Aside from a call to the poisons information centre, three visits to the dentist, one to a paediatric physiotherapist, one to my psychologist, recalcitrance and poor behaviour from me and my children, it also included a near fatal accident.
I nearly killed a young man at the beginning of this week.
And I did not want to write about it. The shame and incomprehension of this close call burn me in waves. But this incident bore a loud message, which I did want to write about.
On the first day back of school after months of lock down, I hadn’t planned to drive my children to their schools. We are walking distance from both. But time does strange things on school mornings. It slithers away at warped speed and suddenly, the window to comfortably walk to school on time slams shut. So, I drove them, on the proviso that this was going to be an exception.
Driving conditions during isolation have been muted. The amount of traffic diminished to that of a tiny country town in the middle of the night. School traffic ceased. Work commuter numbers slashed.
On that first day back at school, cars converged on the local streets and clustered around the schools like flies on a carcass. Drivers were filled with more emotion than a regular school drop off warrants. Joy. Fear. Dread.
My feelings? Happiness over the end to at home learning mixed with mild irritation at not having managed to get both kids out the door on foot on time. And once I’d dropped them, an urgent need to get back home and away from the chaotic traffic.
Impatience bloomed. I decided to make a right turn from a side street onto the main road across two lanes of traffic, to get me home more quickly than a series of left turns would have. The car in front of me went during a break in traffic in the first lane and was let in by a driver in the second lane.
I could see the same driver in the second lane holding a space for me to cross. So, I went.
I don’t remember if I glanced to my right to check the first lane was still clear. But the moment I slammed on my brakes and a young man on a red motorcycle had to swerve to avoid me, is burnt into the pit of my stomach.
I am a careful driver. In over 25 years on the road I have never had a serious accident. I have never driven drunk or while under the influence of prescription medication or non prescription drugs. I don’t text and drive. I was not sleep deprived or sick that morning.
So why this serious error in judgement?
But there was more to it. While we have been in isolation, our worlds shrunk to our homes and occasional short car trips on empty roads, it has almost been like a lengthy period of hospitalisation.
I know from all the times I have discharged from hospital after weeks inside that just because I am out of hospital, my life doesn’t just snap back into place. I have to put the pieces of it carefully back together.
Re-entry into the world after isolation is the same. Our reflexes are slower. We are more vulnerable to chaos.
I am not nostalgic for isolation time. I don’t want to regress into the woolliness of those early iso days, drifting down deserted streets, staring perplexed at empty toilet paper shelves surrounded by people with harried expressions behaving as though the world was ending.
I will be very happy to never again step into the uncomfortable ill-fitting role of someone attempting to assist with my children’s at home learning.
But the jolt of re-entry has been a wake up call. A wake up call that I need to take the time to consciously reintegrate after this most bizarre episode of ‘home hospitalisation’. My brain and body need some adjustment time. My children’s brains and bodies need some adjustment time.
Perhaps the most poignant aspect of my near miss accident happened immediately afterwards. The young man on the motorbike pulled over and came up to my car. I wound down the window ready for, and feeling deserving of, his abuse and anger.
He didn’t abuse me or even swear.
He asked: ‘Did you not see me, because that was really close?’
All I could say was: ‘No, and I am so, so sorry. I am so sorry.’
I will never forget the young man’s face, his emotional intelligence and compassion in an adrenalin soaked moment. And I will never forget his parting words:
‘Be careful out there.’
We need to collectively ‘be careful out there’ as we re-integrate after isolation or we will misjudge situations and possibly make fatal errors.
The other lesson learnt the hard way by another member of the family this week (and one I doubt has anything to do with reintegration) was not to open a tube of superglue with your teeth.
I never considered my mental health as part of the decision to have a baby, because when I first fell pregnant within a month of trying, I had never experienced mental illness.
The pregnancy was uneventful.
Then I went into a thirty-three hour labour on two hours sleep. This severe sleep deprivation and the swirling hormone levels woke a slumbering monster, a genetic predisposition, which ensured that by the time my baby was one week old, psychosis had wrenched me away from reality. I found myself in the Special Care Unit of a private psychiatric hospital trying to explain my way out of my delusions, while my husband and mother cared for my daughter at home.
I am not home schooling my children at the moment.
That implies a level of competence that far exceeds my attempts to provide a bit of supervision while they do what could pass for some form of schoolwork.
In fact, what I am doing could no more be called ‘home schooling’ than calling what my children’s teacher does when they are at school, ‘veterinary surgery’.
The new educational arrangements have made me ask myself this over the last week:
Are there any professions (apart from teachers) who are being asked to convey how to do their whole job to the general public in a very short time, using only online resources? I can’t think of any.
Yet suddenly teachers are expected to translate their university degree and years of practical experience into a format that parents with no training or experience in education can apply to their unwitting children at home.
And there will be some parents who will anticipate the same results as when their kids are being taught at school by the teacher.
I accepted a long time ago that I have no interest in the intricacies of how my children’s education is delivered. And I am not expecting to suddenly become enthusiastic about it, just because external circumstances have changed.
I do care about my children’s education. But my role and the teacher’s role in providing that education are clearly defined and there is little overlap.
I view these as my roles:
To love my children unconditionally and make sure they know it. To set clear boundaries for them. I am privileged to be able to afford to feed them, clothe them, and buy their educational resources. To do my best to allow them a good night’s sleep in a room free of devices, during the school term. To offer them a decent breakfast and a packed lunch, or at least the ingredients to make them. To offer them support in completing homework or schoolwork set by their teacher.
And to make myself available for communication with their teachers at any time.
I regard teachers with awe for the job they do. I know from friends who are teachers the high levels of empathy, patience, resilience, and emotional intelligence, among many other skills, they draw on to do their work well.
I also respect my children’s teachers enough not to encroach on the territory of their expertise.
When I attend parent teacher interviews, I only tend to ask four questions:
‘Does my child seem mostly happy and engaged? Is their behaviour appropriate? Are there any areas they are falling behind in? And, Is there anything else you would like me to know?’
Do you know what I never ask about?
The curriculum. Because I trust the teacher to know it inside out.
I feel for the parents who ask in depth questions related to the curriculum during parent/teacher information sessions, because right now they may struggle with the concept that they can’t single handedly provide their child’s school education at home, no matter how much they research the curriculum.
From an epidemiology point of view, at the time of writing, I believe the best place for my children is at home. But at the same time, my care factor for the quality of my children’s academic education ranks way below how much I care for not only my mental health, but the collective mental health of my family.
I acknowledge that while the two cares might not be mutually exclusive for many households, in mine – they don’t always sit well together. I may be biased by my own life experience, but that experience tells me this:
If my children fall behind in the curriculum, I am confident they will eventually catch back up to where they each normally sit. And they won’t be alone in that experience.
Yet if I tried to deliver the full curriculum to my children at home, I would transfuse the stress of my unsuccessful attempts into them. Over time, their mental health would suffer. Mine might suffer to the point of me having to be hospitalised again.
It would make as much sense as my children’s teachers attempting to perform surgery on their dog with only my online instructions to guide them through.
So, the alternative of my children having to work harder to catch up when this is over feels fairly benign. And this doesn’t mean they are doing nothing now. It just means I don’t hold myself to the unattainable standard of replicating my children’s in school educational experience at home.
And I could be way off here, but I imagine whenever I eventually return my children to their formal school based education – their teachers may prefer those children with their mental health relatively intact and their academic knowledge lagging, rather than the other way around.
(Additional note: The veterinary surgery analogies were drawn from my experience of working as a small animal vet.)
Long before Covid-19 arrived, vets and vet nurses were quiet, hard workers who didn’t complain about less than ideal working conditions. And, possibly unbeknownst to most of the pet owning public, for many veterinary staff, challenging working conditions were the norm.
Since this crisis hit, these essential workers are not getting much opportunity or airtime to communicate the difficulties they currently face at work.
The advent of the Covid-19 pandemic has put the challenges of veterinary work on steroids.
I know a bit about what it takes to work in this industry.
I fell in love with veterinary work at fifteen, when I started volunteering at a local vet clinic. I wiped down tables, cleaned cages, and held animals. Then I started work as a casual junior vet nurse on Saturday mornings.
I committed the second half of my teenage years to the tunnel visioned hard work it took to get into veterinary science at university.
I worked as a small animal vet for twenty years, in many different practices in Australia and the UK. Working conditions ranged from excellent to atrocious.
Thanks to my experiences, I know this:
Vets don’t talk about their work stresses outside their own tightly knit vet circles. Some of us don’t even confide our struggles to our colleagues. We talk about our cases in detail for hours, but many of us still cringe at opening up about the state of our mental health.
Our clients get our kindness, our compassion our sympathy our skills our knowledge, our communication skills. But they never see our vulnerability. They don’t understand how high our risk of burn out (borne of caring too much and being overworked and undervalued) is.
They don’t see that when we walk through the door of the clinic our rostered working hours become irrelevant because we give ourselves over completely to everyone else who walks through that door after us.
Our clients don’t feel our pain when we lose yet another amazing member of our profession to its sky-high suicide rates.
I am currently taking a break from veterinary work while I concentrate on writing and mental health advocacy work. But I have many vet friends who are out there working and hurting.
I have spent the last couple of weeks collecting descriptions of work life from some of my (currently working) veterinary friends and contacts, because I believe that for the veterinary profession to survive this pandemic with its collective mental health relatively intact, the pet owning public needs to know about the difficulties its workers face at this time.
Here are some of the (summarised, paraphrased, and quoted) insights these vets generously shared with me:
On Covid-19 Regulations:
Some aspects of veterinary work make social distancing between staff impossible. For example, it is not feasible for a nurse giving a wriggly, excited puppy a cuddle and a vet looking in its ears with an otoscope, to be 1.5 metres apart.
Some of the protocols necessary to minimise the risk of Covid-19 transmission, such as contactless consultations (where the owner waits outside the clinic in their car, the pet is transported inside by a nurse in PPE, the vet examines the pet and then phones the owner to discuss further diagnostics or treatment), severely hamper efficiency and slow everything down.
Vets are used to working as efficiently as possible:
‘Normally I would type the history while the owner is in the consult and do an exam in between taking notes. Now I can only do one of these things at a time.’
Contactless consultations also limit a vet’s ability to read their client’s body language during the consultation, which can interfere with effective communication between vet and client.
Pets can be more anxious when separated from their owners. This may mean it takes longer to perform a physical exam, or it may be impossible to do as thoroughly as the vet would like.
Covid-19 level cleaning recommended between consults is more labour intensive and takes longer than usual.
Downsizing or closure of a practice due to further restrictions or a Covid-19 infection will have negative effects on the practice’s financial stability very quickly.
‘The nature of small to medium sized veterinary practices even in normal times is to run with incredible efficiency, but still on very low margins. They cannot sustain even mild to moderate downturns. They will not survive and jobs will be lost long before the drop of 30% revenue occurs required to be eligible for the Job Keeper Payment.’
Locum vets are particularly vulnerable to job loss now. As practices work to minimise the risk of a Covid-19 infection in their permanent staff, many locum vets are having their shifts cancelled, and are facing the financial difficulties and mental health challenges that come with job loss.
Vets are also more aware than ever of the financial constraints facing many of their clients.
‘It is super sad when you see a client who wants to do everything for their pet, but they have lost their job and can’t afford it. It breaks my heart. I am doing a surgery at a 25% discount tomorrow. The client didn’t ask for it, but I feel so sad for them.’
‘I feel even more conscious of the usual dilemma we have in vet practice of having to mix financial discussions with emotive ones as most people are understandably a lot more stretched financially right now. But veterinary practices are also under a lot more financial stress and if our invoices are not paid, there won’t be a vet for clients to take their animal to.’
And now more than ever vets are at risk of being on the receiving end of their clients’ financial frustrations.
‘I’ve already been abused in the car park once this week and I am preparing myself for a lot more of that to come as the stress is almost palpable in the air.’
On Mental Health
Vets often hold themselves to a very high standard. Under sub optimal working conditions that pressure will increase stress levels further.
‘Veterinary practice is already an emotionally draining vocation with highs and lows every day. Our staff feel responsible for their patients and care for our clients. And it goes against the grain to just drop our standards of care because of what’s going on. So, we are not going to start cutting corners.’
Many clinics have split their staff into two or more teams to reduce the chance of the whole clinic having to close if one staff member contracts Covid-19. This means vets and nurses may be working under short staffed conditions and even longer hours than usual:
‘The phones are ringing constantly. We hang up and pick up the next one. I am answering dozens of phone calls daily as a vet, as well as being my own anaesthetist, recovery nurse, and doing the usual vet things. And right now none of us have regular access to our stress relieving hobbies.’
Splitting staff into teams at work usually also means no contact between teams outside of work.
‘There were genuinely tears after the last ‘normal’ shift as people realised they may not see some of their friends for weeks, months even.’
Before Covid-19 brought added work stressors with it, vets were already at a high risk for mental ill health. This knowledge weighs heavily on many of us:
‘I’m concerned that abuse of controlled substances will increase and don’t even want to think about the suicide issue the veterinary industry already faces.’
Vets appreciate the many clients who are doing the things that make their work less stressful, such as practicing social distancing, being patient when things take longer than normal, and assessing what might constitute an essential phone call.
For example, now is not the time to phone your vet clinic for a lengthy discussion about which breed of cat you should get.
‘If the public can show extra understanding towards vets and vet nurses that will only be a good thing. We are not the only profession under strain but the pressures we are under are very real. Everything is taking longer so people need to be patient.’
‘We place a lot of blind faith in the honesty of strangers at the moment…I feel angry when I hear of my colleagues having got to the end of a consult only to have a client mention that they just came back from a cruise a week ago.’
‘Thankfully 99% of our clients are understanding and adhering to protocols without complaint, but I don’t think they quite understand how hard everything is for us right now.’
‘The shortage of equipment is tricky – no hand sanitiser, limited paper towels and gloves. It makes it hard to follow the guidelines to use hand sanitiser between every patient. Some human medications we use are in short supply, which will be hard to explain to clients when their pet’s medication needs to be stopped suddenly.’
‘We have also been asked to supply a list of things we can donate if needed – such as ventilators, propofol, midazolam, and surgical gowns and gloves.’
What is getting us through?
Now more than ever, humour, teamwork and appreciative clients balance out the challenges of veterinary work.
‘On the positive side of things, I work with a group of amazing humans and the way we all have each other’s backs has definitely shone even more so in recent times.’
‘On the upside we have always been good at the ‘make do and mend’ mentality. Also, we were born for this – we just need to pretend every person is a parvo puppy!’
(Parvovirus is a highly infectious, potentially fatal viral infection, most common in puppies, and requires full isolation nursing.)
‘Our team are amazing and have chosen to pull together with a plan to fight and minimise risks to client and staff safety, mitigate risk to the business and work toward sustainability.’
‘We have had wonderful support from our clients and community who have commended us for our initiatives during this pandemic to ensure both human and animal welfare,’
To conclude I will reach for words one of my close vet friends passed on to me. Even though upper management of veterinary practices, can be notoriously out of touch with the needs of its veterinary workers, this directive from the upper management of my friend’s practice encapsulates perfectly what I would want all vets working through this pandemic to hold close to each day, and what I would want all veterinary clients to be aware of and respect:
‘Throughout our career, veterinarians have always put our patients first, then our clients, then ourselves. In this pandemic, we must put our safety and the safety of our nurses and support staff first.’
The Covid pandemic feels as though it has equalised our collective mental health. Or if not equalised, then it has certainly ‘flattened’ the mental health curve.
Most people who live with a mental illness have at some point experienced unpleasant times with no fixed end point, over which they have little control. And now the rest of the world is being forced to experience this too.
I imagine everyone’s mental experience of this pandemic differs based on their mental health history (among other factors). But it’s fair to say that right now most, if not all, of us are experiencing some form of mental discomfort.
On the surface, those who live with mental illness appear to be most vulnerable to this. But, this demographic may not be as at risk as we think.
As someone who lives with a severe mental illness but is currently relatively asymptomatic, I feel surprisingly resilient…for now.
Having previously lived through the rock-solid horror of psychosis, the inevitable Covid anxiety that flits through my brain now feels relatively easy to manage. I have an arsenal of finely honed tools to combat it. All that Cognitive Behavioural Therapy, the Acceptance and Commitment Therapy, and individual sessions with my psychologist are coming in handy.
I am also familiar with having my freedom restricted at times. When I am on fifteen-minute observations in hospital, I can’t go outside. At my sickest I have been too unwell for visitors. It doesn’t mean I like it, but I have at least previously encountered similar conditions to the ones I am living with now.
But what about everyone else?
Many people had been living with mild to moderate undiagnosed or poorly managed anxiety and/or depression for several months or years before Covid hit. I am particularly concerned for this group.
They don’t have solid medical and social support systems in place yet. The all-encompassing Covid generated stress is the perfect trigger for worsening symptoms. And accessing good mental health care quickly and efficiently may become even harder than it usually is.
Depression and anxiety symptoms can make the sufferer feel isolated even if they are closely surrounded by loved ones. Social distancing – so essential to manage virus transmission – will exacerbate symptoms of mental ill health in this group.
Then there are the people who have never lived with mental ill health.
They may never have experienced racing thoughts, heart palpitations, chest pain, irritability, distractibility, gastrointestinal signs such as nausea, vomiting and diarrhoea due to anxiety, a low mood, insomnia, incessant worry, or any other mental and physical symptoms that can arise due to stress and/or mental ill health.
These people may not know why they are experiencing symptoms or have the psychological skills to put them in perspective. So, they will suffer more than they need to.
But there is good news in the quagmire of black headlines we are sucked into daily.
We can use our own mental health histories to help ourselves and others in this crisis.
If you live with mental illness and are currently symptomatic, your sole focus must be to do what you can to get well. I know from my experience I am of no help to anyone if I am symptomatic. It’s a cliché but one that applies here:
‘Put your own oxygen mask on before you help anyone else with theirs’.
Firstly, contact the medical professionals you would usually consult when you are symptomatic – whether that’s your psychiatrist, psychologist, GP, community health workers, or psychiatric hospital.
Limit your exposure to the news to once a day – if that. If you have family or friends who can reliably update you on the essential news only, do that. Immersing yourself in the details, is of no practical value, and it can make you feel worse.
Use the same tools you would usually use to distract yourself when you are living through an episode of illness. Eat regularly and well. Don’t consume alcohol or recreational drugs. And move your body in some way, even if it’s small, every single day.
If you live with mental illness and are currently asymptomatic be vigilant but not obsessed. Just because this time is stressful, doesn’t mean developing an episode of illness is inevitable.
Your oxygen mask will consist of continuing to take medication (if you take it), keeping your regular appointments with your psychologist, psychiatrist or GP where possible, eating regularly and well, exercising most days, avoiding or minimising alcohol consumption, and practising whatever psychological skills (for example Cognitive Behavioural Therapy) that you have learnt over the course of your illness.
Be aware of any news developments that have practical ramifications for you, but don’t marinate in the news. Once you have done all this and whatever else you need to stay well – consider this:
You can offer support to those who are struggling mentally, those who have never experienced symptoms of mental ill health. Reassurance that their symptoms are survivable with the right care, could mean a lot to someone who is new to these issues.
That said – only do this if you have the mental energy to spare – otherwise just look after yourself.
To those who sense they may have been living with anxiety or depression for a while and it is worsening: All the suggestions with regards to eating well and exercise apply. Don’t self-medicate with alcohol or other recreational drugs. It will make things worse. Getting the right help is also crucial.
I am acutely aware that accessing good mental health care is a challenge in this country even when we are not mid crisis, but some excellent online resources to start with are: Lifeline, Beyond Blue, and SANE (Links at the bottom of this post)
To all the people who have never lived with mental illness: Distraction, exercise, eating well, and maintaining social connections via technology are a good start. Don’t self medicate with alcohol or recreational drugs. If you are still experiencing symptoms related to anxiety or depression (as listed above) then the online resources at the bottom of this post may be useful, or make an appointment with your GP as a starting point.
And one more thing…
Once you have done what you need to help yourself – take stock of how this situation is making you feel. And then imagine feeling like this for much longer periods of time than this pandemic will last.
Imagine feeling like this but the pandemic didn’t exist and people around you made you feel as though your symptoms weren’t real.
Then translate your feelings into compassion. And when you feel like yourself again (and you will), extend some sympathy and support to those whose mental illness lasts a lifetime.
And to everyone: We can use our individual experiences of mental health and ill health to support each other through this strange new world and into a kinder future.
So look at who you are sharing your living space with at the moment and consider starting a conversation about where on the spectrum of mental health and illness you and your housemates or family sit. Then think about how you could help each other psychologically.
My own household is one of extremes (regarding the adults). I live with severe mental illness, currently asymptomatic. My husband has never experienced mental illness.
So, when he expressed frustration a couple of days ago about his attention span feeling like that of a gold fish, I said:
‘Yes, I know it sucks feeling like that. But it will be ok.’
And I gave him a hug – something which I believe (at the time of writing) is still acceptable and safe to do in a household in which no one is symptomatic or has returned a positive Covid test.
This post is based only on my own experience and anecdotal evidence.
For professional mental health advice please contact your psychiatrist, GP, or for more mental health and ill health information check out the following links, all three of which are currently set up to deal with questions about Covid related mental health issues:
I have spent the last five weeks in a psychiatric hospital for management of a Bipolar 1 Disorder episode.
I am no longer sick. But still fragile. Like an egg without its shell. I always reach a point on the return to wellness where I can get no better in the controlled bubble world of the hospital. A point where staying longer is of no benefit and can even become detrimental.
I ventured back out into the world at the end of last week. A world that hasn’t grown any softer in my absence. It is the same hustling harsh, bruising, breaking place it always has been, but perhaps more so. No one was fighting over toilet paper five weeks ago.
That said, after any admission for a Bipolar episode, jumping back into my life can feel like steel wool on newborn skin in the early days.
No one can tell by looking at me when I leave the hospital that I need rehab and resilience building before I am ok again. For me, on average that takes the same amount of time I was hospitalised for. So, in this case – another five weeks.
People tend to be congratulatory about me being well enough to come home. I don’t want to be a downer. I am grateful to be home. But just because I’m out of hospital it doesn’t necessarily mean it’s over. It can look like it is slinking away not to be seen again for a couple of years. But appearances can be deceiving.
Once, this illness spent a whole year of my life bouncing me in and out of hospital so often, I got dizzy. By the end of that year, in which most months had held a hospital admission for me, it had nearly killed me. So, that’s why I don’t think about exhaling as soon as I am home.
Today is my fourth day at home. I am still acclimatising. But I also recognise something unexpectedly positive borne of the last five weeks.
Being in hospital with Bipolar symptoms has prepared me for the Covid-19 headlines very nicely.
I get a sense from these headlines and the empty toilet paper and pasta aisles in the supermarket that many people are panicking, or at least are very worried by the uncertainty they are being force fed right now.
I am still in the mindset it took to get through my last five weeks. I lived that time (and do every time I go into hospital) in two-day increments. Why? because it is pointless to look or plan any further ahead. Neither I nor my psychiatrist could fortune tell what would happen. Five weeks of observing, tweaking medication or not, and then waiting another two days before assessing again.
To be clear, there is a difference between not taking something seriously, and choosing to engage only in what is in front of you. I take my Bipolar Disorder seriously, especially when it flares. But does that mean it would be helpful to spend my entire admission panicking that this is the time I become a permanent inpatient (they exist)?
Or should I break it into chunks the size of a couple of days and hit repeat, until at some unknown time in the future I am out the other side?
I’ve spent early admissions, years ago, engaging in the first option but have learnt that the way through with the least energy wasted is the second one.
In the same way, I take the Covid-19 pandemic seriously. But you won’t find me panic buying or worrying about whether or when it will end. Breaking this issue down into two-day increments feels helpful to me right now. Every two days (or sooner if the headlines change dramatically) I reassess the basics: Do I and my immediate family have enough food, water, medication and accommodation for the next two days? I am fortunate. So, far the answer has been yes.
Is there any point in trying to predict what might happen next month or even next week, and worrying about it?
Because no one knows where we will be then. You can only act on the information you have at the time. And if right now your basic needs are met and you are well, don’t buy more and more and more food or toilet paper (unless you are doing it for the vulnerable members of our population).
Breaking the overwhelm of a difficult situation with no known endpoint into smaller portions lessens the strain on our mental health and preserves our energy for more productive tasks.
And if we do it often enough that’s what will get us to the other side of this situation too.
I emerged from the manic symptoms about a week ago. Pummelled into exhaustion by the high doses of Lithium and antipsychotic medication, and by the manic episode itself. Even in a hospital setting, taking all the right medication, and having good insight into the symptoms, manic episodes accrue a negative energy balance. It means when you eventually recover you are depleted, bone tired.
And this is where it gets tricky:
That exhaustion can mimic rebound depressive symptoms. One improves with rest and dialling back the antipsychotic medication. The other progresses beyond exhaustion to include other insidious signs that envelop you in a black, poisonous mist. Appetite drops off. The words ‘zero fucks left to give’ cast in a concrete block take up residence in your skull. Motivation evaporates and has to be faked until it decides to return in its own sweet time.
For a week now my psychiatrist and I have been watching and waiting. At first, we were both hopeful. We even (stupidly) dared to imagine I could be well enough to discharge by the end of this week. There is a reason we have a policy of never looking more than two to three days ahead when I’m in hospital. It’s because this illness has taught us – there is no point.
My psychiatrist entered my room mid morning today, looked at me back in bed and said
‘This isn’t good. You’re usually out walking.’
I turned towards him.
I don’t like it when his face arranges itself into concern within ten seconds of seeing me. It confirms what I already know. It also reassures me, because it is evidence of how well he knows me.
I have tilted towards depression, in the opposite direction to where I was headed when I was admitted.
This means we change our treatment plan in the opposite direction. We will cut back the Lithium and we will increase one of the two antidepressants I take. We will give it two or three days.
My mood begins to shift back up before then, in which case I will inform the nurses and they will page my psychiatrist for further instructions. We don’t want to risk another ascent into mania. I’m not reaching for a YoYo or rollercoaster metaphor here, because they both imply the possibility of fun, which this decidedly is not!
The other switch over is the behavioural management of active Bipolar symptoms. For me it means telling myself to do the opposite to what my body wants me to do. So during a manic episode I should seek out quiet environments, be on my own, try not to overexercise. During a depressive episode it means kicking myself out of bed, engaging with others, and above all else exercise, exercise, and then exercise some more.
What a mind fuck.
While I continue to wait out my life in two to three day increments, I don’t feel inclined toward gratitude. But that’s largely depressive symptoms talking. So, I will do the opposite and stubbornly find something to be grateful for. Here we go:
I am grateful that at their current level my depressive symptoms are much easier to manage and tolerate than my manic symptoms were. The intense manic irritability has disappeared, and my concentration and short-term memory have mostly returned…for now.