Distant voices, young lives

Schizophrenia in teenagers can be devastating for sufferers and their families. But the outlook needn't be entirely bleak, says Julia Stuart

Michael Kidd, an affable 17-year-old, would probably make you laugh if you met him. But sometimes his teenage charm abandons him, as it did the time he couldn't sleep because his head was full of images of a man being repeatedly stabbed. All Michael could see until morning was the knife plunging in again and again.

Then there was the time when he pinned his father down in the lounge during a row about cigarettes.

His mother, Mary, 47, recognises his mood swings instantly – as she did on the occasion when Michael was packing his bag for his first day at college. She didn't dare to say anything – she didn't want a fist in the face.

Michael managed only four days at college where, hoping to become a translator one day, he had enrolled to study A-level German. He was admitted into a psychiatric ward. Again.

Michael has suspected schizophrenia. Sufferers experience hallucinations, delusions and thought-disorder, which they often find extremely frightening. Most have their first psychotic episode between the ages of 15 and 25. Dr Richard Corrigall, consultant adolescent psychiatrist at Guy's Hospital, London, said that the causes of the illness are still not properly understood. "Genetics is certainly an important contributing factor, but it doesn't account for everything. There are various ideas about things that might be important, possibly inter-uterine factors, exposure to virus, social stress and neuro-developmental problems," he said.

Degrees of severity vary widely. Some patients have a one-off episode with no residual effects. Chronic sufferers, however, experience repeated episodes with residual impairment, such as diminished social functioning and self-care, which worsens each time. While some patients can be violent, they are much more likely to harm themselves than other people.

The illness is treated with anti-psychotic medication, and patients are also offered psychological help. Cognitive behavioural therapy has been shown to be of particular benefit. Most young patients live at home.

"Schizophrenia has a very variable outcome," said Dr Corrigall. "It would be wrong to say that everybody gets better. It is also wrong to think that people will be terribly affected for the rest of their lives. It's perfectly possible for many people to make a good recovery from the illness and still function really well."

Michael was 14 when he experienced his first psychotic episode, which lasted around six weeks. "He would be in a trance-like state most of the time," said Mary, who runs a business with her husband, Steven, 49. "He was there, but he wasn't there, and he said that during that time he was having terrible hallucinations."

Michael, the subject of a Channel 4 documentary, which will be broadcast on Sunday, remembers the time vividly: "I'd just been to Germany on an exchange. I was back for about two weeks, and then I found I couldn't sleep. I was up all night. My head was full of thoughts. I just couldn't get rid of them."

His GP immediately sent him to hospital, and he was transferred to a specialised unit and put on anti-psychotic medication. He has since suffered two further episodes. One was particularly disturbing for all the family. "It was like a devil had taken him over," Mary said. "He would go into a rage and start throwing things. Very often he would walk around on all fours, pretending he was a dog or a cat, and this would go on for an hour or so. We had to try to be very tolerant with him. However, my other two sons had enormous problems with this."

For her, living with the illness was like "groping around something in the dark". "It's not something you can reason with. It's very unpredictable and it can turn on you just like that," she said, clicking her fingers. "He has the same character as any other teenager, but he has no lid on his emotions and can be shockingly frank and critical."

Steven, whose mother was an undiagnosed schizophrenic, found the experience equally distressing. "Before Michael left, home life was intolerable. We survived, but only just," he said.

In November last year, Michael moved to a residential charitable hostel about 20 miles away from the family home in Lincolnshire, the teenager's first step towards independent living. He currently does voluntary work with children with special needs and plans to go to college in September to study to become a psychiatric nurse.

"Our home life has returned to normal," said Mary. "You're able to spend time in the garden when you want and get a meal ready in your own time – all very simple, but not possible when Michael was at home. Not having to worry about him all the time is a great relief for us as parents. We do still worry about him, but he no longer dominates our thoughts."

Michael goes through good and bad patches that last a few weeks. "When he's going through a good period you can still tell he's ill, because his behaviour is exaggerated," said Mary.

"He is still very ill, as we found out when he recently missed his tablets. But he is now very accepting of his condition and is learning all the time the way forward in how to deal with it."

Michael is still on medication, which helps to keep a lid on the voices. "They're like my own thoughts getting louder and louder, and I can't actually stop them," he explained. "They say things that will hurt me and I don't like it at all." Controlling bizarre impulses can also be a problem. "This is a stupid way of putting it, but this is the way I think about it: there are a couple of little blokes inside my head. Imagine there's an over-ride button in my brain and they press this button and they take control of me. If I'm with someone who I might even like, I'll get a stupid impulse to push them or something stupid like that. It can be sad, because it can mean the end of a friendship for a while, until I explain what happened and they accept it. It's not me, I'm not like that."

Michael not only has to face his own demons, but also the prejudices of others. "Ever since I've been ill, people have started to treat me differently, which I don't like. I've been called all sorts of names – 'Schizo' and 'You're bloody mad, get away from me'. I was always worried at school about making friends. I never seemed to have enough. The people who had been around me as friends even when I was very young noticed I wasn't normal." He added, defiantly: "I don't want to be normal."

Mary finds people's reactions to her son's illness particularly upsetting. "If he had cancer or a big lump growing out of his head he would get far more sympathy. Because they can't see what's happening inside his head, people think he's lazy and rude and has no manners.

"Some people, not all, have a fear about people with schizophrenia. They think they will become deranged, psychopathic killers who have little or no remorse for their actions. Michael, however, is Michael, and always will be."

'Inside My Head: Michael', the first of a series on mental illnesses in young people, is on Channel 4, Sunday, 8pm