Tag: Psychology

Surviving On Snippets Of Hope

I know people who don’t consume the news anymore. Others avidly click, swipe, and share and demand the shares be shared and that donations be made.

A sense of needing to ‘do something’ beats like a heart behind our screens.

Some say the carnage and its causes are complex. Others claim it couldn’t be simpler. Meanwhile, powerful, malevolent toddlers masquerading as leaders extinguish lives with their belligerent tantrums. This kind of hellish tit for tat has been going on all over the planet for aeons. There’s nothing new about our news.

The atrocities we were clicking and swiping and enthusiastically sharing and donating to a year or two ago, are far from over.  This trauma has not stopped. It’s just not as fresh as what we are fed from further south right now.

While my bipolar disorder sleeps, I choose to neither soak myself in headlines nor bury my head in our (increasingly hot) sand.

I have always struggled to understand warring over a homeland, because (regardless of my genetics, birthplace, or heritage) I don’t identify as belonging to a country or a people. I was taught to be a chameleon, a grateful visitor wherever I go. It has been drilled into the DNA of my family who moved around a lot, who has flight in its history, whose ancestors have done their best not to be in the wrong place at the wrong time.

I don’t believe humanity has quite enough humanity to ever achieve world peace. If we had the capacity to resolve conflict without collateral civilian casualties, we’d have done so a long time ago.

Our individual lack of control over global catastrophes and atrocities can feel depressing. But we can each control how we react to our feelings. Providing we are not experiencing a severe episode of clinical depression, we can feed our sense of hope by turning a microscope on our own lives and surroundings.

Good stories play out near us all the time. I witnessed one on holidays at the beach recently:

A not so gentle day. Dumping waves boiled the water. One after the other. If you got caught up in one of those you became an ingredient in a soup of flailing limbs. A bit closer to the shore we laughed and played in the sea foam bubble bath, eyes always on the incoming, legs resisting the drag out into the angry ocean.

Then to my right a little girl, five or six, began to cry. The wash after a wave swallowed her and spat her back up like an acorn. Spluttering, she looked wildly about. I assumed the woman near her was her grandmother. She scooped up the crying girl and pointed to some other adults nearby. The girl shook her head, sobbed red faced, hair plastered to her head.  I just caught the older woman’s words above the rush of water.

‘Can you point to your mummy or daddy darling?’

The girl was crying too hard for speech, too hard to point. This was not her grandmother.

Yet she positioned the girl on one wide hip and purposefully strode away from danger. Finally, where the waves petered out onto the sand, the girl’s father appeared, and a narrative that could have played out so badly, ended well.

While the brutality of the news can suck the happiness out of our heads, good things still exist. And they don’t need to be stories. Simple snippets suffice:

Taking refuge from a storm in a second hand book shop.

 Sleeping cats.

A tidy bedroom and a good book.

The sound of cicadas.

Wildlife visitors.

Converting ingredients into a meal.

Having a kitchen to cook in.

A warm hand to hold walking in the summer breeze.

A rainbow, thunder, and lightning occupying the sky all at once.

The clink of ice cubes against a condensation beaded glass, and the first sip.

Clean pyjamas after an evening shower.

Children growing into themselves.

Free will and choice…

When I disengage from my screens for long enough to look around me, snippets appear everywhere.

I have at times been guilty of outrage in response to what my screens feed me.

But, for me, outrage on its own achieves little. It is hot air shouted into a furnace. And it is a luxury I can’t afford or sustain, because ongoing outrage can convert into powerful fuel for a bipolar episode.

On the other hand, deciding to tend the happiness in my own backyard builds the strength to do meaningful things for myself and the wider world.

PS: If you are clinically mentally unwell, then the suggestions in this post to focus on the positives around you apply only if you are well enough to do so. Symptoms of severe mental illness, especially clinical depression, can make it impossible to focus on the positives without more targeted treatments, such as psychological or medical therapies.

For me, a sign that I need more support than the power of positive thought is when I find it impossible to focus on the positive, and guilt and negative self-talk set in, because I’ve failed to appreciate the positive.

Lastly, if I were currently experiencing a bipolar episode I would not consume any news, and would focus solely on recovery.

You may also like:

Gentle Shoots Of Hope

Deciding To Hope

Accepting The Unacceptable

It has taken well over a decade.

In the beginning ours was an abusive relationship. Bipolar 1 Disorder entered my world by clubbing me over the head and dragging me away from myself and my life. There was no informed consent. No polite knocking at my door and asking ‘Are you ok with this invasion? Are you ok with me setting up camp in your head for the rest of your life?’

That first time, it committed horrendous crimes. It stole my most prized possession. All my control. It obliterated my reality, snatched me away from my husband and baby, sped me up and then poured concrete over me. I was convinced it would kill me…

But it didn’t.

When I finally kicked and screamed my way free, I sat panting on the other side of it, scraping all remnants of it out of my brain and off my skin, I vowed never to let anything do that to me again. This was the first and last time. I knew better now.

I knew nothing.

When my doctor told me it was unlikely that this would be my last encounter with it, I nodded but didn’t believe him.

It came, not immediately but in roughly two-year intervals again and again and again. When the early signs of those first recurrences nudged and poked and then slapped me in the face, I turned my back and raged ‘No, no , no this can’t be happening again!’

My denial fed the power it had over me to super levels.

I tried to fight it with sheer will and my bare hands grabbing at the invisibility of it. It laughed and continued to snatch my sanity, drop kicking me into hospital sometimes for months at a time.

In the face of this illness my denial was a house built of dandelion seeds.

Eventually a sliver of acceptance crept in. But only while I was sick. The moment I regained myself after each episode, I ran back into the arms of my previous life. Working and doing and being who I was before all of this. Driven by a need to prove to the world: ‘See I live with this illness and can still do it all!’

I can…but there is a cost.

In 2015 it broke me. It locked me in a torture chamber and made it clear that it was going nowhere. I sped into a brick wall, lost my reality, lost my living brain, had to have it shocked back into a feeble beginning again and again.

I limped away finally understanding that we were shackled together for the rest of my life.

I told my psychiatrist: ‘I don’t know what to do, I can’t keep doing this!’

He paused, then said:

‘Perhaps you have to learn to take this illness as seriously when you are well as when you are unwell.’

He was right.

By then I had learnt to pay lip service to my management of this illness when I was well by diligently taking my medication, living relatively healthily, taking care of sleep etc, But I had not mentally accepted that I live with Bipolar 1 Disorder every day, whether I am well or not.  I had made the easy, obvious choices, the choices that have become second nature, like exercising and taking my medications.

But it has taken much longer and been harder to make the longer-term decisions that are just as much a part of looking after myself.  Decisions like how to work and what is worth pursuing and weighing up the price I might pay for stress. Things I had the luxury of never considering before.

Fighting acceptance hasn’t served me well. Denial can damage me easily as much as the illness itself.

I have learnt acceptance is not giving up. Acceptance also doesn’t mean that the next time I get sick I will feel nothing but saintly calm. The unfairness of being yanked away from my life with no notice will still sting and ache.

I no longer leave this disorder behind in the rear vision mirror after each episode. It stays in my peripheral vision. But, the less I fight it, the milder the rope burn from being tethered to it.

It doesn’t define who I am, but I no longer expend energy proving it is not part of me. Because it always will be.

You may also like to check out the following posts:

On Uncertainty

The Well Times

Making Sense Of It

Don’t Bright Side Me

I don’t have 800 articulate words tied up in a neat bright-side bow in me today. So this instagram post it is. For context I am now into into my third week in hospital. Some of the manic symptoms are settling. The caption accompanying this instagram post is:

The symptoms are horrible, but it is never just about the symptoms. The symptoms and connotations severe mental illness carry with it. leave me staring at the rubble of my identity during and in the aftermath of every episode. It is never just about the symptoms…

#bipolar1disorder #vulnerability #psychiatrichospital #mentalillness #stigma #identityloss #thoughtfood #abductionsfrommybeautifullife

Other reading:

Visiting Someone In A Psychiatric Hospital?

From Holiday To Hospital In Under A Month

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

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

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

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
.

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

Goodbye My Thought Food Cover Girl

Lucy – photo by Elsa

A dull ache sits in my centre. My cat Lucy, immortalised next to my old red keyboard on my Thought Food home page, is gone.

2 days ago the vet in me woke to a 16 year old depressed, immobile, incontinent feline patient. I  needed more information before communicating with the cat’s owner, who was also me. The owner could read the vet’s face though and it made her feel as though a cactus was growing in her chest.

The vet came back with information later in the day.

Hypothermia, likely anaemia hiding under haemoconcentration, severe azotemia in the face of likely hyposthenuria, severe hyperglycaemia, and elevated ALT

At that point the owner and the vet in me began to overlap, like a Venn diagram, and both parts of me knew enough to know this:

None of these big words gave us a definitive diagnosis. To get to the big word that was causing the multi organ system problems indicated by a physical exam and first round of blood tests, we’d need to enter a new level of the diagnostics game. And with each new diagnostic test we’d opt for we’d open up the possibility of needing still more tests to get to the bottom of it.

What justifies further diagnostics in veterinary medicine?

The chance that the definitive diagnosis is something treatable or manageable to the point of returning the patient to a good quality of life.

When I started work as a small animal vet in 1998 we had fewer diagnostic and treatment options available for pets. It is good to have more options now. There are absolutely cases where we can return animals to a great quality of life where they would have been euthanased when I first graduated.

But this advanced knowledge also complicates matters, particularly when it comes to caring for our geriatric pets.

People often assume that the hardest part of being a vet is euthanasing animals. Yes, it can be devastating. But I have always found it equally as hard, if not harder, to hand hold people through the process of coming to terms with the fact that it is time to euthanase, while their pet is put through diagnostics and treatments that may prolong life but do nothing for quality of life.

An internal medicine specialist may well have wanted to know exactly what the cause of my cat’s abnormal blood results were before giving me their blessing to euthanase.

And, with those blood test results, had my cat been 2 instead of 16, I still would have stopped to consider that euthanasia could be the end point. But I would have gone ahead with more diagnostics because the chances of them leading to an outcome with a good quality of life for my cat would have been higher.

But I also knew that had I insisted on a definitive diagnosis 2 days ago, Lucy could have spent her last days scared, in a fluorescently lit hospital having rectal temperatures, blood and urine samples taken at regular intervals with no knowledge of why it was happening. Had she been able to come home it would have been heavily medicated, and still not feeling 100%.

When I weighed this with the tiny chance that she was suffering something treatable with a chance of return to good health – the risk of putting her through fear and pain for nothing at the age of 16 was not one I was willing to take.

Instead we made the hard choice.

Instead all four of her people cuddled her. We whispered in her little round ears and wet her fur with our tears. And I stroked her velvet neck as she drifted off into anaesthesia and then away into death.

Later that night I laid down next to Lucy’s siter, Lily and burst into deep sobs. These cats entered my life before the mental illness that came with my human children. With Lucy I have lost another part of me that existed before everything changed irreversibly…and not all for the better. The waves of grief beach unexpected thoughts and feelings.

When I work, I am not brutally honest with a vulnerable client if they ask me ‘What would you do in this situation?’ I stick to the facts, lay out probabilities as best I can and make sure euthanasia is part of the conversation so that they can make their own informed decision, in as much as their own time as their pet’s welfare allows.

But if the vet in me had been advising the cat owner in me for Lucy, I would not have held back. I would have said:

‘We can do every diagnostic test under the sun and you will probably get an answer, but we are doing it for you, not for your pet.’

Just because we can do something, doesn’t always mean we should.

In loving memory of Lucy (14.2.2005 – 7.5.2021)

You can find some of my other veterinary content in these posts:

The Cost Of Canine Anxiety

Veterinary Work And Bipolar Disorder: A Podcast Interview

Veterinary Work In The Time Of Covid-19: Unspoken Truths

Welcome To The World ‘Abductions’

Elation

For the last 14 years this emotion and I have had a complicated relationship. Before that, I experienced its giddy joy like anyone else.

It greeted me on the first days of longed-for holidays.

I experienced it on planes during take-off. In that moment of palpable lift, when the wheels left the ground and I shed gravity for a while.

It swooped through my body when I’d meet my childhood best friend, Sandra, at airports and train stations in different countries after years of separation.

Many moments of elation were tied to achievement. School grades, University degrees, getting jobs, have all elicited it. A psychologist would grimace at that, but there you have it.

But when I was nearly 33 something happened that warped elation for me.

I gave birth to my first baby.

The birth of a baby is usually viewed as the ultimate source of elation. Much is made of the overjoy of brand-new mothers.

But I was brewing something sinister when I went into my 33 hour labour on 2 hours sleep. That sleep deprivation, and the massive shift in hormones after the birth became the key that fitted the genetic lock for my dormant Bipolar 1 Disorder. It introduced itself violently, as an episode of postnatal psychosis when my baby was seven days old.

Three and a half years later I did get a day of pure elation after the carefully managed birth of my second baby. But I took none of it for granted, as though I had an inkling the psychosis would be back at the six week mark.

Psychosis in Bipolar Disorder is often preceded by mania. For some people mania is preceded by hypomania, which is like an artificial sweetener to the sugar of real elation. Same same, but different.

I do experience hypomania, but it is transient. Blink and you’ll miss it before it progresses to the high speed car chase of mania. I don’t spend weeks feeling fantastic about everything.  But I’ve lived through enough hypomania to make me wary of true elation.

I force my elation through an airport security like checkpoint before I allow myself to feel it, because I know it could be the hypomanic second that precedes a manic episode.

So when elation wings its way into my heart, I put it through my metal detector of questions: How are you sleeping? Any racing thoughts? How’s your memory and concentration? Any sense of urgency, a pressure in the part of your brain right behind your eyes?

But right now I am truly elated.

Even my psychiatrist agreed I am entitled to it, after I handed him my third baby a couple of days ago.

My third baby is of the paper variety. Its newborn smell is that of fresh new books.  Its gestation period has been longer than a human’s, longer than an elephant’s. 14 years from first words to published.

This baby’s name is ‘Abductions From My Beautiful Life’, nicknamed ‘Abductions’, and it is my memoir.

You will find my DNA all through it. My many selves. The child, teenager, university student, veterinarian, mother, psychiatric inpatient and outpatient, writer, mental health advocate, partner, and friend.

I wrote this book because there are not enough first-person accounts of severe mental illness, especially those featuring psychosis. I wanted to dissolve some of the misconceptions about people who live with severe mental illness, and the stigma that accompanies them.

The road to get this book published has been long, rough, expensive, paved with barely-existent patience, blood, sweat, many tears, diplomacy, and a lot of rejection.

It seems– books that deal frankly with mental illness (other than depression and anxiety) are too prickly for many publishers to touch – or to quote the feedback my agent and I got time and time again:

‘It is beautifully written, and an important story, but it is not commercial enough’ ie it will not make us any money, so we won’t go near it.

After several years of rejections, I did finally find a way to have it published, via a contributory contract with a publishing house in London that I supplemented with my own freelance cover designer and freelance copyeditor, to ensure it was published to a professional standard.

To the countless Australian publishers who passed on this book because ‘although beautifully written, it was not commercial enough’ – I say:

This book was never intended to be the next Harry Potter, or 50 Shades of Grey. But having finally published it I am elated because I have given the people who might be interested, the opportunity to read this allegedly ‘well written important story’.

An opportunity they may never have had if I had given up on it. So if you are one of those interested readers, you now get to decide whether or not you like it, rather than having an anonymous wall of publishers tell you what you should or shouldn’t be reading.

All reviews, feedback, and comments are welcome. For now you can leave them in the Comments section of this post, or email me at anitalink73@gmail.com

And if you do enjoy Abductions or find it meaningful and you can think of someone else it might resonate with, recommend it to them or maybe even gift them a copy.

Publication, purchasing, and launching information:

Abductions From My Beautiful Life will be published on Friday 30.4.2021

You can preorder it now and continue to order it once it is published from:

Amazon Australia – click the link BELOW the image

https://www.amazon.com.au/Abductions-Beautiful-Life-Anita-Link/dp/152898319X/ref=sr_1_1?dchild=1&keywords=anita+link&qid=1619352950&sr=8-1

Fishpond Australia

https://www.fishpond.com.au/Books/Abductions-From-My-Beautiful-Life-Anita-Link/9781528983198

Booktopia Australia

Booktopia https://www.booktopia.com.au/abductions-from-my-beautiful-life-anita-link/book/9781528983198.html

If ordering from the UK:

Fishpond UK

https://www.fishpond.co.uk/Books/Abductions-From-My-Beautiful-Life-Anita-Link/9781528983198

Austin Macauley

https://www.austinmacauley.com/book/abductions-my-beautiful-life

Waterstones

https://www.waterstones.com/book/abductions-from-my-beautiful-life/anita-link/9781528983198

If ordering from the US

Amazon US – click the link BELOW the image

https://www.amazon.com/Abductions-Beautiful-Life-Anita-Link-ebook/dp/B091N7BSZP/ref=sr_1_1?dchild=1&keywords=abductions+from+my+beautiful+life&qid=1619353373&sr=8-1

Barnes and Noble

https://www.barnesandnoble.com/w/abductions-from-my-beautiful-life-anita-link/1139205441?ean=9781528983198

Launches:

To begin with I am planning several smaller private launches over the next few weeks and months rather than one big one. They will probably take place at my house to work as flexibly as possible with ever changing Covid restrictions. But the format will be similar to a traditional launch with drinks, discussion of the book, maybe a reading, and books for sale and for signing, or if you’ve pre-bought your book you can bring it along to be signed.

 If you live in or are passing through Brisbane and would be interested in coming along to one of these smaller launches, please email (anitalink73@gmailcom) or Instagram DM me @anitalinkthoughtfood so that I am aware of your interest when I send out invitations.

I will post further information about launches as they evolve.

For more on how ‘Abductions’ came into being you might like to check out:

Accepted: Crumbs To Canary Wharf

And you can find a brief excerpt here: Book