This is a story about bias...

When you go hypomanic, you overestimate your capacity to work without sleep and food; you overestimate your ability to take on difficult tasks without negative consequences; you believe you can achieve superhuman feats. Often, hypomania can mean hypersexuality and the belief that you're irresistible to the opposite sex. Hypomania brings extreme risk taking, for me, and I'm a big risk taker anyway!

There must be an element of underestimation too. When hypomanic, you underestimate the difficulty of what you're trying to achieve. You underestimate the risks and the consequences of failure. "How hard can it be?" you find yourself thinking, as you get stuck into the quantum mechanics books. I rejected a highly paid career, in favour of building my own business, mostly because it seemed like it would be quick and easy at the time.

Depression has flipped all that on its head. I had an interview with a well known high-street bank earlier in the week. I thought it went dreadfully and I sank into an even deeper depression, because I gave such an appalling performance. I was beating myself about things I said and cringing about holes in my knowledge and experience that the interviewer had exposed. Then my agent phoned me:

"They loved you. They want to meet you again"

I spent the rest of the week dreading this second interview. I imagined all the things that they were going to ask, that would be difficult for me to answer. They were going to haul me over the coals and my incompetence would be laid bare for all to see. It would be embarrassing; shameful. I was losing sleep over it and waking up each day with a feeling of dread.

At the second interview, they cooed enthusiastically at everything I said, and laughed encouragingly at my anecdotes. It was almost as if we were friends and work colleagues, gossiping conspiratorially about the good and bad things that happen in the world of grey suits and office blocks. I thoroughly enjoyed myself.

Afterwards, I thought "oh no!" What if my intuition is wrong again? What if there's an inverse correlation between how I feel like things went, and how impressed my interviewers were?

Depression is almost like a defence mechanism: a reaction to a hostile world where bad shit happens. When the UK voted to leave the EU, and when the USA voted for Donald Trump, I had placed bets correctly on both outcomes, at substantially long odds. I knew I was sad that those things had happened and I didn't make enough money to be happy, but I still didn't really feel anything even though they were awful events. I was prepared for the worst. In fact, I expected the worst.

There are psychological experiments that prove that depressed people are able to perceive the world more accurately, in certain circumstances. This depressive realism is the antidote to illusory superiority. This depressive realism is the antidote to the madness of crowds and a misplaced sense of optimism.

Humans are notoriously bad at perceiving the risk of very real and likely events: stock market crashes, earthquakes and hurricanes. If we were risk-averse according to probable catastrophes, we would steer clear of the Pacific Rim of Fire and the San Andreas Fault, but yet we see insane real estate prices and a concentration of our best technologists, in Silicon Valley and Japan.

London is currently rated by MI5 as at severe threat of international terrorism: an attack is highly likely. When I see huge crowds of people at Canary Wharf underground station, I see a swarm of sitting ducks. There are two vans full of armed police parked nearby, but it doesn't make me feel any safer... it just makes me glad that I don't have brown skin.

On a day-to-day basis, I generally assume I'm going to be blown up by a terrorist, fail to get a job, run out of money, be evicted, be declared bankrupt, never be able to work again, society is going to collapse, there will be riots and looting and the human race is going to retreat into the dark ages of barbarism, religious dogma, superstition and ignorance. It just seems likely, given the evidence.

I might be wrong, but I tend to put my money where my mouth is, and I've sadly been right more than I've been wrong.

I just placed a bet on Marine Le Pen. I hope I lose.

Tags: #depression #bipolar

This is a story about treatment for drug addiction...

Having been to four different rehabs, I feel fairly qualified to give a few insights into what happens behind closed doors. Residential rehabs often hide away in leafy suburbs, where there are large houses that can accommodate human trash: dirty junkies and nasty alcoholics.

"Death's too good for 'em! String 'em up!" I hear you say.

Yes, yes, don't worry. We'll get to the idea that an addict will always be an addict, and that we should just write them off as a lost cause.

Boscombe in Dorset - an area of Bournemouth - is where many councils choose to send their difficult members of society, from all over the country. Supposedly, being by the seaside will be good for recovering alcoholics and former drug addicts. There are certainly plenty of rehabs in the area. Even Paul Gascoigne has found himself shuffling around Boscombe's streets, buying bottles of gin from the local off-license.

Ironically, many years after moving to Bournemouth, I became addicted to drugs and found myself in the perfect place to get treatment for my addiction.

Let's talk a little bit about drug addiction.

Having a 'drug habit' is not the same as drug addiction. 'Experimentation' is not the same as addiction. Partying is not the same as addiction. Addiction will rapidly destroy your health, wealth and prospects. Hospitals, police cells and prisons are the institutional stomping grounds of the addict, on their rapid descent into the fires of Hell. If you're successfully hiding your habit from your friends, partner and boss, then addiction hasn't fully taken hold. Addiction is destructive.

What about detox?

You can't really rehabilitate while the drugs and alcohol have got their hooks in you. If you abruptly stop drinking, you might get the shakes, become delirious, have a fit and maybe even die. If you stop taking heroin, you're going to feel sick and in pain. If you stop taking cocaine or amphetamines, you're going to be unbelievably exhausted and depressed, to the point where you're in real danger of killing yourself.

"You should kill yourself if you're a junkie" I hear you say.

What you haven't understood is that drug addiction is slow suicide. Do you think the addict or the alcoholic isn't aware that their body is getting utterly fucked up, and they're going to go to an early grave?

Detox is about breaking the physical addiction that the body has to drugs and/or alcohol. Detox is about suffering the worst of withdrawal, in an environment where substitute drugs can be administered to make the process safe, humane and tolerable. An alcoholic literally risks death if they stopping drinking without Librium. Is it ethical to ask people to die just because you're hung up on ideas like "willpower"?

There's the term "psychological addiction" that needs to stop being used. It's better to think about addiction like this: why did somebody get addicted in the first place?

"Because drugs are fun" I hear you say.

There are shitloads of people who take drugs all the time but they aren't addicts. Every weekend, raves and nightclubs are packed full of people taking Ecstasy (MDMA). Vast quantities of cocaine gets hoovered up by the eager nostrils of young professionals in cities around the world. Every day, a huge proportion of humanity smokes cannabis or drinks alcohol. Why aren't all these people raging addicts and alcoholics?

If you ever feel like quitting, remember why you started.

Most addicts' lives were truly appalling before their addiction took hold. For sure, addiction doesn't improve anybody's life, but it's not like there's any hope of a better life just because an addict quits drugs. The cycle of petty crime, scoring drugs, getting sick, being hospitalised and being locked up... it doesn't look great, does it? But what's the alternative? Flipping burgers and still not having enough money to make ends meet?

So, it's obvious that the rehabilitation process will only be successful if it can return a person to a better life than the one they were trying to escape from with drugs and drink.

The first rehab I attended was in Bournemouth, situated in a grand house at the end of a sweeping driveway, surrounded by mature pine trees, on a road of millionaires' mansions. The place was full of people from Greater London and the surrounding counties, ejected by their councils to make room for more rich middle-class people.

The biggest issue amongst my fellow rehab residents was housing. Boscombe has vast numbers of crappy bedsits that can just about be afforded with housing benefits. London and the South-East has no cheap housing for undesirable members of society. My fellow rehabbers were gleefully pushed away from where they were born and bred - and their families - because they were written off.

A typical day at the Bournemouth rehab would consist of a breakfast of baked beans, white toast and cheap sausages, followed by many rounds of tea, coffee and biscuits, until the 'therapeutic' day began. There were two or three sessions a day, where everybody sat in a big room, slouching on comfy sofas, vaping on e-cigarettes and slurping drinks. It was supposed to be group therapy, but it was basically just listening to heartbreaking tales of people's children being taken into foster care.

Most of the day in Bournemouth rehab was given over to matters of court appearances, housing office appointments, social worker visits and attempts to obtain various forms of welfare benefits. Almost everybody in rehab was in poor physical health, due to a life of drug abuse. Almost everybody in rehab had some underlying mental health disorder.

Those were the dregs of society, but they were warm and welcoming and they accepted me as one of their own. I was warned by staff to leave my iPhone at home and watch my wallet, but I never felt for a single moment as if my peers were going to rob or take advantage of me. I was somewhat appalled by the staff members' low opinion of their service users, but I suppose there's an element of the gamekeepers and the poachers: anybody who's keeping you under lock and key is kind of fair game, because resentment is going to build about the power that staff exercise over people in treatment.

Over the course of the 28-day program, my fellow rehabbers and I would build up special privileges for good behaviour, such as being allowed to go to Alcoholics Anonymous, Narcotics Anonymous or Cocaine Anonymous meetings. Being allowed to go into town, accompanied by a staff member, was the next privilege that accrued. Then, trips to town were permitted when accompanied by a peer who had attained 3 weeks of good behaviour. Finally, you might prove yourself to be trustworthy enough to go into town alone or as a chaperone.

Transgressions could include: not getting up in the morning, not doing your assigned chores, not attending group therapy, being caught with contraband, failing a drugs test and - most serious of all - going somewhere without permission.

Being expelled from rehab for going into town on your own might not sound like a terrible consequence, but almost everybody was there because treatment was mandated by the courts, as part of parole or an attempt to retain contact with children. Being chucked out of rehab could result in going back to prison, or never seeing your children again. The line between treatment and punishment was rather blurry.

My next rehab was 5-star luxury by comparison. You might have heard of it. It was The Priory.

If you're paying £12,000 for a 28 day stay in the countryside, you'd expect it to be pretty nice, wouldn't you? The Priory certainly delivered on making me feel special and cared after... for a high price. Therapists outnumbered patients, the bedrooms were very well appointed and comfortable, the food wasn't bad and there were luxuries like a gym and grounds to take a stroll around. Nobody was made to feel like a prisoner under house arrest.

Unsurprisingly, my fellow Priory rehabbers were rich compared to the Bournemouth lot. There were six-figure salary earning executives and heirs to multimillion-pound fortunes. Alcohol was also the predominant poison, as opposed to heroin.

One girl was so desperate for a drink, that she filled a mug with hand sanitising gel - which contained alcohol - and sweetened it with orange squash.

Therapeutic days were packed full of yoga, mindfulness, art therapy, educational videos, as well as group therapy. Supposedly following the 12-step program we only had enough time to complete the first two steps. AA and 'aftercare' meetings were held in the evenings at The Priory, which we were encouraged to attend, but most of us just watched DVDs in our bedrooms.

In my final week at The Priory, I asked "what next?"

Turns out that 28 days just isn't long enough to turn your life around. 28 days is just about long enough to get over the worst of the drug withdrawal and start thinking about how awesome the drugs are going to feel after a little break and three square meals a day. Aftercare programs are almost as expensive as rehab and last 3+ months: who's got that kind of money and can afford to take that long off work?

Having been through an acrimonious divorce, sold my house, rescued a tiny fraction of my most treasured possessions, boxed my life up, put everything into storage and suffered a horrible family Christmas, I was pretty fucked up by the whole ordeal. I needed to get cleaned up and straightened out again.

The next rehab I booked, I asked for a detox. I didn't want to have to get up in the morning and go to stupid group therapy. I hadn't slept or eaten properly for weeks. I'd been taking benzodiazepines for months and it was possible that I'd developed a physical dependency that could be life-threatening. I needed professional medical care.

The rehab I ended up in was like an alternative therapy spa break. There was a hot tub - called the sex pond - and a vibrating massage table, with whale music playing in the pitch black room. The main thing I was there for was sleep, food and a doctor on hand in case I had a seizure. Reluctantly, I consented to have acupuncture and to do some mindfulness: both of which I fell asleep during.

Most of the staff were kind and caring, but the guy who owned and ran the rehab was a complete egomaniac who clearly wanted his own cult. This idiot tried to force me to attend 'group' therapy, which was basically him giving interminable boring monologues about the time when he went into a Native Indian sweat tent. Believe me, the last thing you want when you're recovering from a near-fatal toxic combo of drugs, is to be a captive audience for some total moron.

While I was at that third rehab, a man was brought in, smashed out of his mind and covered in red wine. He'd been transferred up from the first rehab I'd been in down in Bournemouth. He'd walked out and gone into town to get pissed. Revolving doors.

I had to get away from that place. It wasn't therapy. Fuck knows what it was. Probably just a bit of respite for both family and addict alike.

Finally, I achieved what I wanted: I got back to London. Bullshit family Christmas was over. Divorce and house sale was over. I was free from horrible destructive relationships and nasty people, but I had picked up an addiction and failed to deal with it. My life to that point had been dictated by people who didn't care about my welfare.

I got myself into my fourth and final rehab: a 13 week residential treatment program in Kensington, West London.

Immediately, the place felt right. Rehabs are supposed to be run by former addicts and alcoholics. The guy who I met on my initial assessment had gold teeth and mean tattoos. The guy who ran the place had a massive scar across his face. These were people whose opinion an addict could respect, because they'd been all the way to rock bottom and back again: they'd seen friends die from overdoses and a lot of other rough shit too.

My most important lesson in rehab was how to do time. I had already been heavily institutionalised by working my whole career for massive corporations - with the limits that full-time work and education imposes on your freedom - but I still had lessons to learn about liberty. It helped a great deal that one of my fellow rehabbers was a young lad who'd been in prison twice by the age of 21.

Rehab is literally a kind of house arrest. You can leave anytime you want, but there will be consequences. It was fun to walk up to the gate (pictured above) and put a foot out over the pavement... just stopping short of taking a single step off the property.

It's not too hard to white-knuckle 3 or 4 weeks of abstinence. The first couple of weeks you'll feel awful, but your body is so abused that it's grateful for the sleep and the food. The next week or two are hard, but you know there's light at the end of the tunnel: you'll soon get your fix. You just have to count down the hours, minutes and seconds.

I don't believe you can rehabilitate somebody in just 3 months. So many things get fucked up when you're an addict. You need to get a job and go back to work, pay your bills and any debts that got racked up, repair and replace broken stuff and get a place to live. Everything got fucked up by my addiction: my shoes and clothes were wrecked and everything in my life was in total disarray.

Imagine being a company director through a period of addiction. My accounts and taxes were all messed up, and important paperwork was lost or misplaced.

What about my CV? How could I explain those periods of absence from work?

What about my routine?

Do you realise how much of your life runs itself on autopilot? You pay your rent/mortgage, council tax, electric, gas, water, sewerage, broadband, mobile phone, home insurance, life insurance, car insurance, road tax, MOT, TV license and a zillion other things. You get up every day, have breakfast and go to work. People know and respect you at work and you know how to do your job. You see your friends and socialise. You have your hobbies and you exercise. Do you think you can put all that stuff back together, running smoothly, overnight?

When you're an addict, everybody distances themselves from you. It's obvious that if you even so much as speak to an addict, they're going to steal your newborn baby and sell it to buy crack cocaine. It's obvious that anybody who injects marijuana or sniffs glue is a worthless selfish nasty person who's out to kill you.

Rehabs are necessary because family and friends are judgemental gossips who offer you useless advice like: "have you tried not taking drugs?" or "maybe you should just stop".

Rehab was a holiday from being judged to be an evil failure, morally weak and simply lacking in willpower.

Rehab showed me that I do have the willpower to stop taking drugs whenever I want. Rehab showed me that I'm not weak and I'm not powerless.

By the time I finished my four stays in rehab, I still hadn't run out of money, I had never been arrested, locked up, hospitalised or homeless. I had been nowhere near rock bottom.

I never actually reached rock bottom though. I experienced things that were awful at the time, but I needed to have those experiences.

Stopping drugs is the least of anybody's concerns. Drugs actually help when your life is unbearably shit. Just ask anybody who suffers from depression or anxiety if they'd like to give up their antidepressants or tranquillisers.

Obviously, I'm glad I never got a criminal record or sustained any life-changing injuries, but maybe I needed to come close. Being locked up in a police cell a couple of times and spending weeks in hospital, were not things on my bucket list, but I think they were necessary experiences to complete my adventure.

When the time was right, I got a place to live, a girlfriend and a job. Without those things, life isn't worth living, but equally, those things don't create recovery.

Bullying was relentless and intolerable at school for 11+ consecutive years. Nothing I did was ever right or good enough for my parents. My parents' relationship was appalling - full of verbal abuse and hostility - and I got involved with a girl who physically and mentally abused me, who I stayed with for many years. I got so used to broken, abusive relationships. Do you think that kind of stuff can get healed by 28 days in rehab? Do you think that all my problems came about just because I sniffed a bit of white powder?

You might think I act normally and sound perfectly reasonable, rational and able to string a sentence together, but it's the opinion of the medical professionals who've treated me, that I'm dealing with depression, bipolar and even borderline personality disorder. Clearly, I've had many episodes of mental health issues... including a period of many years before drugs even entered the picture.

This is called dual-diagnosis: the clusterfuck that is both addiction and mental health issues combined. The tail that wags the dog.

I've cherry-picked the best treatment and the most humane and compassionate approach to fixing my addiction and now I've arrived at the situation where - joy of joys - I'm 'just' dealing with depression and anxiety.

I'm itching to press the 'fuck-it button' because life is intolerably stressful, unrewarding and my depression is refusing to lift. What's the solution? Drugs? Been there, done that.

Rehab taught me how to quit drugs cold turkey. Rehab taught me that I'm in control, so long as my life seems worth living.

Addicts and alcoholics are taught on the 12-step program that they're powerless. I'm certainly powerless, but it's over things like whether I get offered a decent job that pays enough money to be able to live. Being powerless to influence the things that really matter to me in life, such as whether I can live with dignity or not, creates incredible stress and anxiety.

I can choose to stop drinking or taking drugs, but why would I, if the alternative is ESA assessments and having my inadequate welfare benefits cut off by somebody who's not even a qualified doctor? Why would I quit, if I have to prostitute my mind and body, to go and work some pointless bullshit job for somebody promoted into a position of incompetence, if I'm 'lucky' enough to be offered a pittance to do the job?

It's so hard to escape the things that drove us to drink & drugs in the first place.

Rehab was important for me to forgive myself for things that weren't even my fault. I didn't make a mistake, getting addicted to drugs: it was a deliberate act and I'd live my life exactly the same if I got to start over from scratch. Rehab was respite from those who wish to scapegoat sick people.

Fundamentally, rehab connected the 'clean' and the 'dirty' world and allowed me to see that they're two sides of the same coin.

Every saint has past and every sinner has a future.

Tags: #addiction #drugs #alcohol

This is a story about a year in review...

Are you sitting comfortably? Good. Then I'll begin.

For anybody following along at home, there are a few highlights buried in the 600,000+ words I've written to date. There's some required reading for anybody making a study of my psyche.

I decided I wanted to write something more popular and so I drew some graphs explaining mood disorders, like bipolar. It was my most read blog post of 2016.

Along the same lines, I wrote about the onset of depression and attempts to treat it.

I wrote a letter to myself.

I was an inpatient on a secure psychiatric ward, so naturally I came up with a bizarre thought experiment. I even did a drawing of my quantum suicide experiment.

When I was bored out of my mind at work one day, I wrote a short story called The Factory.

If you ever wondered why I have a semicolon tattooed behind my ear, this is half the story.

Everything you never wanted to know about addiction.

But, is it art? This is a good example of me rambling while strung-out. I'm surprised I could even see the keyboard. I just like the title and it's a bit of a private joke, sorry.

There's a 3-part account of the time I lost my mind and started hearing voices.

That'll probably do. There's a lot to get through there.

Of course, there's also the first draft of my novel if you have time to read 53,000 words. I'm going to start editing it tomorrow, so any feedback would be gratefully received.

I've slightly bent the rules, because I have a bit of a warped sense of time, but these are all significant pieces of writing for me, that I associate with the events of 2016.

Happy New Year's Eve.

Tags: #writing #bipolar #depression #suicide #physics #addiction #mentalhealth

This is a story about compatibility...

Very often, when you're acutely aware that there's something that you need to avoid crashing into, you'll end up staring at it, unable to tear your eyes away. When riding a board or a bike, flying, driving or otherwise in motion, you tend to go in the direction you're looking. If you want to avoid a crash, you should look at a spot away from danger.

Is this the reason why we don't talk about taboo subjects, because we're worried about tempting fate? We turn our back on the ugly truth and try to pretend like everything's OK.

My Christmas stocking included some bath salts.

Clearly, Santa has the same dark sense of humour as me. That's great. I think humour is a fantastic way to exorcise the demons of the past. First comes talking, then understanding and finally you can laugh and joke about a topic that was originally quite painful and difficult to remember. Repressing memories and walking on eggshells is no way to move forward.

If we don't have honest conversations where we can talk about how we really think and feel, then we build up a load of sensitive topics. Secrets and lies lead to paranoia and weak relationships. Keeping schtum about my parents' drug use - when I was a child - was too much of a burden. Writing openly has been liberating and has allowed me to move on from shame and regret, to regain my self-esteem and confidence.

I remember a desperate scramble to cover up my admission to The Priory. My psychiatrist had made a referral to a "private hospital" for treatment of an acute episode of bipolar disorder. All perfectly true, but there was a certain economic use of the truth. What would most people think, if they found out that I was spending weeks in the UK's most notorious treatment specialist for drug & alcohol abuse? They would leap to the wrong conclusions, surely?

It's so bloody exhausting keeping up appearances. One must be aware of how things can be [mis]interpreted and people aren't likely to share their true thoughts and feelings: "better keep him away from the kids if he's mentally ill" or "I bet he's a raging alcoholic behind closed doors if he's been in The Priory".

We're brought up to believe that our reputation is like a balloon: one little prick and it goes pop. We're scared to take time off work, because we'll have gaps on our CV that need to be explained. We're scared to share details of our private lives, lest our employers decide we're unreliable and judge us on preconceived notions. Who wants to work with a madman?

When it comes to dating, the same applies. Who wants to date somebody with flaws; defects? Who wants to take a risk on a ticking time bomb; an unsteady ship? And so, I should have found myself unemployable and undateable. "Take your pills, sit in the corner and shut up" says society.

However, if you ever meet me in a work or social context, you may gain the [false?] impression that I'm pleasant company: a healthy, happy and capable member of society, engaged in productive endeavours. Strangely, you might have the wool pulled over your eyes so much that you actually mistake me for a normal human being.

Surely this is thanks to the excellent medication that I take?

Well, no. I don't take any medication. I don't do therapy. I haven't had a course of electro-convulsive shock treatment. I don't even have a psychiatrist at the moment.

"But you're going to murder everybody if you don't take your pills."

Yes, that's right. I'm your worst nightmare. I'm out there, on the dating scene, luring unsuspecting vulnerable young women into my web. I'm a dangerous fantasist; a con-man. I'm so good at living a lie that I've constructed an elaborate fable that looks, smells, tastes and sounds very much like an authentic real life, but it's all fake. It can't be real. What about the secrets we now know?

If you take your secrets and turn them into jokes, you defuse that ticking time bomb... or at least that's my working hypothesis.

I certainly feel a lot happier knowing that I've met somebody with enough of a good sense of humour to make a joke on Christmas Day about my chequered past. I feel less sensitive, paranoid and insecure than ever before. I feel like I'm myself, and that's OK.

Maybe it's just a getting old thing: the realisation that we're all flawed in some way. We're all human. We all have weaknesses and strengths, and we all have history; baggage even. It seems better to wear my heart on my sleeve than present myself as some whiter than white, holier than thou saint who never put a foot wrong in their life.

I doubt I'll ever unify my professional and private identities, but I certainly don't regret jettisoning the traditional approach to dating. Honesty seems to have been the best policy in this case.

Tags: #dating #sex #bipolar #addiction

This is a story about data collection...

Here's a graph of my daily step count for the last 18 months, as recorded by my iPhone. I practically always have my iPhone in my pocket, so it should be fairly accurate.

As you can see, there are big gaps.

I've added a 14-day moving average to the graph too, which is the dotted line.

How do I interpret this?

The optimistic interpretation is that I was overdoing it last year and had a big crash. There's a little gap in the graph that you can hardly see at the end of October. I was in hospital then. This year got off to a shit start and then improved and stabilised, but I still had a hiccup at the start of October. The graph is much flatter on the right hand side - on average - than it is on the left hand side. Perhaps the volatility in my life has been reduced.

The pessimistic interpretation is that there's a strongly downward trend. There are also signs of repeated periods of inactivity: shit times. Perhaps there's a cycle that would be clearer to see with more years of data.

I could bring in my Android phone data which covers the period before this, and maybe some other data sources too, but it was a pain just to produce this. 

Interestingly, if you own a smartphone, you should be aware just how much it's tracking you all the time you carry it around!

Tags: #bipolar #mentalhealth #depression #computing

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...

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

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.

Tags: #depression #bipolar #medication #suicide #career

This is a story about being objective...

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.

Tags: #bipolar #depression #mentalhealth #addiction

 This is a story about drug dealers...

The top image shows an official UK prescription. A doctor registered with the GMC prescribed me the medication and a pharmacist registered with the GPHC filled my prescription. The bottom image shows black market prescription drugs for sale on the Dark Web. When you buy from the Dark Web an anonymous vendor will sell you whatever you want, no questions asked.

In order to receive my official prescription, I had to answer 14 yes/no questions. One of the questions was "do you have high blood pressure?". How the hell should I know? The last time I had my blood pressure checked was 11 months ago, and I've gained loads of weight and have been drinking far too much since then.

According to my order tracking, a doctor spent 7 minutes deliberating my 14 answers - 30 seconds per answer - before writing my prescription. I never met this doctor, we never spoke and they never saw my medical records.

Some years ago, with a great deal of arm-twisting from my private psychiatrist, my GP agreed to prescribe me Bupropion for the depressive episodes of my bipolar disorder. In the UK, Bupropion is not licensed for the treatment of depression or bipolar disorder. NICE guidelines do not recommend the use of Bupropion for anything other than as a smoking cessation treatment. Basically, my GP faced being struck off the GMC register if I suffered some horrible medical complications because of an adverse drug reaction.

I've been back in London for 3 years and I've had 2 different GPs since then: one in Camden and one just across the road from where I live. Neither of them has prescribed me a single medication, but the Camden GP took it upon himself to phone me on my mobile in his personal time to see if I was still alive. My GP went out of his way to try and help me.

The average face-to-face GP consultation time in the UK is just under 9 minutes. Imagine having just 9 minutes to establish that somebody is suicidally depressed and then select a psychiatric medication for your patient. The medication could either save them or reduce their quality of life even more. It's not much time, is it?

And so, I became an educated well-informed patient. A doctor I spoke to some years ago said that I would be better off finding a "prescription pad psychiatrist" who would write me a prescription for whatever I wanted. These doctors exist. They're available online, without even having to meet them or speak to them on the telephone, it would seem.

I have no criticism of the ethics of what the doctor and the pharmacist who I obtained my official UK prescription from are doing. It doesn't seem unethical to me.

Interestingly, it cost me £90 for 60x 150mg Bupropion tablets. I could easily buy the exact same medication for less than half that price on the Dark Web. If I was to buy the medication from India, it would cost me less than £6 (plus postage).

On the NHS, a prescription costs £8.40 if you're working and not entitled to welfare benefits.

Basically, you pay for convenience. With the online pharmacy I had a short form to fill in and I got my medication delivered next day. With the Dark Web, I would have had to faff around with Bitcoins, but my medication would also have been delivered next day. With my doctor, I would have had to make an appointment, and there's every chance that they wouldn't have been prepared to take the risk of writing an off-label prescription. With the Indian medication, their postal service is appalling and it takes weeks for a delivery to arrive.

One reason not to order from the Dark Web though, is that you can get anything you want. It's easy to start window shopping. Once you've loaded up your account with some Bitcoins, it's easy to fill up your 'shopping basket' with all kinds of things that you're curious about, or things that you know you really shouldn't be buying because they're bad for you. It's a slippery slope.

One of the reasons why I don't have any drug dealers phone numbers and I've never bought drugs from a drug dealer, is because it's so convenient. I don't believe in the idea of a 'pusher'. People want drugs, plain and simple. The drugs push themselves.

One of the reasons I'm not using internet banking at the moment, is because it makes it too easy for me to buy some Bitcoins, transfer them to a Dark Web marketplace, and have a little jiffy bag containing deadly white powder, hitting my doormat the very next day.

I don't believe prohibition works, but certainly making things a little more inconvenient does offer some protection from temptation. I wouldn't even know where to begin, trying to find a drug dealer, unless I wanted to buy low quality cannabis or terrible quality imitation cocaine from one of the many dealers who hang around by Camden Lock.

Prohibition created legal highs. Prohibition created the Dark Web. Because I'm an IT expert and a sensation seeker, when I read about legal highs in the news I was tempted to give them a go. The rest is history. All of that "moral panic" crap in the media had precisely the opposite effect than intended. A naïve middle-class IT professional working for an investment bank, suddenly became exposed to a world that I would never have become part of, if it wasn't for the fact that prohibition lowered the barrier to entry.

As the legal highs started to get banned, I then took to Internet forums to find out where people who had stockpiled - like me - were supposed to go after we ran out of drugs. That was how I found out about the Dark Web. Yet again, prohibition moved me from a world that was legal, taxed and regulated, towards the dark and murky world of illegal drugs.

One day, in a pit of despair at my spiralling addiction, I decided to order all the drugs. I bought crack, heroin and crystal meth. I didn't even know what to do with them. You can snort heroin and meth, but not crack, as it turns out. How does a middle class homeowner even smoke crack? I didn't even own a cigarette lighter.

A couple weeks later, I had nailed my door shut and put newspaper all over the windows. It's remarkable how quickly a respectable middle-class rich person can turn the house they own into a crack den.

What's also remarkable is how quickly you figure out that you've bought a one way express ticket to an early death, if you have vast sums of money and a reasonable intellect.

One day, I smoked a pipe - I had bought a meth pipe off the Dark Web by this point - that had been filled with heroin, crack and meth. I thought "is this as good as it gets?". The room was bathed with a yellow light, even though it was barely lit. There was a calm serenity. I thought "this ain't even that great" and decided that I'd better stop before I decided that it was great.

It's the strangest thing, flushing rocks of crack and a big bag of heroin down the loo, not because you're addicted and you want to quit, but because you can see how easily you could become addicted.

People think that drug addiction is all about wanting drugs and taking drugs, but it's not that at all. Drug addiction is about identity, routine, habituation, ceremony, lifestyle... things that I even struggle to explain. If you're just locked in a room with a virtually limitless supply of drugs, because the postman keeps bringing your supply and you have lots of money in the bank... you'd think you'd just take drugs and more drugs until you died or ran out of money.

In actual fact, addictions are self-limiting. Given a clean pure supply of drugs, eventually, addiction becomes kinda boring or the downsides start to outweigh the upsides.

I'm lucky, because I'm wealthy and I'm not a total dumbass. I tried so many drugs, and eventually found one that was far better than crack, heroin or crystal methamphetamine, but cost less than £1 a day.

I used to buy a packet of capsules off the Internet for £27. This was a legal high called "NRG-3", which turned out to be MDPV: I've nicknamed it supercrack. The packet contained 20 capsules, and each capsule had 100mg of MDPV in it. I would hide these capsules all over the house, so that I would never have to hunt for very long to get my fix, when the cravings became unbearable.

I would divide the 100mg contents of a capsule into 3 equal piles. Then, I would divide one of the piles into 2 lines. I would snort one of the lines, which would weigh approximately 17mg.

17mg of MDPV is a very strong dose. Basically, it's enough to be bat-shit insane for 24 hours. I would pretty much always end up going back for the second line... so that's 48 hours of insanity, with no sleep. I would go back to work for a rest.

120 days of bat-shit insanity for £27.

Cheap.

Deadly.

You spread 120 days over the weekends, and you've got 2 years worth of hiding a drug habit. If you do anything for 2 years, it becomes an integral part of your life. It's hard to change the habits of a lifetime. Again, you've gotta be smart and spot the changes in your behaviour.

I started cancelling plans, because a 1-day drug binge turned into a whole weekend drug binge.

I started not making any plans, because I was planning on taking drugs all weekend.

How the hell I held down a job during this time, I have no idea.

My psychiatrist and my GP thought I was self-medicating for depression. They thought I was in control. They actually told me "don't stop what you're doing... just try to cut down gradually". My GP signed me off work for 5 weeks, and I thought "great! I can take drugs for 4 weeks and then spend a week recovering".

It's true that my clinical depression and abusive relationship had led me to self medication, but when it became drug experimentation, I lost control over the course of a year. I started with a legal drug called Methylone, which I took every day and it worked to alleviate my depression. Then, when I found NRG-3 during a messy breakup, I was completely hooked.

Less than a month after becoming addicted to NRG-3, I started carrying a letter with me and a £20 note in an envelope. The letter said:

"I am a drug addict. If you have found me with breathing difficulties or unconscious, please put me in a taxi to A&E".

In actual fact, the letter was far more detailed and contained some information that would have been useful for any medical professionals who had the misfortune of trying to look after me... but you get the idea. The penny had dropped. I knew I was in trouble. Self-medication had turned into experimentation, which had unleashed addiction.

For others, there are 3 valuable lessons I learned:

1. Depression, stress, relationship difficulties, money worries, housing worries: these are the things that create a festering swamp. Addiction will take hold, not because of the drugs, but because somebody's life is already awful. If you want to prevent addiction, you need to improve people's lives, not ban drugs.
2. Even though it sounds disingenuous, it does make sense to shop around. Think about all those Oxycontin addicts who haven't yet figured out that heroin is stronger and cheaper. They're going to one day. How much money are they going to 'waste' in the meantime?
3. Addictions are naturally self-limiting. People need to quit on their own terms. There's an oft-quoted line about how addicts and alcoholics "can never get enough of their drug of choice". In actual fact, very few people can actually afford to take as many drugs as they want. Look at the mega wealthy: aren't you surprised that so few of them drop dead from drug abuse?

Alcohol is a dumb choice of drug, because it's so damaging to the liver. In a way, benzos are the smart alternative. GHB/GBL makes you 'drunk' but it doesn't have the same hangover, and it's not so damaging to the body. You can buy 10 litres of "alloy wheel cleaner" from BASF in Germany for about £500. That's equivalent to 7,000 shots of vodka, and it won't give you cirrhosis of the liver.

Cocaine is a dumb drug of choice, because it's so expensive and the adulterants are highly damaging to the mucous membrane in your sinuses, to the point where you might lose your nose. You can buy nitracaine from China in bulk for just a few dollars per gram, and it'll be 99% pure.

Heroin is damn cheap. It's the injecting that causes the problems: collapsed veins, abscesses and dirty needles leading to blood-borne diseases. With an adequate supply of medical grade diamorphine, a heroin addict can live a long, healthy happy life, and will probably "grow out" of their habit in their 40s or 50s.

Crystal meth is cheap anyway. Smoking meth is undoubtably incredibly destructive to teeth and lungs. It sounds crazy to say this, but given an adequate supply, at least crime will go down and the need for prostitution goes away. With higher self-esteem because people are not selling their body to get drugs, surely a large number of addicts are going to stop using eventually?

I'm not saying "legalise all drugs and have your local supermarket stocking crystal meth". Drugs are so widely available and so cheap, we're at the point where prohibition is like a bad joke. Shutting the original Silk Road marketplace on the Dark Web just caused dozens more imitators to spring up and fill its place. You can't legislate to control human nature. It doesn't work. Supply and demand are the only forces that you need to understand.

If you have a loved one who you think is at risk of addiction, or struggling with addiction, you can prevent that journey from even starting by making their life vastly better so that addiction never takes hold. Once an addiction has started, you're not going to be able to cut it short by cutting off their supply of money or forcing them into some rehab program. An addict will simply go around any obstacle. An addict needs to quit on their own terms, when they've had enough.

Perhaps I will never have had enough, because perhaps my life will never improve. Certainly, when you're depressed, stressed, bored shitless by your job, worried about money, isolated and lonely... those things are perfect breeding conditions for addiction to take hold. Why the hell are you being clean & sober, if your clean & sober life is utter bullshit?

This is how I've arrived at the decision to start using drugs again.

Except, I'm being smart... I think. I think I'm smart. Correct me if I'm wrong. Am I smart?

What am I doing differently? Well, nothing really. I'm combining my experience from far too many years of ups, downs and dangerous self-experimentation. However, I have meticulously gathered data. I have documented pages and pages of details on my drug and medication use, and cross-correlated that with my mood diary, earnings, movement data and every other data source that I could harvest.

My conclusion: I need a fast-acting antidepressant that gives me a mood improvement.

So, I decided to prescribe myself Bupropion.

It arrived today.

I took it.

The experiment continues. It's a big relief to finally change something, after 6 painful months of controlling the variables, even though it was causing me untold mental anguish.

Actually, two things changed today, which is a shame, in terms of conducting a decent trial.

Today, I'm unemployed.

Anyway, I need to get another job, and it might just be a little easier, now that I have relented and I'm taking happy pills... let's see, shall we?

Tags: #drugs #addiction #mentalhealth #medication #depression

This is a story about unhealthy coping mechanisms...

I've been surviving on a combination of barely concealed loathing and contempt for my job, copious amounts of alcohol, occasional use of tranquillisers and a lot of passive-aggressive blogging. It seems to have worked, according to my bank balance and my CV.

In four months, I had one day off sick and a one-week holiday. That's not bad. Just 6 working days that I was unproductive. 1 out 82 working days unwell is only 1.2%.

It's been killing me in unusual ways though.

I've been comfort eating a lot. When I first started my contract, I was munching my way through loads of sweets and nuts at my desk. I was having a great big lunch. I was having cakes and pasties. I was having super-size meals at McDonalds. I was coming home and stuffing my face with crisps, ice cream and unhealthy meals.

I've been drinking far too much. To begin with, I was picking up a bottle of wine on my way home, every single day. I switched to beer because I could drink more of it, but there would be less alcohol in it. There's 94ml of alcohol in your average bottle of white wine. There's 75ml of alcohol in 3 cans of lager, even though the beer is double the volume. Then, things got out of control briefly. I was having two bottles of wine, or 6 cans of beer. The alcohol was a real problem, but then so was the job. Sobering up at my desk was a way of getting through the day.

Early on in my contract, I decided that I wasn't going to blog at work. I wanted to do my best to look busy. I didn't even want to surf the web and read the news websites that I like. I certainly didn't want to be looking at Facebook on my phone all day long. However, that just made things worse. Getting through the empty boring days was excruciating agony. By the time I got home, I was so relieved, but so stressed out, that I felt I needed alcohol to relax and face the next day.

Then, I started to read the news. I found myself constantly clicking refresh, willing something to happen. The summer months are fairly dreadful anyway. The politicians have gone off on holiday, the markets are quiet. Not a lot was going on. Brexit provided a very unhealthy obsession for a while, and I took great delight in trolling the closet racists and xenophobes. Post-Brexit was quite anti-climactic, and just tragic.

I decided that the only way that I was going to stay sane was to write 3 times a day. I was briefly mailing short stories that I was writing to a couple of friends. They helped to keep me sane by being the willing recipients of my bleak allegorical tales of wage slavery: read Alan the Alcoholic if you want to know what I mean.

Finally, I decided I would allow myself to blog at work. I had the additional problem of being told I could no longer use my personal MacBook and I would have to have some piece of shit PC "because data security" or whatever. Anyway, I then didn't have access to my photo library - I try to use images that I own the copyright for - and I didn't have Photoshop to be able to make high quality edits. There's also a slight worry about what kind of corporate spyware is watching what I'm doing.

Somehow, I've nearly limped through to the end of my contract, and I even managed to work my notice period, which is something I haven't done for 6 or 7 years. I'm even getting a couple of leaving dos, as opposed to being escorted off the premises by security (that's never actually happened, but things haven't been wrapped up 'neatly' in recent years).

Obviously, I'm on really dodgy ground, because I'm going to be looking for a new contract in a fortnight or so, and I suppose prospective new employers could stumble on my Twitter profile, Facebook page or this blog. So, to be sensible, I probably have to blog "nicey nicey" for a couple of weeks, so that all the juicy gossip is buried deeper than most miserable corporate drones would ever dig.

I'm not sure what the magic formula is for recovery from clinical depression / major depressive disorder, bipolar disorder, substance abuse (dual diagnosis), borderline personality disorder, functional alcoholism and all the other labels that get bandied around. However, I'm pretty sure that it looks like this:

• An absolute imperial fucktonne of cash. I mean LOADS.
• Rest & recuperation. I don't just mean a couple of weeks. We're talking months or years
• Surround yourself with addicts and people with mental health problems. Nobody else 'gets' it
• Cut horrible toxic people out of your life
• No compromise
• Force yourself to do things you don't like very much
• Do something that requires discipline and routine, and stick with it for months, if not years
• Set yourself some achievable goals, where you're in control

That last one is probably the most important. I absolutely love the fact that I've been blogging for over a year, and I'm on track to write 365 blog posts and 450,000 words in less than 13 months. I've blogged from psychiatric hospital. I've blogged from San Francisco. I've blogged from a desert island off the coast of North Africa. I've blogged through a couple of projects from hell. I've blogged through depression. I've blogged through addiction. I've blogged through isolation. I've blogged through loneliness. I've blogged through suicidal thoughts and self harm.

The only thing I haven't quite done yet is to blog through happiness and contentment, but either that's coming or blogging is keeping me trapped in a certain mindset and stopping me moving on with my life.

I don't think writing like this is keeping me stuck in a rut. I can't imagine my life without writing now. Writing has become such a part of me. I'm more a writer than anything else. There's nothing else I live for, as much as writing. There's nothing else that I put as much passion and energy into. There's nothing else I'm as enthusiastic about.

I guess for many people, work is what defines them. "What do you do?" is the classic middle-class party icebreaker question, when meeting new people. What do you even say if you hate what you do, or you're flailing around to find something new? What should I say, on Thursday, when I'm out of a job again?

If I tell people I'm an IT consultant, that's slightly misleading, because that's a thing that I do just to get money when I'm desperate, and I won't even be consulting for any clients on Thursday, or for at least a fortnight or so after that.

However, I'm not going to stop writing when I finish my contract. I can't see me ever stopping writing, now I've started. What would I do with myself? How would I structure my day, without writing?

Obviously, writing is not a panacea, and it's a dangerous strategy to turn yourself into an open book. So many people will gleefully abuse your honesty, in order to gain a competitive advantage over you, put you down. So many people are looking for an excuse not to hire you, or to sack you. I'm giving my enemies all the ammunition they could possibly want.

However, isn't there something poetically wonderful about loading the gun, handing it to your enemy and turning your back on them? If they choose to shoot you in the back, with the bullet that you loaded in the weapon that you gave to them, isn't that going to eat away at them for the rest of their life?

Isn't there something exciting about deciding to say things that you're not allowed to say because of the conspiracy of silence? People are so afraid about becoming unemployable, and tainting their professional reputations. I almost want to start linking to this blog from my LinkedIn. Of course, every time I write the word "LinkedIn" the higher up the Google search index I will climb when somebody types "nick grant linkedin" into the little search box.

I'm not sure how much the 9 to 5, Monday to Friday routine has given my life some useful structure. I think, on balance, it's been more damaging to my mental and physical health to have a shitty project and an offshore team, than any benefit that I have gained by forcing myself to get out of bed every morning. I have no difficulty getting up and getting on with being productive, when I'm working on something that isn't mind-numbingly boring and depressing anyway.

The suffering has been worth it, financially, and with money comes opportunity: the opportunity to find something better to do with my limited time on the planet. Life is short: too short to be working a job that's like death itself.

Who knows how I'm going to feel when I wake up on Thursday. Will I feel elated, depressed, motivated, anxious?

I'm not exactly in a rush to get my CV out into the marketplace and find myself in another shitty contract. I want some time out, and I want to be more picky about the project I choose next time, even if I am still in a precarious financial situation. It's unwise to become complacent about your employability. Catastrophic market events can happen at any moment, and work can dry up overnight.

Will I be able to cut down my drinking, eat less, exercise more, or will the task of job hunting loom large and make me unbearably anxious? I certainly lost a lot of sleep during the week that my contract was terminated early and my flatmate revealed that he didn't have any money to pay his rent & bills for the 4th month running. Life's never straightforward, is it?

Health vs. wealth. That seems to be the battle that is being fought. Is it possible to have it all? Watch this space.

Tags: #career #mentalhealth #addiction #depression #bipolar #alcohol