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Hot Cross Buns Ruined My Easter

Despite being fully possessed of as much emotional baggage and unpleasant childhood/adolescent happenings as the next basket case, I have always been reluctant to engage in any kind of talking therapy.  Blame it on the Yorkshire genes.  Recognising, however, that Being Northern was probably not going to cut the mustard as reasonable justification for continuing with my favoured coping mechanisms (consisting chiefly of vodka, self-harm and hiding under the duvet), I decided to pursue J's suggestion of a practical talking therapy that would help me address and combat my 'triggers' - things that set off a hypomanic or depressive episode - without delving too much into the realms of exploratory psychotherapy.   This turned out to be cognitive beahvioural therapy, or CBT.  CBT exploded onto the mental health 'scene' a few years back and swiftly established itself as the new millenium's therapy du jour.  It's supposed to help you look at the way that you think, identify unhealthy thought patterns and tackle them with the Power of Logic, gradually rewiring your brain until it dispenses with throwing spanners labelled 'EVERYBODY HATES YOU' into the works of your everyday life.  It's actually not a bad plan on paper, and it definitely works for some people - converts to CBT are zealous in their praise of it.  So, all things considered, it looked to be worth a shot.

There are many reasons why it didn't work out, not least the fact that my therapist (let's call her T) and I just didn't hit it off.  But I like to blame it on hot cross buns, partly because it makes for a catchy blog title.  Hot Cross Buns are, for the uninitiated, not the all-butter fruit n'spice bun forever immortalised in nursery rhyme.  They are homework sheets that you have to complete to chart how your mind and body react to bad or intrusive thoughts.  This handy key should help you differentiate:

Hot Cross Bun

Not Much Fun

It turned out that the act of recording my negative thoughts and actions, then analysing them with someone with whom I had zero rapport was not entirely conducive to better mental health. Couple this with my notoriously poor handwriting skills and you come out with hours' worth of exchanges that went something like this:

T: So you've written here....what does this say?
19: Oh, um, yeah that says 'clawing at my face'.
T:  Clawing at your face....mmmm.  OK.  And do you think that was productive?
19: Um...well, no but...
T:  No.  So what could you have done instead of that...that clawing, mmm?  Can you think of anything you could have done?  That could have been more productive?
19: Um...

And so on.

It is possible that events on the day of my first appointment have also clouded my overall view slightly.  By the time I had clad my flu-ridden body in several layers of mangy yet comforting jersey and dragged it the 20 minutes down the road to the hospital, the combination of ill-sweats, flu-shivers and the November drizzle's magical frizz effect had conspired to lend me the air of an escapee from the electro-shock room in One Flew Over The Cuckoo's Nest.  This uncomfortable thought was not quieted by the ominous iron bars on the windows of the squat building I had been directed to.  It was this building that was to play host to an event so ridiculously farcical as to have no place outside Sophie Kinsella novels, or 00s rom-coms starring Jennifer Aniston. As I schlepped woozily up the stairs and rounded the corner to the waiting room, I found myself quite suddenly nose-to-nose with A.  A from school.  A who is now a trainee clinical psychologist working in the hospital proposing to treat me, apparently.  Suffice to say that, in a VI Form common room perpetually one step away from descending into a scene from Battle Royale, A and I occupied diametrically opposed (and geographically literal) sides.  It was therefore natural that, in that hideous, car-crash moment of mutual recognition, and despite the fact that A was clearly now a medical professional and therefore this would never happen (would it?), all I could envisage was the Class of 97 gossip phone tree springing into action, poised to revel in the gory details of my inevitable demise. 

A aside (I wrote an email  to her supervisor explaining the situation and requesting that we didn't work together), I'm aware that at some point it might be a good idea to board the therapy train again.  But for the moment, I'm more than happy to put off discussion of my psyche and let the Lamotrigine do its work. At least until I can look in a baker's window at Easter without screaming, that is.

 



 








 

Diagnosis: Part One

October 2011

My most recent plan of action re: combating The Condition (Trying Really Hard Not To Be Crazy, or TRH – see above) had by this time comprehensively failed: all of my concerted efforts to train it or to (quite literally) beat it out of myself had ground to a halt in the face of the worst low I had experienced in years.  Whilst I don’t wish to bore you with unnecessary details/whine about my Inner Pain, it might be useful to have a little bit of context here.  Everyone experiences their highs and lows in different ways, and I guess mine are best described as types of noise, so I've outlined these below:

Ever so slightly cringy as it sounds, if I had to soundtrack my highs I’d choose the overture to Mozart’s Marriage of Figaro. It moves at breakneck speed, but in joyful, harmonic explosions which always resolve into perfect cadences. Whilst high, I have genuinely believed myself to be something approaching a superior being, operating at a higher level. I can feel my intellect sparking off ideas: stratospheric, beautiful ideas that make your humdrum world, your dull moral code, seem laughable. In my highest states, I have actively courted danger, exhilarated by the feeling of nihilism and by my proximity to destruction whilst simultaneously believing that nothing as mundane as the effects of physical reality could actually harm me. I also lose all ability to empathise when high – I am separated from the rest of the world, so why would the rest of the world be affected by my actions? The world moves too slowly for the speed I want to, NEED to move at. Physically, I can feel my heartbeat pulsating though my body and my skin fizz-crackling with energy. My head is filled with animated, chattering thoughts.

And so to the flip side of the coin. Most people think of depression as silence, a void. Mine is a cacophony featuring white noise and voices, my own and not my own, whispering, shouting, wailing my uselessness. These build to a crippling anxiety which I feel physically, like a fist around my throat and chest, making me pant. My stomach churns and instead of the world not keeping up with me, I become vertiginous, as though the world is a travelator rushing forwards and I am about to be thrown off. I try to get rid of the noise and voices in various ways – beating them out, clawing at my face and neck, burning them out with cigarette ends. The rush of pain brings momentary calm, and sometimes I can cry. Sometimes the exhaustion will let me sleep. The delusions here are not the symphonic ones above. The only peace I can find is in thoughts of death; of how and when. I wonder how quick being run over would be, I know that jumping in front of the Tube would be easy and instantaneous. I am convinced that everyone in my life would be better off if I were not here, that I’m an utter nuisance because my brain can’t function like a normal person, I can’t function like a normal person, can’t be relied on, can’t help anyone, can’t be useful. I’m disgusting and everybody is looking at me, realising it. I’m an awful person; worse than a waste because I actively drain everyone around me.

So. At the peak of the latest cacophony, I hadn’t slept in weeks, had been self-harming with increased frequency, had forgotten what it was like not to need headphones to drown out the voices, and D was beginning to wonder who had made off with his girlfriend. At this point, and with enough distance from my last fiasco of a foray into psychiatrics, I was forced to admit that maybe it might be possible that in the entirety of the medical establishment, someone might be able to shed a little light and a little relief on the situation.

In the event, speaking to J turned out to be a very different experience from my assessment seven years ago. He was the first person ever to explore my relationship with bipolar, which turned out to be a damn sight more complex than I’d imagined. It was also one of the most crucial steps towards coming to terms with my condition. Although it falls under the category of being a mental illness, most sufferers will tell you that they wouldn’t be without their bipolar. I am amongst them. As for many others, this 'illness' has been at least partially responsible for many of my creative and academic successes. Most bipolar people will tell you that being high is amazing; so amazing that however 'orrible the lows are, they have continually thought of them as pay-off for feeling more alive than the average person.  They will also, myself included, tell you that even at their lowest ebb they cling to the knowledge that they feel more, and more keenly, than most other people.

So it’s not as cut-and-dried as an exterior force that you want to fight. But neither is it – for me, at least – an exterior force at all. I’m told that some people develop symptoms of bipolar later in life, some in their teens, some even earlier. For me, it’s been a constant companion. I have no recollection of a time when my brain did not work in the way it does. In fact, it has come as something of a surprise, over the years, to learn that not everybody experiences a relationship with their brain in the same way that I do; still more that they often do not see their brain as something with which to have a relationship at all, but simply a functioning tool in their bodily machine.

It has also come as a surprise over the years that some other people have an objective, constant understanding of both themselves and of the world, indeed of reality itself, often based on a fundamental sense of self-worth.  For years, right up until I found myself in J’s office, I retained the certainty that nobody actually existed in this way. Surely no one really, actively liked themselves, or thought that their voice and opinions were genuinely more valid than the next person’s. They had just learned to act like that; trained themselves tirelessly into this unnatural way of thinking, essentially because they were stronger, better, and more efficient than I. It continues to astound me that there are countless numbers of people walking the planet who, though they appear quite ordinary to the naked eye, do not entertain the company of a voice in their head telling them just how shit they are most of the time. Who operate from a basic level of happiness with themselves; for whom social gatherings are always to be looked forward to as a source of good clean fun.  If this does not transpire, then it is generally for a solid, tangible reason rather than a sudden, overwhelming certainty that the people whom I have just met/ have no reason to dislike me/have been my closest friends for 10 years think that I am a twat, and with good reason, for I am fundamentally a useless specimen. When J probed me on this, I ended up realizing that for years and years, I had been like a slide projector: my outer shell remained the same, but a plethora of wildly contrasting selves whirled around on a reel somewhere inside me, being projected out onto the world in line with my mental state. No ‘self’ felt like a lie until my state shifted, at which point it becomes laughable to think that what I firmly believed only a moment ago could possibly be true, when its opposite was so mind-blowingly clear. In the same way as my interior self could shift, so the exterior world could change shape entirely at a moment’s notice. As the states and the selves shifted, I would berate my brain for not working properly, not seeing the Real Truth. I would also have windows of what may or may not have been clarity between these changing states and changing selves, in which I would become terrified of being crazy, my brain felt like an intruder, an enemy.

The upshot to all of this conjecture, however, is that - for better or worse - bipolar is a part of me. A part as fundamental as my hair colour. And, just like my very boring mousy brown, however much I might try to change it, it never quite matches the rest of me. I might like the change to ice white or auburn, others might like it, some might even be fooled into thinking it’s natural. But I know that it’s not real, and that it’s only a matter of time until the roots start to show.

Eating and Sleeping

There’s a tendency to think of ‘getting better’ as an all-consuming, quasi-spiritual journey, chock-a-block with euphoric highs, cavernous lows and grand revelations every verse end.  Unsurprisingly, I tend to think that in part, that's the bipolar itself talking.  Whenever I had entertained the idea of 'getting better', it had always been vague and romantic, though almost certainly involving a solitary journey somewhere far away, with plenty of tears and filterless cigarettes.  In reality, as J pointed out, what I was faced with was not a problem to be solved by drastic, short-term means, but a long-term condition.  This is infinitely more terrifying to my mind because it essentially means that there is no ‘getting better’ at all.  There is only patient, consistent management of what is there, and as you may have gleaned, patience and consistency are rarely adjectives that feature on the 'Profile' section of my CV (unless I'm seriously desperate and trying to lie my way into a book-keeping temp job).  

The idea that you are not going to ‘get better’ is a hard one with which to come to terms. On the one hand, the idea that there is nothing wrong with you can make you feel quite euphoric. Certainly I have felt vindicated at this notion – 'I don’t need ‘fixing'! I’m not crazy! Why are you all so terrified of extremes? BORING!!'  On the other hand, the idea that you have to live with this…thing, and everything that goes with it – the depressions, the instability, the uncertainty over whether you will ever be able to hold down a job, a relationship, a career, and not least the stigma that goes with it…that can be daunting. Especially when you’ve spent so long telling yourself that you can be normal, you’re just not trying hard enough. In a funny sort of way, that self-destructive attitude was a kind of protection I put up around myself. Basically, if you tell myself that it’s your fault you're not normal, then you don’t have to accept that you don’t have control over your brain. Because that is a scary notion. 

The moment I did accept this, though, was - as ever, when we face our fears - the first real turning point in my recovery.  Almost as soon as I had let myself admit that I didn't have control over my state of mind, strategies for gaining control were presented. These were and are, as it turns out, pretty mundane.  They consist of the following:

Take your medication.

Eat properly. 

Sleep properly. 

Exercise.

Repeat. 

Addicts and those in recovery from other conditions report much the same thing. My sister, S, who has suffered with eating disorders for most of her adult life, describes getting better as simply: 'doing what you did yesterday.'  

It's difficult to maintain a balance of any kind when you're used to living with constant, extreme changes of state.  As I write, for instance, I'm struggling to control my relationship with diet and exercise.  Having maintained healthy levels of both for a while, and feeling the positive effects, my natural desire was initially to push them to the extreme and enter a Triathlon whilst surviving on a handful of nuts and seeds and six cups of coffee a day.  This having inevitably failed, leaving me knackered, uptight and nursing an injured calf, my instinct is now to spend an entire month consuming nothing but cider and mini eggs from the comfort of my sofa.  I am fighting the urge, however, with the help of my unusually patient partner, D, whose encouragement and reminders to eat, sleep and generally not 'be a penis' are - touch wood - keeping me on the straight and narrow. 

Getting Here: Part One

October 2011

J is overrunning and I am living on 6 years and 7 months of borrowed time by my last calculation. After living with The Condition for as long as I can remember, flirting with varying degrees of seriousness with putting a name to it before running terrified in the opposite direction, I have finally thrown in the towel and come here, to a discreet institution in south London, to Seek Help.

I’m reminded in the waiting room of the previous attempts I have made to Seek Help, which, like many in my situation, have come in dribs and drabs throughout my life. The most concerted effort previous to coming to J was after failing to die when I was supposed to and – on the intervention of my family – undergoing psychiatric assessment in my university town. The frustrating thing about mood disorders, however, is that their symptoms are cunningly akin to those also associated with the chronic condition known as Being Nineteen. These typically include, but are not limited to:

A) Frequent changes of appearance, beliefs, principles, even accent – the putting on of a new personality and identity at the drop of a hat. These coincide neatly with:

B) Obligatory severe mood swings, which make it nigh on impossible to commit to anything long-term. The troughs and peaks of these are broadly experienced as follows:

C) Self-loathing. This typically leads to:

i) Social anxiety, which in turn gives rise to awkward behaviour in group situations and repeated incidences of self-medication through controlled substances (a nicer way of saying ‘development of alcohol and drug dependency’).

ii) Inability to fulfill work, study and relationship commitments.

iii) Deliberate self-isolation and immersion in the works of Sarah Kane, Georges Bataille, Nietzsche, insert further clichés as applicable.

D) Feelings of invincibility, as though the normal rules of the world do not apply to oneself. This typically leads to:

1. Uncontrollable spending and financial trouble.
2. Excessive casual sex with scant regard for emotional damage caused to self or others.
3. Putting oneself into dangerous, unstable and/or risky situations with scant regard for the consequences to self or others.

Tricksy. This is also further complicated by the fact that bipolar exists – like most things in life – on a spectrum, ranging from severe depression to full-blown mania. Just before you get to mania, there’s a state called hypomania, characterized by a burst of fizzy, sparkling energy in which everything is faster and brighter and funnier and impossibly wonderful. It’s suddenly possible to survive on no sleep and still be more productive than your ‘normal’ self three times over. The feelings of invincibility start to creep in here, too, and can have detrimental effects (see above). It remains distinct, however, from full-blown mania which at its peak can veer into the realms of psychosis, incorporating auditory and visual hallucinations. Whereas a hypomanic person might think they’re a bit special, a manic person can literally believe that they are Jesus. Whilst I have experienced a couple of isolated psychotic episodes (terrifying and not recommended), I do not experience ‘true’ mania as part of my condition. Recently, this led J to give me a diagnosis of Bipolar Affective Disorder, Type II (a lady called Karla Dougherty wrote a guide to living with this entitled ‘Less Than Crazy’ which pretty much sums it up). Aged 19, however, it was suggested that I could not possibly be bipolar as I didn’t get ‘proper mania’, and that whilst I had suffered with a speck or too of severe depression and anxiety, I was also a bit wild and silly, and should really try harder to be stable and pull myself together. The best course of action in the immediate term appeared to be providing me with a heavy dose of a tranquilizer so addictive that you’re not supposed to take it for longer than three weeks, ‘just to take the edge off’. In the end, I took it for around five months, with one GP advising that I keep a prescription in a drawer as ‘some patients find it eases their mind, just being able to look at it and knowing that there’s some if they really need it’, and some Prozac. Unsurprisingly, medicating extreme highs and lows with strong medication inducing extreme highs and lows was not especially effective, but more of this later. My very northern mother, K, and stepdad, T, eventually brought me home, took me in hand and weaned me off the opiates. Following the spiralling high they had brought about, K, T and I also needed little persuasion that the uppers were a bad idea, and all of us were put off psychiatrists for the time being. Perhaps they were right on one thing though, I reasoned, unreasonably. Perhaps the highs and lows I had lived with for as long as I could remember were just adolescent character flaws and I really did need to just…well…try harder. In any case, the alternative was that I actually was bipolar, and that, as I had discovered, was proper mental. So, for the moment, a chapter of the recovery process I like to call Trying Really Hard Not To Be Crazy (TRH) looked like the best course of action.

Of Common or Garden Manic Depressives

It is probably unsurprising that bipolar disorder has attracted such a significant amount of press in recent years.  Let’s face it, the vertiginous highs, desolate lows, incitement to extreme acts and celebrity sufferers make it a pretty tasty morsel for your average journo.  So it’s little wonder that in the early 00s it rose to the status of mental illness du jour, with a public profile variously helped and hindered by the seminal Stephen Fry documentary and a glut of exploitative Kerry Katona reality shows.  But what of the lives of your common or garden manic depressive?  A swift Google will provide you with a smorgasbord of very brave, confessional e-lit detailing the often difficult to read experiences of bipolar sufferers in the throes of depression, hypomania and mania.  What I have yet to find, however, is a voice which goes beyond raising awareness of the symptoms and experiences brought about by the condition.  Bipolar is, as I have learned to my cost, still viewed as a dangerous disease, its sufferers to be pitied and/or feared.  There are a great many of my friends and family who do not and will never know about this huge part of myself because it is so taboo.  What I would like to do here is to take a small step towards redressing the balance; to provide you with a real person’s real(ish) time experience of what, for want of a better word, I must call ‘recovery’: the process of learning to live with bipolar from the point of diagnosis onwards.  Part of making sense of the diagnosis and assimilating it into my life has been, for me, understanding the history of the condition and its treatment, as well as exploring my own relationship with it.  So there’s some of that in here too, though I’ve tried to steer clear of misery-lit territory.  I hope it might even be funny.  Some of the entries are written off the cuff on the date they were blogged, others are transcribed from diaries, scraps of paper and BlackBerry memos written along the way.  All chart the events since I first set foot in the offices of a psychiatrist named J in October 2011.