Writing On A Tightrope

What is the thing that could unseat you from your life?

For me it is attempting to control things beyond my control. This urge originates in my DNA and is exacerbated by living with Bipolar 1 Disorder. When this illness sweeps in unannounced and for however long it pleases, it rips my sense of control apart. The rebuild is always hard work.

And while I have learnt to loosen my grip a little more each time I recover, control of the control issues is still a process in progress.  

My kryptonite is sick children.

Over the last six weeks, various illnesses, hospital admissions and a surgery between my two children have threatened to overwhelm my relatively well-honed CBT (Cognitive Behavioural Therapy) skills. Neither child was ever in acute danger, yet I battled the clench reflex of control. I loathe feeling as though I am not in the driver’s seat of my life. This time I was on a bumpy road trip I never consented to, delegated to a back seat with no seatbelts and poorly locking doors.

But something unexpected helped.

At the end of April, I started a five week online Creative Writing Course with the Australian Writers Centre. Three to four hours a week to cover course material and submit an assignment. No penalty for not submitting the assignment, other than missing out on feedback from the lecturer.

I completed two weeks without distractions before the illnesses descended.

I immediately indulged in some classic black and white thinking and catastrophising and thought I’d abandon the writing course. Thankfully CBT skills prevailed: Neither child was on life support, and doing some of the course would be better than doing nothing.

I decided to do the minimum I needed to submit an assignment each week. Surprise, surprise – the writing was a welcome relief from the stress of sick children. Spinning and shaping words into new work left me feeling more in control of my world. The gentle nudge of an assignment due, felt as though someone had handed me a balancing pole as I walked my tightrope.

We are (hopefully) through the worst (of the sicknesses) now. The course finished a couple of weeks ago. But I thought I’d share two of the creative writing assignments I submitted, for those who are interested. Both are a scene with a 200-word limit.

I hope you enjoy this foray into another branch of my writing life:

Assignment 1:

Anton pulled on his fur lined hat with the ear flaps, leather gloves, woollen scarf, and snow jacket. He collected his fishing rod and box and left for the lake just as dawn poked its pink fingers through the patchy clouds. Snow crunched like fine gravel under his boots and his breath came in clouds.

He loved the peace and solitude of ice fishing. Some winters the lake froze into a clear pane of glass, and you could see fish moving sluggishly under the ice. This winter, the ice had incorporated snow, until it was as opaque as wedding cake icing.

Anton had barely lowered his line into the ice hole and himself onto the bench when he felt it. Not the usual twitch of a fish, but a heaviness.

He reeled in his line and squinted.

Waterweeds.

His stiff fingers untangled the dark green filaments around his hook. The curtain of weeds hid something fleshy, something covered in blood vessels. It had a cord, like a length of blue wool dangling from its belly.

It had ten fingers and ten toes.

 A gasp shot from Anton’s mouth. His fingers trembled across his chest in the sign of the cross.

Assignment 2:

It’s 2022. I should be used to wearing a mask by now. And yet, I suddenly notice the itchy edges on my cheeks. My breath moves hot and thick and sour inside it. Outside the mask (for a sip of water) the dry air is laundered with disinfectant, hand sanitiser and soap.

The bedside chair is designed to exacerbate my sore back. All the other parents’ anxieties hum around us. My own worries are a fistful of wriggling worms trapped in my stomach.

Th attempts to jolly up this space with zoo animals on the curtains dividing each bay, and jungle scenes on random walls, have failed miserably. The fluorescent lights erase all beauty. Behind my son’s bed a multicoloured cluster of tubes and canisters, buttons and power points sit patiently waiting for the terrible moments when they are called to action.

My boy’s soft hand is invaded by a plastic tube, covered in gauze, and clutches ‘Scrat’ his tiny plush toy wombat. The nails-down-a-blackboard screech of a toddler in the next bay jerks me upright. My back spasms.

In this place time obeys different rules, and my heart in its chest full of quicksand keeps beating, somehow.

You may also like to check out:

The Well Times

Bipolar Day 2022 – Great Inequality

Well

I remember my response the first time my psychiatrist suggested I could have an underlying bipolar disorder. That it had been the fountain of chaos that erupted in the form of postnatal psychosis the first time it came to call.

Denial. I believed he was telling me as a duty of care, because that was the case for some people. But not me.

I remember my response and where I was when he confirmed my diagnosis of bipolar 1 disorder several years later.

He was standing at the door to my hospital room that looked like a stack of post it notes had thrown up all over the walls. They were covered in technicolour squares that I had scribbled random ideas on and reminders of where I had put my fountain pen or my toothbrush.

Unwell

I had no short-term memory. My thoughts raced delusionally down corridors in my brain that had been emptied of the rational. At night, I wrote and wrote thousands of mostly nonsensical words. Sleep wouldn’t come, even with high doses of medications. I didn’t want sleep to come anyway. It ate into my thinking and writing time.

But back to that moment when I looked up at my psychiatrist in my neon rainbow dump of a room and asked: ‘Postnatal psychosis or bipolar?’

He didn’t torture me with hesitation. Just delivered the sentence: ‘Definitely bipolar!’

Those words spread through my insides like a cold, nasty liquid. For nearly four years I had teetered on the edge of believing that my mood disorder would be confined to the perinatal period like so many other women. That there would be an end to it.

‘Definitely bipolar’ felt like a life sentence. Devastated doesn’t begin to describe my sick feeling. Then that sickeningness was replaced by questions I cringe at now:

‘How can I subject my children to a mother with this illness? How can I ever achieve anything again?

I was very achievement oriented back then, and self-stigma told me vicious lies.

It will be 16 years in August since bipolar disorder flew fiery through my life the first time. I am glad I didn’t know what was ahead of me then because fear would have told me I wasn’t strong enough to get to the other side of hell so often.

If I could go back now, I would tell myself that although my life would be different, it would still be my life. I would tell myself that my entire relationship with fear would change because of this illness. For the better.

That I repeatedly reach points of wellness where I stretch out my hands and grab fear by the shoulders. I stare deep into its eyes and compare it to what I feel during psychosis. And I find most everyday fears evaporate in the memories of what I’ve survived.

I wish I had known that my children would benefit from having a mother with insight, not only into her illness, but life. A life I’d describe as good.

I am not naïve enough to believe I’ve had these empowering experiences through force of will, intelligence, doing the work, taking the medication, fairy dust…

I will say this repeatedly in different mediums and articles, because it is important to acknowledge, again and again and again: I live with immense privilege. I am a straight, white, cis-gendered tertiary educated woman with no concurrent disabilities, who can afford private health insurance.

It is helpful that I have worked to gain insight into my symptom pattern. Exercising and taking medication that works for me, is also crucial. I am not shackled by addictions to substances that could derail my stability. But every one of those things would be much harder to enact and maintain, without my privilege.

My privilege does not mean I haven’t suffered. It doesn’t invalidate my experience, but it must be acknowledged for context every time I tell my story, otherwise that story is shallow, loses meaning, and does a great disservice to the many people who live with this illness, but without privilege to boost them to the head of the line when it comes to accessing the best care, and being the most supported they possibly can be, during the challenge that is living with this chronic, intermittent, potentially fatal illness.

You may also be interested in:

The Well Times

My 2018 World Mental Health Day

World Maternal Mental Health Day: It’s Not All Postnatal Depression

Mental Health Snobbery

Is stigma surrounding mental illness only generated by people who have never been mentally ill?

No.

There is a version of the S-word that lurks below polite conversations about ‘stigma surrounding mental illness’. It occurs amongst people who experience mental ill health, and it is camouflaged by the notion that we are all in this together and all experience a similar level of stigma.

But we are not, and we do not.

I first became aware of this after my encounter with acute Postnatal Psychosis, and the rupture from reality that accompanied it. My experience didn’t fit the binary mould of the common Perinatal Mood Disorders: Perinatal Anxiety (PNA) or Perinatal Depression (PND).

Over time, I discovered that (not all but some) mothers who have experienced PND or PNA, especially if it is mild, carry harsh opinions about those of us who need medication and hospitalisation or who live with other diagnoses.

Some examples:

I once read an account by a woman who was able to resolve her mild PNA by going to a special mother’s group, which, she wrote:

‘Thankfully didn’t have any loonies in it, just normal mums who were struggling a bit.’

Another time, when I was hospitalised in the Mother Baby Unit of a private psychiatric hospital, I heard a group of mothers cackling in the common room:

‘At least we aren’t like the real crazies in the rest of the hospital.’

This snobbery irritated me at the time. Several years later, I became one of the ‘real crazies’ (patients in the main hospital) and… felt sad for these women who left their experience of mental illness with the same narrow mindset they had entered it with.

That said, most of us start the ride into mental ill health with biases.

I remember during my first admission, two of the mothers in the Mother Baby Unit were having ECT (Electroconvulsive therapy). I didn’t have any strong conscious opinions about ECT. But if I’d been asked, I suspect I’d have said: ‘That will never be me.’

Six weeks later, that was me.

ECT is still one of the most stigmatised treatments. Some of the strongest perpetrators of that stigma are those living with mental illness who have not had ECT.

 A couple of years ago, I encountered another patient in the hospital to whom ECT had been suggested as a treatment option. She asked me about my experience, and then said:

‘Well, I am a scientist and need my brain to work properly, so I can’t consider having ECT.’

I swallowed the prickly implication she had just hurled my way and thought of the surgery I had performed, the book I’d written, all the ways I’d successfully used my brain post ECT. I avoided that person for my remaining admission.

Patients new to mental illness often inadvertently extend their self-stigma to others.

During my last admission another patient told me that they had been in hospital for a week and that they were worried about the length of their stay. They asked me how long I had been in for. I replied: ‘This admission? Three weeks’

They visibly recoiled. Their thoughts may as well have been printed on their forehead:

‘More than one admission? Three times the length of my stay? And you are still here?’

I didn’t add that for me, three weeks was a minimum length stay, that in the past I had spent months hospitalised, that I would never be cured. Instead, I said:

‘Just take one day at a time, and don’t compare yourself to anyone. Everyone is different.’

But I know it can be tempting to play the comparison game. When I feel frustrated and vulnerable, my thoughts can turn poisonous:

‘Must be nice, to only have to take one medication or none.’

 Knowing very well that there is nothing nice about having to take even one medication or being unwell, even if you don’t need medications.

And that moves us on to the medication debates.

Before I came down with Postnatal Psychosis and Bipolar Disorder, I was a reluctant medication taker. I wasn’t specifically anti psychiatric medications. It had just never occurred to me that I would need them. Then I got so incredibly sick, that the prospect of refusing something that might help me was ludicrous.

Today the debates around psychiatric medication stigma tire me, because it is simple. If you don’t need medication to help manage your mental illness, that is awesome for you, but it doesn’t make you stronger, or better than anyone who does.

Anti-medication stances are a luxury not everyone can afford. Voicing that stance without acknowledging the accompanying privilege, can stigmatise those who do need medication to manage their illness.

And appearances can be deceiving. Someone experiencing moderate or mild symptoms without access to good mental health care, may suffer more than someone, like me, whose symptoms and treatments may look worse on paper (psychosis, ECT, etc) but who has had consistent access to excellent quality mental health care.

No one’s lived experience should be used to minimise or stigmatise someone else’s.

So, whether this is your first and only episode of mental illness or it is one of many, or you’ve been lucky enough to never experience one,  when you form an opinion about others living with mental illness, please replace judgement with compassion and think before you speak or write.

You may also be interested in the following posts:

Psychiatric Medication And Stigma

World Maternal Mental Health Day: It’s Not All Postnatal Depression

Welcome To Motherhood

ECT: Blowing up some myths – Part 1

ECT: Blowing up some myths – Part 2

The Well Times

What does well look like for you?

I have painted many pictures of myself when a Bipolar episode knocks me out of my life for a while.

But what about my well times?

I don’t identify with the cartoonish cliché of Bipolar Disorder. I don’t spend each day either drowning in depression or being supersized by mania. This depiction of the illness lacks nuance. It’s a stereotype wheeled out for memes or lazy reporting.

I can only speak about the fingerprint of my own experience. Severe, but well managed.  

Sure – when I am unwell, I tend towards very unwell. I won’t sugar coat that.

But, for me…for me – when I am well, I am well…well.

In my well times my life is not a daily struggle. If anything, I struggle less than many ‘mentally healthy’ people. Thanks to my Bipolar Disorder, my box of psychological tools to deal not only with my illness but life in general – is full. But before it thundered into my life, my toolbox contained the equivalent of a pair of tweezers and some toenail clippers.

I am well now.

And it looks a little like this…

It is settling into myself. It is being alert to all I am capable of. It is a beautiful, clear, hard-won self-knowledge

It can be simple things – being able to read and drive and go to the shops, immerse myself in my family.

But it is more than the simple things.

It is actively pursuing my edge, courting the possibility of foundering, because I know the feeling of foundering will be fleeting compared to the dull ache of regret which could plague me for years.

A couple of weeks ago an interesting job opportunity dropped into my direct messages. Both it and I were great on paper. Veterinary qualifications and experience. Writing qualifications and experience. Listed as the first requirements.

 It lit the spark I needed to update my CV, which had been languishing back in 2015.

I applied for it. I was invited to interview.

And perhaps for the first time I thought about what I wanted, rather than blindly throwing whatever I needed at it to get the job.

And so, I clicked ‘join meeting’ with all the skills and experience I could bring (for example writing well) and all that I couldn’t (for example managing stakeholders).

I came away thinking – I could do this, but do I want to? If offered the position I think my ego may have convinced me to squash myself into a shape I didn’t naturally fill, just to prove I could.

Thankfully, being authentic in the interview paid off.

Having a way with words was more important to me, and stakeholder management was more important to them.

And when I got the email thanking me for my time but telling me that I wouldn’t be progressing further in the application process, I felt – a sharp little sting and then… relief, because I really didn’t want to squash myself into someone I wasn’t.

There is always a danger in well times.

It is the fear of what may happen in the unwell times.

There are times, even when perfectly well, I have to resist the pull to sit in a metaphorical corner rocking with my hands over my eyes doing nothing, because I know what has happened to me, could happen again.

I’ve felt that pull many times. I have resisted it many times. Over time I’ve gathered proof that resisting is the only way to have the life I want, even if it is a life lived with this illness. Without that resistance I would lack a lot. My second child and my self-worth top a long list.

Most recently that resistance has gifted me an updated CV and a stronger sense of who I am and what I want.

I know in the last couple of years, mental unease has crept into many people’s lives and distorted their thoughts, feelings, and view of life. It’s a foreign and frightening landscape to find yourself in. And finding your way back to the well times can feel impossible.

For me, the first steps back to wellness always start with a couple of questions:

What does well look like for you?

Does your toolbox contain more than a pair of tweezers and some toenail clippers?

You may also like to check out:

Where’s Your Comfort Zone?

My Mental Health Toolbox

On Uncertainty

Am I A Stay-At-Home Mum?

Taken around 2008 – consent to share given in 2022

My 11 year old clobbered me with this question recently, and it felt complicated.

I say ‘clobbered’ because – for me – the words ‘stay at home mum’ come with baggage. This phrase and I have an uneasy history. My judgement started early.

As a child I never dreamt of future motherhood.  At thirteen my family and I moved from Germany to Australia. The change in schools was ‘resilience building.’ The first year or two I learnt to live with being intermittently bullied. Then, to my relief, at the end of grade ten several of my tormentors left school. They were either pregnant or would soon be.

The idea of motherhood, when linked to these girls who had taken such joy in making my life hell, became abhorrent.

Homing in on my goal of becoming a vet drove me through my last two years of school and into university. I worked hard, and with tunnel visioned arrogance. I saw children as a hindrance and the women who devoted their lives to staying at home and looking after them as little more than shepherdesses tending their flock while life passed them by.

When Michael (my now husband) and I started going out I spent the first years of our relationship reiterating that I would never want children. My career would always come first. He supported me.

8 years later we married and moved to the UK to work and travel. After we returned to Australia I continued working and started a second university degree.

Then, somewhere between 31 and 32, I sensed I would regret not trying to have a baby. It took one month to conceive that first baby. The plan was for me to stay at home in the beginning and go from there.

The universe laughed heartily.

I spent close to the first four months of motherhood in the mother baby unit of a psychiatric hospital. Along with parenthood I was served postnatal psychosis, catatonic depression, electroconvulsive therapy, and a lot of medication. I had no history of mental illness before the birth.

 At times I was too unwell to look after my baby. And even when I could – my survival and care had to come before caring for my baby. I didn’t have the luxury of martyrdom. My baby and husband needed me alive.

Eventually I recovered from that episode of illness. But as much as I loved my baby, I found the stay-at-home mum loop of feeding, cleaning, settling, on endless repeat mind numbingly dull.

I returned to veterinary work part time.  

My work re-engaged my brain. A day’s work felt like I had achieved tangible results, instead of running on the hamster wheel of domesticity all day.

Three years later, we had a carefully considered second baby whose arrival was also accompanied by a savage return of psychosis, mania, depression and a now definitive diagnosis of Bipolar 1 Disorder.

Once I’d recovered, I struggled with the same aspects of stay-at-home motherhood I had with my first baby and returned to part time veterinary work.

Veterinary work is not particularly compatible with motherhood.

Shift ending times are academic. Needing to be home by a set time after work guarantees an emergency turning up, a regular appointment blowing out, or needing to catch up on phone calls and notes.

Childcare centres with their sharp closing times were not an option. My husband took over childcare when he wasn’t working. My mum helped too. But we largely relied on a nanny to cover my work shifts during the week.

By the time the nanny had been paid, my hourly rate sat at around $15 hour – to consult, perform, diagnostic tests, soft tissue surgery, dentistry, radiography, radiology, pharmacology, emergency medicine, euthanasia – for my patients and to communicate effectively and compassionately with my clients.

I worked for my sanity rather than the money.

At one point I switched to weekend work to make it a little more financially worthwhile. My husband was the stay-at-home parent for those days. He worked weekdays. We tag-teamed parenting and never had any time together as a family.

Veterinary work is rewarding.

It is also emotionally and mentally demanding. Many clients carry anxieties into the consulting room with their pet. At the end of a workday I had little emotional energy left for my family because I’d spent it on my clients.

Thankfully my children’s demands on my emotional energy were minimal when they were little.

But now, at 15 and nearly 12, it is all about being emotionally available.  And unlike changing a nappy or cleaning up pureed fruit, sensing where on their emotional barometer they sit and responding appropriately, is something I don’t believe can be outsourced.

Just over 2 years ago I stepped away from veterinary work.  In large part to focus on having my book published and explore my writing interests further, but also to be there for my children at ages when I feel they need me most.

I am grateful we can afford this choice.

My thoughts on stay-at-home motherhood have thankfully changed since I was fifteen. But some flinty fragments of my old views persist. I still don’t like the term ‘stay at home mum’. It implies too much domesticity, and that the bearer of this title has no interests outside of her children.

I would be a terrible mother if I hadn’t built a career first, and if I didn’t have interests outside of mothering. But the balance has shifted from shoving my family around the demands of an unyielding career to finding interests and opportunities that drape themselves more gently around the needs of my family.

So, in answer to ‘Am I a stay at home mum?’ My answer is ‘Sometimes.’

My memoir Abductions From My Beautiful Life was published in April 2021 and is available through most online booksellers including Amazon, Booktopia, and Fishpond. You can find an excerpt here Book

You may also like to check out these links

Welcome To Motherhood

Veterinary Work And Bipolar Disorder: A Podcast Interview

Your Mental Load = Your Responsibility

Gentle Shoots Of Hope

I entered this year softly. Sparkling into it from one minute to the next, without expectation. But finding joy on the other side of the second hand.

I could now spend a paragraph on the 2020/2021 disclaimer for happiness, the guilty acknowledgement of everyone who may be suffering, that feels as though it has become mandatory whenever you write or talk about anything remotely good happening to you in pandemic times.

But I won’t, because in this moment it feels disingenuous. The events of the last couple of years may have thrown it into sharper relief, but virus or not there have always been people who have it worse than me and those who have it better.

So – no disclaimers. We’ve all had challenges from the dung heap of life thrown at us. I don’t believe bad things happen for a reason. But I do believe that it is the rubbish times that make magic moments shine when we happen upon them.

I spent New Year’s Eve last year (2020/2021) in hospital – just one day in a holiday package that started with an admission on Boxing Day. I didn’t feel well enough for people. Including my husband and children. Dinner came with a serve of ‘seasonal vegetables’ leached of colour and boiled into malodourous oblivion. Dessert was my nightly mouthful of dry medications washed down with tepid water. Long before midnight I was obliterated by that medication and happy to be so. Joy was not part of the equation.

When it came to thinking about New Year’s Eve plans for last year, I had only recently discharged from hospital after another Bipolar flare. A brief 3 week admission starting in late October that bled well into November.

I juggled the idea of having friends join us for what is a special evening for me.

From the ages of six to thirteen I grew up in Germany, in a culture that celebrates New Year’s Eve joyfully and raucously. I remember towers of champagne glasses filled and overflowing with bubbles from the top tier down. There was music and animated conversation, which gave way to the fireworks at midnight. People bought their fireworks from the supermarket and let them rip into the newborn year from their snowy backyards.

On New Year’s Eve 2000 I introduced my (then new) husband Michael to this way of celebrating. We were living in the UK, but had travelled back to Germany for the holidays. We spent that New Year’s Eve with Sandra, one of my closest friends, and Thomas – her partner, and their friends. We had raclette, lots of drinks, and laughed so hard. Just before midnight, we climbed into our coats, boots, hats, scarves, and gloves and walked, stumbling ever so slightly, down to the beautiful lake Sandra and I had spent childhood summers swimming in and childhood winters ice skating on. It was freezing. Too cold to feel our faces. The whole village was there. The air smelt of nothing but fireworks. We were in our twenties and euphoric.

Thomas died barely six weeks ago. The loss of someone we loved has been compounded for me because I can’t hug his wife – my lifelong friend whose hand I used to hold as we jumped into a New Year.

New Year’s Eve in Australia is different. It is the hot afterthought to a showy Christmas. The vibe around New Years for many Australians is ‘Meh – can’t be bothered.’ or it’s a night of heavy drinking that culminates in a headache on New Year’s morning and a set of resolutions, which won’t last past January.

And yet I celebrate the ending and beginning of years…when I can. In part it is fuelled by nostalgia. It is also because I have learnt to celebrate things while I can, because there will be times when I have no choice whether I get to celebrate or not. There are times when I am too unwell. Times when it’s overboiled vegetables instead of home cooking.

Not celebrating can also be a missed opportunity for making memories. Memories of joyous hours, which become part of everyone’s narrative. Memories that become unspeakably precious in hindsight when we have lost those we shared them with.

And so, I sent out some invitations and had a beautiful night.

There were candles and sparklers and laughter across an increasingly messy tablecloth as the night moved on. We ate pistachio baclava with mint and rosewater syrup and white peach sorbet for dessert.

By 2 am the house was buzzing. I had picked up my older child and two of their friends from another party to join the other couple of kids already at home for a sleepover. In the early hours of this New Year my house was steeped in happiness.

For me, 2022 has started with love and energy, and out of the losses and difficulties of the previous year I sense gentle shoots of hope are emerging.

One of the positives of 2021 was that my memoir Abductions From My Beautiful Life was published. For an excerpt and more info click here Book

You may like to check out how some of my other years have gone in these posts:

2020 Ends In Hospital

Covid Lockdown In A Psychiatric Hospital

2018 – The Year I:

Invisible Damage

9.30 pm at the medication station.

I confirm my name and date of birth. A nurse hands me a tiny paper cup. It rattles slightly, this mix of yellow, white, and orange lolly shapes.

‘See if that looks right.’

I never go on looks alone. I recite the contents of the 13 tablets back to the nurse, as though I were the one prescribing and dispensing:

‘750mg Lithium, 50mg agomelatine, 100mg quetiapine XR, 150 mg regular quetiapine, 1mg clonazepam, and 10mg of temazepam (prn)’.

Just before I swallow them, my mouth feels full of loose teeth.

And then I drift down a dimly lit blue carpeted corridor that ends in an opaque glass window covered in giant blown dandelions, until I am back in my room.

I feel so removed from my life I may as well be orbiting it in a spaceship.

I feel the anxious tug deep in my belly, knowing the longer I orbit, the longer and harder my earthling reintegration will be.

Outside of these corridors, this mission to heal my brain, my family pushes and pulls itself into an unnatural, temporary shape. Each member forced to stretch and thin out to cover the hole of my absence.

My family hurts in ways I can barely imagine, while the hurt in my brain lands me in this other world.

It feels as though my family is the only family to contort itself for as long and as often as mine does every time I get sick. It doesn’t matter that they are all resilient and used to it. It doesn’t matter that we manage it as well as anyone possibly could.

I don’t want my illness infiltrating my children’s’ growing years. But it does. Each time a little more.

This frustration doesn’t negate my gratitude for having access to a hospital that allows me whatever time it takes to treat acute episodes of this illness. But at the same time my gratitude sometimes feels like petrol when I attempt to douse the flames of frustration with it.

I know people feel relieved when I announce I am coming home. I don’t share their relief because it is not an easy slotting back into place. It is tearing my way back into a family that has been forced to operate without me. It is blinding and muting myself to all the tiny little things …and the bigger ones that they have had to do differently to survive the lack of me.

And yet, I know that my absence from my family is less damaging to them than my symptomatic presence would be, when I am barely safe in my own company. My distress at having no memory or concentration, at being loaded like a gun with pathological irritability, losing touch with reality – these are not things I want to subject my husband or children to.  It would shred us into irreparable pieces. So, I choose the lesser of the damages.

Even as I hate to think about the scar tissue left behind, I know I can repair the stretching, thinning induced by my absence, given time.

That time starts at discharge.

I will be home to begin work to repair while I work to reintegrate…possibly within days.

PS: The list of medications included in this piece is a snapshot of one evenings’ medications for me in hospital. It should never be used as a comparison to anyone else’s medication. Psychiatric medication regimes are highly individualised and often change over time. A medication combination that works well for one person can be a disaster for someone else, even if they share a diagnosis. Always consult a psychiatrist before taking any psychiatric medications. If that’s not an option, then a GP

You may also like to read:

When Covid-19 And Bipolar Recovery Collide With Unexpected Results

From Holiday To Hospital In Under A Month

Psychiatric Medication And Stigma

From Holiday To Hospital In Under A Month

The place from where my words usually come is wrapped in wet cotton wool. I am in hospital.

For years now my prodromal signs of loss of concentration and short term memory – which can be precursors to either a manic/psychotic episode or a depressive episode – have always landed on the manic/psychotic side.

This time the signs were the same. My psychiatrist and I gambled, counted on the past history of manic psychotic, adjusted medication accordingly.

Only it went the other way. I flattened, unhelpful phrases trudged like a battalion of soldiers through my soggy brain: …better off without you…. Everyone. 

There is no need for alarmed raising of eyebrows. This is not my first go on this merry-go-round.

Those derogatory words and phrases are completely alien to me. I can see them for what they are. Just a clinical sign. Nothing more, nothing less. They don’t prompt me to hatch self destructive plans. They prompt me towards my psychiatrist, and towards hospital, because the world feels like sandpaper on my soft brain. The hospital won’t fix it quick, but it will bandage the raw areas while they heal.

At this level I find depressive symptoms are easier to manage, easier to live with than manic symptoms…unless of course I plummet to the complete paralysis of catatonic depression…and then it’s just as horrid, possibly worse.

I may expand on this comparison of symptoms  in the future. For now there is no concentration, and motivation feels like riding a slug to catch up with a leopard made of quicksilver. There is literally no point.

I do own a new hospital mug. The design is fresh, green, paisley, floral… It is sprightly. It’s the  small things that make it less bad.

2020 Ends In Hospital

Insight: The Essential Ingredient

Visiting Someone In A Psychiatric Hospital?

Covid Lockdown In A Psychiatric Hospital

Medical Decision Making And The Wallpaper Effect

Thassos Island, Greece- Ouzo and olives at sunset -long before I had to make medical decisions for myself
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Let’s play a game.

Imagine being recommended a medication that you were told could lower your risk of dying. But to be fully informed before taking it, you were first required to spend 24 hours in a room wallpapered with all the potential risks and side effects of taking that medication printed in large, bold font.

The words all over that wallpaper are:

Dizziness, nausea, weight gain, diarrhoea, constipation, abdominal pain, vomiting, back pain, migraines, suicidality, paraesthesia, restless leg syndrome, blurred vision, ringing in the ears, eczema, itchiness, hives, agitation, irritability, nightmares, confusion, muscle pain, swelling of the face, lips, tongue, and/or throat that may cause difficulty in breathing or swallowing, impaired concentration, poor memory, hair loss, decreased thyroid function, hepatitis, liver failure, hallucinations, slurred speech, kidney failure, trouble walking, tremors, seizures, coma, death

After 24 hours you are let out of the room and presented with the medication. Would you take it?

I’ve had some experience assessing health related risk versus benefit. Professionally I’ve done it with every animal I have recommended a treatment or diagnostic test for, from the simple (routine vaccinations) to the complex (invasive surgery in a patient who is already unwell).

But perhaps my personal experience of taking psychiatric medications on and off for the last 15 years is more relevant. The above list is just a sample of the potential side effects of some of my medications. If I printed them all out, and then wall papered my house with them, I could easily torture myself into not taking any of them.

This is the wallpaper effect.

I don’t disregard any of the words on that list. I know someone who almost died as a direct result of taking one of the medications I take. I have recently been diagnosed with decreased thyroid function, very likely as a direct result of taking one of my medications, There have been other medications I have tried and had to discontinue because of side effects.

And to put the risks I am working with into perspective: Common side effects for many of these medications are considered able to affect up to 1 in 10 people, uncommon side effects may affect up to 1 in 100 people, and rare side effects – so the more serious ones in the above list – may affect up to 1 in 1000 people.

As risks go, they are not exactly tiny.

And yet I opt to religiously take these potentially life-threatening medications. Why? Because the risk of side effects (in me, at the moment) is less than the risk of my Bipolar 1 Disorder symptoms being poorly controlled.

I have a higher risk of both a poor quality of life and death from my Bipolar 1 Disorder if it is unmedicated than I do from my current medication regime. My risk of death if I do nothing to manage this illness sits between 15%-20% (including not only suicide but non intentional causes of death due to manic or psychotic symptoms, which can include increased risk taking, hypersexuality, poor judgement and delusional thinking).

Thanks to modern medicine, humans in first world countries  are confronted with death less often. It is easy to delude ourselves into thinking that death can be avoided if we ‘do our research’ and make the right choices.

Speaking of ‘research’: True research is not a google search. Neither is it being spoon-fed unsubstantiated claims on social media by someone who couldn’t make their way through one research paper if they tried, let alone the hundreds it would take to qualify what they were doing as actual research. Research is something academics, including scientists and some medical doctors, are trained to do. It is rigorous, unbiased, and a skill that takes years to learn.

I believe the choices most of us make about our health have less to do with ‘research’ and more to do with the biases our environment soaks us in.

If you see mobile morgues or dead bodies outside your window, you are more likely to want the vaccination that reduces the chances of you dying from what killed the people outside your window, even if the vaccine carries a very small risk of death.

If you don’t know anyone who has died from that same illness, but you are marinated in the announcement of a potentially fatal side effect of the vaccine every time you look at a screen, you are likely to be more reluctant to be vaccinated than someone in the first group.

The scientific risk of death due to side effect is identical in both populations but the human response is different according to which narrative is shoved into our malleable brains. The capacity to weigh true risk against benefit flies away.

And that is why I choose not to live in a house wallpapered with my medication side effects.

On Uncertainty

Covid Lockdown In A Psychiatric Hospital

Work Leave For Mental Illness If You Are Not Naomi Osaka

Naomi Osaka’s decision to step back from her job for reasons of mental ill health has stirred up a lot of debate in the last week. And yes, it’s great that she is being open about her mental ill health being the reason for this decision.

But Naomi Osaka is not representative of most people who experience mental ill health during their working life. The main reason is that (financially) Naomi can afford to take enough time off to recover.

I don’t point this out to minimise her suffering. Mental illness doesn’t discriminate. It will make you feel equally shit whether you are wealthy or not. But the luxury of time off for an employee to recover fully from an episode of mental illness is not one many workplaces will or even can accommodate.

This week several experts have stated that it is illegal for employers to discriminate against employees living with a mental illness, that these employees have a right to time off and to have their work modified to accommodate that mental illness.

I have mixed feelings about this. I feel exasperated, bemused, and tired. Because these earnest, well intentioned experts have no idea how mental illness and work mix in the real world.

The first time I experienced mental illness (postnatal psychosis followed by rebound depression) I was hospitalised for close to four months. ‘Luckily’ for my employer I was on maternity leave, so absolutely no thought had to be put into managing my absence, because it had already been planned for.

After I recovered, I continued to work as a small animal vet for another 12 years before taking a break to have my book published. In those 12 years I experienced a severe Bipolar 1 episode on average every 2-3 years. When I say severe, I mean requiring hospitalisation for weeks or months on end followed by a gradual re-integration to life outside the hospital.

Here are the two deal breakers my illness presents to most work places:

Firstly, for me, the onset of episodes of illness is sudden – ie between 24-48 hours. There is no time to plan or find someone to fill in.

Secondly, when I’ve had to phone work to say I would not be in for my next shift, I’d have to follow that with ‘I have no idea how long I will need off’.

Again – luckily for my employers – in those 12 years I was a casual employee. This meant I was effectively fired each time I got sick.

The practice I worked for was not doing anything illegal, and from a practical and financial point of view they could not have indefinitely held a position open for me. Each time I eventually recovered, and because there is almost never a shortage of work for vets – new hours were found for me. But me being able to slot back into the same workplace each time was due to the nature of the industry, not due to any laws to protect my position and income.

I am privileged, and thankfully my husband could support our family without my wage when I got sick. But my survival and roof over my head have had absolutely nothing to do with my workplaces being able to accommodate my mental illness.

Just because it isn’t legal to fire people or make their life hell because they live with mental illness doesn’t mean it isn’t happening. I know plenty of people who live with this reality.

This injustice occurs because of a gargantuan power imbalance between an employee who lives with a mental illness and their employer. Whether employers are aware of it or not: They hold all the power. Here’s why:

Stigma still prevents many people from disclosing they live with a mental illness to their employer – especially when they are asymptomatic. Once that person becomes symptomatic, they are likely to struggle just to get through each day or hour. Symptoms such as poor concentration and memory, distorted thinking, irritability, a sense of hopelessness, panic attacks, and non-existent self-esteem, (to list just a few) make it incredibly difficult if not impossible to not only schedule a meeting with their boss or with HR, but then present at that meeting as a fully functioning human being.

And if they do, and their boss discriminates against them they often don’t have the mental resilience and the finances for a legal battle to bring their discriminating employer to justice.  

These employees will often just go quietly –because that is all they have the energy for. Then their employer gets to shrug their shoulders and say: ‘Well it was the employee’s choice to leave!’

I am grateful to Naomi Osaka for cracking open the conversation about mental ill health at work a little wider. If it causes even one employer to stop and consider that the playing field between them and an employee who lives with mental illness isn’t even, it will be a good thing.

But there is still a long way to go before people who disclose their mental illness at work can expect to be treated the same as anyone who discloses a physical illness.

To read a bit more about my work life, you might like to check out my recently published memoir: Book and how it came to life: Welcome To The World ‘Abductions’

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