My first acute episode of mental illness was psychotic depression. Looking back on it the whole thing was very scary compared to later instances:
- it was my first psychosis
- it was depressive rather than manic
- it featured paranoid thoughts, by definition frightening
- it was my first time in hospital
On discharge my sick note read “Mental illness”, nothing more specific. They hoped this was a one-off. I went back to work, continuing to attend as an outpatient for a year and after six months tapered off chlorpromazine, a rather old-fashioned but nevertheless effective antipsychotic.
Psychotic delusions
In this first episode I experienced a paranoia which had built up over a number of weeks with suspicious thoughts and delusions that were so credible, close friends and family believed me when I shared them.
People were out to get me – the Head of IT at work was hacking my computer; terrorists were hunting me down to put me on trial and execute me because I was a wicked and evil person. In the months prior to hospital admission, I had been taking a bath in two inches of water because I did not deserve to deprive others across the globe of their water supply. Finally it all came to a head on a Saturday night, my flatmate contacted friends who crossed London with their three-month infant to see me, sitting up in bed but inconsolable at the “crimes” I had committed since childhood. Things deteriorated further on the Sunday and I took refuge at the home of another friend. I was by then clearly deluded and wisely she removed the internal door key to the room where I was sleeping. But I did not sleep, obsessing with thoughts of my wrongdoings and that I deserved to die.
In the morning one of the Saturday friends took me to their GP and then to the West Middlesex Hospital A&E where I thought the doctor who assessed me was some kind of impostor and asked to examine her ID pass before I made any disclosure of what was going on in my head. When then referred on to the Maudsley Hospital in Denmark Hill, I professed I was a malingerer, that they should let me go home and I would be fine. Still with friends and joined now by my sister and partner we sat for hours in a large, looming hall at the front of the building, waiting for a bed. A trip to the McDonalds on Camberwell Green brought their Chinese New Year special, chicken and sweetcorn soup and some light relief from the day’s drama. Finally a bed was found in Kent, which I refused – then, in the early hours one at the Maudsley itself. A nurse in civilian clothes, arrived and offered me a capful of orange liquid (chlorpromazine), I hesitated for a long time, thinking it was a poison. Once taken though it slowed my thoughts down enough to agree to admission and the nurse took me through a series of darkened corridors.
Then it goes blank.
I woke the next morning in a curtained bay with three other women on a first floor ward. Later I was transferred to a single room on suicide watch, where a Mauritian nurse, Lourdes, looked on. Of course her name, with its religious connotations, prompted me to believe she was some kind of plant and I anxiously persisted with questions about the water supply in her home country.
Getting a diagnosis
Gradually I regained a shaky equilibrium and after a month was back to work. A year later though another psychosis occurred, this time mania. With it came a diagnosis – manic depression (as bipolar disorder was then known). A strange process (to me as someone unfamiliar with hospitals) followed where I had to collect a 24 hour sample of urine, which was decanted into one of those square 5 litre containers for vinegar in chip shops. I duly past the kidney test and started on lithium, which I still take today.
Questioning a bipolar diagnosis
Initially I found the diagnosis reassuring – other people had experienced what I had, doctors knew about it, it had a name and a treatment. As time went on however, I talked myself out of this. It was simply the stress of a particular point in my life that anyone would have found impossible to bear. The medication was unnecessary, I was fine and back to “normal”. I know that many people with bipolar go through a similar stage, denying that it is the medication keeping them well, that they are doing it all themselves.
I think part of this links to the stigma of mental illness, that unlike physical health, some think it’s a sign of weakness or personal defect. The comparison with insulin and diabetes is often made as a parallel to counter this idea, however even if you sign up to the parity of mental with physical health, as I do, there is always a nagging doubt. Thus I talked my psychiatrist into believing I no longer needed drugs to keep me well and tapered off lithium and was meds free for about four or five years.
A month after 9/11 I was back on the ward and back on lithium.
Which is where I have been ever since.