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.