Views about causes of psychotic experiences
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. Even where there was no clear cause for their first experience, people could sometimes identify things that later triggered repeat psychotic experiences. Stress and distress
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. For those with repeat psychotic experiences, stress, built up anger or frustration could trigger another psychotic experience. Andrew X says that he only gets psychosis during “really acute moments of stress”. But what constituted distress varied and even boredom could be a problem for some people we spoke to. You can read more about depression, stress and trauma in the lead up to people’s first experience of psychosis, about living with depression and severe anxiety alongside psychosis and about how managing stress as an important aspect of keeping well.
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. Traumatic events do not always have an immediate effect though; it could be months or years before psychosis occurred. After a head injury Lucy experienced depression but it was some time later, when the depressive feelings worsened that she began to experience psychosis. Ruby’s father had abused her as a child but it wasn’t until she was 19 that she began to hear the voice of a child and a man. Later she understood these voices to represent her younger self and her father.
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”. For some people we spoke to being exposed to troubling or frightening images or stories could also be a trigger. Diet, substances and sleep
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. Many people said they struggled with sleep around the time of their psychosis. It was hard to say if lack of sleep had contributed to the psychosis initially, or whether it just made it continue for longer. During their psychotic experience many people said they were getting only a few hours sleep a night. Lucy struggled to sleep when she was hearing voices and would go out on long walks at night until she was too tired to go on. Joe’s voices were “aggressive” which made him feel “too shit scared” to sleep. Yet getting proper sleep was mentioned by some as important in keeping well or getting better.