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Hope, meds and schizophrenia.

Last Chance Saloon is the story of Neil 'Twink' Tinning, a troubled, magnificent man living with bipolar disorder, and his unique attempt to understand the science behind his, and many other, mental health conditions - all while getting ready to play the biggest gig of his life.

In part 3, the death of Amy Winehouse inspires Twink to create music while we're given an unsettling insight into his daily medication regimen. To try to gain insights into his own condition, Twink interviews Professor Michael O'Donovan, an expert in schizophrenia, at his home in Cardiff. As Twink talks to him, he learns exactly what schizophrenia is, why it's such a troubling and stigmatising illness and how genetics is providing hope for future treatments.

Previous episode: Part 2 - All about the brain

Next episode: Part 4 - Brain scans, clichés and complexity


[Previously on Last Chance Saloon…]

Neil ‘Twink’ Tinning: The thing is it’s not a band.

Interviewer: Well, what is it then?

Twink: To be honest with you, it’s probably more to do with the fact that it’s rehabilitation for me, and I’m using music as some type of therapy.

Twink: We’re talking life and death issues here, we’re not talking about some namby-pamby, can’t get out of bed because he doesn’t want to get out of bed or whatever it might be. It’s a little bit more serious than that.

Scientist: Yes, absolutely.

Twink: A good day can be as simple as getting through the day … and a bad day might be thinking, well, should I go on the internet to find out how to tie a hangman’s noose.


Twink: This is a medication taken at night time. These are metformins, anti-psychotics, which are quetiapine. These are zopiclone, which are my sleeping tablets. Mirtazapine ... I’m actually on 17 tablets a day. Noel Gallagher, this is drug taking!


Twink: I've been working really hard over the weekend on this idea that I had. I got motivated to do something after Amy Winehouse's death, which I found to be really tragic. Thinking of mortality, thinking of loss; trying to incorporate that in the music, but still have some hope.


Twink: This is the interview I've always been looking forward to. This is the one I'm wanting to get in.

Michael O’Donovan: Finding out what this guy does for a living and why he deserves to get paid?

Twink: Yeah, that type of thing! Let's get into schizophrenia. Why is schizophrenia so misunderstood?

Michael: People can understand almost conceptually what anxiety is, because everyone at some point experiences anxiety. People can conceptually relate to mood disorders because everyone experiences mood. Schizophrenia is in some way quite enigmatic; people, I think, find it difficult to relate very easily to what's going on. It's pretty difficult to put yourself in the shoes of someone with schizophrenia. As a consequence, it is very misunderstood; it's probably the most stigmatised-against disorder. In some sense, because it's about cognition, it's about perception, it's about belief, it's almost one of the most human disorders that exists. It's kind of at the core of being a human being.

Twink: The first thing that bipolars tend to do is, once they start feeling better, they stop taking the meds – and that's a really bad situation. I've seen it happen to so many other people, where they've stopped taking the meds and they go ill. So I'm very, very strict on making sure I take my meds every day.

Now these ones are the ones that really knock you out, these are the quetiapine. These are sleeping tablets called zopiclone – I can't sleep without these; I'm that dependent on them. What happens, with the quetiapine, is you take them and you get uncontrollable hunger, this craving for food. You just eat and eat and eat. And that's my medication regime for this evening. See you in the morning.

Twink: So what is the definition of schizophrenia?

Michael: When you're saying that someone's got schizophrenia, what they have at its core is they have very unusual beliefs, which we call delusions …

Twink: Your tan looks good with a white shirt – you can see your body colour through it, so you're obviously getting a good tan.

Michael: … It's not just like believing my football team is going to win the league this year, despite all the evidence to the contrary. It has to be something a bit more bizarre. Someone is stealing my electricity in order to charge up a spaceship in their garden, or something quite bizarre.

Twink: I had an idea for a lick, for a banjo lick, and I recorded that, which is this [plays music], and I thought, well, okay, let's put a beat behind it [plays same music with beat]. And I got the beat going to play to, and I put a banjo roll on it, which is like a rhythmic thing, syncopated rhythm, and that'll come in just about now [same music with additions].

Michael: Hallucinations are typical as well, so most characteristically, they're auditory hallucinations, and that means that you hear things as if they were coming in the outside space around you. You hear them but there is no stimulus, so there is nothing actually there.

Twink: Try and just relax a bit; you're very serious.

Michael: At its most classic, it is a voice or voices that are not recognised as self and that occur in external space. I mean, when you're thinking aloud, so to speak, you're pretty clear that it is going on inside your head.

Twink: So pull the curtains back. Like, natural, yeah [laughs].

Michael: Whereas someone with an absolutely characteristic hallucination will be locating it as, maybe, the corner of the room or outside the house or under the bed or in the wardrobe or on the radio. It is heard the same way you hear me speaking. When you're thinking to yourself, you're unlikely to be hearing two, three, four different voices arguing about you or criticising you or commenting on what you actually happen to be doing.

Michael: No back shots? [laughs]

Twink: Well, if you want!

Michael: No, that's fine, that's good!

Twink: In the morning I have to take my meds, and this is venlafaxine – this one's been particularly helpful, raising my mood a little bit from being constantly bad to a little bit better. When you're taking 17 tablets a day, it gets a bit challenging to remember which one's which and which one does what. I'm only allowed me tablets on a weekly basis, because all my overdoses prior have always been tablet overdoses.

Twink: How do you treat schizophrenia?

Michael: At its most simple, medical level, you use medicine called anti-psychotic drugs, but that will not abolish many of the problems. So people with schizophrenia, the vast majority of them cannot find employment, have problems with housing, have problems with relationships. So they also need a lot of social support.

Twink: Are there similarities between bipolar and schizophrenia?

Michael: They do overlap. People with schizophrenia also have mood changes, odd behaviour; people with bipolar disorder not infrequently when they are very ill have hallucinations, delusions, odd behaviour. So the symptoms overlap and it can be quite difficult to distinguish between the two, assuming such a distinction is entirely valid.

Twink: I guess because I've got a goal, which is the 28th of March 2012, I know I need to do certain things – like I know I need to get good on the banjo for that date. I know that the band's got to be good for that date. We have to work on our visual image, and losing weight is all part of this visual image that I want to present. So that's my sort of goal. Whether I achieve it or not I don't know, but I'm going to give it a good shot.

Twink: What sort of research is being done here in Cardiff?

Michael: Speaking for myself, probably the main thrust at the moment is genetics. The purpose of the genetics is to find some biological clues as to the origins of the disease. What we want to do is take the genetics, and not just try and link the genes to disease, but also genes to how, maybe, different ways the brain is activated. So you try to link genes with brain-imaging findings.

Twink: Why is it important to continue research and get more funding?

Michael: We have very little grasp on how it develops. We have no real clear understanding about how risk factors, of which there are many, can possibly lead to this clinical picture. That all adds up to schizophrenia being one of the most important causes of human suffering, family suffering, economic suffering, and somehow we have to break that. One proven way of breaking this sort of thing is through biomedical research, so that we can identify positions in that chain between risk and disease that we can interfere with, interrupt or, if we're really lucky, prevent altogether.

[Sound of phone ringing and music fades in]

[Coming up in part 4…]

Scientist: Techniques were becoming available where we could look into people's brains … and that just fascinated me, to be able to get a glimpse with neuroimaging of people's working brains.


Twink: Where's creativity in the brain?

Scientist: There's no answer to that.


Twink: The process of actually lying on a slab made me feel a bit like I was being laid out in a morgue. To be honest with you, I was terrified.

[Music to fade]

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