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Detached from Reality
Episode 527th June 2023 • Beyond the Smile • Marylayo
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Psychosis

In today's episode of MaryLayo Talks, I’m with guest, Dr Keith Gaynor about Psychosis. Keith explains what can cause this mental disorder and how those experiencing psychosis may be supported.

The conversation included:

  • What’s psychosis?
  • What are the signs and symptoms of psychosis?
  • What can trigger psychosis?
  • How can psychosis be treated?
  • What drew you into specialising in Psychosis?
  • How can a friend or family member support something with a history of psychosis?
  • Bible scripture to meditate on and help spiritual wellbeing.

Take a moment to delve into what may be 'beyond the smile' - listen in to the conversation.

Guest details:

Dr Gaynor is Assistant Professor in the School of Psychology at University College Dublin and a member of the Clinical Psychology Training Programme. He is also a Senior Clinical Psychologist and author of the self-help book 'Protecting Mental Health'.

Guest's social media: Twitter, Linkedin and Website

MaryLayo's spiritual wellbeing tip: Meditate on the bible scripture Isaiah 43:1-2

Connect with MaryLayo:

LinkedIn

Instagram

For help in dealing with mental health related matters, please seek specialist advice and support if needed.

Transcripts

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Marylayo: You. Welcome to Marylayo Talks, a

podcast that discusses mental health and

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spiritual.

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Wellbeing, before we jump in, there may be

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episodes that are particularly sensitive for

some listeners.

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And if that applies, then I hope you'll be

able to join me whenever you feel ready and

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able you today's episode is on psychosis, and

my guest is Dr. Keith Gaynor.

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Keith is an assistant professor at University

College Dublin and a senior clinical

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psychologist.

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He explains how adverse events can link to

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psychosis and how we can support someone who's

dealing with such challenges.

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Let's go and chat with him.

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Thanks for joining me, Keith.

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Dr Gaynor: Thanks, Marylayo, it was great to

be here.

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Marylayo: So, Keith, you know a lot about

psychosis, and when I think of psychosis, I

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think of a very serious mental health

condition.

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So help us out and just give us a breakdown in

terms of telling us what psychosis is.

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Dr Gaynor: Absolutely.

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So psychosis is really interesting.

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On the one hand, you're exactly right, it is a

very serious mental health condition.

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But also, what I think most people will learn,

and hopefully learn a bit from the podcast, is

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that we can all have little experiences

through our lives where we have little blips

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of psychosis.

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So even though we mightn't experience the full

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condition or mightn't have the illness, we

actually will have had little experiences that

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mean we can understand what that might be like

for somebody else who has a full blown

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condition.

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Marylayo: So how would you describe the

condition itself?

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So what are like, the signs, the symptoms?

What does it mean?

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Dr Gaynor: So psychosis is where we become

detached from reality, so that we're

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experiencing reality in a way that no one else

in the world is.

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And so typically that is people who might hear

voices that aren't there, so they'll hear

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noises or sounds or people talking to them,

but there's nobody present, or they'd see

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things that aren't there, or they'll have

beliefs that are untrue, but they'll hold them

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really fixately.

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So they might believe that their neighbors are

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out to get them or the CIA is bugging their

phone, or that there's something very paranoid

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kind of beliefs, or very grandiose beliefs

that they're Jesus, or that they'reincarnated

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from somebody who's very special.

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Marylayo: Is there anything that makes them

latch on to those certain beliefs or

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thinkings?

Is there some triggers?

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Dr Gaynor: Absolutely.

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And so what we'd often find is actually the

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triggers have been building up for years.

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So one of the things to know is that about 4%

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of the population will have a psychotic

illness in their lifetime.

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Yeah.

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So if you think of the population of London, 8

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million people, you're going to have hundreds

of thousands of people who have a psychosis.

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So it's unusual, but not that unusual.

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And so it's a relatively common but very

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serious disorder.

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But the most extraordinary kind of thing has

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happened that over the last 30 years is that

that kind of 4% figure all came from people

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coming to clinics or doctors or so on.

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But actually when people went out and knocked

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on doors and did surveys, they found that

between 20 and 30% of people might have had

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these experiences but not been affected by

them, not found them upsetting.

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They were able to go to work, have

relationships, get married, do all the normal

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things.

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But in the background they were also

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experiencing some unusual things and they just

integrated as part of their life.

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And so we have this really interesting idea

of, well, what makes an illness?

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So we might say, okay, hearing a voice.

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Well, that seems very strange.

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But actually, if it's a part of my life and I

integrate it and I'm able to do all the normal

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things and see my friends and go to the movies

and go to work, actually, maybe that isn't an

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illness.

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Maybe that's just an unusual experience.

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Marylayo: Right.

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I mean, that's a good point.

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So then what makes let's just call it a

psychotic experience.

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What makes it serious and what makes it not?

So when would you say it's severe?

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And actually it requires treatments, help,

external support.

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Dr Gaynor: Yeah. So there's a great model out

there at the moment, kind of a newer model.

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So if we thought in the past it was illness or

not ill people fell into those two camps, we

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were well or not well.

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And the Dutch and lots of very good

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researchers in London have been saying there's

a proneness persistence and impairment.

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Most of us can be prone or we have little

blips where we have a little experience of a

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psychosis or unusual belief.

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I'll give you an example.

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I have a shared office with a colleague,

another psychologist, and we're tapping away

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at our computers.

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And certainly Ireland, and I don't know how

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the NHS is, we have old computers, they're

very likely to break down.

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And she's doing a big report and took her all

we to write it.

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And just as she about to press save on us, the

computer crashes oh dear, goes again types the

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whole thing goes again.

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Just as it's about to be done, the computer

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crashes again and it's all white.

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And the first thought out of our mouth was

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that it are trying to delete us.

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And of course they weren't.

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We just have old computers.

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But just for just that one moment, there was a

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little paranoid thought, a little blip,

actually, this isn't a coincidence or an

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accident, actually, there's some sort of

little conspiracy behind it.

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Marylayo: Okay, that's a good explanation,

actually, in terms of what you mean by people

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generally can have maybe a bit of.

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Dr Gaynor: Just a little blip for a moment.

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And so we can have a little moment where we

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jump to a conclusion, or we make a link that

isn't there, or we see someone is out to harm

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us, or talk behind our back or gossip about

us, or actually they're not thinking about us

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at all.

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And of course, if that is happening all the

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time and we're going that's happening with all

our friends every time we come to work, then

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you start to see actually this is persisting.

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This isn't just a one off little moment.

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This is happening every day.

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Well, that's much more serious, that's much

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more likely to affect how happy we are in our

life, how comfortable we are seeing our

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friends going to work.

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And then if we start to get distressed or we

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have a drop in functioning, we're not able to

go to work.

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We decide, actually I'm staying at home,

actually, I don't trust the people in work, so

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I'm not going to put myself there.

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And then it's starts to really impact our

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life.

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And that's typically when we define, okay,

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this is an illness and this person might need

some support.

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Marylayo: As you were talking, I was even

thinking about how broad then it can be.

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So for example, I can imagine someone who is

very, very sensitive, let's just say they're

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suffering from anxiety and therefore they are

hypersensitive to people's reactions, how

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they're interacting with people just because

of how vulnerable they feel.

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And so I guess what you're saying is that

comes under that broad umbrella.

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It just might not necessarily be seen as or

considered to be serious enough.

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Dr Gaynor: That'S it when that anxiety just

stretches into a little bit into paranoia.

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Now we can all get a little bit paranoid

sometimes, then actually we've moved out of

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anxiety or now into what we'd call the

psychosis continuum.

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Marylayo: Right, okay, and are there

particular triggers what can cause psychosis

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then?

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Dr Gaynor: Yeah, so there's lots and lots of

so there are lots of good evidence and lots of

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causes.

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So there's a whole range of social factors.

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And so if we've experienced trauma or adverse

events in our life, if we've experienced

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discrimination or hate or bullying or having

been victimized in any way, if we're a

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minority second generation migrant to a

country, all of those social factors are

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linked to psychosis.

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And if you think of why if we have early

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experiences of threat in our life and we've

real experience of threat and being

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threatened, then it doesn't take very much for

that to get extended to, okay, well, I'm

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expecting threat, I'm expecting danger even

when it's not there.

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So if I think if people have been out to get

me in my past, then it's not a huge jump to

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think, well, the next person might be out to

get me or the neighbors are out to get me, or

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people actually aren't.

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But we start misinterpreting a look, a sign,

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things that are happening to us as something

that there's something behind it.

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But we have very good reasons in our past for

why that might be the case.

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Okay, those are all the social kind of

factors.

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Yeah, there are a lot of biological factors.

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So genetics is important.

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So if I have an identical twin with psychosis,

I have a 50% likelihood that I'll also have a

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psychosis, which doesn't mean it's determined

by genetics.

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I have a 50% chance that it won't be, but it

definitely plays an impact.

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Things like drug use, things, all those kind

of if we're taking yeah, well, we would see a

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lot of cannabis, but also any of the kind of

heavier drugs as well.

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But we would find because cannabis would be

the most common one most commonly used drug in

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Ireland, we would have a lot of people who'd

have cannabis induced psychosis.

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Again, it's not unusual for people to have a

paranoia or paranoid episode and cannabis and

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then actually it extends and it extends and it

extends.

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And if someone is slightly vulnerable who has

had difficult experiences in their past or is

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using the cannabis to medicate away some of

the anxiety or some of the things that have

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happened, people often use cannabis in that

way.

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Actually.

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It's very easy for that to build up for some

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people.

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Marylayo: Okay, so those are the triggers.

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Those can cause different types of causes.

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From what you've said, I would imagine that if

for someone experiencing it, it could be

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pretty scary, especially the serious side when

we're talking about it being actually an

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illness absolutely.

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Where people are telling you that what you're

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feeling, what you are seeing, what you're

hearing is not actually true.

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So how does someone who's going through that,

how do they get that help?

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Dr Gaynor: So I think that there's kind of two

pieces.

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One is kind of all the formal services, so

actually going to your GP and talking to your

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GP, and there'd be lots of psychological

services and psychiatric services who actually

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do this work all the time, help people.

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And the interesting about someone with a

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psychosis, they might believe something that

really is clearly untrue, but it's not going

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to shift by just saying that's not true,

you're wrong, by getting into a row about it.

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So for family and friends, it's about walking

alongside them.

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It's supporting all the things that are doing

that are helpful and good and positive parts

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of their life, and not necessarily getting

into a row about the other piece, but then

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supporting them to kind of seek help and gain

help through services.

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But a key, part of the key factors that makes

it worse is isolation.

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People pull away, well, you don't believe me?

Well, I'm not going to meet you for coffee.

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And of course, we as friends, we don't know

what to do.

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This is really unusual for us.

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If you're really best friends start saying

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really unusual things, you go, well, do I call

or do I not call?

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So there's a really key bit for us, actually.

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This is when people need friends the most.

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This is when the family needs friends the

most.

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And that actually we can do a huge amount just

by hanging out, just.

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Marylayo: By being present and supporting them

and encouraging them to get the help that they

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that's it.

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Dr Gaynor: And if they're not going to get the

help, that's okay, we can sit there and we can

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talk about the movies and the football and the

weather, anything else.

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We can stay a friend for them because

isolation is a real problem here.

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If you think that if you're frightened and

your thoughts are really frightening, or

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you're hearing voices that are really

frightening, can you imagine what it's like to

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be alone?

And actually, it's very easy to get

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disconnected from reality because you've spent

the whole time in your bedroom or your whole

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time in the internet, and actually just to

have someone who'll sit there and talk

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football with you.

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Here's a bit of reality.

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Why do you think it'd be a Tottenham?

How are they doing?

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And you're there and you just stay as a

presence, as part of reality for them.

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And if everyone disappears, all the friends

and the colleagues and the family, because

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they don't know how to deal with the

psychosis, then all those aspects of reality

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disappear as well because the person doesn't

have access to them.

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Marylayo: Sure. Okay, in terms of what I would

call medical intervention yeah.

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What does that look like?

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Dr Gaynor: So there's a whole range of

effective medications for psychosis.

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They work really well.

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They work for about 70% of people.

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They have some difficult side effects

sometimes, so people will often have to kind

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of have an ongoing conversation with their

prescriber that okay, if this is working on

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the one hand, on the other hand, it's

impacting me in these ways.

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What's the right dose and what's the right

type of medication?

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Marylayo: And when you said, like, side

effects, are we talking about gaining weight?

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I think I've heard those kind of things, yeah.

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Dr Gaynor: So different medications have

different side effects and then they affect

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individuals differently based on our own

metabolism and things.

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But some of them can have weight gain, some of

them can have sexual dysfunction side effects

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and things like that.

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People can be a little bit drowsy on them, but

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actually it very much depends on the person.

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And then actually, if it's something that's

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impacting someone in a way that really isn't

helpful, the worst thing they can do is just

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stop.

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Okay, well, I'm not taking that anymore.

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And actually, most consultants be really

happy, come back and go, look, actually this

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one, I'm really finding the weight gain really

difficult.

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What can we do about that?

And typically a consultant will come up with a

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good answer.

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They will find a dose that works or a

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medication that works for people.

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Marylayo: Sure. So the key is to keep talking

and keep sharing that anxiety.

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What's, putting them off, perhaps for them,

taking medications that could be effective for

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them.

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Dr Gaynor: Yeah. And there are lots and lots

of other routes, which there might have been

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25 and 30 years ago, actually, medications

have come on a long way.

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Marylayo: Sure. Apart from medication, what

other kind of routes are there?

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Dr Gaynor: Well, I'm a psychologist, so I do

lots of talking.

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And so I work half time in a university, and I

work half time in a psychosis clinic, so

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everyone I see has a psychosis.

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And a key part of this is actually sitting and

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talking.

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And often the person's experiences are really

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frightening.

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The people in their life don't necessarily

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know what to do with that.

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If someone comes in and says, god has been

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talking to me and he's sending me messages

through the TV, your mom and dad don't

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necessarily know how to manage that.

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But actually a key part of kind of helping

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someone is, okay, let's just make that how

does that make you feel?

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What's going on when that's happening?

Does that happen when you're stressed?

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Does that happen when you're happy?

What's going on around that?

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And allowing someone kind of the same

breathing space to talk through those things

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as you would talk about anything else.

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We don't have to hide this away.

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It to be stigmatized even inside of us, which

it often is.

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And so you'll talk about voices, we'll talk

about beliefs, we'll talk about experiences.

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Marylayo: I'm interested when you say you'll

talk about these kind of things, is it more a

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listening role or is a dialogue between you

and the individual?

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Dr Gaynor: Oh, definitely a dialogue.

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Yeah.

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You try and have as real a conversation as you

can.

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And there's a key bit here of there's a kind

of a line that you're not endorsing the

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beliefs necessarily, but you're not

necessarily fighting them either.

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You're getting the person to think them

through.

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And is there any other way of understanding

why they might have those beliefs or have

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those experiences?

And often when you help the person put in the

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context of their lives, we'd often go back

through all of the person's experiences of

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threat in their life.

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They might be able to say, oh, actually, this

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is really like those things I experienced when

I was a teenager.

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Really like those things I experienced when I

was a kid.

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Okay, and they're coming up for you again, but

they're coming up in this new way.

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And by able to helping the person make those

thinks, they're often then able to kind of

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challenge the ideas themselves.

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Marylayo: Right, okay, so it's a form of

enabling the person to identify roots that

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have led to their condition.

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Dr Gaynor: Exactly.

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And then the other half of it is, okay, well,

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how do I cope with it now?

It's frightening and scary, and this thing is

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happening to me at midnight.

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Okay, what do I do then?

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And so we do lots of meditation, we do lots of

breathing, we do lots of work on the body that

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people are able to soothe their own bodies.

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Because often when you have a symptom, a

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psychotic symptom, it's very frightening.

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It's kind of panicky.

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So all the things that work for panic are

really helpful, all the things that work for

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distress are really helpful, and all the kind

of tools that you'd be using for every other

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aspect of psychology, anxiety and depression

and distress are useful here.

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Marylayo: So Keith, like, you've been doing

this for many years and your interest and your

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passion comes through.

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So what actually led you to specialize in

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psychosis?

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Dr Gaynor: Well, it's it's a long time ago, so

arted working in psychosis in:

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researcher.

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And so so my background is psychology.

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But really psychosis was seen as a medical

only approach until about the mid ninety s.

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And it was key people in London who kind of

said, no, actually, psychology is a really

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important role here.

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It's only kind of from the mid 90s that that

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started to come through.

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And so in 2007 it was a really exciting time

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to be a psychologist in psychosis.

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And I was part of a big research and a big

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research trial going, okay, gee, what would be

good psychological inventions?

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What works psychosis?

And so got lovely opportunities then to meet

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people with psychosis and to sit down and chat

and to hear their stories, just to kind of

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learn from them, and that's kind of very

passionate from that point.

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Marylayo: In terms of the research that you've

done or been part of, what would you say are

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key, interesting findings?

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Dr Gaynor: So, I suppose a key kind of part,

what would be a piece of research I did in

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London, which met people who had very unusual

experiences, so saw things that weren't there,

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heard things that weren't there, or had very

unusual beliefs, but who had no illness aspect

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to them.

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They might hear these things every day, they

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might see things every day, but actually they

were still working as a bank manager and still

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working as a primary school teacher and still

being married.

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Marylayo: And everything, and basically didn't

affect their.

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Dr Gaynor: Didn'T affect the rest of their

lives.

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What were the factors that allowed them to do

that?

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And so there was a couple of things.

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It was how easy and difficult their early life

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was in some ways, but the key part of it was

the kind of social support they had now.

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And those people often existed in a social

setting that supported those beliefs in some

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way, that allowed them to be a little bit

quirky, or allowed them to have slightly

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unusual experiences and didn't stigmatize them

or alienate them or isolate them.

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And so sometimes those people would have been

part of spiritualist groups, or might have

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been part of so if you believe in UFOs, that's

fine, but it's much nicer if you believe it in

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a group of people who believe in UFOs and

actually then everyone endorses this and you

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don't feel alone with that.

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Marylayo: So those were the ones from your

research that seemed to cope better yeah.

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Dr Gaynor: And so that gives an obligation to

all of the rest of us is how can we reach out

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and support people who might be having

difficult experiences or unusual experiences

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rather than us expanding our idea of what

normal is.

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So we're going to embrace a much wider

perspective.

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Marylayo: Okay. And is there anything else

from your research that you think oh, that was

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a really interesting one.

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Dr Gaynor: Think that the key changes in the

last couple of years.

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And a lot of my research at the moment is

about what sort of trauma it's in the last ten

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years that we really know that trauma is a key

driver of psychosis.

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The trauma you experience in early life.

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Is a key reason why you might go on and have

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psychosis in your 20s or thirty s and that

also think about, well, what type of trauma?

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And so obviously initially all that research

focused on kind of big traumas or big single

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incidents of trauma and one of the things

we're learning is actually small but

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repetitive incidents of trauma are really

important.

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So like being bullied in school and that

mightn't be you might have been shot or

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attacked but actually if it was every day you

were being excluded and picked on and

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victimized that that's really important and

that plays out in lots of ways then later on

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in someone's life.

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Marylayo: And you have a book yeah, protecting

Mental Health yeah and that explores how

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individuals can nurture positive mental health

and also reduce negative emotions like anxiety

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and depression.

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Are you able to leave us with some tips and

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advice please, from your book?

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Dr Gaynor: Yeah, absolutely.

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If COVID taught us anything is that we can't

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do this on our own.

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So we often think about psychology as

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something that happens inside of us but I

think it would be much better if we thought

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about psychology as okay, how do I join with

somebody beside me?

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How do I connect with somebody beside me?

And that one of the real difficulties in

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modern world is we are disconnected.

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We might be connecting through phones but what

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we're not doing is just meeting someone and

going for a walk or going for a coffee or just

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chatting like we would have at the school

gates yeah.

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And that the best thing we can do for our

health is go and meet someone face to face and

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actually just be with someone else for a

period of time and that's about the healthiest

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thing spend quality time yeah, with people.

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Marylayo: Are there any other tips or advice

that you would give to maybe someone who's

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experienced psychotic episodes in the past or

currently?

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Is there anything you want to leave?

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Dr Gaynor: I think that I really believe that

psychology has a really useful role in

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psychosis, and I think lots of people in

services psychology can be difficult to

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access, and it can be kind of restricted how

many sessions you get and things like that.

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And that actually if you have any chance of

engaging in any kind of form or kind of

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talking therapy, that it's likely to be

helpful.

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So I really encourage people to come back

round again and to try and find as many routes

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as possible to talk about what's been going on

for them.

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Marylayo: And lastly, anything else you would

want to share for those who are like, close

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relative, family friend, maybe spouse of

someone who has those experiences?

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Dr Gaynor: Yeah, and this is an enormous

experience for the family.

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I think this is that often we think about the

person with the illness as that they're having

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all the distress, but actually it impacts

everyone in the family and so they need huge

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support.

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And so there'll be lots of very good mental

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health charities in the UK who do offer family

support.

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And I know through our service we do, and what

people would tell us is it's when they meet

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other families and the light bulb goes, god,

we're not the only people who are struggling.

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Marylayo: With this peer to peer kind of

network.

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Dr Gaynor: And that just kind of normalizes,

kind of some of the difficulties and takes

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some of the stigma out of it.

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And that peer to peer support is everything, I

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think, for families, it's really, really

helpful.

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Marylayo: Brilliant.

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::

All right, well, on that note then, Keith, I

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just want to thank you, really thank you for

joining me on Marylayo talks and sharing some

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::

of your experiences, some of what you found

that advice.

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And for those of you who are listening, please

join me soon.

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::

Bye for now, here's a spiritual wellness tip

that you can meditate on.

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It's Isaiah, chapter 43, verses one to two.

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And it reads, do not be afraid, for I have

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ransomed you.

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I have called you by name, you are mine.

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::

When you go through deep waters, I will be

with you.

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::

When you go through rivers of difficulty, you

will not drown.

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::

When you walk through the fire of oppression,

you will not be burned up.

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The fires will not consume you.

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::

Thank you for listening.

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Do follow and join me again.

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Next time on Marylayo Talks Beyond The Smile.

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