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.
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.
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
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.
In one week my immediate family and I are leaving for a holiday on Heron Island. That was a difficult sentence to commit to. Not the sentence, just one word.
The certainty inherent in those three letters. Articulating it feels like I am going to jinx it, like I will alter the course of history, even though I know that’s impossible.
This is our third attempt at this holiday. The first was over Easter 2021. I almost needn’t follow that up with any explanation. To use a recently much reworked cliché -everyone was in the same boat…or in our case not in the boat bound for our holiday destination.
It was a time of global holiday cancellations. We were all still invigorated by the adrenaline of the early days of a pandemic many believed could be conquered and left behind.
We rebooked our holiday for Easter this year. But in a twist of acutely painful timing our city was locked down. Ironically only for 3 days. But they were the exact 3 days we were meant to travel to Heron Island.
By the time that little lockdown ended, everyone else was off to enjoy their Easter camping trips. We were left feeling slapped, as though we had been singled out by the universe to miss out on our holiday.
But we rebooked again. For next week. Knowing it might not eventuate this time either.
And about three weeks ago doom crept into the family. We began to censor ourselves and each other. Snapping ‘If it happens!’ if anyone dared mention anything to do with the holiday. We shot each other down with sarcasm and repressed feelings as though expressing any plans, hope or joy associated with this holiday would save us the disappointment if it had to be cancelled again.
So, just under three weeks ago our family decided – that instead of clenching everything, and white knuckling it through this will-we-wont-we time, we would allow ourselves to feel the joyful anticipation of this holiday.
We began to talk about what snacks we’d take on the car trip. What we were looking forward to most. We wondered if we would see clown fish. We started making packing lists.
Don’t misunderstand me. This is not about mindlessly Pollyanna-ing the reality we live in. All four of us are abundantly aware that things can look like they are going ahead one day only to have them snatched away in a minute.
While it is true that right now we have no control over whether our holidays or special events will be cancelled at the last minute – it is also true that we never did, we just weren’t as acutely aware of it.
But we can choose how we feel in the lead up to planned events. We can choose to anticipate disappointment or anticipate joy. Whether it ends up being disappointment or joy is almost irrelevant because it isn’t about the eventual outcome. It is about how we feel right now.
We can choose to scrunch ourselves into a ball of anxious negativity. But for what? Being able to say ‘See I told you it would be cancelled’ if it is cancelled? Like a sort of sick Schadenfreude directed at ourselves.
Or we can choose a more relaxed, positive attitude that coexists with the knowledge that it may be cancelled, but that the anticipation is pleasant. If the holiday goes ahead we will have had a much nicer lead up to it, than having to spend the first few days unclenching from the negativity.
If it doesn’t happen, we’ll be disappointed, but we won’t have wrecked the preceding few weeks with dread.
Choosing to have low expectations in an attempt to avoid disappointment is not only flawed, but in these times of immense uncertainty it doesn’t serve us well. It robs us of joy. The brave thing to do is hope in the face of uncertainty regardless of whether that hope ever grows into reality.
That said, I have two disclaimers for the hope approach.
The first is that the ability to conjure hope relies on reasonable mental health. Someone experiencing symptoms of mental illness, especially those featuring depression or anxiety will no more be able to think themselves into hope than a diabetic can think their blood glucose levels into the correct range. They will need the right treatment for them before hope can become a choice again.
The second is that if you are attempting this with children, they need to be old enough/emotionally mature enough to understand that the hope does not guarantee the holiday.
For today, everyone in my family is well enough to hope that by mid next week we will get to see those clown fish and soak in the endless blues of the sky and the ocean surrounding our tiny Island destination.
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.
CN: brief non specific mentions of suicide, trauma, and eating disorders
If you have lived experience of mental illness, who tells your story?
Or even just fills in the blanks?
Silence about lived experience of mental illness from those who live with it is a frustrating paradox. Silence breeds stigma. Stigma breeds silence.
And there is a certain hypocrisy to complaining about the stigma if we choose silence.
I don’t say this lightly or without understanding the complexities of speaking out about our lived experiences.
I don’t live with an unprocessed trauma underlying my mental illness. Nor have I experienced treatment (or lack thereof) in the public mental health system. So, I have no right to speak about the ability or willingness of people to share their lived experience in these circumstances. I live with straight, white, cis-gendered, able bodied privilege. This means my path to diagnosis and high quality mental health care has been smoother than for those who don’t. All these factors make sharing my experiences easier.
One of the things I love about writing this blog is having ultimate control of my narrative. I don’t get paid for my posts. But I also don’t answer to anyone.
But I did recently have my voice stolen for a bit and I loathed the experience.
I’ve done some media interviews over the years Radio And Podcast Interviews and have generally felt empowered by and happy with the outcomes. Until this most recent one.
I agreed to it before I knew it would be written in first person based on a phone interview with me, but not written by me.
I was sent the article to fact check before it was published. The facts were correct. I hadn’t been misquoted, but it sounded nothing like me. It made me feel less than who I am. I was able to suggest some alterations. But even once my changes were incorporated the final article still felt clumsy. I would not have published it as one of my posts.
The journalist who interviewed me didn’t even tell me when the article was published. I found out when another journalist (who’d read the article) contacted me to ask if I’d be willing to interview for another ‘first person’ article written by them, about my experience of psychosis.
I politely declined. This (second) publication’s articles are sensationalist, pumped out to shock the masses and exploit the contributors. It would have been a hatchet job on my values. The opposite of empowering those with lived experience, educating those without.
I have no hesitation broaching my experience of psychosis with individuals, organisations, or the media, but only on my terms. Stories of psychosis are still in a different category to those of anxiety and depression. The media is not as used to them. They have to be handled with care and controlled by the person telling them.
I don’t even like my family or friends speaking for me about my illness. Not because I don’t trust them, but because I have more practice at relaying my experience with context and nuance.
However, disclosure around mental illness without an awareness of how to do it safely can be damaging, even dangerous. Whether you disclose your experience to one person, several, or in the media, yours and your audience’s safety must be your first priority.
If disclosure is likely to compromise your current mental health or retraumatise you, then you are not in the right space for it.
Especially if you are sharing with a wider audience you have to consider that some of that audience may be living through an episode of mental illness at the time of your disclosure and be particularly vulnerable to any information you share.
Content notes at the beginning of any article or interview containing triggering subjects for example suicide or trauma give your consumer the choice about whether they feel well enough to read/watch/listen on.
There are safe ways to relay distressing experiences to your audience. For example sharing an experience of a suicide attempt can help open up vital conversations around suicide and lessen stigma. But sharing explicit details about methods can be harmful to anyone in your audience who may be experiencing suicidal ideations. Similarly specific details about body weight, diet, or exercise should be left out of a safe disclosure around eating disorders.
Sharing your experience of mental illness is a personal decision. You have the absolute right not to.
But think about this – If you live with a mental illness and choose silence, you are leaving a space, for someone else less qualified to speak for you. A hole shaped like you, to be filled with more stigma.
If we give the world a void instead of our voices, it will fill it with its own assumptions. So, if you are well enough and able to do so – set your terms and boundaries, choose your conduit and gift the world your story.
I decided not to publish the link to the external article mentioned in this post. If you are interested in reading it to compare its style to my usual posts feel free to message or email me and I will share it individually.
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.
Most would agree that even just seeing the billowing smoke, the hellish glow, buckled tin roofs, smouldering ash, the ghostly silhouettes of dead animals lining the roads into obliterated small towns, even when viewed from the safe parts of the country and the globe, even when the horror is confined to a steady scroll behind a screen, is overwhelming. The helplessness bruises our emotions. We can be forgiven for making a donation, posting something derogatory about our inept prime minister and then switching off our screens for a bit.
For the fire fighters, the people in masks in boats under those bloodied skies there can be no thought other than surviving one hour or minute to the next. The same goes for the emergency services, the army personnel, those with loved ones in the danger zones, those who have lost loved ones.
But what about the rest of us. Yes, we can donate to the Red Cross or Celeste Barber or any of the other funds set up to try and help deal with this unprecedented crisis. We can go shopping and buy things on a list that are needed by the emergency services.