With Mental Health Awareness Week fast approaching, we have seen an explosion of mental health programmes on primetime TV. On Tuesday 2 May, BBC2 aired a 'Horizon' episode titled 'Why Did I Go Mad?' which looked at different experiences, different causes and different treatments for psychosis.
Psychosis is probably one of the most misunderstood areas of mental health: many people confuse psychosis with psychopathy - how many times have you heard the phrase 'psychotic killers?' But psychosis and psychopathy are two very different things. In fact, a person experiencing a mental illness is actually three times more likely to be the victim of a violent crime, rather than the perpetrator. Nonetheless these stereotypes persist and many of us would regard a psychotic person as dangerous, based on what we have read in the media. So a programme dispelling some of the myths around psychosis is very welcome.
What I really liked about this programme is how well it used powerful personal stories to bring it to life. David, Rachel and Jacqui, who have all experienced psychosis and all tried very different treatments were eloquent and honest in portraying their experiences; and it felt very raw watching Rachel try a new form of avatar therapy to face one of the most frightening and critical voices she hears (watch the programme if you aren't sure what avatar therapy is). So top marks for the BBC on using the personal story; it helps demystify psychosis to see 'real' people just like us living with it daily.
What I also really liked was that when we first meet Jacqui in her kitchen she is explaining how the voices in her head are now helpful to her - they remind her to leave money out for her daughter to take to college. This also fights the stereotype that people who hear voices always hear scary and frightening ones, when some people find their voices can be comforting or helpful and that not everyone necessarily wants to 'cure' themselves - they may prefer to find a way of managing them.
About two thirds of the way in though, Professor Singh talks about how the rate of psychosis is higher among the migrant population than it is among the general population and points towards discrimination, marginalism and exclusion as risk factors for developing psychosis. Which immediately raises the question of why didn't the producers feature a migrant with personal experience of psychosis on the programme then? Unfortunately BME groups are more likely to be diagnosed with a mental illness, and more likely to drop out of treatment than the rest of the population, yet they consistently seem to be under-represented in mental health TV programmes? It doesn't make much sense to me.
On a similar note, 'Why Did I Go Mad?' doesn't consider cultural relevance when it comes to psychosis: in certain tribal communities (some African or Indian communities for example) people experiencing delusions may not be regarded as mentally ill, instead they may be seen as spiritualists who can receive messages from deceased relatives or from the gods. What is regarded as 'abnormal' in one culture, may not necessarily be regarded as abnormal in another, and that's a really important point when it comes to addressing mental illness.
Finally, I think what really got my goat about this programme was that it implied that experiencing psychosis meant you had schizophrenia. The two were intertwined throughout the whole show. Just to be clear: having an episode of psychosis does not automatically mean you have schizophrenia. NOT AT ALL. Schizophrenia is a very complex mental illness that has both positive symptoms which refer to changes in behaviours and thoughts, (delusions, hallucinations etc) and negative symptoms which refer to withdrawal or a lack of functioning that you would expect in a healthy person (so loss of interest in life, lack of motivation, feeling uncomfortable around other people). Psychosis on its own does not indicate schizophrenia. In fact, following their first episode of psychosis around 80% of people make a full recovery (Picchioni, Murray, 2007).
It is true that psychotic symptoms are a part of schizophrenia, and may also be present in bipolar disorder but it is also possible to experience psychosis due to being unwell, having a high fever, being extremely sleep-deprived, or being very malnourished. In some cases, there may be no apparent cause at all and the person may never experience another psychotic episode. This, alongside the weird creepy fair ground scenes that kept popping up throughout 'Why Did I Go Mad?' meant that while it did some things right, there is still some room for improvement.
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