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#NaNoWriMo2016 - Day Twenty-Three

10 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

23. The Box

At the house, Neil's dad, Colin, was going through his son's stuff. There was a winter coat folded up at the bottom of the wardrobe on top of a pile of jumpers. Colin took the coat out, put it on a hanger and hung it up. He found some space in the chest of drawers and started to re-fold and put away the thick wooly jumpers. At the bottom of the pile, there was a shoebox shoved right to the back of the wardrobe. He took the shoebox downstairs and sat down with it at the dining room table.

The shoebox was nearly full to the brim with medication boxes. These were not plain white cardboard boxes that pharmacies gave out prescriptions in, but glossy retail boxes with logos of the pharmaceutical companies and drug brand names emblazoned on them in bright colours. The medications had smarmy names like Abilify and Effexor, suggesting they would confer abilities or be effective.

Some of the boxes had text that was predominantly in Arabic or Cyrillic script, and it was hard to tell exactly what the medication was.

As well as the boxed medications, there were also pills in blister strips that had their ingredients and dosage printed on the silver foil. Some of them had pharmacist's instructions printed in purple ink directly onto the unboxed strips, along with the price, in Indian Rupees.

Finally, there was a big plastic bag filled with mixed loose pills. Some pills were round, others were lozenge shaped, a few were in capsules and others were diamond or triangular shaped. All the pills and capsules had letters and numbers stamped or printed onto them. The pills were mainly white, blue, pale yellow, pink and aquamarine. The capsulses were half green and half yellow or half red and half white.

In a notebook Colin started to write down all the names and dosages of the boxed and blister packed medications. The boxed medications all had two names, but the pills in the strips mainly seemed to only have one ingredient printed on their foil. He then wrote down a description for each of the loose pills: "Round, light pink, GG925".

There were nearly 30 different medications in that shoebox, none of which looked likely to have been prescribed by Neil's doctors.

Going into the box room, Colin now located a small filing cabinet where Neil kept his old bank statements and credit card bills. He returned to the dining room table with a stack of paper that was dated within the last year. The bank statements mostly had recurring direct debit payments for things like mobile phone and Internet. A quick scan through the credit card bills found a few transactions in foreign currencies. It was wholly unclear what the payments were for from the various merchant names.

He went back to the filing cabinet and pulled out all the credit card bills for a two year period, ensuring he had every single one. Then, he found all the bank statements and credit card bills in a big pile of unopened mail. It was no surprise to find that there was no money spent on the credit card after Neil's disappearance.

Putting everything in chronological order, he marked any suspicious transactions on the statements. There were one or two foreign currency transactions on every statement for 6 consecutive months. Immediately after that, some payments to "Frog Eye Wares Ltd" caught Colin's eye. The transactions were all for the same amount - £27.90 - and there were 3 on one statement and 4 on the next: 7 in total.

The credit card transactions ended 6 weeks before Neil had disappeared. Going back to the bank statements, there were two payments to Western Union of circa £150 and daily spending that seemed to always be just over £55, as well as regular cash withdrawals for £50. In a little over a month, Neil appeared to have siphoned off nearly £2,500 from his current account, either getting cashback at local shops and pubs, or at an ATM.

Doing some quick calculations, Colin estimated that his son had spent about £1,300 in foreign currency transactions that he assumed must have been to buy medications from overseas. Neil also seemed to have diverted approximately £3,000 somewhere else, over a 6 week period. "Any problems with drugs or debts?" Lara and the family had all been asked by police officers and private investigators when he went missing. There was no way that this paltry sum of money suggested either. Neil's parents weren't rich, but they would have lent him a couple of thousand without a single question if he'd asked. Besides, Neil's bank account still had money in it and he only had a few hundred pounds of credit card debt.

When Colin was opening Neil's post, he'd made a pile for Lara, but he'd spotted another pile on a sideboard that Neil must have stacked up before he disappeared. Looking through the first few letters, they were all addressed to Lara, but he decided to go through the pile in case there was anything for Neil mixed in with it. He was questioning the futility of the exercise when he found a single piece of paper folded in half.

INVOICE

...

FRL-V4-0.5G £25.00

Postage £2.90

TOTAL: £27.90

Paid in full, with thanks.

...

 

A credit card card receipt for £27.90 was stapled to the invoice, with "customer not present" printed on it. There didn't seem to be a telephone number or an address anywhere on the invoice, just a website: For all enquiries go to www.frogeyewares.co.uk.

Back at the filing cabinet for a third visit, Colin pulled out Neil's mobile phone bills. Some really old ones were itemised with every number and how much the call cost, but the ones from recent years simply showed the amount for line rental and the total amount for call charges.

Unplugging Neil's laptop which was sat charging on a desk in the box room, he coiled the cables and took it downstairs. Returning the shoe box to the wardrobe upstairs, he turned off all the lights and left the house with the invoice tucked into his notebook, the laptop and its charger.

Back at the family home, Colin booted up the laptop and managed to log in using a password that Lara had suggested. She had suggested several of Neil's possible passwords, as well as some variations, but the first one on the list worked. Colin was no computer expert but his job in the civil service had required him to be reasonably IT proficient, so he was able to search for any documents on the computer, check Neil's email inbox and Internet browsing history. The laptop was completely blank, as if it had never been used from the day it was bought.

Using his own computer, Colin now started searching the Internet. The first thing he tried to do was to visit the website from the invoice.

"This website is now closed." was displayed in plain white text on a green background. Nothing more, nothing less.

Searching for "FRL-V4-0.5G" produced no results. Shortening the search terms to "FRL-V4" the Internet suggested a website about a seaport in France. This seemed unlikely to have been sold 7 times, and for less than £30. The acronym "FRL" turned out to have a multitude of uses, none of which offered any promising leads. It was a dead end.

Finally, searching for "frog eye wares" turned up two hits: one was a County Court website and the other was an article from a local newspaper from that area. The court website would not show the result when it was clicked on, displaying instead a "page not found" error message. The newspaper said that a local businesswoman and two of her associates had been arrested and were standing trial in connection with the frogeyewares.co.uk website. There were no details except the date of the article, which was 3 months old.

It was getting late and phoning the court or the newspaper would have to wait until Monday morning.

Now, searching for each of the names of the medications in his notebook, Colin found that the boxed ones were a mixture of antidepressants and atypical antipsychotics with antidepressant effects. The pills in the blister packs were medications more commonly prescribed for narcolepsy and attention-deficit disorders.

Finding out what the loose pills were was a much harder challenge, but there was a website with an excellent search facility that allowed the shape, colour and any markings on the pill to be input. For white round pills, the results were reliable, but for pills that were pinkish or greenish, or of more exotic shapes, there weren't any results. Searching for the markings alone found a lot of results, but Colin ploughed through the pages and narrowed it down to a likely set of candidates.

With a list of active ingredients from the pills, he then searched the Internet to find out what kind of medications they were. There were anxiety drugs, sleeping pills, painkillers, analgesics and more ADHD medication. There were also treatments for fatigue, lethargy and the promotion of weight loss through appetite suppression. A significant number of the active ingredients were listed as controlled substances.

Perhaps Neil did have a drug problem, but if so, why had he left these precious pills behind and how had he managed to hide and pay for an addiction so cheaply? Neil would have lied, cheated, stolen and gone into debt before he disappeared without a trace. Drug problems spiralled. The evidence was undeniable: Neil had been illegally in possession of a number of controlled medications with abuse potential. However, he didn't appear to have been buying them or taking them in great enough quantity to suggest drug abuse.

Not wanting to upset Lara and family with incomplete theories, conjecture and inconclusive evidence, Colin decided to keep quiet over the weekend and pick up his investigation again on Monday morning. He was frustrated and confused, but he was a patient and methodical man, calm and stoical in a crisis.

 

Next chapter...

 

#NaNoWriMo2016 - Day Twenty-One

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

21. The Cell

"If you don't mind, please empty everything out of your pockets into this plastic tray."

Neil put his wallet, mobile phone, house keys, loose change, used tissue and a folded piece of paper into the grey plastic tray, which had a sticky label on it with "Neil - Room 8" written on it in red marker pen.

"Do you have anything sharp in any of your pockets that could hurt me? I'm afraid we have to check we've got everything."

"No."

The nurse patted Neil's clothes down and checked the waistband of his trousers and underpants.

"OK, would you mind taking off your belt and your shoes, please. Just pop your shoes down on the table here next to the tray."

Neil complied.

"We have to keep your belt, sorry. I saw you brought a dressing gown and we have to keep the cord from that too. We're also going to have to take the laces from your shoes. We'll go through your bag from home in a minute but you can't have necklaces, cables - such as mobile phone chargers - razors, scissors, keys or anything else sharp."

"OK."

"If it's alright with you, we'll hang on to your mobile phone and keep your wallet safe here at the nurse's station. If you need something for any reason, you can ask one of the staff to get it for you, but we'd really like you to try and relax and get used to the ward for the first few days, so we'll be keeping your phone right here."

The nurse was now coiling the dressing gown cord and putting it in the tray, as he went through rest of Neil's belongings.

"We have to keep aerosols here. If you need your razor you can have it while somebody supervises you shaving."

"I'm not feeling suicidal" Neil said.

"OK, that's great, but there are other patients here who might be. The bedroom doors aren't locked so we have to keep all these high risk items here for everybody's safety."

The nurse showed Neil to his room. The door had a window with a blind which could be opened and closed from the outside. There was a single bed with a foam mattress, a writing desk, a plastic chair, an open wardrobe with drawers at the bottom, a sink and a plastic mirror screwed to the wall. A big window was secured with a wire tether so it could only be opened a few inches. There were no curtains. Across the hallway there was a wet-room with a shower. There was no shower curtain. There were no locks on any of the doors.

"Get yourself settled and then come and sit in the lounge. We try to encourage patients to not spend time in their rooms during the day."

Neil sat on his bed with his bag next to him for a few minutes. He thought about unpacking but he really didn't want to give the impression that he was OK about being detained in hospital against his will. He'd been told to bring a few essential clothes and toiletries. Visitors could bring him anything else he needed once he'd settled in.

In the main part of the ward, there was a lounge at one end with several sofas arranged around a big TV which was hung on the wall. At the other end of the room were a number of tables and chairs. There was a nurses' office and two rooms with sofas in, which had big windows so you could see in and out. There was a doctors' office and an examination room which were private. There was a door leading to the male bedrooms and another one leading to the female bedrooms. A recreation room had a pool table, table tennis table and books in it, as well as a number of patients' artworks displayed on the walls. There was also a small kitchen for the patients to be able to make their own drinks and snacks.

A noticeboard displayed a timetable of the week's events, which had many of the same things that Neil was familiar with from day hospital: art therapy, music therapy, drama therapy and community meetings. A whiteboard had the first names of the 18 patients who were staying on the ward, with their allocated nurse's name written next to it in green marker pen. The ward was at its maximum capacity, with 9 men and 9 women.

There was a dispensary hatch where patients would queue up to get their medication several times a day. There was a door that led out to a small courtyard surrounded by high walls on all sides. That was both the smoking area and the only place that patients were allowed outside without staff supervision.

CCTV cameras were everywhere, except in the bedrooms and bathrooms. The ward was secure but the patients were considered low risk. There was only one locked door between the ward and the main corridor of the hospital that led to the other wards and facilities. For a few days, Neil had to stay on the ward, but then staff members were allowed to escort him to and from the drama studio, art studio and music room.

Some of the patients had obvious scarring on their arms where they had cut themselves. A girl's neck was bandaged. Other patients had problems that were more subtle. A man with a big beard smelt of pooh and always wore pyjamas. Many were quiet and withdrawn and a few would shout randomly, talk or sing to themselves.

"BBC one, BBC two, ITV" a man started. "Channel four" he said, raising his voice an octave higher. He repeated this same phrase over and over in a lyrical and rhythmic way, like he was chanting a mantra. It was quite catchy and Neil found it stuck in his head too.

"I just want to be dead."

This is what Michael said loudly every single morning before breakfast. Neil was a late riser, but he could hear his fellow patient shouting all the way down the corridor.

"OK, Michael. Time for your morning medication" a staff member would coo, coaxing him towards the dispensary hatch. Michael would shuffle along in his slippers. By the time Neil got up for breakfast, Michael would be sat quietly at a table with a vacant stare and a half-eaten bowl of cereal in front of him.

"NEIL! What are you having for breakfast?" Nicole shrieked with excitement.

Nicole was young but some developmental disorder meant that she was even more childlike. Her eyes were always half-closed with her bottom lip protruding. Saliva dripped liberally from her mouth. However, despite her tenuous grasp on almost all aspects of reality, she had latched onto Neil, much to his annoyance.

"I don't know. I might have toast."

"I was going to have toast."

"Actually, I might have corn flakes." he toyed with her.

Nicole hesitated for a moment, looking crestfallen. Then her face lit up.

"I'm going to have corn flakes."

Neil swiftly poured himself some rice crispies and dashed out of the kitchen to find a table with only one spare seat.

"Those aren't corn flakes, Neil." said Nicole, coming out of the kitchen and looking with dismay at her own bowl. "Sit here with me" she gestured, standing by an unoccupied table.

"How's it going?" Neil asked a patient who he didn't know, sat at the table next to him, ignoring Nicole's entreaties.

"Not great" the man replied.

Nicole huffed and sat down to eat her breakfast. A staff member rushed over to join her, fearing there would be an upset outburst if the poor girl felt too overlooked.

In his first three weeks in hospital, Neil saw the psychiatrist three times. He had a few meetings with mental health nurses and a physical health check-up, but his life was one of ordered institutional hospital routine: medication, mealtimes, planned activities and lots of time spent watching TV.

Suddenly losing his liberty had been terrifying and his natural instinct was to yell for lawyers, demand his human rights and to complain about the arbitration that had led to him now being held under lock and key. However, he also feared the power of the state institutions. The police, the National Health Service, the government, the law: he was no match for these massive entities and he knew that he would only make things worse for himself if he made a fuss.

He now deeply mistrusted the system and regretted seeking medical help at all. He felt betrayed by his doctors, he felt that the medications had made him sick, he felt that the crisis team and Lara had conspired to lock him up. He was angry that the police were used for his "welfare" when he really felt they simply provided the muscle to drag him away from his home if he tried to fight for his freedom.

Neil's faith in medicine had been completely shattered, but now, as he lay contemplating his wrecked body he knew he urgently needed medical help. He was dying.

The can of cola that he had found in the shopping bag he'd left outside the caravan had worked its way quickly through to his bladder and he needed the toilet. Grabbing a half-full glass from a nearby shelf, he urinated into it. His urine had been getting more and more cloudy and smelled terrible, but now there was a copious amount of blood present.

His organs were failing. His lungs were flooding with fluid that he couldn't cough up. His chest was tight and his breathing was laboured. His ankles were swelling up as his heart struggled to pump blood around his body. His dehydration and malnutrition had reached the point where his body had start to eat itself and his muscles were wasting away. He was so fatigued that he struggled to move and he blacked out from low blood pressure if he raised his head too quickly.

Death in the filth and darkness of the caravan was nearly upon him.

 

Next chapter...

 

#NaNoWriMo2016 - Day Twenty

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

20. Segmentation

When Lara was working her day shift, she would get home at around 7:30pm and have an hour where Neil was vaguely compos mentis. He would take his medication at around 8pm and by 8:30pm his eyelids were heavy and he would be slurring his words.

"Time for bed, Neil."

Uncomplaining and compliant Neil would be led to the bedroom where Lara would help him undress and get under the covers. It was as if he was blind drunk: barely able to comprehend where he was or navigate the short distance to the bedroom on his own. It was alarming to see how heavily medicated he was, but Lara trusted the judgement of the doctors and had confidence that his health would soon improve.

During her night shift, Lara became aware just how little of the day Neil was awake and active. Sleeping until nearly 11am, he pulled on some clothes and lolloped down the staircase where she heard him collapse on the sofa. The sound of daytime television could be softly heard from the bedroom, but she knew he was half-dozing with glazed eyes, not taking anything in. Before she left to go to work in the evening, his mind seemed a little less cloudy, but he had little more than an hour before he had to take his 8pm dose of medication.

The change from his depressed demeanour was unmistakable. When he was depressed he was present, but also cold, withdrawn and a little passive-aggressive. He was hostile towards the world, fatigued, but his mind was still sharp. Now, he was a shell of a man: he shuffled around, slept and ate, but there was no living spirit within him. He was dead behind his eyes, which seemed more sad than the expression he wore when he said he didn't want to live anymore.

It was pretty clear when Neil skipped his medication. He would be wired: wide awake with manic eyes and an electric energy, restless.

"Did you take your meds?" Lara asked.

"Whose prescription is it? Mine or yours?"

"It's yours."

"OK. Good. You worry about your medications, I'll worry about mine."

He wore a fierce expression. He was upset, defensive, offended that she would question whether he was taking his drugs. It was obvious when he hadn't, but she couldn't press him further on the matter without an explosive argument.

At first, he only skipped doses sporadically. It was as if he wanted to occasionally remind himself what it was like to be unmedicated.

Returning home one day, Neil was not in the snug or in the bedroom. Looking in the box room and the spare bedroom, Neil didn't appear to be in either. As she walked through the hallway towards the kitchen, she heard a sound come from the cupboard under the stairs.

"What the hell, Neil? What's wrong?"

He was in the cupboard completely naked with a bright red mop bucket on his head.

"Get away from me! Shut the door!"

"What's wrong, Neil?"

"Don't let those bloodsucking bastards get in here. Keep the fucking bats away from me" he shouted, with his hands flailing in the air.

"What's wrong with your arms? They're covered in scratches."

This seemed to stir some memory in him that he had forgotten. He started attacking his skin.

"Insects. Ants. Under my skin. Look at them crawling under there!" he picked at something unseen on his arm. A little blood appeared where his fingernail dug in.

"Neil you're seeing things. There aren't any bats. There aren't any insects."

"Fuck off. Fuck off. Fuck off." he shouted, cowering in the corner of the cupboard and pulling the bucket down over his head as if it could protect his whole body.

"Please come out from there. You're covered in scratches. You're hurting yourself."

"Leave me alone. You're a liar. You're a fucking liar."

"What am I lying about, Neil?"

"You know what it is."

"What is it?"

"You know. You all know. Fuck off and leave me alone."

The crisis team convened an assessment with Neil's doctor, a psychiatrist, a social worker and a mental health nurse. Two police officers stood in the hallway. Lara hovered in the doorway of the snug looking extremely anxious. Neil was sat at one end of the sofa in his dressing gown.

"We know you've stopped taking your medication, Neil. You should have refilled your prescription a week ago."

"I told you. The side effects were intolerable."

"Yes, but the medication was controlling your illness. You need the medication to stay well."

"I wasn't unwell before I started taking it."

"That's not true. Your notes say you were very unwell. The crisis team have been in contact for quite a while now."

"I wasn't hearing things. I wasn't seeing things."

"That was because the medication was working."

"The problems started when I stopped taking the quetiapine."

"There you go then, see! The medication was working. Why won't you start taking it again?"

"I told you. I'm OK. I can't stand the side effects. I don't need the quetiapine."

"But you had a psychotic episode. You got very sick without the medication. You need the medication to control your illness, Neil."

"What illness? I was depressed. That was all."

"Neil. You're very sick. You're exhibiting all the symptoms of paranoid schizophrenia. We're all very worried about you. You're not safe if you're not taking your medication."

The social worker from the crisis team got up and took Lara into the dining room.

"Look, we're going to have to take him into hospital to look after him and to assess him."

"OK, when? How long for?"

"I think we're going to recommend that he stays for 28 days. He's really sick and we need to get to the bottom of this. He's clearly not coping at home. You've been doing a great job, but he needs to be looked after in hospital."

"So, you're sectioning him?"

"We need to make our final decision, but it's likely that he's going to go to hospital under section two. He's not well and it's the best thing for him right now."

"What happens next?"

"We'll find a bed for him at a local facility and then he'll be admitted. Once he's settled in you'll be able to visit. He might not have to stay for the full 28 days, but we need to make sure he's in a safe place where the doctors can properly assess him and help him get better."

"He's angry with me. He was furious that I called you guys."

"You did the best possible thing you could. He was a danger to himself. It's really great that you called us and we can start to get Neil the help he needs."

Lara wasn't able to get to the ward during visiting hours until the weekend. Neil didn't want to see her and refused to come out of his bedroom.

"I'm sorry Lara, he doesn't want to see you right now" a nurse explained.

After 3 weeks, Neil appeared back at the house.

"I didn't know you were coming home."

"They let me have some leave. Time off for good behaviour" Neil chuckled darkly. He avoided eye contact and he scowled.

"Are you OK?"

"Would you be OK if you'd been forcibly removed from your own home, bitch?"

Lara drew her breath sharply, as if she had been physically struck.

"Neil!" she sharply rebuked at the harshness of his language, but she was more hurt and shocked than anything.

"It wasn't like that" she said with a concillatory tone. "You were really sick. Do you remember what you were like? Do you remember? You were under the stairs with a bucket on your head. What was I supposed to do?" Lara asked, reaching out to touch his arm. Neil pulled away from her baring his teeth, his eyes flashing with rage.

"Stay the fuck away from me."

She knew she sounded patronising and he felt betrayed. He had been brooding in hospital and the situation was highly charged, but she wanted him to know that she hadn't meant to hurt him. It was painful to see so much anger and mistrust directed towards her.

"Look. I love you. I care about you. I just want to see you get better."

"You got all those people ganging up on me. You turned my own doctor against me. What right do you have to do that?"

"You were having a crisis, Neil."

"Stop using my fucking name. It's just me and you here. There's nobody else here. Fuck."

Neil stormed off. Lara heard the sound of shattering glass and then a yell of pain. She hesitated and then started to walk upstairs. Neil crossed the landing and went into the bathroom. Tentatively, she poked her head in the doorway.

"Fuck off. Fuck off and leave me alone."

Neil was wrapping tissue paper around his hand. There were blood spots on the grey tiles all over the floor around his feet.

"Why the fuck are you still stood there? Fuck off. FUCK OFF" he screamed.

Lara went into the bedroom where a full-length mirror was shattered. The glass was mostly clean but large dark red blood spots were soaked into the carpet, trailing through the hallway and into the bathroom. Neil emerged and walked into the spare bedroom.

"Are you OK?" she asked.

He slammed the door closed.

"FUCK OFF!" she heard him yell, muffled inside.

On Sunday evening Neil left the house without saying a word. Lara waited until about 9pm and phoned the hospital.

"Is Neil back?"

"Yeah he came back a couple of hours ago."

Lara was relieved. She had been torn, not knowing whether to phone the crisis team again or not, knowing that Neil would feel even more betrayed. She sunk into the sofa and convulsive sobs hit her before she'd even put the phone down.

 

Next chapter...

 

#NaNoWriMo2016 - Day Nineteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

19. The Hospitals

His first day in a psychiatric hospital had been spent as a day patient. The crisis team had arranged for Neil to get out of the house and see a different psychiatrist. They'd picked him up in a minibus from home and driven him to another local hospital that Lara had never heard of. It was surprising how many institutions there were in town, dealing with mental health patients.

A breakfast of toast and cereal was provided at the hospital in a large canteen with a huge bay window looking out onto a garden filled with mature shrubs and trees. The hospital itself was an imposing red brick Victorian building, originally built as a sanatorium. There were parquet floors and a grand staircase in the foyer. Otherwise, the hospital had been institutionalised, with fire doors painted glossy pale green, linoleum floors and lots of blue signs with white lettering.

After breakfast, the patients were corralled into a circle in the canteen. Tea and biscuits were served as a support worker went through the day's activities and asked who would like to do what. There was music therapy, art therapy and drama therapy. Neil said he would do all three.

There were long periods of time where nothing seemed to be happening and there was no sign of any staff members. Patients were hanging around in two rooms: the canteen and a lounge. The lounge had an array of different size and shape sofas around the edge of the room and a vending machine in one corner. A tall sash window offered a view out to the gardens on the opposite side of the building from the canteen. Nobody was talking to each other. Some patients sat completely still with glazed eyes, as if in a trance. Other patients paced around nervously, avoiding all eye contact and distancing themselves from others.

After a seemingly interminable wait - there were no clocks anywhere to be seen - a woman appeared asking for Neil.

"Are you joining us for music therapy?"

"Yes, I was going to."

"Well we're starting right now."

Neil followed the woman through a door. She seemed irritated as if he should know where to go and when. The music room was nearly full with about 20 patients holding instruments, sitting around a large square table. He didn't recognise anybody from breakfast. The room had a high ceiling and it was quite dark. The walls were covered with blue fabric covered cork-board and there were many crude paintings and drawings pinned up.

"Choose anything you want and we can start" said the music therapist, gesturing to a corner filled with an array of percussive musical instruments.

Neil picked up a tambourine and sat down in a free chair at the table. The music therapist sat at a piano and began to play a simple melody. Tentatively, a patient started to tap a bongo drum in a staccato rhythm that was not in time with the music. Another patient shook a pair of maracas at random intervals. Neil started to gently jangle the tambourine in time with the woman on the piano and she started to sing, presumably to amuse herself as nobody else knew the words or the tune. Everybody else in the room held their instruments motionless, except for sporadic flurries when they became emboldened enough to briefly make a noise.

Eventually, Neil got bored and started to beat time on the taut skin of the tambourine quite loudly. Following his lead, more and more patients started to join in with the rhythmic bashing of instruments. The sound built and built and the music therapist played louder and wailed badly out of tune. Finally, she stood up and gestured that everybody should calm down, gently shushing.

"We could wake the dead with that racket" she said, laughing at her own joke.

"OK that was a brilliant session. Please help me tidy away the instruments. Thanks everybody. I really enjoyed that."

The patients all disappeared in different directions and Neil made his way back to the canteen. Most of the people who he'd seen earlier were still there. Spotting the patient who had been shaking the maracas, walking through the foyer, Neil intercepted her.

"What happens now?"

"Well I'm just going outside for a cigarette. Get yourself a drink and have some cake. Then it'll be lunchtime."

A table in the canteen had been laid out with large plastic jugs of blackcurrant and orange squash. There was a chocolate cake and a victoria sponge that had been sliced into small portions on paper plates. Neil took a plastic beaker from a stack and was about to pour himself some squash when one of the catering staff rushed over.

"I'll pour that for you, dear."

"It's OK, I can do it" said Neil.

"No I have to pour it for you."

With his drink and a plate of cake, Neil sat down at a table with a girl who was fiddling with her phone. She looked up.

"Are you OK?" she asked.

"Yeah. Bit confused about what's going on. You alright?" he replied.

"No. I'm not good at all" she said, suddenly looking very worried. She studied the floor.

"Do you want to talk about it?" he asked.

She looked up momentarily, made a little half-giggle and then started fiddling with her phone again.

After about an hour of awkward milling around, a servery hatch was opened in the canteen and a trolley with knives and forks on it was wheeled out into the room. Patients started to line up at the hatch, where there was a hot plate and the catering staff were taking off the foil lids on a number of plastic containers. Neil took his place in the queue. There were a number of dishes to choose from including pasta and a meat pie. Neil chose meatballs in a tomato sauce, mashed potato and green beans, which were dolloped onto a large white plastic plate by a lady in a hairnet with a long serving spoon.

"Gravy?"

It seemed an unusual question, but the dish could certainly be improved with some kind of sauce. The lady poured thick brown liquid all over his food from a big aluminium jug. Lunch reminded him of school dinners, but not in an unpleasant way. There was a stodgy pudding with lashings of thick yellow custard to finish the meal and it was all washed down with tap water in tiny plastic tumblers, poured by one of the catering assistants.

As he was finishing his meal, Neil was approached by a camp man with a bright happy smile who almost danced into the canteen. Half lowering himself to table level but not sitting down, he laid his hand gently on the middle of Neil's back.

"You're joining us for drama today. Is that right?"

"Yep" said Neil, covering his mouth which was still half-full of food.

"OK perfect. There's only a few of us but we always have a lot of fun. We'll be in the drama studio in about 30 minutes, alright? Wonderful" he said, answering his own question.

Neil wanted to ask where the drama studio was but the man had skipped away before he could swallow his mouthful and call out to him.

"Oh good. You're here" the drama therapist said when Neil finally located the right room. There were four patients, arranged in a semicircle facing the therapist. Everybody was seated in the middle of a large polished wood floor. Around the edges of the room were chairs stacked up, boxes with hats, props and clothes rails with various costumes.

The session began with some icebreaker exercises where each patient had to say the name of another patient before throwing them a ball to catch. They then re-enacted the story of Goldilocks and the three bears several times, rotating the roles so that everybody played each character. The therapist prompted them with questions while they were doing this.

"How do you feel that your porridge has been eaten, baby bear?"

"Uh. Hungry?" Neil replied.

With more tea and biscuits there was a community meeting where everybody sat in the canteen and somebody asked a sequence of questions about whether anybody had any problems with the facilities or could think of any service improvements. The nurse and support worker who ran the meeting were met with stony silence.

Art therapy comprised colouring in with pencils or felt tip pens. Neil chose a picture of an orange tree and meticulously shaded every leaf. He had almost completed it when a man appeared at the door of the art room.

"Neil. Can I borrow you please?"

Led up two flights of stairs, the man knocked on a door.

"Come" came a voice from inside.

Opening the door, a young doctor held out his hand.

"Neil isn't it? Good to see you. Take a seat please" he gestured towards a plastic chair. "I'm Doctor Akinbole, a registrar psychiatrist here at the hospital. I'm hoping we can do something to help you today."

"Oh.. kay..."

"Now, I come across quite a lot of cases of young men. Fit and active. Productive and happy. Sometimes problems can materialise in your twenties. It's nothing to be ashamed of and I'm sure we can help you get back on your feet."

"Alright" Neil tentatively offered.

"So you've been working full time, you're engaged and you've been in a long term relationship with this lucky lady?"

"Yes, that's right"

"That's great. Great" the psychiatrist said, smiling.

"Well listen, there's a medication that's helped a lot of my patients in a similar situation to yours. It's an atypical antipsychotic, but it's very good with depression too and a whole host of mental health issues."

"Antipsychotic?"

"Atypical."

The psychiatrist reached for a book on his shelf and leafed through the pages.

"OK, what we're going to do is start you on 200 milligrams today, 400 tomorrow and 600 the day after. Then you'll be taking 600 milligrams every night. This medication is great because we can ramp up the dosage really quickly."

"What about all my other medications?" Neil asked.

"Well, we'd better keep you on those for now. We don't want you to have any nasty withdrawal effects. We can taper you off those gradually in future."

The psychiatrist was now scribbling in his prescription pad.

"Here you go" he said, standing up. "Any problems, just phone the hospital and leave a message for me."

"Thanks" said Neil, taking his outstretched hand and shaking it again.

"I'm sure you'll be feeling much better soon. All the best" the psychiatrist said, ushering Neil out of the door.

Descending the stairs and standing in the foyer, Neil felt very lost and shellshocked. After a slow and relaxing day, his consultation with the psychiatrist had been a whirlwind affair and he was shocked at how quickly he had now received a prescription for a third medication. There was also something scary and unpalatable about the word antipsychotic.

On the first day with his new medication he woke up with a very dry mouth and was very sleepy until late morning. On the second day, he struggled to brush his teeth and get into bed because he was fighting to stay awake. On the third day, he needed to go to the toilet during the night and found that he was confused and staggering like a drunk. The dry mouth was terrible, he felt tired all the time and his appetite for chocolate biscuits became insatiable.

After some weeks, the side effects had not abated. Neil's life consisted of taking his medication at 7 or 8pm at night so that he could be awake for a few daytime hours, where he sat semi-comatose watching trash TV. Phone-calls to the hospital and messages had not managed to raise any response from the psychiatrist but eventually he spoke to another doctor. He was told not to reduce the dose, but he could split it into two or three doses throughout the day. This meant that Neil was half-asleep the whole time and barely conscious of what was even happening from one day to the next.

Two months elapsed and Neil was comfortably numb but there was no change or improvement. There was no way he could ever work while so heavily medicated. He booked an appointment to see his GP and halved his dose the night before he was due to see the doctor.

"I want to come off the quetiapine."

"Ok, but you can't just stop taking it until I write to the psychiatrist and ask his opinion."

"I can't stand the side effects and I have no quality of life."

"I understand, but we have to be very careful when you stop taking medications like these."

"It's not helping me. The side effects are awful. I'm just drugged all the time. It's like a chemical straightjacket."

"Let me write to the psychiatrist. I'll get back to you as soon as I can."

 

Next chapter...

 

#NaNoWriMo2016 - Day Eighteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

18. Psychosis, Madness, Insanity and Lunacy

"How did it go at the hospital?" Lara asked.

"Dr Asref has written me a prescription for two medications and he's made the referral to the crisis team" Neil replied.

It was the third time he'd visited the small community hospital as an outpatient and the second time he'd met the psychiatrist. Lara had never even heard of the hospital, even though it wasn't far from their home. The hospital mainly dealt with mental health patients.

The first appointment Neil had as an outpatient was for an assessment with a mental health nurse, 8 weeks after his doctor had made the referral to psychiatric services. He'd spoken to the nurse for about 90 minutes, while a trainee listened in and furiously scribbled notes. The nurse was kind and easy to talk to. He seemed to know exactly what kinds of things Neil was going through and was able to second guess what Neil was about to say, which made Neil relaxed and chatty for the first time in months.

The second appointment was with the consultant psychiatrist. He was not particularly conversational and seemed to be almost rambling to himself about various diagnoses and treatment regimens. He had presented Neil with a stack of photocopies of information on various medications and the consultation was suddenly over. Neil was confused and a little cut adrift. Asking what happened next, he was told to wait for another appointment where he could say which medication he'd like to try.

"Did you get the mirtazepine?" asked Lara.

"Yeah, but the consultant said I should take venlafaxine with it"

"Two medications?"

"That's right" said Neil, rattling two boxes of pills at Lara with a grin.

He seemed happier but his behaviour was worryingly erratic and childish. He would say and do regrettable things with no care for the consequences, or he would burst into tears and leave things in a mess if anything didn't go well.

One day, Neil had suddenly decided to demolish the garden shed with the supposed intention of building another one, but he hadn't purchased any materials to construct a replacement. Lara found him in bed when she got home, dreadfully upset and stressed about what he had done. That evening, she had to move the contents of the shed that could be damaged by rain and store them in the spare bedroom, while Neil cowered under the duvet.

His energy levels had improved, but often he would stay awake all night on the Internet. When Lara came home he would want to tell her about all the things he'd found out about UFOs, conspiracy theories, quantum physics, stock market trading and chaos theory. Neil's eyes would be flashing wide with wonder and excitement, but his thoughts were jumbled up and he was talking so fast she could only pick up every third word. He would get frustrated that she wasn't understanding and storm off in a huff.

"Did you get a new diagnosis?"

"He can't make up his mind. He said he's still convinced that it's major depressive disorder, but he also mentioned borderline personality disorder and bipolar disorder. He wants to treat me as if it's treatment resistant depression" Neil replied.

"Who are the crisis team?"

"Well, it's a number to phone if I'm thinking about hurting myself"

"Are you still having suicidal thoughts?"

"Not really. I'm too busy with my project"

Since losing his job Neil had been obsessed with the idea of creating an out-of-the-box security system bundle that would include wireless CCTV and motion sensors. The house had become increasingly full of equipment from Far-East manufacturers that Neil was tinkering with. Lara worried about how much it was all costing. How did he intend to sell this system if he could even make it work?

"Can I have the crisis team number?"

"Yeah. I'm supposed to give it to you and family so they can phone if they're worried about me" he replied. "And to any employer, but I don't want work sending round their goons to spy on me" he spat.

Neil's employer had become concerned that he hadn't turned up for work and had called his emergency contact - Lara - to see if he was OK. Lara was working and hadn't been able to answer her mobile, so the police had been phoned out of concern for Neil's welfare.

Neil had ignored the knocking on the front door, hoping that the police would just go away. A neighbour let the police into the back garden and they jumped over the fence. Neil heard the officers shouting at the back of the house and knocking on the back door. Yelling from the back windows, the police had insisted he come to the door so they could see he was OK. Neil had begrudgingly complied.

Lara was weary from constant worry about how Neil. She was very much relieved that there was now somebody else to contact in an emergency.

"People care about you, Neil." said Lara.

"Why are you using my name?"

"What do you mean?"

"Is there anybody else here? Why have you got to refer to me by name?"

"I don't know what you mean"

"You're so fucking patronising" said Neil, storming off.

Lara could hear him go into the box room upstairs. She knew he would be pretending to fiddle with stuff, brooding angrily. He would probably sleep in the guest bedroom again, even though it was packed with junk and the bed was covered with stuff from his project. Perhaps he would be awake all night surfing the Internet, following some thread that captivated his interest. They were definitely not going to have any further cordial discussion tonight.

Picking up the tablet on the coffee table - an impulse purchase that Neil had made - Lara searched the Internet. Typing "borderline personality disorder" she wondered what borderline meant. Did it mean that it was a milder form of the illness? As she read the symptoms she decided that it didn't really seem like Neil at all. They'd been together for so many years and they were engaged to be married. The part about unstable relationships didn't seem to fit at all.

Searching for "bipolar disorder" she came across a number of symptoms that sounded much more like Neil's recent behaviour. Rapid speech and disordered thinking, irritability, spending money and risk taking. She read the word "hypersexuality" and felt a knot in her stomach. He'd shown relatively little interest in her recently, but she knew he was watching more and more pornography. With a kind of shamelessness she heard him masturbating at night and found discarded tissues littering the floor. He made little effort to hide his Internet browsing history.

"Delusions of grandeur" and "psychosis" were things that were a little hard to place. Lara had worked a night shift and she heard him on a phone conference call during the day with his boss and human resources. Neil had ended up yelling about how he knew more than "all of you put together" and how he would create a competitor company that would "crush you like a bug". She knew that he had become frustrated and enraged by the conversation which had been ostensibly about sacking Neil, but his crazed response was completely out of character. She put it down to the extreme stress of the situation.

He was withdrawn and distant. It seemed inconceivable that he would be hearing voices or suffering with hallucinations. In her eyes, Neil was still strong, rational, intelligent and in control. She trusted him. They had always been open with each other about household finances and shared the burden of balancing the books. Even though she was cross that he'd thrown away his job, she thought that it was necessary for Neil's health and that he'd easily get more paid employment when he was ready to go back to work. They had enough savings to cushion their loss of earnings in the short term.

Two days later, Neil had disappeared.

"What do you think I should do?" Lara asked on the telephone.

"Have you rung the crisis team?"

"No. I don't know what the best thing to do is"

"Well, he didn't like it when the police got involved" Neil's dad replied.

Neil's dad was a practical man and had become a useful person to phone when she didn't know who else to speak to. Lara's parents were very sympathetic towards Neil, but it meant that they tended to share and exacerbate her worries rather than offering simple clear-cut advice.

The crisis team had promised to arrive within an hour. That was early on a Saturday morning. Neil had returned home in the afternoon, but had barricaded himself in the box room and refused to talk to Lara. Some eight hours after she had originally got in contact, there was a knock at the door.

"Hello, Lara?" asked a balding man, slightly overweight and wearing rimless spectacles. A mousey woman waited nervously behind him in the darkness, clutching a bulging ring binder.

"Yes, Hi"

"I'm Dan. This is my colleague Sue. Can we come in?"

"Please. Please do. I've been waiting all day" said Lara, ushering the two visitors into the hallway. "Neil, there are some people here to see you" she called upstairs.

Dan and Sue stood awkwardly and Lara gestured towards the snug, where they entered and sat down.

"Sorry... Lara was it?" Dan said.

"Yes, Lara"

"We had a number of urgent calls come in."

"That's fine."

"I'm a social worker and my colleague Sue is a nurse. We're here to make an initial assessment and see how we can help. Can you tell me what's been going on? It's Neil isn't it?"

"Yes, it's Neil I phoned about."

Lara noticed that Neil was hovering by the door.

"Ah Neil. These people are from the crisis team. They're here to see if you're OK."

"I'm not" said Neil, half entering the room but not sitting down, surveying the scene with distrust.

"Hi, Neil. I'm Dan. This is Sue" said the social worker, leaping to his feet and offering his hand. Neil took it and shook it. Sue half stood up, but remained quietly in the background. "Can you tell us what's been happening with you?"

"I can't cope anymore. I feel desperate. Suicidal"

"I'm sorry to hear that, Neil. How long has this been going on for?"

"On and off for months. It got really bad this week."

"OK, I need to ask you some basic questions." said Dan, now looking at Sue. Sue opened her binder and readied her pen.

"Do you know what day it is today?"

"Yes. It's Saturday the 20th of August, 2016."

"Do you know who the Prime Minister is?"

"David Cameron. No, er, I mean Theresa May"

"OK, and where are we?"

"We're in my house"

"Are you hearing or seeing anything unusual. Any voices?"

"No"

"Are you receiving any instructions, do you believe you are able to make people say or do things you want?"

"No"

"Is there anything you're anxious or concerned about right now?"

"I'm worried I'm going to kill myself"

"OK. Thanks, Neil" said Dan, glancing at his colleague. "It says in my notes that you've never been in hospital, because of your illness. Is that right?"

"Yeah, that's right. I've never been in hospital in my life except as an outpatient."

"Well, I think the safest place for you right now is at home. Where your partner and family can keep an eye on you. The crisis team can come and check on you, to make sure you're OK. How does that sound?"

"I want to die"

"OK well psychiatric hospitals are pretty crazy places. You wouldn't get a lot of rest there. The staff don't have a lot of time to help everybody. You'll be much better looked after at home. Do you have anything to help you sleep?"

"I've got mirtazepine. That makes me really sleepy"

"That's great. Do you know where it is?"

"It's on my bedside table."

"Lara, do you want to get it for Neil? And a glass of water" Dan prompted.

While Lara was gone, Dan and Sue sat quietly smiling and then Sue's mobile phone rang. She stepped out of the room and let herself out of the house while taking the call.

Lara returned with the medication and a drink.

"OK, Neil. What you're going to do is take your usual medication and then we're going to come and see you tomorrow and the day after. We're going to come and visit you here at home every day until you're feeling better."

Sue now let herself back into the house and popped her head around the door.

"Dan, we've got to go."

"Alright, sorry it was such a flying visit, but we have to attend to an emergency situation" said Dan, standing up and smiling. Pausing for a moment and taking on a more serious expression he said "everything's going to be OK. Hang tight. We'll be back tomorrow."

"OK, thanks" said Lara, following Dan to the door. Sue was already outside, eagerly wanting to get away. Neil was sat on the sofa, a little dumbstruck by the whole experience.

The front door closed, Lara returned to the snug.

"That went OK. There'll be somebody coming to check on you every day. That's reassuring isn't it?"

Neil simply looked at her blankly and then went upstairs to bed.

 

Next chapter...

 

#NaNoWriMo2016 - Day Eleven

10 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

11. The Shadow People

It had started out as a joke. Had he read about The Shadow People somewhere or had somebody said something to him? Neil couldn't remember. However, they seemed very real when they turned up in his life. It was always "they" or "them". When he started to try and explain who they were and how he knew that they were watching him, antagonising him, he struggled to put things into words. It was such a strong feeling, being stalked by them, but yet it was something that could not easily be expressed to people who had never felt so persecuted.

Neil had grown immensely frustrated, first with Lara, then with concerned family members and later with his doctors and other healthcare professionals. He quickly figured out that he couldn't very well say "The Shadow People are out to get me" without being locked up in a mental institution for the rest of his days, but he remained convinced that there were very real malevolent forces that were targeting him. It was difficult for him to try and explain things to people, when he himself saw that The Shadow People had just melted away in the cold light of day.

Earlier in the year, Neil began to believe that Lara was becoming hostile towards him and he started to become afraid and mistrustful of her. He started locking himself in the bathroom. Then he started barricading himself in rooms. He even locked the doors to the house. Lara's parents had come to help her to move out for a short time, to look after her while the couple was going through this crisis. Neil was convinced that they were all conspiring against him. When his doctor and his own parents showed up at the house at the behest of Lara, Neil felt totally besieged and betrayed.

The involvement of the police at times meant that Neil often imagined officers kicking the door down and dragging him away against his will. The escalating crisis had meant that the police were concerned about Neil's welfare. He knew the police had been looking for him and trying to get in contact whenever he went missing, but his very worst fear - apprehension by the long arm of the law - never actually happened. However, Neil was sure that he saw blue flashing lights outside his house and he could hear police officers communicating with each other via their radios.

As the crisis dragged on, everybody seemed to be antagonising him even though he wanted to be left alone. He wanted to be isolated in privacy, barricaded in a safe cocoon. Lying in the bedroom, he thought he could hear his mother speaking to somebody on the street outside. He heard car and van doors slamming and boots that sounded like the police force about to mount an assault on his home. Pretty soon the front door would be battered off its hinges and somebody would shout "POLICE! STAY WHERE YOU ARE". Then, he heard the TV in the lounge turn on. The TV wasn't tuned in to any channel and he could hear the hiss of static roaring out from the loudspeaker.

It took a long time to build up the nerve to go and investigate the TV, because Neil was sure that the police were going to storm the house at any moment. He crept down the stairs. He thought he could see people moving around on the porch outside, through the frosted glass above the front door. They would surely break the front door down at any moment. Growing impatient, he made his way to the door of the snug. He could hear the TV hissing with static quite loudly now. Stepping into the room, he looked at the TV screen. It was black. There was no sound of static anymore. He switched it off at the wall just to be sure.

Having returned to the relative safety of the bedroom, he heard the radio in the kitchen start to blare out static hiss. Entering the kitchen, the radio seemed to be off but it was still crackling and hissing. He turned it off at the wall and there was a kind of popping noise and the hiss stopped.

Later, the TV started up again. He knew that was impossible because he'd switched it off at the wall. The sound was unmistakable though. He wandered around the bedroom, trying to figure out precisely where the sound was coming from. It was definitely the TV in the snug. Creeping down the stairs and into the room, the TV was silent and there was no red standby light glimmering in the darkness. Who the hell was playing tricks on him? Neil was certain that the TV had definitely been turned on a moment before he came into the room. He unplugged it from the wall so that it was impossible for any power to flow down the cable. He assumed that the socket switch must be faulty.

The radio started hissing with static and Neil rushed to the kitchen to unplug it. This was becoming hard to explain. It had to be somebody playing tricks on him.

That was how The Shadow People slowly entered his life. They would come when he was tired and it was dark. He knew they existed because he could hear them whispering to each other, he could see them moving around as his eyes adjusted to the darkness and he watched the faintest light dancing on the walls, on the curtains, underneath doors, through cracks. Neil didn't dare throw open a door or switch on a light, because he was worried that other people were watching too. What if the police were there, waiting to make their move? What if his neighbours happened to be looking at that particular moment and saw him wild-eyed and sleep deprived, acting strangely?

Neil crept around the darkened house. All the curtains and blinds were pulled closed. Sometimes, he didn't know whether it was early morning or late evening. He didn't know what day it was. During daylight hours everything seemed a little more normal and he relaxed. Sometimes he would doze for a few hours. Daytime was confusing, because many of the threats seemed to have vanished. The police had given up and gone home. The Shadow People had disappeared. His persecutors seemed to know when he was at his most vulnerable.

Using his expertise as a CCTV engineer, Neil rigged up cameras to watch the front of the house and the back garden. The cameras had night vision, which gave blurry monochrome images in low light conditions. Watching the monitor screen intently for hours on end, Neil never saw anything that conclusively showed evidence of any untoward activity. He set up motion sensitive triggers and recorded video footage 24 hours a day. The only thing he captured was the postman delivering letters. This gave him little comfort. Instead, he wondered if The Shadow People had gotten more sneaky. Perhaps they had figured out a way to get into his house without needing to come in the front or back door.

Venturing into the attic, Neil knew that there were gaps into the attics of the terraced houses on either side. For hours, Neil crawled around in the roof. He spied into his own house through gaps around the lighting fixtures in the ceiling. He looked down through the hatch and imagined that he could escape the police if they broke in, by hiding up in the attic.

Covered in dust and fibreglass insulation, he finally descended down the ladder from the attic. The town and the street were too "hot". There were so many noises of human activity around him and people knew exactly where to find him. If he truly wanted privacy and to avoid being found, he would have to come up with an escape plan. Neil started to imagine how he could slip away and find some remote corner of the world where Lara, family, police and The Shadow People wouldn't be able to track him down and harass him.

Having a few good meals, getting some sleep, thoroughly washing and putting on clean clothes, Neil was in good shape for the journey down to the caravan. He looked after himself better than he had been doing for weeks, if not months. It was important to look as presentable as possible if he wasn't going to draw attention to himself when he ventured out into public.

When he was well rested and well fed, The Shadow People retreated, but it was important that he put his plan into action so that they wouldn't bother him when he was vulnerable. He knew that his fears of being dragged out of his safe space by the police, or persecuted by The Shadow People, would diminish whenever he slept, ate and took his medication, but those things conflicted with other strong forces that were driving him.

It had taken patience to execute his escape plan. As soon as he was freed from the clutches of psychiatrists, police and The Shadow People, he was sure that his life would be amazing. It had been exhausting, fighting the forces that conspired against him and living in constant fear.

At first, living in the caravan had been everything he'd hoped for. For about a fortnight, his plan had slotted into place perfectly. Then, everything had slowly crumbled. All his well laid plans seemed to fall to pieces and he felt as persecuted and afraid as he ever had done before.

When wind and rain lashed the aluminium skin of the caravan and the branches of the surrounding trees brushed the walls and the roof, Neil found the noises soothing, but soon he started to hear things that sounded like dog walkers, horse riders and nosey neighbours, all intent on discovering his private hideaway. Every trip out for supplies brought worries that he was leading people back to his secret sanctuary.

Now, he felt just as besieged as ever, but also dangerously isolated given the precariousness of his life and his survival prospects. The Shadow People would let him rot and die in that caravan, knowing they had successfully hounded him to his death. Nobody else would ever understand what had driven him into his current situation.

 

Next chapter...

 

#NaNoWriMo2016 - Day Ten

10 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

10. Waiting Room

"Do you want me to come and see the doctor with you?" Lara asked.

"No, it'll be difficult for you to take the time off" replied Neil.

"I don't mind. It's important. I can do it if it will help" she said.

Neil was now in his third week off work and he was starting to get anxious about returning to his job.

"I just wish I felt better, but I think I feel worse than I did a few weeks ago" he complained.

"Try not to stress about things. Go and see the doctor again and see what they say" she said in a comforting tone.

He'd left it almost to the last minute - Thursday - but Lara was now coming home expecting to find out what had happened at the doctor's. Neil was sat on the sofa as she came in the front door and hung up her coat. There was no new prescription on the coffee table in front of him.

"So, how'd it go?" she asked.

"They're referring me to a psychiatrist."

"Well that's good. You'll get a specialist's opinion" she said.

"Yes, but it could take weeks, months even before I get an appointment to see a consultant."

"What's the plan for the interim?" she asked.

"The doctor's signed me off for another two weeks. I said I was getting very stressed and anxious about going back to work. He said I should contact my HR department who can involve occupational health."

"He?"

"Yes. I saw a different doctor this time."

"Doctor Hughes?" she asked.

"I can't remember. It'll be written on the sick note, I guess."

"How do you feel about things?" asked Lara.

"I'm anxious about what it's going to be like, going back to work after five weeks off. It's a long time, you know?" he replied.

"People get sick. It happens all the time" Lara said as reassuringly as she could.

"Yes. But not me. And hardly ever anybody else at work" said Neil.

"Everybody will be happy that you're feeling better again when you go back to work. It'll be fine" she soothed.

"We agreed I would keep taking the same antidepressants. It's too early to tell if it's going to have a positive effect yet. It could be weeks before it helps my mood improve" he said. "I've got enough to last me a couple of months now" he continued.

"You refilled your prescription?"

"Yeah. I felt embarrassed in the chemist. All those pills. All those sick people and then there's me" he replied.

"Lots of people have to take medication for all kinds of reasons. There's no shame in it"

"Yes, but I still felt ashamed. I didn't want anybody we know to see me, walking home with that paper bag full of pills from the chemist" he said.

"Awww. You'll feel better soon" she said, pulling his head into the crook of her neck and cradling him slightly. His eyes were downcast and sad.

"The doctor said to keep an eye on things. Go back if there's any problems. There's not going to be any follow-up appointments or anything. I've just got to wait for a letter with an appointment date to see the psychiatrist" Neil said with a resigned tone.

Psychiatry. Lara's only real first-hand experience with psychiatry was helping patients with their prescriptions when they were on the ward. The patients were often quite difficult to deal with, but not because of behaviour that she understood as classical mental illness. She would be pestered all the time by the patients - "Nurse, it's time for my medication" - who would get extremely upset about the disruption to their normal routine. There were endless arguments about their prescriptions.

On the ward, the nurses would do three medication rounds per shift, plus respond to patients who were allowed a certain amount of pain medication on request. Unless otherwise indicated in the patient's notes, Lara could only dispense small doses of paracetamol, taken orally. The patient's own medications were usually locked away in a bedside cabinet that only the nurses had the key to. Any medication that the hospital's doctors had prescribed would be dispensed by the nurses at set times and that was when they usually unlocked the cabinet if there was something else that the patient was taking.

Psychiatric inpatients had their usual medications meticulously recorded in separate notes. Although the patients often knew which pills they had to take and how often, Lara had to follow the notes to the letter. The routine of the general hospital was different from the psychiatric wards the patients were used to and they could get very agitated if they felt they were overdue getting their pills.

It was surprising just how many medications some patients had to take each day. There were mood stabilisers and antipsychotics. There were antidepressants and anxiety drugs. There were sleeping pills and tranquillisers. The night shift would start with two hours of hell, as patients begged for their sleeping pills. The first dispensing round of the night shift wasn't until 9pm, so the nurses would get no peace until then. Mercifully, the psychiatric patients were often knocked out cold until the next morning though, which meant they were less trouble through the night than the others.

When on night shift, trying to sleep during the day was hard. Slamming car doors, traffic noises, people yelling in the street below, children screaming in the back gardens. The world was set up for the 9 to 5, Monday to Friday worker. Nearby builders and roadworks could mean a week with barely any sleep at all. Lara often longed for some sleeping pills herself and she knew that some of her colleagues did use medications to help them get some quality sleep during the day.

The few psychiatric patients Lara came into contact with were the most extreme. She saw the aftermath of self harm, suicide attempts and psychotic episodes. However, on the general ward the patients were heavily medicated. They were dazed and confused, with cloudy minds. They shuffled around. Some of them had uncontrollably dribbling mouths and involuntary tics.

She knew that Neil was going to see a psychiatrist - as an outpatient - but Lara made no association between him and the kind of extreme cases of mental illness she occasionally encountered at work. Neil seemed perfectly healthy and normal to all outward appearances, although she could tell that he was lethargic and more anxious and negative than she'd ever known before.

Later that Thursday evening, Lara attended an engagement party for a couple they distantly knew through other friends. Lara had started to socialise again, but on her own. She could see an expression of exhaustion and stress spread over Neil's face when the topic of going out was ever discussed. It was clear that he really wasn't up to socialising yet.

"How's Neil?" asked Katie.

Katie was Russ' new girlfriend. She was still slowly ingratiating herself with everybody and Lara felt sorry for her, as she struggled to become included in the group. Katie was young and pretty and the other girls treated her as if she wasn't worth getting to know. "She'll just be another casual fling" the girls said behind Katie's back.

None of the other girls had really asked about Neil. They had decided to just ignore the issue. If anybody else had asked, Lara would have dismissed the question with a cheery "he's fine". However, Katie was somehow disarming and approachable. Lara drew her to one side. The rest of the group were engrossed in their usual comfortable conversational routines.

"He's ever so depressed. It's sad to see him like that. I don't know what to do" Lara confided.

"There's not much you can do. Don't beat yourself up. Is he taking anything?" Katie asked.

Lara was taken aback by Katie's directness, but it was good to talk to somebody who seemed to immediately understand what the couple were going through.

"He started antidepressants a couple of weeks ago" said Lara.

"Well, it can take time to find the right one. Don't lose hope if you don't see any quick improvements" said Katie.

"Do you?..." Lara tailed off, worried her question was too personal.

Katie gave a little chuckle.

"It's fine. You can ask. Yes, I've been on antidepressants for a few years now. They do help, when you find the one that works for you" said Katie.

"But you seem. You seem so..." Lara stumbled, not knowing how to finish her question.

"Normal? Happy?" Katie said, grinning.

"Yeah" said Lara, nervously.

"Well, I have my bad days like everybody, but life is mostly OK now. A few years ago I just closed the curtains and didn't get out of bed for what felt like forever. I couldn't face the world"

"That sounds like the stage Neil's at" said Lara.

"Well, it does get better; easier. Recovery can be slow and nonlinear. Or it was in my case, anyway" said Katie, with as much reassurance as she could muster.

"He's just so desperate to get back to work, but at the same time I can see he's anxious. I know he can't face it at the moment. He's barely left the house in weeks" said Lara.

"There's no rushing these things. Tell him there's no rush. It can be a long road"

There was something harsh and brutal about this, even though it was spoken kindly. Katie spoke directly, truthfully, sympathetically. Lara had read things like this on websites, but it hadn't sunk in until now. There had been a sense of denial; there had been false hope.

"Look. Phone me. We'll meet up, just the two of us. You need support. You need to think about yourself too" said Katie.

Lara felt strong emotions welling up inside. She had been holding it all down, holding things together, acting like everything was going to get back to normal overnight. She was worried she was going to cry but she didn't. She was stronger than that.

Katie reached down and squeezed Lara's hand and made a sympathetic face. Lara was grateful to have made a friend who talked so openly, so freely, so directly.

The party was starting to disband and Russ was making his way over to the girls. Katie's face immediately switched to the bright happy expression she usually wore. It didn't seem fake to Lara. It made sense, to present a front and avoid discussing things that most people wouldn't understand.

 

Next chapter...

 

#NaNoWriMo2016 - Day Four

11 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

4. Prosaic

Senility seemed to reveal hidden racism inside some of the sweetest old men. Every Friday evening at the hospital, the last weekday shift would hand over to the first weekend shift. Weekend shifts were mostly covered by agency staff. Many of the agency nurses were of African descent, which was a fact that failed to escape the notice of otherwise unobservant geriatric patients.

"I am a nurse. I am a fully qualified, registered nurse" one of the agency nurses stated calmly to an irate patient. This was not an uncommon situation she had to deal with.

"How can you be a nurse? You're not even English" said a man, his voice raised.

Lara could hear the conversation between nurse and patient from down the corridor. She had her coat on and was carrying her handbag. She was now making her way out of the building to the car park. Her working week was over. She had a tough decision to make: did she continue taking the most direct route to the lifts, or did she turn around and take the back staircase down to the basement, and walk round the hospital to the staff car park? She decided to press on. Her uniform was mostly covered by a long coat.

"Nurse! Nurse!" shouted the old man, as Lara scurried past an open door, keeping her eyes fixed straight ahead. Glass windows either side of the door allowed anybody walking along the corridor to be easily be seen from the ward.

Lara knew that the old man was trying to get her attention, but she also knew that nothing could be achieved by involving herself in the altercation. The old man would never accept that not all nurses looked like Florence Nightingale and Britain had become a multicultural society during his long lifetime. Tragically, it was part of the job description, that agency nurses would have to deal with this kind of mistreatment over the weekend, when the familiar weekday staff were mostly not working.

Stepping out of view into the lift lobby, Lara felt a twinge of guilt for not taking the stairs, but this was outweighed by the sense of relief that the weekend was beginning and she could start to relax. A pair of metal doors slid open and Lara squeezed into the lift. Leaving the building at this time was always busy. Every lift going down would be packed full of people.

The hospital was a modern monolithic white cube, 5 storeys high. It was the largest hospital in the county. Built on the outskirts of town, the hospital was surrounded by a sprawling car park, divided into short stay, long stay, and far away from the main building, a car park for the general staff members. Near the staff car park was a second building in the same architectural style as the hospital, but much smaller. This was the accommodation block where many of the younger nurses lived.

As Lara reached her car, a group of young women spotted her and started calling her name and waving for her to join them. One of the group sprinted over to where Lara stood, frozen, car keys in hand.

"Will you join us for a drink?" asked Lara's friend, Anne.

"I'm sorry, Anne, I've really got to be getting home. Neil's not well" Lara replied.

"Still?" Anne asked, slightly shocked.

"Yeah. Don't know what's wrong with him. I hope he's been to see the doctor today"

"Oh dear. Well, maybe you'll come out another time?" Anne asked brightly, clearly not wanting to stress Lara out any more and slowly backing away to rejoin the group.

"Sure" said Lara, relieved that Anne could see she was keen to get going.

Anne skipped back to her other friends. Lara knew most of them. They were all a little younger than Lara and they had bonded through living together in the staff accommodation block. They had been very welcoming and friendly and Lara was grateful for the opportunity to socialise outside the group of familiar couples that she and Neil spent the majority of their time with.

Jumping in her car as quickly as she could to avoid any further attempts to pressurise her to go out for a quick drink, Lara gave an apologetic wave as she drove past the group on her way out of the car park. Young and carefree, full of energy, all her workmates waved back enthusiastically. Lara's heart sank a little, because she knew how much fun and refreshing it was to spend time with them.

Pleased to find a parking space quite near her house, Lara was also pleasantly surprised to see that there were lights on downstairs. This was the first time this week that she'd returned home to any signs of life.

Opening the front door and stepping into the hallway, Lara hung her coat on the coat rack and dumped her handbag on the floor. The door to the snug was open and Neil was sat on the large sofa, studying a large piece of paper covered with tiny print. The paper had many creases in it from having been folded up very small. On the coffee table sat a small white cardboard box with a printed prescription label on it. There was also a small white paper bag, emblazoned with the logo of their local chemist, open on the coffee table too.

Neil seemed engrossed in reading the tiny print on the piece of paper. It had also become their custom that week for Lara to have to initiate any conversation.

"So, I take it you went to the doctor?" she asked.

"What? Er, yeah. I got this" Neil distractedly replied, as if the rest of the story was implicitly clear.

Lara stifled a sigh and went upstairs to get changed out of her work clothes. Clearly she was going to have to drag the rest of the details out of him. Frustration replaced a sense of relief that Neil was up and about and had finally sought a doctor's opinion.

Unhurriedly making her way back downstairs, Lara sat down next to Neil on the sofa. She was close, deliberately invading his personal space in the hope of waking him from his trancelike state, studying the leaflet that must have accompanied the medication that he had been prescribed. Neil paused and looked her in the eye for a fraction of a second, but then feigned continuing to read his leaflet.

"So, what happened, at the doctor?" Lara patiently asked.

Neil went to answer but then held his words back. He opened his mouth as if to speak but then froze and it became clear he didn't know how to begin. After a moment, his face flushed and he started to blurt out words.

"They called my name. I sat down. Asked how she could help. Burst into tears. Couldn't stop crying" Neil haltingly said. He was emotional, but he didn't seem like he was on the verge of tears. He seemed somewhere between embarrassment and confusion.

After a moment, he seemed to calm himself down and he began again, more relaxed than before.

"The doctor said it was OK and I should take my time. I started to tell her that I couldn't get up in the mornings. I couldn't face going to work. I couldn't face the world. I was tired. So very tired"

He took a breath. He was blurting his words out very quickly.

"She asked how long it had been going on for and I told her a few weeks..."

"A few weeks?" Lara now interjected, even though she was clearly cutting Neil off mid-sentence. Her mouth hung partly open, further betraying her shock.

"I mean the tiredness. Not the getting up" Neil replied.

"Yes, but why didn't you say something before?" said Lara in a tone that was concerned, not angry. She was reacting reflexively, but she knew she had to try to control herself if she wanted to avoid upsetting Neil.

"The doctor. She said I sounded as though I was depressed and anxious" said Neil, ignoring the question. "She asked me if I had heard of flux-o-tin" he said.

"Fluoxetine?" asked Lara, enunciating the syllables - flew-ox-ah-teen - with a little emphasis, but not so much that she would sound patronising.

"Yeah, that one" replied Neil. "She said that many patients found that it helped them when they were feeling anxious about things, like work stress, as well as low mood. She said that my symptoms could be caused by an imbalance in my brain chemistry, and fluoxetine often helped to balance it out" Neil continued.

"Yes, I know fluoxetine. At work I have to help patients take their prescriptions that they bring from home. Quite a lot of them take fluoxetine. It's the same as Prozac" Lara said.

"Prozac? Well why doesn't it say that on the box or any of the leaflets?"

"Sometimes the pharmacy gives you a branded medication, sometimes they give you a generic version. At work we have to learn both the brand name of the medications as well as the active ingredient" Lara explained.

"But everybody's heard of Prozac" Neil stated, his voice now tinged with a degree of frustration.

Neil sat forward on the sofa and cast the leaflet he had been holding onto the coffee table with a dismissive flick of the wrist, before slumping back, looking away from Lara and staring up at the ceiling. Lara had seen this kind of reaction before at work when she saw doctors speaking to patients; normally young men. It was a kind of shock and disbelief; denial even. Lara couldn't understand why Neil was having this reaction now, with her, rather than earlier with the doctor.

"So I'm on Prozac. Great!" said Neil, his voice dripping with sarcasm.

"You know I've got to take this stuff for at least 6 weeks?" he said, now shaking the small white box at Lara, which rattled with the sound of the pills inside in their blister packaging. The question was rhetorical. He needed to vent.

"I felt relieved when the doctor signed me off sick for another two weeks, but now I don't know what to feel. Can you believe that the doctor even asked me what she should write on the sick note? Stress, anxiety, depression or just mental health problems. I didn't know what to say. She put me on the spot. I said she should write stress"

Lara reached for his hand and squeezed it. She made a sympathetic face.

"They're doing some blood tests too. Could be an under-active thyroid. Won't know until next week, but that's more what I was expecting, you know? Something physically wrong with me"

"I hate to bring this up, but we had planned to have dinner with Russ and Katie tonight. Do you want me to cancel? I'll ring them and come up with some excuse" Lara gently offered.

"I don't know. I don't know anything anymore. I'm confused. I'm upset. I'm frustrated" said Neil, standing up.

Looking down into Lara's eyes as she sat on the sofa, she sensed Neil's care for her and his awareness of her feelings too, but his thoughts were in turmoil. He turned and went upstairs. She heard him kick off his shoes and get into bed.

Neil was asleep, fully clothed, when she joined him in bed a little later. She guessed that it must have been an emotionally exhausting day for him. Perhaps it was side-effects from the medication.

 

Next chapter...

 

Only Smarties Have the Answer

2 min read

This is a story about a pill for every ill...

My pills

There was a young man who swallowed a lie, about how hard work and loyalty to his company would make him successful. It left him exhausted and with depression, that wiggled and jiggled inside his brain. I don't know why he swallowed the lie. Perhaps he'll die.

There was a young man who swallowed 150mg of Bupropion - a fast acting antidepressant - to cancel out the depression and exhaustion, that wiggled and jiggled inside his brain. Perhaps he'll die.

There was a young man who swallowed 5mg of Olanzapine - a mood stabiliser - to cancel out the hypomanic highs that were created by the Bupropion, that was supposed to fix the depression and exhaustion, that wiggled and jiggled inside his brain. Perhaps he'll die.

There was a young man who swallowed 15mg of Mirtazapine - another antidepressant - because the Bupropion wasn't working so well any more on its own, to fix the depression and exhaustion, that wiggled and jiggled inside his brain. Perhaps he'll die.

There was a young man who swallowed 25mg of Lamotrigine, to raise his seizure threshold so he could take more Bupropion, stabilise his mood more and as a third antidepressant, to fix the depression and exhaustion, that wiggled and jiggled inside his brain. Perhaps he'll die.

There was a young man who swallowed 10mg of Diazepam - an anti-anxiety drug - because by now he was pretty jittery from all the damn drugs, that were supposed to fix his depression and exhaustion, that wiggled and jiggled inside his brain. Perhaps he'll die.

There was a young man who was going to swallow 2,000mg of potassium cyanide, to end the depression and exhaustion, that wiggled and jiggled inside his brain. Of course he would die.

 

Top picture, from left to right: Mirtazepine, Olanzapine, Bupropion, Diazepam, Lamotrigine.

 

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The Doors of Self-Perception

14 min read

This is a story about being objective...

Yardsticks

If you want to compare two measurements you have to use the same yardstick. If you are comparing two subjective things then how can you possibly draw any concrete conclusions?

At times, I have kept a mood diary. I rate my mood from 1 for worst to 10 for best. Who's to say that if I rate myself as "1" during prolonged depression that's comparable to "1" on a bad day when otherwise I've been feeling mostly normal?

During a lengthy period of depression, where nothing seems to hold any pleasure or enjoyment: subjectively, life is terrible. I also have periods when I'm generally in a much better mood, but something really shitty will happen. The shitty thing might feel like the end of the world at the time, but I'm not going to kill myself over it: I'll quickly get over it and move on with my life... so can it really be a "1" even if it feels like it at the time?

If your mood slowly improves or declines, over the course of several weeks or months, can you spot the trend? If you're suffering a lengthy depression, does your yardstick change? You might have a day where you just feel normal, but now you rate that 10, because it's the best you've felt in as long as you can remember.

Do you even remember how you used to feel, before you got depressed?

This might be why I have a tendency to invite hypomania, because at least it's clearly some kind of polar opposite from depression, even if I don't exactly feel "happy".

Defining "happy" has started to get really hard.

Going in search of happiness has been a disappointing experience. Anhedonia means the loss of pleasure and enjoyment of things that you used to get a kick out of. Finding that you no longer love the things you've always loved to do, is terrifying, because it's further confirmation of the way that you feel: "everything is shit".

I ended up completely rebasing my whole idea about what made a happy day:

  • "Got to work only an hour late"
  • "Didn't quit my job"
  • "Only drank one bottle of wine instead of two"
  • "Survived another week without being sacked"
  • "Got out of bed at the weekend before it went dark"
  • "Went to the shops"

I know that I must be unwell, because I used to have happy days that were more like this:

  • "Cooked a healthy dinner"
  • "Went for a walk or a bike ride"
  • "Took some cool photographs"
  • "Went to an event"
  • "Made a new friend"
  • "Did some work I'm proud of"

Now, I could do those things, but I don't feel like it. Often when I try to force myself to do things, I get very stressed about it and I find it really exhausting. When I get home I feel wiped out and that I shouldn't have bothered. I find myself out taking a walk and nothing takes my interest enough to photograph it. That's weird. I used to live behind the lens.

So, I started to bring in more objective measurements: movement data, alcohol consumption, number of social engagements, number of words written.

When I analyse the data, I think the most reliable predictors of my subjective feelings of depression, are movement and alcohol. Looking at last year, I was averaging 12,000 steps a day, and although I had alcohol binges, my average consumption was reasonably low. This year, I'm averaging 7,000 steps a day and drinking excessively nearly every day.

Now, you might think "walk more, drink less" would be the solution, but this assumes a causal relationship. Perhaps I was more in the mood to walk more and drink less, last year. Perhaps the relationship is the other way around and my poor lifestyle 'choices' are actually due to depression.

We often tell people to eat healthier and exercise more, to improve their mood, but perhaps it's the people who have a happier mood who are the ones more likely to eat right and be active. In actual fact, healthy eating and being more energetic could be a good predictor of happier people.

The cause-effect relationship is not always clear. Psychologists had published a paper that appeared to show that smiling made you feel happier. However, when the experiments were repeated, the results could not be reproduced. If you can't reproduce the results of your experiment, it's not good science.

A friend made the following amusing observation:

"People who are dying of dehydration can't just mime drinking water to quench their thirst"

I think this hits the nail on the head perfectly. While depressed people can eat healthier and go to the gym, they're just going through the motions. They're not getting the benefits that their happy counterparts are getting, and in fact it could be pure torture for them.

There's an experiment where a pigeon is fed at a computer-controlled random interval. What the researchers found was that whatever the pigeons were doing the first time they got fed, they then decided they needed to do again, in order to get fed. Let's say the pigeon was cocking its head to the side when the food was released, the pigeon will then start repeatedly cocking its head, and believe that it is causing the food to be released, when in fact it's completely random. Essentially, the pigeons had become superstitious.

It seems relatively random - unpredictable - when a depression is going to lift. Let's say you were trying acupuncture or homeopathy at the time when your mood started to improve: you might assume a causal relationship between the alternative treatment and the lifting of your depression.

Even a double-blind placebo trial is not exactly fair. Psychiatric medications do make you feel noticeably different. I would be able to tell whether I was taking an inert placebo pill, or something psychoactive. I would know whether I was in the control group or not. Placebos don't work if you know you're taking a placebo, so this could explain some of the mood improvements seen with antidepressants. The antidepressant might look effective, when compared with the control group, but it's the placebo effect.

Antidepressant clinical trials generally only take place over 6 to 12 weeks. Many common antidepressants take 6 weeks before their effects can even be felt. There is no focus on long-term outcomes in these trials, only that the medication should perform better than placebo.

Many trials of longer duration have shown that being unmedicated might be more effective in the long-term, than taking antidepressants. Pharmaceutical companies are not concerned with long-term outcomes. In order for a medication to be sold to the public, it merely has to be safe and proven to be marginally better than placebo.

You would have thought that taking antidepressants would be a lot better than not taking them, right? In actual fact, there might only be a 15% chance of you feeling better, but there's a 15% chance of unpleasant side effects. The very process of going to your doctor, being listened to by somebody nonjudgemental, and then feeling something even if it's not actually better, might convince you that you're improving, when actually your depression could be lifting quite naturally anyway.

Culturally, we have developed a strong superstitious belief in the power of medicine. We believe there's a pill for every ill. We believe that a man in a white coat can wave a magic wand and we'll be cured of any ailment; discomfort.

You only have to go into any pharmacy during the winter, to see signs that say "we have no medication to treat your common cold". The fact that doctors and pharmacists have to tell people not to waste their time with an incurable virus that has unpleasant but non-life-threatening symptoms, shows how strongly we believe in the power of medical science to save us from even a runny nose.

There is a clear difference between "feeling a bit sad" and depression. Depression is life-threatening. Depression has a massive impact on people's quality of life. However, we are often medicalising a non-medical problem.

If somebody who's feeling down visits their doctor and receives some medication that's basically a placebo that makes them feel a bit different - drugged - then their pseudo-depression will lift, because it was going to anyway. The non-judgemental medical consultation will also have marginally assisted.

However, those who have prolonged severe depression - to the point of suicidal thoughts - may find that their quality of life is actually reduced by medication, because it gives no real mood improvement, but it does have unpleasant side effects. The longer-term studies seem to back this up.

Through extensive research, I found a number of medications that are very rarely prescribed, but have been used for treatment-resistent depression. These medications are dopaminergic not serotonergic.

There are a whole raft of medications used to treat Parkinson's disease, that have been shown to exhibit antidepressant effects and can successfully treat patients who had previously been treatment-resistent.

In the most severe cases of depression, deep-brain stimulation has been employed with remarkable efficacy. Deep-brain stimulation had previously only been used on patients suffering from Parkinson's disease, to stop their tremors.

The idea of having electrodes implanted into my brain does not sound immensely appealing. Rats who have had electrodes implanted in their lateral hypothalamus will starve themselves to death, in order to press a lever thousands of times an hour, to stimulate their brains. Do humans who have had the same procedure, just stay at home hitting the button as often as they can? We have wandered into the territory of the neurological basis for addiction.

This is how I arrived at my decision to use a medication that helps people to quit smoking.

My very first addiction was to nicotine. I had no choice in the matter. My parents forced me to breathe their second-hand smoke. Because I was a tiny child, the concentration of nicotine in my bloodstream would have been very high. Second-hand smoke was responsible for inflicting an addiction onto me in my infancy.

In the UK, nightclubs, bars and pubs used to be filled with smoke, until July 2007. My addiction was therefore maintained through passive smoking. The timing of the ban seems to correspond with my first episodes of depression.

The stop-smoking drug called Zyban is actually France's most popular antidepressant. The French have found that Bupropion - the active ingredient in Zyban - is also effective for treating alcoholism. The link between addiction and depression seems clear.

I have a theory that my brain is in mourning. I was subjected to second-hand smoke throughout my childhood, and I spent a lot of time in smoky clubs and pubs. Nicotine withdrawal was something I was used to experiencing again and again, but what I'd never been through was a prolonged period of withdrawal, because I would regularly get a hit of second-hand smoke. It wasn't until the age of 27 that I was finally able to escape nicotine, because of the smoking ban, even though I have never smoked in my life. You would expect that such a prolonged addiction would produce a profound psychological effect, when my brain realised it was never getting any nicotine ever again.

I then experienced a later period of addiction. Although there were periods of abstinence, these never exceeded 3 or 4 months, and the total amount of time that I struggled with addiction is close to 5 years. The addiction was extreme. The drugs I was using have a much more profound effect than cigarettes. Still today, after 6 months of total abstinence, I get shaky sweaty hands and feel sick with anticipation at even the merest thought that I might be able to obtain some drugs.

Although Bupropion is a poor substitute for the addiction I once had, it does at least slightly soothe the aching sense of loss... the mourning.

Thinking about this more now, it seems obvious that I should mourn the loss of the love of my life. My addiction was so obsessive, overwhelming, all-consuming. How on earth can you let something like that go, with just a 28-day detox, or a 13-week rehab, if it's been a huge part of your life for years?

It should be noted that my mental health problems, which predated my addiction, compound the problems. To give an official name to my ailment: it's called dual-diagnosis. That is to say, Bipolar II & substance abuse. Yes, substance abuse is a kind of mental illness. Take a look at the kind of self-harm that addicts are inflicting and tell me that's normal behaviour. That is why substance abuse is classified as a disease.

Bipolar II is a motherfucker, because it comprises both clinical depression and hypomania, which are both destructive. Therefore, I'm actually suffering with triple-diagnosis and trying to fix 3 illnesses... although the hypomania is something that most people with Bipolar II wouldn't give up, and substance abuse is hard to stop because of addiction.

I haven't had a hypomanic episode in almost a year, and I've been abstinent from drugs of abuse for 6 months, therefore the final nut to crack is this damn depression, which might turn out to simply be the fact that - subconsciously - I'm depressed that I can't take drugs anymore. It feels like the love of my life has died, hence why I'm describing it as mourning.

How long it will last, I have no idea, and I've lost patience... hence resorting to a mild form of substitute prescribing. I successfully beat addiction once before using Bupropion. I beat it using progressively weaker drugs, until I was weaned from my addiction.

You wouldn't ask a smoker to quit without nicotine patches. Why would you expect somebody with an addiction to harder drugs could quit with willpower alone? The only slightly unusual thing is that the stop-smoking drug seems to be just as effective for addictions to things other than nicotine.

Perhaps we will one day treat all addictions as compassionately as we treat nicotine addictions. Certainly, there doesn't seem to be a lot of appliance of science, when it comes to treating addiction to anything other than smoking.

Subjectively, cold-turkey & willpower is a fucking awful approach to beating addiction. We have the scientific data to show that smokers are 4 times as likely to successfully quit, with nicotine replacement therapy and smoking cessation medications like Zyban.

Of course, a relapse would be disastrous, but haven't I already relapsed back into depression?

I've been on medication for 5 days now, and Bupropion should start to be effective within a week, so perhaps I will feel an improvement in my mood any day now. Certainly, my suicidal thoughts seem to have stopped, but that could be psychosomatic and also because my horrible contract ended.

You see what I mean about how hard it is to control the variables? Human lives are messy and complex. It takes vast quantities of data to be gathered over many years, not a 6 to 12 week trial with 30 people.

Also, there's an argument to say that your subjective yardstick is altered by your experiences. Your perfect 10 can become unattainable, except through the use of powerful narcotics. Does that also mean that the best you can ever hope to feel is mildly depressed, now that the bar has been set so high? My only hope is that my brain "resets" itself over time. The brain can downregulate parts that are overactive, in order to maintain equilibrium, so it can also upregulate... eventually. The big concern is neurotoxicity: have I irreversibly "burnt out" the reward centres of my brain?

6 months isn't long though. I'm going to see what happens if I can make it to a year. Presumably, there might be marginal improvements that have happened already, but are too subtle for me to perceive. The data actually bodes well: instead of spiking back up into hypomania, things have plateaued during the last couple of months.

This unethical self-experimentation doesn't yield any results worth publishing but it does give clues as to what could be worth researching. A sample size of one is not statistically significant, but it's important to me, because my life depends on it.

 

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