Pretty On The Inside

Two weeks ago I believed my insides were rotten and black. My heart felt like a sad, lost thing. I expressed this belief to two male psychiatrists who squirmed uncomfortably as I concluded the conversation with the unequivocal intensity of a manic patient, in a voice both deadly serious and loaded with the terror of real hopelessness, ‘everyone in this room is very horrible.’

Hospital

In previous lives I would have been the first to the whipping post. I would have been tortured and oppressed, silenced, beaten, starved, institutionalised; I would have suffered chastity belts and clitorodectomies. I would have been forced to suffer a lobotomy; I would have been thrown over the side of a ship. Fortunately times have changed but these days we face a the sinister presence of a system in which is in place to help the vulnerable and which, in many cases fails to help no matter how dark and terrifying things become, and no matter how hard I begged I found time and again that I was offered only excuses and the firm click of the door closing behind me. Instead of violent or more obvious discrimination I walked free from the hospital my husband had me committed to in a bid to prevent me falling off the edge of the earth, hauling my belongings, so high I saw the sky split open before me over Ormskirk, and I stared into it and thought to myself, my thoughts out loud, ‘my God, even You don’t love me now.’ My husband trailed behind me trying to calm me, with a knife in his pocket which I bought from Debenhams in a fit of depressive futility and which the hospital nurses confiscated from me on a search on my arrival there. I spat ‘I hate everyone’ like a teenager on discovering for the first time the absolute unfairness in the world though with a world-weary venom, and considered as the car moved onto the motorway throwing myself under the wheels of a moving vehicle though my husband had fortunately applied the child-locks. I talked about scoring drugs. He said he would divorce me if I did. I talked about ‘pain’ in a last ditch attempt to try to get someone to understand. Nobody seems to understand this word ‘pain’ or its relevance to a third-lifelong psychiatric patient. Such a familiar word, ‘you’re a fucking pain,’ ‘you’re a pain in the neck’- the psychiatrists think I am talking about backache – ‘no’ I say assertively, when I still hope they might help; I say, ‘think about the worst thing you can imagine happening to you – I am aching in this way CONSTANTLY.’

The life of a manic depressive who suffers many acute episodes in their lifetime is generally dramatic in unexpected ways, expansive in an existential sense and starts and stalls and progresses perhaps more haphazardly than someone not blighted by catastrophic extremes of mood. I have been hospitalised many times but can easily count seven significant hospitalisations dating back from the age of around thirteen, with eight significant and prolonged periods of mania or mixed affective symptoms or prolonged periods of ultra rapid cycling mood-swings, and four periods of depression or psychotic depression severe enough to warrant a serious hospitalisation. I have made several serious suicide attempts or attempts at self-harm which have required hospitalisation. I have taken every mood stabiliser, and the majority of anti-psychotics, and have had very long periods where I have had to use benzodiazepines, including clonazepam, lorazepam and diazepam to stay calm enough to live in any kind of manageable state. I have used antidepressants which have created elation and euphoria and have had to be stopped indefinitely. I have had periods of ‘stability’ on mirtazapine, lithium, haloperidol, chlorpromazine, respiridone, and depixol, though I must stress that at no time during any of these periods did I live a fulfilling life where I felt healthy or happy, or that the world around me was real, and I believe they prevented me from suicide only by dulling my experience of my world and my thoughts to the point where even ending my life seemed pointless. I continued to live my life without severe mood-swings though felt each day that I would rather sleep than do anything meaningful, and felt inertia which was frankly indescribable, even to me. I felt overweight, unattractive and endlessly sad. When I am very high I always tell everyone medication has never worked because I absolutely couldn’t stand the thought of being medicated again. And why would anyone who believes they are the centre of the universe want to feel drugged and alienated from both themselves, the people they love and society in general, ever again?

Although mood and emotion are inextricably linked and coupled, mood colours the world in a way emotion never can. High and low moods in a severe manic or depressive or mixed episode are recurrent and occur without the person having caused or created that mood in themselves. It is impossible for someone to ‘bring on’ bipolar extremes, though if a person has a disposition to the disorder, stress and trauma can cause symptoms to develop. I can only speak from personal experience and from evaluating the experiences I have of speaking to countless others diagnosed at some point with the disorder, that it is often a case of both nature and nurture which accounts for someone with recurrent and severe mood-swings which require hospitalisation. Often, it is a stressful event or series of triggers which bring on a serious episode but this is not always the case. Often it is simply a disposition, or even a default setting in the brain. Manic depression is unique to each person and so each person’s experience of mania, psychosis or despair is felt differently and so has to be understood uniquely. If you’ve ever taken ecstasy and believed the person you’re with, especially if it’s someone you don’t know, is just about the most amazing person you’ve ever met, that you understand them so well and they understand you and you’re going to ride off into the sunset together and life will never be the same again, only to discover during the comedown that these feelings dissipate rather dramatically, then this is a good analogy for describing the unrealistic nature of a high mood – and how it colours poor judgment and uninhibited actions but the realistic nature of emotion returns as the mood comes down again – the emotion is the universal structure which, though also unreliable, more reliably indicates the true feelings of a person who is not experiencing an abnormal mood-swing. Sadness and happiness are universal things. Sadness and happiness occur unexpectedly but never without cause. Mania and depression very often can occur without prior warning or any real explanation. It is true that there have been many stressful events in my life lately but I feel now not sufficiently so to warrant a suicide attempt. My life is wonderful. I know many wonderful people who care about me and love me, and I love many people. I have a wonderful career as a writer, which is fulfilling in every sense. I have a home and a family I am proud of, who bring me great happiness and joy. I have a great many things to regret and be sad about and experience ongoing pain over but sadness does not equate to the profound despair of a suicide attempt or the realisation that life cannot go on, and if it does go on a day longer then that will be something to regret unreservedly. I was in an unreal state each time I took the decision to walk this path. I would regret this though I feel I cannot regret a set of circumstances I had little control over. I feel great sadness and despondency, and some responsibility, though to what extent that responsibility was diminished is something only I can really ascertain.

So when the doctor I hadn’t thrown chairs at told my husband ‘your wife just has trouble controlling her emotions’ and my husband tentatively relayed this discussion to me a week later I shut my mouth and again, felt like falling off the edge of the world. There are some things during this time I felt were worth jotting in the margins of my notebook: the doctor in question asked me in an antagonising tone if ‘this is all just a cry for help, then?’ and ‘a cry for help’ simply doesn’t equate to booking a hotel room and buying a knife, only to be prevented from acting by services intervening and the whole scenario causing many people including myself enormous distress – that dying is far harder than it first appears, and that power necessitates people at the top and those at the very bottom and when you are at the very bottom there will always be someone more powerful than you ready and willing to drop you from a great height if no-one seems to be watching. The trick is not to look them in the eye at all.

I have a belief, however naive, that my emotional life is quite pristine at times. When my mood is quite stable I find I can cope with just about anything; that I can calm myself easily in difficult situations, that I can relate to others and have virtually endless empathy and compassion. I feel I can quickly and sensitively assess situations, others, and communicate my way through any kind of hell. I’m as fallible as anyone else and more intense than most people I know and acknowledge this, but part of this is intellect, and part of this is a turbulent but healthy emotional life; I have no difficulty navigating the emotional landscapes of this life. I’m a balanced person, psychologically, I have reason and logic at my disposal, I’m philosophical, and in fact quite a spiritual creature. I have painful insight into my own experience and the human condition generally but this has helped me write successfully (at least some of the time). I am a kind person and I try hard for the people I love. My children are emotionally secure and happy, and despite being difficult when I’m high, my husband tells me I make him very happy and that he believes I am brave and strong. I often feel like a successful human being! – not in terms of social concerns like money and status but just in myself.

All this said, with all the will and insight in the world I fail to successfully control my moods. I have found ways of using and utilising hypomania to my advantage, as many people with these extremes learn to do given enough time, in writing, in performing my work on occasion, in spending time with people and appearing capable and confident, and ‘happy.’ I have found ways of riding the wave of depression and despair but have found no adequate remedy or way of stoppering that severe and crushing ‘pain.’ I work so hard to ride the wave each day now, but still it comes. My life has regularly fallen apart, through every fault of my own but crucially in the wake of a tumultuous mood-swing in every single case; the sky has split myself wide open right in front of me, I can’t count the things I have lost, and I have dragged myself both away from and into the void – just to have a psychiatrist who has never met me in his life before sit my husband down and say, ‘listen, she doesn’t have a mental illness, so we can’t give her medication; she just has difficulty controlling her emotions.’

Once I wrote this grandiose statement when high and I like to repeat it these days: ‘rage is underrated.’ Without rage, how does one confront the hideous but delicate hypocrisy and corruption psychiatry awakes in the heart and mind of a manic depressive when the door is closed firmly behind them and the judgment of one man playing God in a room full of disciples just trying to earn a decent living is that the person expressing great distress is really full of shit? I have been too exhausted lately to fight or write, and this is awful, as writing is my way of interpreting the world and understanding my own thoughts; but I feel now that what has happened to me has been the greatest injustice and insult to my intelligence and self-awareness. Essentially, what the doctors are saying is the things I have expressed and the way I have presented for most of my life in their offices is bullshit, that I have someone lied and managed to fool them all, that I am emotionally unstable, not to be trusted or listened to. I am not trusted or listened to because I am articulate, strong and passionate, and I talk too fucking loud. It is patriarchy at its worst and because I have refused to shake their hands or be patted on the head, or live a docile existence on drugs which make me feel demoralised and controlled – I have been spat out of the system I only came to for help. And it is not just me; I have met countless (specifically and almost exclusively) women who have been catapulted into this mindfuck of neglect and unfairness. Psychiatry is a whole universe of its own and is outside most people’s remit of experience – it lies on very, very shaky foundations, is not a science and there is no ‘cure’ for bipolar disorder – and it often fails to see a person as a whole being and not just a set of unconnected symptoms which either fit or don’t fit the ‘typical’ and ‘standard’ clinical models and profiles which describe the mentally ill. I am not the first writer with bipolar disorder. I am not the first writer to attempt suicide, and I am not the first writer to describe the alienating world of modern psychiatry.

My mind and every other mind is so unique, vast and individually intricate and beautiful and I will always defy category in this life, though I was happy to live within the parameters of the term ‘bipolar’ if it did indeed mean I would be offered help, support and relief, however temporary, from the pain I experience mentally. I have worked with psychiatry, worked with the medication, tried and tried again. I have seen psychologists and social workers, and have taught myself meditation, how to use routine and writing as structure and therapy, and look after myself to the best of my ability. I believe the only description of my mind which will ever be realistic, adequate or enlightening as to my own experience is in my poetry – where my disconnected thoughts and subconscious workings settle into meaning which is interpreted and understood by those who read and find meaning in it. Poetry, and art and music, all describe that which cannot be expressed or described in any other way. I am ever grateful for its presence in my life. I am also ever grateful for those who support me.

The psychiatrist I did throw chairs at when I was rocket-high, crossed his legs and asked, ‘so you’re the philosopher?’ At this point I had been crying in despair in a seclusion room all night, unmedicated, wanting to be ‘under the ground with a cold heart and no consciousness’ with no-one to talk to and as was most painful to me that night, no means to successfully end my life. I was crying so deeply I couldn’t immediately respond or talk so when he said, ‘so you don’t want to talk now, well you’ll have to talk another time’ and attempted to dismiss me, I replied in absolute agony (before telling him not to patronise me) ‘yes, of course I want to talk, I’m just SO DEPRESSED.’ They expect you to talk when you can barely manage it and yet when you do articulate your experience they are suspicious of it – no psychiatrist has ever really allowed me to speak. A lot of their statements are provocative and ultimately, acts of manipulation. All I ever really wanted was a doctor who would look into my eyes and say ‘I want to make the pain go away’ and for them to believe what I am saying. For them to be able to conceptualise both what this pain is and means and how I differ from every other person who is alive, or who has ever lived. Time and again I return to the Nirvana song ‘Heart-Shaped Box’ for relief – a song I once heard described as ‘a dysfunctional love song’ though for me it describes the misery of a psychiatry and a system that does not allow for patients who refuse to do exactly as they are told – ‘hey, wait/I’ve got a real complaint/ forever in debt to your priceless advice’ – ‘throw down your umbilical noose so I can/ climb right back.’

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