I SLEPT a long, long time on Wednesday night, but last night, although I went to bed exhausted around 10:30 I woke again at 4 and could not, and barely even tried to, get to sleep again. I had a plate of two-day-old "wild mushroom" stuffed pasta with broccoli and cheese beside me that I've been finding increasingly revolting. Partly because I was stupid enough to buy stuffed pasta even though I knew I had been going off it. Partly because I've lost my appetite enough to be able to go on just one meal a day for the past few days.
I made a mistake, by the way, in yesterday's depiction of a severe manic spell: the starbursting ideas I mentioned may be irrelevant. That I can vouch for when memories are examined under the steady glare of sanity. But at the time, everything seemed ultra-relevant and important and sparkled so dazzlingly it was all too compelling and THAT is why I got so lost in the blizzard of my ideas. It was absolutely impossible to separate wheat from chaff, to examine any one idea and most especially to think out a stream of consequences in stages. Which meant that when truly stupid ideas grabbed me (example: to take a flying leap through the upstairs window) the full folly of my compulsion never dawned on me until many weeks later. Which I still find really disturbing and I'm extremely glad my Dad brought me up NOT to be impulsive. If I had been an impulsive person, and had given in to just one of the deluded ideas upon which I thought at the time I ought to act out, I'd have got into trouble deeper than I could ever have imagined. I can just imagine Advocacy for the Prosecution painting me as the most evil person alive, when I was too ill to calculate anything and most especially to analyse or think out the consequences of anything further than one single obvious stage.
Books and websites say a manic person is extraordinarily distractable. That may be; but it felt to me like I could not keep my mind poised enough to focus on any single topic at all without every possible eventuality bursting out at me all at once so that I was swept so far away, I'd forgotten my destination anyhow. And found myself completely lost, but just as happy to be in the new place as wherever I had been, or been going... Couldn't say anything succinctly. And if there was an and, but or because in the sentence I seemed to get blown so badly off course that I'd start out saying one thing and finish saying many things utterly different and unrelated. The psychiatric social worker who interviewed me in the mental hospital, where Naomi, chair of the weekly Nutter Club (a dual-diagnosis meeting for drug-addicted people with serious mental issues) had driven me. Nothing to do with wanting to get admitted. I didn't want to go into hospital. All I wanted was somebody to bear witness to the state I was in, because I hadn't slept in days, hadn't been to bed for about 48 hours and counting and knew something about me was Drastically Different. My mood, for one thing, which was high and kept going higher, in complete contrast to the various shades of unhappiness and depression I had floundered in for years...
I wanted someone to vouch that my fluctuating mental state was real. And not an exaggeration or a lie. Because that's how I felt: that for years I had being taken for a liar, someone who felt it necessary to embellish my own experience and turn run-of-the mill depression, which millions experience, into something more fascinating. When in actuality I was doing all I could to downplay my increasingly extreme moods, lest I end up with a terrible diagnosis with a title like Bipolar, swinging round my neck, like a Gold Medal from Hell. Then of course the consultant dual diagnosis specialist told me I had "manic depression and schizophrenia". And despite my "elevated mood" and excitement, I was devastated. I had only just come to terms with the notion that I might actually be a manic-depressive junkie. Or worse still, if I listened to the voices who told me this: that I really did have schizophrenia. That's the only time I've ever got home after a doctor's appointment and cried. All afternoon long.
I don't consider myself a special case: especially crazy or confused or complicated. Every time I have found myself with one sickness or another: Depression, Chronic Fatigue Syndrome or Psychosis ~ I have known another person who's had what I have, only far worse. Pinky is probably the most tangled and traumatized psychiatric case I have ever met. Her Borderline Personality Disorder is severe and it seems to me that at least 75% of her pain and suffering is caused by that, and not clinical depresion and not her enduring paranoid schizophrenia. She's now on TWO antidepressants: Venlafaxine (Effexor) on top of Mirtazapine (Remeron), both at maximum doses, which they never prescribe anyone unless they're truly in dire straits. Two weeks ago she was so upset, almost screaming in mental torment and agony. Yet there was nothing I could say or do that would make her feel any better. She only ended up in hospital because she did something impulsive and the police bundled her in there... Now she has a massive burn on her leg, which is at least second degree, because it's broken out in gigantic blisters. It's only bandaged, so she tells me, because another patient troubled to do that for her. (But how did she get hold of the bandage?) The nurses did nothing. She never even got to see a burns specialist for two days, because the nurses could not be bothered to care for her, even in the most basic way. She set fire to her pyjamas. Which to me seems to be another sign of the impulsivity powered by her Borderline Personality Disorder. Which fuelled her depression and psychosis, creating a complete emotional mess. Apart from being burnt, she seems about as well now as she ever gets; that is: she would probably pass as "normal" to most people. Less than a week ago she was definitely not "normal". Wandering about in a daze. Repeating her sentences over and over. Too frightened to go in the lounge, because she said the TV was talking to her directly and telling her what to do. I can cope with my friend, because she is my dear friend and has nobody elsewho can help her, eg withdraw money without thieving it from her, bring in cigarettes, without which she would go into true meltdown. Etc etc... What I couldn't cope with was the heavy atmosphere on her old ward. The other patients seemed extremely disturbed compared to times past when I've been on mental wards. Eg FOUR patients on one-to-one supervision. Tired-looking nurses stationed outside open bedroom doors, all in a row. I've never seen that much one-to-one "care" (though it's pretty obvious they don't care. Don't care at all.)
When I told the doctor how stressed I felt, she asked me whether Pinky had anyone else who could help her and I said no. That is the most terrible thing. Her best friend, who I named "Perky" committed suicide and we all thought that was the end of Pinky, but she survived, because she is a Survivor. She just hates being alive, because life has dealt her the most dreadful hand of anyone I have ever met. When a person who already has paranoid schizophrenia gets extremely depressed, to the point where they don't speak to anyone any more, they call that schizoaffective disorder (depressive type: my type is bipolar). So on paper, our diagnoses sound the same, yet our experience is vastly different. She has had far worse depression than I've ever had and for longer. Yes I have gone right down to the bottom, but I only stayed there for hours and days (in different episodes). Pinks has been depressed into stupor for months on end and had to have ECT. That's why I didn't see her as that severely ill this time round, because she was still able to communicate. People with extreme depression usually barely speak or even move at all...
O man yet AGAIN I end up on the same subject. I'm just finding it hard. Really hard to deal with this. I force myself to go visiting when really I don't want to go visiting at all. Now that she's in company of less disturbed people it's a lot easier. Over the years they seem to have tightened up their procedures so that only the very most desperately disordered (or dangerously deluded) people get admittance to a ward. No matter how upset a person might be, if they're not judged to be a suicide risk, or a danger to others, they probably won't get let in. No matter how much they beg, plead of cry, they are turned away. And the staff who do it know that if they misjudge a situation, they may well be the very last person that patient asked for help. Another sad truth is that psychiatrists cannot really help people who are "just" upset, or stressed past breaking point, or bereaved. Even if they're really, really upset and suffering intolerably. If it's not mental illness, doctors usually can't help. They can treat schizophrenia. Ordinarily they can bring down a manic episode quite easily. Clinical depression they can treat with a choice of over forty antidepressants, or mood stabilizers (there are four main ones) or antipsychotics (about 28 types) (quetiapine, which I'm on, is a treatment of choice for bipolar depression, because it does not elevate the mood the way antidepressants do ~ which can easily trigger a manic episode). If all else fails, there's always ECT. But no way in hell would I ever submit myself to that, no matter how bad I felt.
But my point is, I've seen extreme cases of psychosis clear up entirely within a few weeks. Yet people who come in to escape bad relationships, or bereavement or simply because they cannot escape loneliness and pain, probably will not be helped, and that's very sad...
I've heard people talking about antidepressants just "taking the edge off" the symptoms, but cannot relate to this. Whenever I've taken antidepressants for long enough, and it only takes about two weeks, my mood improves distinctly and depression vanishes completely. (Which kind of implies some chemical imbalance was the cause and disproves the notion some of my old drug workers liked to harbour, that I was only depressed because I was addicted to heroin). The problem tended to be that I became too hyped up and excitable (and sometimes, plain agitated). Then the last time, when I took mirtazapine, after the brief 7-day high I went crashing down, far lower than I'd ever been before I took the pills, and ended up in a terrible state for over a month. It was my old druggieworker who took one look at me and said "it's those tablets you're on" and sure enough when I stopped them I improved drastically.
The one single good thing about having a nasty label like "schizoaffective" is that if I ever do become seriously ill or desperate, I know that psychiatrists will take my case seriously because I've got the second most serious psychiatric condition there is. (Schizoaffective disorder is said to have an outcome worse than ordinary mood disorders, but better than schizophrenia.) So if I do ask for help, they turn me away at their peril. I've not only been turned away from the psychiatric Emergency Department in years past and told to come back when I was "actively suicidal", but TWO psychiatrists have summarily chucked me off their lists. The first time I had the impertinence to SMILE while recounting how dysphoric I had felt and I suspect that doctor (who had never seen me before; he was taking over another doctor's clinic at the University I used to attend) assumed I must have been stoned on cannabis. Which I was not. I was only reacting to his manner. I had the not-uncommon condition named "smiling depression". Most of my laughs and smiles back then were faked anyhow. The second time a medical student didn't seem to know what to make of me and so called in her supervisor, who was a notorious hater of junkies. He told me I was on so much methadone that antidepressants wouldn't help me anyway, which was an utter lie because I did get successfully treated with mirtazapine once. It was the second and third times I tried to go on it that I became hypomanic and all the trouble ensued... All that was BEFORE I got any diagnosis except depression, then
CFS, then depression again ~ and I spent years knowing "something" else was wrong, yet no idea what it actually was... So any trust I had in psychiatrists has been long-since lost and even though my last one was a very good doctor, as a group, I don't trust them at all. Dr Lovelace is booking me an appointment with a shrink. As much as anything, I think I really should see one as it's been eighteen months since my last appointment and I can't tell Dr Lovelace that it happened in a methadone clinic as I don't want "drug addict" back on my notes...
Where am I going from here? I don't know. I'm just trying to say, there is one good thing about having a horrible psychiatric label pinned on your forehead and that is if you need desperate help, you're more likely to get it fast than someone with a less "severe"-sounding label like "anxiety and depression". Even though anxiety and depression is far more horrible than any schizoaffective episode I've had. When my depression goes very low, I feel so dazed and out of it I'm almost anaesthetized. But the depression I had when I was younger was more horrible. I didn't want to die, and so I lived in terrible pain. I was a loner and yet I could not stand to be alone. So I would go visiting people who weren't my friends, get there and have nothing at all to talk about. So I'd sit in the corner, silent, wondering how anybody could think up any conversation at all. My university years were the pits. It's just amazing that I managed to make friends at all...
Well I have to terminate this long and rambling piece here. If you're wondering why so much psycho-talk, it's because I have spent so much time on mental wards visiting my friend, and it seriously started to do my head in... But I think I'm better and she's better now. So that's good. If I can only get my sleep and my mood back to normal, because it's still too low, then all will be FINE!
ETTA JAMES: STORMY WEATHER
***
AT THE WEEKEND, after I'd got a bit over-exuberant and what she likes to call "really manic" but I would categorize as "a bit hypomanic" (no way was I "really manic" in doctorly terms; I was just a bit elevated in mood; a little hyper) my friend Binky told me I really need more help from the mental health services than I'm currently getting. It's true the first thing she did on my arrival was to insist on laundering my clothes, which I thought were clean but she definitely didn't. Then I had a shower in her heated bathroom, which meant that I spent longer than a couple of seconds in there. And on coming out and changing into grey jogging bottoms and a fuschia pink teeshirt that she insisted was red but it wasn't ~ it was most definitely pink ~ I have to admit, I felt a whole lot cleaner. That is, cleaner as in less dirty. Not altogether clean. I never am and never feel "clean". But maybe that's my inner drug-addict being honest, hey.
