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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”.

Age at interview: 22
Sex: Female
Age at diagnosis: 21
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Even I don't know where it came from for the very moment. Let me analyse everything that happened and let me judge it for myself for where it came from. For me, it came from various sources fora person's life and a person's mind is very complicated. And for people it's very difficult to pinpoint things that traumatise them. To pinpoint things that make them feel a certain way because in life, people would rather just brush it under the carpet and not deal with it. It's easy to just brush under the carpet things that bother people in life. Do you know what I mean so. People need to understand that they, for themselves can't tell other people where the space they're coming from is because it can come from multiple sources. There's no one cause and effect for this, especially psychosis, it comes from various spaces. So people need to kind of be open minded regarding where it's coming from and not just, 'cause I think it's, it's easier. And I think people want a reason for why it happened. It's like oh, it's got to be this, it's got to be that. But sometimes it's not that clear cut. Your just gonna have to accept that as an answer, because otherwise your gonna be finding yourself very unsatisfied and the person isn't gonna agree with you, for example, I didn't agree—when someone, when someone said to me oh, it's this. I would be like maybe, but I feel like it's more, it's just more than the one, do you know I mean? It's more than just the one thing you're judging it for. It could be multitude of things. But you, you can't prove that. But I, for certain can say from the space and I can certainly feel the instinct that it's that that it came from kind of a bottling up of emotions and then outpour, get rid of all the blockages now you know so it can never happen again, kind of thing. 
Even where there was no clear cause for their first experience, people could sometimes identify things that later triggered repeat psychotic experiences.
 

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.

Age at interview: 19
Sex: Female
Age at diagnosis: 15
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I think it's quite a common thing that people think if you have mental health issues that you must have had some sort of tragic experience in your life. But that just wasn't the case for me. You don't need to experience something really bad or be in a really bad situation in your life for it to happen, it just happens.

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 

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.

Age at interview: 22
Sex: Female
Age at diagnosis: 21
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I think during the time period it was like I was, I was aware that like something is coming kind of thing. I could feel it. There's, there's like there's something. I was like, I was not satisfied with the way things were during that time period, I had to, I was always, I was also made aware that I didn't really want to do law. So I was like, oh, I, even though my whole life I've been working up to this point and I mean uni, it's my third year now. I just couldn't find the care for it. So it was, it was a very transitional transformation kind of time period. So, for it to happen during that time. It was like, okay, so kind of—

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.

Age at interview: 18
Sex: Female
Age at diagnosis: 17
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Because we started doing GCSE from year 9 and year 9 was a bad year for me anyway, because I started to self-harm and stuff and fell back into my depression and feet first and yeah. And then, of course, 'cause obviously that's when I started to get bullied, because I was self harming. And because of how I, because I was different from everyone else. 

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. 
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.
 

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.

Age at interview: 23
Sex: Male
Age at diagnosis: 20
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Because we kind of notice a trend that when they, psychotic symptoms are kind of seem to appear when there's not much going on in my life, which obviously I commented that okay, frustration and not enough going on in my life as well as not being, not being able to do what I want, stuff I wanna be able to do. It does appear, they often appear when there's kind of like during the holidays and stuff like that when it's kind of not much going on, if you know what I mean. 

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. 
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.

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”.

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To be completely honest, I had the same boyfriend for almost three years. And then we broke up when I got in the sixth form. I just started, I mean I’d always been a person that got wasted, but I just did a lot of intoxicants really. And lots of Ecstasy, stuff like that. And it just tipped me over the edge like properly. I mean I don’t think drugs are good. I think they’re bad for you. I don’t think they’re good for people. But at the time I didn’t really know the severity of what they were doing to my brain. 

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.

Age at interview: 24
Sex: Male
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I just - I think maybe, they’d always sort of - I'd always kind of had running commentary in my head, and thoughts what go through your head, when you're kind of anxious or nervous and sort of, or feeling low. When you’ve got a low mood. And sort of your brain tells you that you’re not worth anything, or you know, you’re not sort of, yeah. And I - maybe when that grief came, it kind of zeroed in on it a bit more. I think just the shock of it all happening, and then the sort of - maybe there was a thought, thoughts of kind of like, you know. When someone passes away close to you, there’s suddenly that thing of, somebody who had seemed like kind of - yeah, you kind of get shocked a bit because you kind of expect people close to you like your family to always be there. 
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”.
 

Andrew X thinks unprocessed emotions contribute towards his psychosis.

Andrew X thinks unprocessed emotions contribute towards his psychosis.

Age at interview: 24
Sex: Male
Age at diagnosis: 14
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Have you noticed that there's always sort of depressive and lonely state that comes before any of the experiences that you've had the paranoia or the hearing the voices?

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

Age at interview: 23
Sex: Male
Age at diagnosis: 21
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So first time I had anything was the beginning of my second year at university. I was walking back from Sainsbury's, just with shopping. And it was like I was having a sort of bit of a rough time with it anyway. But I just basically had a voice coming over my right shoulder, and it was my grandfather's voice, who was not a great guy. Just saying "Well, I mean, what are you doing? "I found it odd that I have to use his voice to actually say his words, but just do. So it's like "So, what are you doing? Why are you bothering? You're, you’re just going to end up hurting people. You should just - you should jump in front of that car. That's what you should do." Yeah, that was the first thing [sigh]. Tracking back a bit from there, I think the reason why I was having problems was over that summer I'd lost quite a lot of people. So my cousin had died, in a fall. My- one of my friends died of lung cancer. One of my friends died of an infection from another health problem. And one of my favourite teachers died of pancreatic cancer. And I think just having them all, altogether in, within the space of about three months, just blew my head off a bit. 

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." 
For some people we spoke to being exposed to troubling or frightening images or stories could also be a trigger.
 

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.

Age at interview: 22
Sex: Female
Age at diagnosis: 19
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There have been other times different things so I went to the cinema to watch Miss Peregrine's House For Peculiar Children. And something you have to be very careful with when you have psychosis is what you watch and you, like what you let go into your brain, because you not consciously, but it sort of goes into the back of your mind and your mind tries to process it, but it can really effect your hallucinations. Then I was absolutely adamant that there were monsters that were gonna come through time and try and destroy the world and it was my job and I was the only one that could do it to stop them. So, I started, I would go where I thought that the monsters were gonna come through time, I would go and stand there for hours at a time. Sometimes late at night and just wait for these monsters to come so that I could stop them destroying the world. Yeah. Other things can creep in. I mean, the constant ones have been Darren and Alice, but at different times other things have creeped in. I've had like, I stopped taking my medication because I thought that somebody in the pharmacy had replaced the tablets with something else and they were trying to poison me. 

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. 
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.
 

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.

Age at interview: 21
Sex: Male
Age at diagnosis: 19
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For me, being the person I am, and that I was – I’m a social guy, you know, I drink a lot, you know - blah, blah, blah. For me, drink - drinking. I've cut down my drinking. It's helped me massively. It's - It might not be relevant advice to many people, but it could be relevant to some. And that's what's important about it, because if it's relevant to, relevant to you - if you cut down on your drinking, that'll stop your psychotic symptoms a lot. It'll, it’ll reduce them. When I came out of hospital in March 2015, I didn't have a drink for six months. I decided I'm going to go proper teetotal, see what it does to my system. And, I experienced a lot less psychotic symptoms. 

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.

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On and off, I was on and off for years and years. Then I got well for about, I’m crap with like time and stuff. But I got well for a really long time. And then I got really, really ill again. Then I got well for about four or five years. And then last winter I came again for two months in to hospital. And then since then I’ve been pretty good. Like I’m really, really trying to keep well now. And that makes a massive difference.

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.
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.
 

Andrew X talks about the importance of “sleep hygiene” for keeping well.

Andrew X talks about the importance of “sleep hygiene” for keeping well.

Age at interview: 24
Sex: Male
Age at diagnosis: 14
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It's gotta be about looking at my sleep, making sure I'm getting good sleep. Making sure that I'm not, that I'm socialising, making sure that I'm making those connections. Doing some mindfulness stuff. Meditation if I have to. All that sleep hygiene jazz that's talked about. Sleep hygiene is like, you know, getting a good routine you know, have a nice warm, hot drink. Don't drink caffeine before bed and all that sort of stuff. 

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. 
 

Joseph wasn’t eating or sleeping well around the time of his psychotic experience and he thinks his immune system was very low.

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Joseph wasn’t eating or sleeping well around the time of his psychotic experience and he thinks his immune system was very low.

Age at interview: 22
Sex: Male
Age at diagnosis: 21
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You said you weren't eating, you weren't sleeping. 

So it was about four hours sleep a night. 

Yeah. 

And only enough time to cook a pizza, which - I don't know if you've ever gone long periods without eating a lot - it's hard to then eat a big meal. 

Okay. 

So, yeah. Not a lot of food. And then - oh, I think the doctors told me it's the three S's. So, a lack of sleep. Stress. And substance. So for me, substance wasn't anything illicit. But yeah, I'd say heavy use of the caffeine. That would definitely count as substance. And I think that definitely had an impact. And it's just a group of things. 

Was that just that week that you'd been moved, and you were kind of training yourself. Was it just that week that you were doing this? The lack of sleep, and the not eating properly, and too much caffeine? Or had it been something that had been anyway? You were -

It was particularly bad that week, or maybe month leading up to. 

Yeah, long days are not unusual. So unless you live close, you will get only about - I suppose it averaged about six hours sleep. So, that was unusual, that I was doing more like four. I mean, six still isn't great, but it was enough. So it was particularly - Yeah, so my immune system was probably very low. Like all my levels, very low. 
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