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How mad are you?

2008-11-20 08:11:54

By Rob Liddell

Producer, Horizon

Most people get anxious in their daily lives, but where does the line between

sanity and madness lie and is it easy to recognise?

Do you ever worry about leaving the gas on, or arrive at work and worry that

you've not locked your front door? Perhaps you get anxious before having to

give a talk or wake up in the morning and are barely able to drag yourself out

of bed?

These are normal reactions to the twists and turns of modern life. But all

these actions can also be seen as symptoms of mental illness.

Those with Obsessive Compulsive Disorder (OCD) know this only too well. Classic

symptoms of the illness include repeated checking of things like the gas and

door locks.

FIND OUT MORE...

Horizon: How mad are you? Part Two is broadcast on BBC Two on Tuesday, 18

November at 2100BST

Catch up on Part One using the

It is motivated by a genuine and deep-rooted fear that the person or their

loved ones will be in grave danger if they don't check. It's an emotion that

everyone can relate to, the idea of the house burning down is probably enough

to get anyone out of bed just to check "one more time".

But checking and rituals can quickly come to dominate a person's life. Hours

every day are taken up with compulsions which have a major impact on work and

relationships.

Distinguishing between reactions that are generally considered healthy and

those that are signs of a full-blown mental disorder has always been a

challenge for psychiatry, the science of the mind.

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The 10 volunteers are challenged to perform a stand-up comic routine. Most

disorders have symptoms that in a milder form can just seem like character

traits. But how pessimistic do you have to be before a psychiatrist would say

you had depression? How much insecurity makes you schizophrenic? Just how hard

is it to tell the difference between "illness" and "health"?

The BBC science series, Horizon challenged three mental health experts to see

if they could make that distinction.

Body image

It selected 10 volunteers of all ages and backgrounds. Half the group had a

history of various mental disorders, the other half didn't. The question for

the panel was simple - who is who?

They were filmed during a week of activities, ranging from group bonding

exercises to specific psychological tests. All were designed to explore some of

the classic symptoms and traits of some major psychiatric disorders.

A distorted body image is a key symptom of eating disorders like Anorexia

Nervosa and Bulimia Nervosa. People living with these illnesses tend to see

themselves differently to the way they actually are, both in terms of body

shape and weight. But what complicates matters is that almost all of us do that

to some extent.

The volunteers took photos of each other wearing white lycra suits and the

images were stretched out of shape. They were then asked to shrink them back to

the way they saw themselves.

Yasmin, 36, is an amateur rugby player and physically she is one of the larger

members of the group. Like all the other volunteers she was faced with an

unflattering image of her headless body stretched. She exaggerated her own size

by only 8%, which was less than anyone else in the group.

But what interested the panel was how she really agonised over it. She said it

was her least favourite task of the week by a very long way and she took twice

as long to do the test as any of the others.

Even the panel felt uncomfortable watching her, including Ian Hulatt, a

psychiatric nurse and mental health advisor to the Royal Collage of Nursing.

But he felt her reaction was character, not illness.

"That was probably in response to how she feels about social messages about her

being overweight in our culture," he says. "That wasn't sufficiently out of

context or unusual to make us feel it was pathological."

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The volunteers are asked to clean out a cowshed. The results of the group as a

whole mimicked larger research studies showing that most people think they're

bigger than they are. Effectively when we look in the mirror we don't see a

true picture of ourselves reflected back. Those with eating disorders tend to

be on the extreme end of this scale.

Millions in Britain worry about the way they look, count calories and diet.

Like many of the disorders explored by Horizon, the facts are shocking: 10% of

adult women will be affected by Bulimia, one in 10 of those with Anorexia are

men.

Social Anxiety

The test the volunteers found most challenging was performing a five minute

stand-up comedy routine on stage in a local pub. Even at the first rehearsal

there were no volunteers to go first and almost everyone in the group found the

idea daunting.

Several exhibited signs of social anxiety. One actually admited feeling sick at

the very thought of public speaking, but ended up with a strong performance.

Another who appeared more relaxed beforehand ducked out early.

"From what I saw there is no difference at all between people who have had

mental health problems and have recovered and those that never have," says

Yasmin, after the performances.

But the panel picked up several indications. One volunteer displayed pessimism,

another had disjointed speech and another showed risk-taking behaviour.

The public need to realise that you cannot just look at someone and make

assumptions

Ian Hulatt Psychiatric nurse

But for the panel the biggest clue was not a true symptom. One of the

volunteers used a rationalisation technique to cope with the situation,

imagining the worst that could happen and realising it isn't that bad after

all. The panellists identified this as Cognitive Behavioural Therapy, a sign

she had undergone counselling.

The programmes explored major disorders including Depression, Schizophrenia,

Bi-Polar Disorder, Obsessive Compulsive Disorder and Eating Disorders. All of

them are serious illnesses that have the power to devastate the lives of those

affected by them.

But despite the seriousness of these illnesses, identifying who has them was a

real challenge for the panel of experts.

"It makes a point the public need to realise that you cannot just look at

someone and make assumptions," says Mr Hulatt.

"When someone has been labelled with a disorder or episode of mental illness

it's very unhelpful to interpret everything they do through a poorly understood

label."

The programme found that it is wrong to assume they cannot lead normal lives.

This is coupled with the fact that mental illness is a problem that affects as

many as one in four of the UK population, yet it is often misunderstood,

shrouded in stereotype and stigma.

Making the two documentaries was a real eye opener. In the course of the

production we met some amazing people who have struggled with disorders and

overcome them. We met brave people with no history of mental illness who, to

explore the line between mental health and mental illness, were willing to risk

being labelled with an illness they do not have.

They all tell a powerful story, that having a mental illness doesn't have to

become your defining characteristic and that it shouldn't set you apart in

society.