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It’s hard to tell someone you’re hearing voices. And no wonder. Psychosis, as it’s known, doesn’t generally get a good press. The term itself is widely misused – think about as ‘Psycho Ward’ Halloween costumes (rightly causing an outcry.) It’s a historic thing, that’s how it was portrayed in days gone by. Yet hearing voices is much more common than you’d think. It’s normal, it can happen to anyone, especially after a period of stress - and it’s very treatable.
The Liverpool Early Intervention service’s main purpose is to provide quick access to help for people experiencing psychosis. While for some people the first episode may be the last, all the evidence is that, left untreated, the problem can become much worse.
We asked consultant psychiatrist John Stevens and Claire Seddon, a consultant clinical psychologist with the service, to explain psychosis and the importance of intervening early.
Dr. Stevens: “It’s a sort of emotional ‘perfect storm’ – an especially bad situation caused by a combination of unfavourable circumstances. It’s subtle. It comes on slowly and can be quite frightening, you hear things, and your thinking becomes muddled. You put two and two together and get five.
“As it becomes harder to tell what is real from what is not, a person may start hearing or seeing things that other people can’t. They might start to believe things that others around them think are unlikely, for example that people are targeting them, or can hear what they’re thinking. A common example is the feeling that messages are being sent to them, maybe through a television programme, or a song. It can be confusing and scary.”
The Early intervention team works with people to explore the root of the problem and to support families to recover.
Dr. Stevens: “We can’t always pinpoint one thing, although adverse events as a child or an adult can mean you have a vulnerability that could make it more likely. Eight out of 10 people affected are between 14 and 35, although older people do experience psychosis.”
Claire Seddon: “It’s not black and white, it’s a sliding scale but usually it’s when someone has lost touch with reality, often through developing exaggerated or unfounded beliefs that cause distress and interfere with day to day life. Often it’s not until the unusual behaviour becomes really obvious that people ask for help”.
“Parents may mistake it for teenage angst and either ignore it or worry and wrap the young person up in cotton wool. There can be red herrings too; using drugs for example. Cannabis use from an early age while the brain is still developing is a known risk factor, but parents and even professionals put problems down to this alone. In fact it may be a way of trying to cope, even though it’s worsening the situation.”
The team wants psychosis ‘out there’ - being openly discussed - so people are less afraid to seek help. Dr Stevens: “We need to normalise it much more. It can happen to anyone but there’s still stigma, it’s a label and people don’t want that.
Clare Seddon: “We start by offering a space to talk, maybe at home or somewhere else familiar and safe. We help the person and those around them learn more about psychosis, which reduces worry and stress at home.
We’ll offer advice around medicines to fit the person’s lifestyle. Talking therapies are also helpful to understand how these experiences came about and rebuilding confidence. It’s not unusual to feel anxious while you’re getting better, so we help people through getting back into work, education and family life.
“We try to help people understand who they are and where they’re coming from. We say ‘Lots of people are feeling this way, it’s a response to things that have happened to you and it will get better, it’s not the future’. “