Psychosis (young people)
Views about causes of psychotic experiences
The causes of psychosis are complex, varied and can be difficult to verify. Although there are medical guides on causes and triggers for psychosis each individual experience of psychosis is unique. Doctors, service users and academics disagree about whether diagnoses such as bipolar and schizophrenia are useful in understanding psychosis (see our resources section for links to further information).
Research on lived experience of psychosis shows that many factors are thought to play a part. Here we set out some of the views of the young people we interviewed, about the things that they believed may have caused (or contributed towards) their first experience of psychosis.
Looking back, some people found there were very specific things, or a combination of things, that happened around the time of their psychotic experiences. Luke, who had just started a new fast paced job, thinks a combination of “work, booze” and city life, together were the cause of his first psychotic experience. When Joe’s voices were becoming more frequent, he was directing a show, sitting exams, and was only sleeping 3 hours a night, all of which he felt contributed towards his psychosis.
While some people felt they could identify causes, for others psychotic episodes felt “unpredictable” or it was harder to say what the main cause was.
Sameeha feels there is “no one cause and effect for psychosis”. She thinks her experience of psychosis came from a “bottling up of emotions”.
Sameeha feels there is “no one cause and effect for psychosis”. She thinks her experience of psychosis came from a “bottling up of emotions”.
Nothing “really bad” happen to Hannah before she first saw a vision but she now thinks “anxiety” is a trigger. She also tries to avoid seeing “scary images” which can become “visions” later.
Nothing “really bad” happen to Hannah before she first saw a vision but she now thinks “anxiety” is a trigger. She also tries to avoid seeing “scary images” which can become “visions” later.
Yeah. I'm always aware of my triggers. So that affects me in how I don't go and do certain things. So I've never been to Thorpe Park. Because of their basis on some of their rides with like horror imagery. So I've missed out on quite a few trips, because of that. I didn't go paint balling at one of my friend's parties, because I was afraid of the masks that they'd be wearing of that being a trigger.
That's all managing it. It's you've got to a place where you've got all these strategies like you said.
Yeah.
And, but it sounds like it does, I mean, has that been a big impact for you sort of I suppose saying, I can't come to your party or so it's sort of, it's strategies which are working to help you, but it does sort of slightly cut back on your flexibility, not flexibility, but the options, I suppose.
I think I've been lucky in how the friends that I've had to say no to with those situations. They're aware of what's going on so they understand. They are not hurt by it. They don't mind.
Yeah. Yeah. That's good. And what about sort of romantic relationships we have to ask about everything. Would you say that your experiences have affected that?
Yes. I think so. If they're big fans of horror films, I’d have to say, I can't watch it. And then you'd have to explain why and then you’d have to try and get them to understand which can be difficult. But they've been understanding.
Do you think that psychosis affects men and women differently?
I don't know what you mean by that.
Just in terms of the sort of social impact or relationships or—
Maybe.
Not something you've kind of come across.
I haven't, no.
And can you tell me a little bit about your family now?
My family.
What's been good or not so good in terms of support and how important that's been in the process for you.
They've been really good. My parents have always been really strong supporters with me. And my brother is brilliant. He makes sure that if we go and see a film that has spots of imagery in it, he will tell me to close my eyes or if we are out in public and it's around Halloween and there's posters or something scary, he'll tell me to close my eyes and then tell me when I can open them, which is very nice.
Just sort of out of interest, do you find that, 'cause it sounds like for quite a while you've been managing any exposure to images. Do you think that's helping to make the images fade or anything?
Yeah, I think so, because they get, I think my mind gets the images that I see from those images. So you deprive it of that, that source then it struggles to come up with new ideas. I think I'm, another trigger I sand being anxious, so in like when I have expectations like exams and stuff or anything like that then the anxiety that comes with that would trigger psychosis as well, so at least that's something that I had to manage.
And is it the same tools that you use for that, same strategies or—
Yeah, trying to keep myself busy, so watching something and listening to music. Sitting with my dogs. I find that quite therapeutic. Just like talking to them and petting them.
Stress and distress were mentioned as causes and ongoing triggers for psychotic experiences. In particular many of the people we interviewed said that they had been feeling distressed, stressed and anxious when they first experienced psychosis. Sam said her anxiety built up after she was bullied in school and this eventually “turned into” psychosis. Sameeha said she was experiencing “high stress” but hadn’t allowed herself to “accept” what was happening.
Sameeha was aware “something was coming” and was going through a “transformative period” rethinking what she wanted from her life.
Sameeha was aware “something was coming” and was going through a “transformative period” rethinking what she wanted from her life.
It must have been quite big then. Because you were in your third year.
Yeah, definitely.
There you are, in law, which is sort of fairly, yeah—
Yeah, rigid and structural.
Rigid and structural. And then, you said, it was brought to your attention or somehow—
Yeah. Look at, a month or two I was like travelling back and I was just like, I don't, this isn't what I wanna do for life. I'm aware, I, why did I even choose law. Is it simply because of the money, because it's a good job, 'cause society wants me to work 9-5 every day. And I'm just like oh, I, I don't even know where I stand in life at the moment. I just followed the path that was easier that my parents took pride in for me. And so now, I just, it was, there was a time where I just need to figure out like who I am and it was a shock, because technically I was an adult. Do you know do know what I mean? I was 21. So, I should know everything, technically according to everyone else, I should know how to run my life and what to do things and how to do taxes and council tax and everything like that. But it, it was a time period like that. I am just gonna go see where everything is. And it eventually it led me to that.
And was there something else going on around you that made you have those kind of, you know, where do I wanna be in life kinda thoughts?
It was, it was just like, I think with everyone, everyone just wants to be comfortable, do you know what I mean? So, it was, uni I was like, out, outcast, do you know what I mean. It was like, you could talk to people, you can have a and b conversation, that's fine. But everything seems a little bit trivial, do you know what I mean? Small talk only gets you so places that I rarely had interesting conversations. Everyone just wanted to drink. Everyone just wanted to go clubbing. Everyone just wanted like the trivial things. I was never about that, not even when I was younger. So I just found, I just found myself like yeah, in that period where I was just yeah, I don't know. I mean, I'm in this place where [sniffs] I've not been before, because all I did was just follow the 'Yellow Brick Road' and eventually I found myself lost, so to speak, kind of thing. So, yeah, I did feel that kind of change come in.Sam’s psychosis “stemmed from being bullied” in school. She had also been experiencing depression and was self-harming.
Sam’s psychosis “stemmed from being bullied” in school. She had also been experiencing depression and was self-harming.
So that was in the school environment.
Yeah. And the teachers just, basically in the classroom just ignored it. And half the time when I decided to shout back at them, I got in trouble. So I just stopped saying anything and just slowly stopped turning up.
Sounds like there wasn't very much awareness.
No, they sort of and there was no point sort of telling anyone, because when you did, they just sort of like told the person that you told them and even if they said someone told me that they knew the person that was bullying you knew it was you that had gone to someone and it just got worse. I stopped telling anyone and I just stopped turning up to lessons. That was the only way I could just sort of escape it, because they started, because it was like really hot classrooms. I wasn't gonna sit with three coats on just so I wouldn't get poked fun at, you know. But, and that's sort of when I started sort of like hearing bad things about myself, because of like that. The only thing going through CAMHS and that, they've sort of realised is that it's sort of stemmed off being bullied.
I was gonna say.
Yeah, they sort of realised it's sort of, that's the only thing they could sort of put it on it. It's sort of being stemmed off sort of being bullied about, you know- And especially because I was overweight in school and constantly being called, fat. And they [sighs] and then I started hearing things like about myself and I started like hearing the bullies when they weren't even around me or I was sat in the office on my own. And, so, it wasn't until my key worker sort of decided to say, ''Look, you need to go and see someone because it could be something more than...'' I said, ''No, it's just anxiety.'' And she said, ''Yeah but it could—'' That's when she started to think there could be something more than that. Andrew Z has noticed that his psychosis now seems to happen in the holidays when there isn’t “much going on” and he thinks it’s his brain’s way of compensating.
Andrew Z has noticed that his psychosis now seems to happen in the holidays when there isn’t “much going on” and he thinks it’s his brain’s way of compensating.
Engaging your brain.
Not engaging my brain. Maybe, maybe it's overcompensating for the fact that there's not much engagement. Doesn't receive much input and so it's kind of producing its input itself or something. Quite like sensory deprivation, I suppose, yeah.
Trauma
Some people talked about experiencing a ‘trauma’ at a time of their first experience when they already had underlying mental health difficulties such as low mood or depression. Tariq felt he was “psychologically damaged” by two years of abuse/bullying in school and then had “another traumatic” experience when he had open heart surgery. He was depressed and he thinks these events triggered his psychotic experiences. Andrew Z fell behind with his coursework at university and was “kicked out”, which sent him “over the edge” into “quite a bad psychotic episode”. When Becky’s boyfriend cheated on her, the anxiety of what felt like rejection had a profound impact on her, which she describes as “almost a switch in my head…I became a different person”.
People also spoke about other traumatic events such as the death of someone close, that came just before their experience of psychosis, heightened their existing feelings of low mood, or led them to increase their drug or alcohol use, which then further affected their mental health in a bad way.
Fran had been using recreational drugs socially, but remembers after splitting up with her long term boyfriend, doing a lot more and it “tipped” her “over the edge”.
Fran had been using recreational drugs socially, but remembers after splitting up with her long term boyfriend, doing a lot more and it “tipped” her “over the edge”.
Yeah. And was everyone that you were hanging round with also doing it, so it’s just that –
Yeah. And the way I look back on it now, I mean I was the one that the shit really hit the fan with. But I look back on my friends and stuff then, like we were all a bit mentally ill. Like when you’re a 16-year-old and you’re doing, you’re getting that high every weekend. I think quite a lot of my friends weren’t that well, so they didn’t notice it in me really.Peter was already feeling low when his father died. The “shock” of losing a family member made his brain “zero in on” his negative thoughts about himself.
Peter was already feeling low when his father died. The “shock” of losing a family member made his brain “zero in on” his negative thoughts about himself.
Some people we spoke to saw psychosis as their brain’s way of trying to cope with something that could not be properly processed or thought the brain could be “warning you about something”. When Ruby hears the voices of her abusive father and younger self she feels it’s her “brain’s way of trying to process what was going on”.
Andrew X thinks unprocessed emotions contribute towards his psychosis.
Andrew X thinks unprocessed emotions contribute towards his psychosis.
I'd say unprocessed depression, anxiety, stress and traumatic events. So when I processed things in my mind the right way, I am feeling sad, okay, let's look at this sadness. Why is it? It's because, I don't know, your favourite cake at Greggs ran out. So, okay, that's, that's nothing psychotic and you don't need to worry about that. File that away in the correct way. That, that bit of depression is dealt with. But when I was younger, all these depressive things that were, all these depressing thoughts that were happening, I didn't have the understanding to be able to process them correctly. So they were just causing my brain stress. They were just hitting on my brain the anxieties were hitting on my brain and they weren't dealt with in the right way. You know, so they weren't processed. They were raw. It's like, you know, if I had a, if I cut my arm and there was blood pumping everywhere, you know, it's, it's almost the same. You are gonna do something to stitch that back together or deal with it. You're not just gonna put a big plaster on it and hope that it sorts itself out, because it needs something more, because there's a big gaping hole in my arm. And [sighs] that's what, for me what I need, that, that for me is the root of my problems, is that, regulate yourself emotionally which is not easy to do, by the way, when I fail I will hold my hands up to that. I am not perfect. And then then that helps deal with the psychosis. In some cases it stops it completely. You know, I can be really responsive to myself. Because I know my emotions and I know that yeah I am a bit stressed this week. I need to take some action about that. After four people he cared about died over one summer Joe started having hallucinations in which people he cares about are going to be hurt. He thinks there’s a part of his brain that can’t say “I’m worried” that is producing the voices and hallucinations
After four people he cared about died over one summer Joe started having hallucinations in which people he cares about are going to be hurt. He thinks there’s a part of his brain that can’t say “I’m worried” that is producing the voices and hallucinations
So, yeah. I think most of my hallucinations, at least when they get bad, when they're violent - which I haven't had them in quite a while now revolve around people I care about being hurt. And I think that's probably- As a root of that, that's the bit of my brain that worries about this happening to other people doesn't really know how to communicate that I - doesn't know how to say the words "I'm worried. " And so it just says, "This is what's going to happen, you should deal with that so it doesn't happen." Ruby describes how watching certain films and TV programmes can trigger her psychosis.
Ruby describes how watching certain films and TV programmes can trigger her psychosis.
Yeah, that tends to be more on those sort of delusion side of psychosis rather than the hallucination side. But, I mean, that was triggered off again by a programme I was watching, Homeland. And her medication does get swapped. But she doesn't realise. And yeah, so generally before I watch something now, like this was when I, I didn't have, I didn't really know that it was gonna affect me in that way. I tend to sort of ask my friends, ''Has anyone watched it like what's it about. Like what sort of things does it mention. ''And there are certain things they steer away from. Things that kind of psychologically- like oh that could be a possibility, yeah, 'cause my brain tries to convince me then that it is it latches onto things and sort of twists them.
People mentioned other things that they believed may have been a factor in their experience of psychosis such as social drinking and recreational drugs, lack of sleep and poor diet.
Staying away from drugs and alcohol was felt to be very important for some. Green Lettuce tries not to have cannabis because it gives him hallucinations. But Chapman said drugs help him to feel more ‘normal’, and to experience the things that everyone else feels, like the wind and the sun.
Luke finds that drinking alcohol socially makes his psychosis worse. Cutting down has improved his mental health. He thinks it’s important to “have the maturity” to do that.
Luke finds that drinking alcohol socially makes his psychosis worse. Cutting down has improved his mental health. He thinks it’s important to “have the maturity” to do that.
That's amazing.
And now when I - Now I've gone back to drinking, I’m drinking considerably lot less. You know, I'll have a sesh now and again. Yeah. I don't, don't go all out, you know - control it. And, and for me, that was a great thing to control, like when I was only 19, because we all live our lives quite uncontrollably when we're young, but. I felt a bit sorry for myself that I couldn't do things like my mates could. But, but really, that - putting the control of that in place - And that could be an example that's applied to something else. You know, you might be into your drugs, you might be into whatever - you know - keep everything under control. And yeah.
Okay. And then, that's obviously - you know - that was something that - a strategy that you kind of came up with yourself? Obviously you noticed that there was a link there, and that there were benefits? So, sort of your own.
I noticed that my drinking patterns were - I drink a lot more in the upload to a psychosis. And it would sort of be a vicious cycle, really. I also found like being hungover would affect - I'd feel more depressed, and,- more likely to do stupid things. But for me, it felt like I was putting myself at a higher risk of getting psychotic when I, when I did drink. And what, what was funny for me as well, when I stopped - I call it stopped drinking. I, I sound like an alcoholic, I sound like it was a real issue for me. But actually, it was having that maturity to accept that this is an issue for me because I've got psychosis issues. It's not just saying, you know - it's not saying I'm stopping alcohol because it's destroying my life. But it's going - it's a massive impact in psychosis. Actually, all the medication I take says 'don't drink alcohol'.
No one's going to do that, no one listens to that. But you know, having that - stepping up and being mature, probably before your time, if you get diagnosed young. That's the best thing you can do. Step out of your kid - you're not a kid any more. Grow up, pretty much. Grow up faster, and you'll reap the benefits. The things that help Fran stay well are friendships, and staying off drugs.
The things that help Fran stay well are friendships, and staying off drugs.
What’s helped most?
Quite a lot of things really. The people I love. Had some amazing people just stick by me, like all of my family and my friends. Some friends left, like some friends didn’t, but the ones that stayed it’s like they’re worth their weight in gold. But good stuff sometimes to a certain extent and self-motivation. But I’d say more than anything not taking drugs. I’m not a person that can take drugs.
So every time you got ill between the years, was it cos of drugs? Or were there different reasons or?
I think there were different reasons. But the different reasons always had an undercurrent of drugs, yeah.Andrew X talks about the importance of “sleep hygiene” for keeping well.
Andrew X talks about the importance of “sleep hygiene” for keeping well.
Does that help for you?
Yeah, it does. And I get really angry having to admit that sleep hygiene works. 'Cause I don't like it. I don't like being told how I need to manage things. Like, it's like, but it works. It's like and you're sitting there and you're like, you know, it does work. It's like no, it doesn't. You know, it's that tension, why is this working?
Some things really simple and so I now have to be really like, you know, maybe I shouldn't pull that all-nighter to get something done or whatever. And I just have to be really careful in that respect. And ultimately, if, if those things, if, if those, if things still aren't changing then I need to be able to reach out. But the thing is, I think I said this earlier on. I reach out, there's no services that are responsive to that.
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