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Magazine Opinions Science & Technology Society & Culture British society Mental
health Wellbeing


PSYCHOSIS: WHEN YOUNG PEOPLE HEAR VOICES

The voices that Dina hears aren't nice to her.

By Lucy Maddox  
April 23, 2015
May 2015
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Artistic view of how the world feels with Schizophrenia. © Craig Finn

Dina is a 14-year-old Ed Sheeran fan, helps to coach swimming on the weekends
and is trying to decide which options to pick for her GCSEs. She has a pet
rabbit called Hotdog and she doesn’t like mushrooms. She also hears voices that
other people can’t hear.

Hearing voices is one of the most commonly-known symptoms of psychosis: an
umbrella term used to describe a collection of unusual experiences that signal a
loss of contact with reality. Psychosis (or the more chronic condition
schizophrenia) is often thought of as an adult mental health problem. In fact
about 80 per cent of first episodes of psychosis occur between 15 and 25 years
old, with some even younger.

Psychotic experiences are often classified as “positive symptoms” or “negative
symptoms.” Positive symptoms are ones that are “added on,” such as hearing
voices that other people can’t or having suspicious or paranoid beliefs—thinking
there is a conspiracy against you, for example, or thinking that other people
may be mind-reading or even controlling your thoughts. “Negative symptoms” are
things that get taken away, such as a lack of motivation or a lack of emotion.

It is possible to have some psychotic-like experiences that don’t interfere too
much with everyday life, but for people with extreme and distressing psychotic
symptoms, functioning “normally” is really difficult. Imagine trying to have a
conversation with someone while you have two people whispering, one in each ear,
some of the most horrible fears that you have about yourself. Imagine trying to
sit a GCSE mock exam while you can hear a voice just behind you telling you that
you are going to fail.



Dina’s voices aren’t nice to her. The things they say make her feel bad and
suspicious of her friends and family. Sometimes they encourage her to do things
to hurt herself. Sometimes she does what they say.

Psychotic experiences are similar whatever the person’s age, but their meaning
and impact for a child or teenager might bring additional challenges. Dina is
yet to experience the potential of what she can do and be in her life. She
hasn’t taken her GCSEs yet, so although she’s predicted good grades, her
diagnosis calls that into question for her and her school. She has some close
friends, but her sense of self is very affected by peer approval. She fears
bullying.

Compare Dina with Emily: a 30-year-old woman, also hearing voices, but who has a
successful job in the City, a happy marriage, an established group of friends
and a good track record in education and work. Emily is highly distressed by her
psychotic experiences, but her sense of who she is as a person is stronger than
Dina’s. Emily has already achieved many things, whereas Dina has yet to prove
that she can obtain the milestones laid out for her.

While even as adults our lives can travel forward in many different ways, if we
have fewer personal successes and experiences that we can remind ourselves of,
then anything which shakes our sense of who we are can potentially have a bigger
impact. Theories of identity have moved on from the idea that we get a fixed
sense of self in adolescence, but as a teenager we have certainly had less
chance to explore the possibilities of who we are. Experiencing any mental
illness during adolescence can be hugely stigmatising. Fellow students, and
sometimes even teachers, might show curiosity, insensitivity, fear or
discrimination. Most teenagers returning to school from the adolescent acute
psychiatric ward where I work worry about what their friends will think of them
and how to explain where they’ve been.



Getting in early and trying to help someone make sense of and manage their
experiences is one of the most important things we can offer. The National
Institute of Clinical Excellence Guidelines for treatment of psychosis in young
people recommend that two types of talking therapy are routinely offered:
individual cognitive behavioural therapy and family intervention, alongside
anti-psychotic medication if appropriate, delivered by a specialist child and
adolescent or early intervention service.

As a recent Prospect roundtable discussion highlighted, there is substantial
concern among professionals about the funding of mental health services in
Britain. Despite political promises, mental health and social care services for
both adults and children have experienced significant cuts in recent years,
which makes their job harder. If we want to be a society that helps young people
to recover quickly and successfully from psychosis and other mental illnesses,
we need to make sure we prioritise mental health in children in more than just
rhetoric.

Lucy Maddox is a clinical psychologist and lecturer. These views are her own and
not those of any organisation she works for. Patient details have been
disguised.

Lucy Maddox

Lucy Maddox is a child and adolescent clinical psychologist working for the NHS
and a lecturer at the Anna Freud Centre.

More stories by Lucy Maddox


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