

and slowly weaning himself off his medication.

'Really, I just want to see myself as a normal person,

'and yes, I've had this past history of problems,

'but I want to really move away from that.'

Just because I've had this label attached to me

of schizophrenia and depression, blah blah,

that doesn't make me less of a human being, you know?

Historically, there has always been a stigma attached to mental illness.

-FILM:

-'Like many young and intelligent mental patients,

'this girl doesn't mind us filming her at all.'

During the 1950s, it was a big step to visit a psychiatrist.

'She is asked what her symptoms are.

'Depression, anxiety, or something more serious like hallucinations?'

Usually, the only option for people with anxiety or depression

was mind-numbing tranquillisers.

Then, in the '70s,

scientists discovered the benefits of a new drug

originally invented to treat high blood pressure and obesity.

When it was given to mild depressives,

they showed a remarkable improvement.

MUSIC: "Summer Breeze" by The Isley Brothers

In the '80s, that drug was then marketed as Prozac.

Hailed as a miracle cure for depression,

it became the most highly sold antidepressant in history.

Prozac also paved the way for a completely new wave of drugs,

selective serotonin re-uptake inhibitors, or SSRIs.

Serotonin is the body's feel-good chemical.

It helps us regulate our moods and emotions and makes us feel happier,

but it is thought in people suffering depression,

their serotonin levels may be too low.

When this chemical is released across synapses,

it is usually re-absorbed to be used again.

But SSRIs block this absorption,

which allows more of the chemical to infiltrate the brain.

Depression strikes 2% of young people,

but for some, this can be one extreme of another mental illness

called bipolar affective disorder.

18-year-old Zemzem lives in London

and is studying psychology at college.

One year ago, she was diagnosed with bipolar,

which affects 1% of people in the UK.

I think I'm just a normal person, really.

I don't think I'm different to anyone else,

apart from the fact that I am bipolar,

which, to me, I don't think is a major thing.

It's just like introducing your name to me.

Well, yeah, I think I'm pretty normal.

This illness used to be called manic depression,

and people with it suffer extreme moods.

We all have changes in our moods, usually in response to life events,

so, for example, if you have a bereavement,

you feel sad for a few weeks or months,

if something good happens, then you feel happy.

The difference with bipolar is that

the changes in mood happen over a longer period

and they don't happen in response to life events.

They seem to take a life of their own,

so you have several months of feeling very depressed,

and then several months of feeling manic, or very elated.

Bipolar often strikes in your teens.

Zemzem was at college when she first became ill.

I was really stressed out. I had UCAS that needed to be handed in.

I had, like, troubles with my friends and family, and stuff like that,

and all of it just mounted into one.

And I had so many deadlines to do.

I had a drama play that I had to perform in front of my whole class.

And all of that pressure just mounted up and just got bigger

and bigger and bigger and bigger.

Manic episodes can be similar to psychosis

when you lose contact with reality.

The day of my episode, I left my house

and I walked towards this train station

and it was just a really weird feeling.

Everyone's voices and everything I could hear was just escalated

and it was really, really loud.

I kept getting off the train

and getting on the train again and getting off the train. That's when...

I think the high started to hit me. Little things would just bug me,

like the train announcement and stuff like that,

and then I ended up going to a random station and just asking for help.

Zemzem was admitted to hospital, and three months later, aged 17,

she was diagnosed with bipolar affective disorder.

We don't fully understand why it is

that the onset of bipolar tends to be around the adolescent years.

One thing that we do know is that

around the sort of late teens and early 20s,

people generally are going through a lot of stressful experiences.

The other thing is that the brain is still developing

and the final stages of brain maturation

don't occur until the early 20s.

During adolescence, millions of connections between brain cells

are fine-tuned to sharpen brain function.

And it's during this complex process

that many mental illnesses can kick in.

Hi!

This one's cute.

Today, Zemzem is out shopping with her mate Myra,

who's often helped her through the bad times.

Such a fun-loving girl.

It's a shame to see her when she's sad.

What are the kind of things that trigger your condition?

What makes you tick?

Not sleeping properly, eating properly, that triggers it most

because then I get into a spiral,

everything will start piling up and piling up and piling up,

and any sort of problem I'd have, I'd think, "This problem is because XYZ,"

and it won't be related to that, do you know what I mean?

To keep myself happy and calm, I need to stay away from stress

and stressful people or stressful situations.

Very positive female. Well done!

One of the biggest risks for developing bipolar is genetic.

The risk in the general population is about 1%,

but if your first-degree relative,

that means either your mother or father or your brother or sister,

has bipolar disorder, then that risk goes up to about 10%.

So while some of us might be hard-wired to become bipolar,

the critical genes first have to be switched on,

usually by stress or a traumatic event.

But Zemzem's mental illness does have a positive side to it.

To help her cope, she's begun writing poetry.

In the town where the queen wears a crown,

There are children crawling the streets

Hunger pumping through their veins,

Their eyes bloodshotted with pain

Scribbling verses, trying to get some fame

Cos you know the game is a tough one to play.

I think it's quite useful for me

because that's when my creative juices are flowing a bit more.

If I'm angry, if I'm upset, I can just put pen to paper

and I think that's quite helpful, especially for other people as well,

just to, like, understand where I'm coming from as a person.

Creativity has always been associated with mental illness.

Van Gogh, Virginia Woolf, Stephen Fry and others

have suffered from bipolar and other mental disorders,

but finding a scientific link has been tricky until recently,

when two studies showed there could be a connection.

Recently, there has been some evidence emerging that showed

that people with bipolar disorder,

and also, interestingly, their relatives,

were more likely to hold creative occupations.

When people are manic,

they often make very intuitive leaps of imagination,

linking new ideas together.

It may be that a little bit of mania

might actually be quite good for creativity.

Zemzem has taken the drug lithium to help stabilise her moods

and accepted her mental illness as part of her life.

I don't think bipolar affects me that much any more,

so I don't dwell on it as much as I used to.

I'm just taking the positive out of it rather than the negative.

I'll be like, "Yeah, I'll get through this, just..."

I think I'm a lot funnier now.

SHE LAUGHS

I try to be, anyway!

Over the last decade,

the understanding of mental health has been transformed by science.

Genetics, understanding the role the brain plays,

and psychological treatments

are making huge leaps forward.

Together, these advances could help change the lives

of millions of young people who suffer from mental illness.

MUSIC: "People Help The People" by Birdy

# People help the people

# And if you're homesick, Give me your hand and I'll hold it

# People help the people

# And nothing will drag you down

# Oh, and if I had to break

# Oh, and if I had to break... #

Subtitles by Red Bee Media Ltd