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Agony Aunt

3 min read

This is a story about pen pals...

Inbox

I invited people to write to me, and they do. My DMs on Twitter and Facebook are full of messages from readers. My email inbox is full of emails from readers. This is good. This is what I asked for. This is what I got.

I agonise a lot about whether it was the right thing to do, to write so candidly and brutally honestly about suicide. Some people would expect a massive content warning, trigger warning, or some other kind of disclaimer. Some people - including most responsible journalists - wouldn't even grapple with the topic at all. There's a widespread fear that suicide is contagious, which is not a wholly unwarranted fear, given that suicide does seem to occur in clusters; there is fear of copycats.

Being in touch with so many people who've read what I've written, is somewhat reassuring. Nobody is saying "I wasn't going to kill myself, but now I am, because of what you wrote". Of course, you might say that the ones who think that don't get in contact, but that's a preposterous idea. I have an ever-growing dataset, and almost without exception, people get in touch because they're already suicidal.

Of course, you might say that if I push just one person over the edge, that's one too many. I agree. I'm not pushing anybody. If anything, I'm trying to nudge people back in the other direction. If they want to research suicide methods on the internet, they're going to find the information they need. At least what I offer isn't a dry step-by-step instruction manual. I'm genuinely just saying "yes, suicide can be achieved by these methods, and it's OK to feel like you want to end your life, but I'm upset that anybody feels like life is not worth living; I feel like life is not worth living a lot of the time"... and that's OK. I'm allowed to say that, because I feel it, and it's not doing anyone any harm. I'm not trying to inspire or provoke anyone into committing suicide. People die in darkness and ignorance, not in a world of honesty and openness.

Will I one day have angry friends and relatives contacting me to accuse me of being to blame for their loved one's suicide? Probably, but they should probably ask themselves why their loved one was driven to searing the internet for suicide methods and other information on self-murder, instead of finding whatever they desperately needed from their loved ones. I didn't invent suicide. I'm not in charge of suicide. I'm not telling anyone to commit suicide. I simply exist, sharing my own story, which people tell me is relatable, for those who are in crisis.

Anyway, I've got to go... I've got emails to answer.

 

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Get Help

4 min read

This is a story about treatment and therapy...

Crisis counselling

I write about my own personal experiences of depression, anxiety, suicidal thoughts, suicidal plans and suicide attempts, because that's what I would want to read if I was in crisis. There's a mountain of material on the web about the symptoms of mental illness, dealing with a crisis, coping with suicidal thoughts, counselling, crisis support, mental health teams, crisis teams, doctors, healers, witch doctors, shamen... and all the rest of it.

It's all been done to death.

So, here's what I'm doing: I write.

I've tried absolutely tons of medications, and all of them have undesirable side-effects, and ultimately didn't bring me a good long-term outcome. I refuse to accept that I simply haven't found the right medication, at the right dose, in the right combinations: personally, I've exhausted that avenue, and found it to be a fruitless exercise. That's not to say that medication won't work for you, and you shouldn't try it, but it didn't work for me.

I tried counselling and behavioural therapies. Nope. Probably OK if you're just 'a bit sad' but if you're reading this then you're probably well beyond being 'a bit sad'. That's not to say you shouldn't try therapy. Everyone's different. However, for me personally, I don't think 45 minutes a week is going to fix all my problems, sorry.

It's important to acknowledge, though, that following the treatment routes which have been resoundingly proven to be ineffective, can be a useful distraction which will eat up a few years of your life. Although I can say with certainty that the long-term outcomes are not attractive, in the short term, there's a lot to be gained from the process of learning about all the different medications and trying them out: it'll keep you busy!

Also, we shouldn't underestimate the power of having a kind non-judgemental person, listening to your traumatic story. Being heard is super important; super healing. Having somebody tell you that you did the best with the hand you were dealt, can be incredibly important, to forgive yourself and start to feel better about being unwell; not so guilty or broken.

I write because it's unlimited free therapy. Instead of only having 45 minutes a week with a therapist, my therapist - the blank page upon which I write - is available 24 x 7 x365, and I can spend as long as I want in a therapy session for free. The free part is not to be underestimated: therapy is really expensive (although it might be money well spent if it works for you). Also, the blank page is the world's best listener: it never interrupts, misunderstands, disagrees, challenges, contradicts, argues or otherwise talks back, which is *perfect* as a therapist.

Given that therapy is pretty much just guided introspection, there's no reason why you can't learn the techniques to explore your own thoughts and feelings, without a guide. Now I'm in the habit of sitting down in front of my blank page every day, I find it really easy to explore whatever's bothering me, or to dig into baggage from the past... whatever I want - it's my time and I'm paying for it!

From personal experience, not professional qualification, I really urge you to write on a regular basis, therapeutically. It's helped more than anything else I've tried, by far.

Of course, we would all love to find an authority figure - a doctor or similar high professional status person - who we can put our faith in to 'cure' us and take care of all our problems, but the reality is that depression and anxiety are modern epidemics, and medicine has failed to provide effective treatment; the problems are getting worse, not better. Ultimately, we are - unfortunately - personally responsible for our safety and wellbeing. Much though I wish there was a magic person in a magic building with magic beans, like a doctor in a hospital with some pills, it's turned out to be a massive disappointment... we're on our own.

Of course you should phone the crisis hotline if you're on the brink of committing suicide. Of course you should go to your doctor and take their advice. Of course you should seek professional help. However, if - like me - you've tried all that and found it to be a dismal disappointment, then I imagine that's why you're here, right now, reading this.

Try writing. It helps.

 

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Dark Thoughts

4 min read

This is a story about storm clouds...

Rain on glass

I often assume that after a lengthy period without abusing drink, drugs, medication and other mind-altering substances, I'll reap some rewards. I tend to think that a period clean and sober will bring good health, and in turn, that life will improve. It's certainly true that drugs have brought nothing but chaos and turmoil into my life, making it completely unmanageable, as my mental health problems are exacerbated. Eliminating most psychoactive substances has certainly turned my life into something which looks - to the outside observer - to be stable, productive, functional and indeed, at times quite enviable. To all intents and purposes, I look, smell, sound and act like a normal member of mainstream society.

Internally, there's nothing to help me cope with the intrusive thoughts; the traumatic flashbacks.

In the comfort of my own home, as I've already written about, I yell out, grimace and flinch, as I'm assaulted by all kinds of post-traumatic flashbacks. I have horrible nightmares. I suffer lengthy periods of skin-crawling agonising anxiety, where the hands of the clock are barely moving; it lasts for an eternity.

There are no rewards for being clean and sober; only suffering.

It's unthinkable, lifting the lid when there's so much trauma. It's insanity to have it all hitting me like a freight train, every single second of every single day, even when I'm asleep.

I like to think that my brain is mending itself. I like to think that by reliving those traumas, my brain is kind of re-organising itself and exorcising stuff. I allow myself to yell out, flinch and grimace, because it seems better to let it out than to fight it and attempt to suppress it.

Thinking about it, there's mountains of stuff. There's an unimaginable amount of stuff.

The memories - the bad memories - come thick and fast, intruding into whatever I'm doing, unless I'm really working hard; really concentrating on something. I have so few distractions that there's plenty of time for my brain to throw a relentless torrent of terrible, dreadful, awful traumatic memories at me, which are so bad that they're physically painful and cause me to cry out in shock.

I don't think I'd have been able to cope without medication, but now I've lost that crutch, it feels like I stored up years worth of terrible stuff without dealing with it properly. Now it's all hitting me, seemingly all at once.

I'm unusual, in that I'm one of the least psychoactively altered people - I don't have any tea, coffee, coca-cola, fizzy drinks, nicotine, cannabis, alcohol or medication. I don't eat, drink, swallow, smoke, inject, snort or otherwise ingest anything mind-altering. That's very unusual. To give you an example, out of hundreds of people I work with, I'm the only one who doesn't drink tea, coffee or other caffeinated beverages, and my teetotaling makes me even more unusual.

As a friend said to me, quoting a popular Tweet: I'm raw-dogging reality.

It's really brutal. It's really awful. I don't recommend it at all. It's not nice. In fact, it's thoroughly unpleasant and intolerable. Don't do it. It's not worth it. It's not healthy, it's hell.

Why am I doing it then?

I have the unshakeable belief that I can achieve mood stability by avoiding all mind-altering substances, including the things we don't usually bother to think about, like tea and coffee. I feel a lot more stable - mentally - having given up everything. I'm trying to regulate my mood by doing other things. I'm hoping that I develop some healthy habits.

Certainly, after a couple of weeks teetotal, I have a lot more energy and enthusiasm; I'm a lot more active; I sleep better. These are not things to be sniffed at. Alcohol and depression combined to create a very sedentary lifestyle, which was horrifically damaging to my health. I was drinking myself to death, even though I appeared very functional and otherwise doing very well in life.

So, I'm suffering the dark, horrible invasive thoughts, driven to find out whether my brain will eventually rid itself of the toxins and settle down. Certainly, there are health benefits, but I am suffering a great deal.

 

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Invasive Thoughts

4 min read

This is a story about Tourette's...

Surveillance owl

I struggle with invasive thoughts. The thoughts are so traumatic that they cause me to wince and yell. I shout out in pain and shock when the thoughts hit me. It makes me appear like I have a tic.

What is a tic anyway?

Somebody who suffers with Tourette's is able to suppress their tic for a brief period, but then they have to let it out; to scratch the itch, as it were. I'm not claiming to have Tourette's of course, but I have some of the symptoms.

I live alone - except for my cat - in a big old house with thick walls, so I can shout out when I get hit by the invasive thoughts, and I'm mostly not bothering anybody. Sometimes I go out for a walk and I can't control the thoughts, so I yell out and flinch - tic - while I'm walking down the road. If anybody sees me, they must think that I'm very strange.

I can control my tic - mostly - when I'm in a work setting. Sometimes it gets the better of me and I mutter something or flinch in the company of my colleagues. They mostly don't notice or comment, but sometimes they do, occasionally.

I don't particularly try to control my tic when I'm with my girlfriend. We're usually in a relaxed private setting anyway, so I don't have to concentrate on controlling it as much as I can. The invasive thoughts, yelling, yelping, flinching, grimacing and other things too, happen all the time. It's fairly disconcerting to anybody who's not spent time in the company of somebody with the particular neurological complaint.

I won't be seeking any medical help for the problem. It seems to be exacerbated by alcohol, or rather by withdrawal from alcohol, so the solution is to either drink all the time, or not drink at all. I need to lose some weight and get healthier, so I am choosing the latter at the moment. It's not a severe and debilitating enough problem to seek medical help.

You know when you lie awake at night and you start remembering lots of embarrassing memories? Imagine that, except that it happens from the moment you wake up until the moment you go to sleep, and the memories are so traumatic they feel like they're causing you physical pain. That's what my invasive thoughts are like.

I might have Post-Traumatic Stress Disorder (PTSD). It seems likely. Given the severity of the trauma I've experienced, and the long-lasting problems I'm having as a result of it, it seems like the most probable thing. It's well beyond "embarrassing memories".

The thoughts don't particularly bother me; they're fleeting. Of course, I'd rather that I didn't yell, grimace, flinch and otherwise react to the severe traumatic flashbacks, but the damage is done and there's nothing much I can do about it. My life is - on the whole - unaffected by the invasive thoughts, given that they are short sharp shocks and not bothering me except for those unpredictable but frequent instants.

I wonder if I've got brain damage, but the question is a bit of a non-sequitur. The brain is a plastic organ, so it's continuously adapting; I definitely don't have a traumatic brain injury or any impairment to suggest any lasting permanent physical damage which my brain hasn't been able to adapt to, and doesn't continuously continue to adapt to.

There have been plenty of incidents which are bound to have damaged my organs, but my physical health seems mostly OK. Of course my kidneys and heart are a worry, and my general fitness levels have dropped to a really bad level, but I'm working on getting fitter.

In the course of writing this, I haven't been bothered by invasive thoughts at all; they only bother me when I'm bored. I like to keep busy. I like to keep my mind occupied. If my brain is active then it doesn't have time for invasive thoughts.

 

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Fried Brain

1 min read

This is a story about burnout...

Robot arm

I can't brain today. I have the dumb.

 

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World Mental Health Day and World Homeless Day 2019

5 min read

This is a story about annual events...

Hampstead Heath

I sometimes forget that I have a 1.3 million word repository of 4 years of my life documented in exquisite detail. Given that I have chosen to manage my mental illness - bipolar disorder - without medication, it's extremely useful to have everything written down. Memories are easily corrupted. It's easy to romanticise the past. Past traumas can be forgotten. Pain fades from memory. By having everything stored digitally like this, it's easier for me to avoid getting stuck in a cycle of boom and bust; making the same mistakes again and again.

Mental illness combined with some dreadful circumstances which exacerbated the problem, like an abusive relationship followed by an inevitable divorce, plunged my life into utter chaos. I was homeless and slept rough. I was sectioned and kept in secure psychiatric institutions. I very nearly lost everything.

Today is both World Homeless Day and World Mental Health Day. The two things go hand-in-hand, but the choice of day was a coincidence, I expect, although ironically it's quite apt.

There is a powerful relationship between mental health and other problems, such as being able to work, having money problems, having relationship problems, homelessness, drug abuse, alcohol abuse, self harm, suicide and crime, amongst other things. To say that drug addiction causes mental health problems, for example, is a mistake of confusing correlation and causation. To say that mentally ill people are more likely to become homeless is a mistake of cause and effect. As you might imagine, not having a secure, dry, affordable, pleasant place to live is toxic to good mental health - how can anybody be expected to have any kind of sense of wellbeing when one of their most basic needs is unmet or under threat?

We might dismiss housing concerns, believing that local councils and "the government" ensures that nobody goes homeless, but it's lazy and ignorant to believe that housing is not the number one concern of people in crisis. The root of all problems is not mental health or drugs, or Brexit... it's housing.

The proportion of people's wages spent on rent or mortgage payments, has steadily risen, while wages have fallen in real terms. Vast numbers of people are on zero hours contracts or work in the 'gig economy'. Unemployment figures do not tell the real story: millions of people live under constant threat of eviction; homelessness.

Do I really have to spell this out?

Living with the constant threat of losing your home is incredibly stressful.

People are working all the hours they can to try to make ends meet, and they are still only one or two missed paycheques away from being chucked out onto the streets. One hiccup and they'll be homeless. Living with that kind of daily threat creates intolerable anxiety.

If you put somebody under an enormous amount of pressure and stress, for a very long period of time, it will negatively affect their mental health. It's inevitable that the lack of affordable housing in the areas where there are job vacancies, would create a mental health epidemic.

In London, where there are the most jobs, the housing is also the most expensive, over competitive and overcrowded. Yes, there are lots of jobs in London, and they're better paid than elsewhere in the UK, but the housing is terrible quality and massively overpriced, plus there are heaps of people competing for the few place to live, and the nice places to live are virtually unattainable except for the mega-rich.

Where I currently live, I pay a fraction of what I used to pay in London, and I have a lot more space, but when my contract ends I will struggle to find another one nearby - there simply aren't as many jobs in the area, hence why far fewer people want to live here and why the cost of living is lower.

This is capitalism in action. This is supply and demand. Capitalism is maximising how much money it can extract from our pockets, before we all go insane and/or kill ourselves. Capitalism is highly efficient at creating the maximum misery, in its pursuit of the maximum profit. Capitalism is not about freedom or choice. Capitalism is about the immoral destruction of human lives, in order to deliver relentless 'growth' at the expense of our quality of life.

I'm one of the lucky ones. I have emerged from that dreadful chaotic period of mental illness and homelessness, and I now enjoy a reasonable standard of living, but I am painfully aware of how insecure my existence is; how quickly I could be turfed out onto the streets again. I'm acutely aware that my mental health cannot be taken for granted, and the pressure to keep earning vast sums of money, month after month, to line the pockets of an idle capitalist, is incredibly toxic to my mental health.

 

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Brexit Psychosis

5 min read

This is a story about learned helplessness...

Polling station

Following the news is a misery-making endeavour. Following politics is a misery-making endeavour. While the world appears to offer the illusion of free will and the opportunity for us to influence outcomes, this is manifestly a lie; the idea that we have any control over our destiny is patently untrue.

Brexit is the ultimate misery. Exactly half the country want something which they are not being given, and the other half don't want something which is being threatened to be forced upon them. Three years ago we - the British citizens - were given a so-called 'choice'. One half of the country chose something impossible and the other half of the country chose to avoid something which is obviously terrible, and then nobody got what they wanted. Nobody will ever get what they want, because Brexit voters were promised impossible things, and those who voted to remain in the EU will never regain those lost, wasted, sorrowful years, even if Article 50 is revoked - the economic damage and the social damage is still done, the friendships lost and the divisions widened.

It doesn't surprise me to increasingly read about people whose mental health has deteriorated to the point of breakdown, due to Brexit. The headlines are always Brexit-related. The media narrative is unswervingly Brexit-related. The constant bombardment of the doomsday Brexit scenario and the home-grown terrorism and threats of violence by the far-right, intent on perpetrating atrocities against peaceful and valuable members of European society, is a toxic atmosphere which is hard for even the most psychologically secure and happy person, to be able to weather.

I suppose I consider myself a teeny bit of a Remain activist, having been on a couple of pro-EU marches and poured a mountain of energy into teasing out people's real reasons for voting to leave the EU, which invariably is a racist motivation. "Britain's full" and "Muslims don't integrate" are the dog-whistles for the far-right, which I hear all to often from people who I thought were more intelligent, kinder and generally not racists but unfortunately, there are tons of racists. There are lots of secret Tory voters, who are actually really horrible people, and it turns out that Britain is riddled with racists too.

Following the political developments and trolling a few racists has been somewhat of a hobby, but at other times it's hard, because I do genuinely wish to avoid the UK leaving the EU. An organisation I was working for last year was planning on closing their UK subsidiary if Brexit goes ahead. Every organisation I've worked for would be affected negatively by Brexit. Chaos and disruption isn't good for anybody, except for wealthy unscrupulous opportunistic scumbags, seeking to exploit vulnerable people.

So many people are working as hard as they possibly can, but their living standards are declining. So many people are doing everything humanly possible to make things better, but things are getting worse.

We are helpless.

The news backdrop of Brexit, climate change and imminent economic catastrophe, does not create a great environment for human happiness and contentment to thrive. Current circumstances are anathema to a sense of wellbeing. Depression and anxiety are the surefire consequences of the dismal outlook; the hopelessness of it all.

We are inherently programmed to move away from things which are uncomfortable and unpleasant, and to change and improve things. Yet, we have no opportunities anymore. Hard work will get you nowhere. There's nowhere to run; nowhere to hide.

Of course my outlook is coloured by depression. Of course I view things in a profoundly negative way, because of my state of mind. That doesn't mean I'm wrong though. Humans have a faulty positivity bias. I am able to perceive reality far more correctly than somebody with a neurotypical brain. I'm not smarter than everybody else, but I'm able to see through to the pure reality, with a cold, analytical and rational brain, due to faulty mental health.

Our asylums are full of people who think "the end of the world is nigh" but they're occasionally correct. The difference between the terminally insane and myself, is that I'm functional and they are not; I can justify and explain my train of thought and they can not; I can show my chain of deductive reasoning and they can not. Do I have a crystal ball? Do I claim to know the future? No. I'm just like an economist saying "in the long run we are all dead".

It's through our collective behaviour that problems develop. It's our group sentiment where the problem lies. I have a gut feel that a critical mass is close to being reached, in terms of the millions of people who are desperately unhappy and would be prepared to watch civilisation burn.

That way madness lies. Although I briefly entertained the idea of revolution, I'm now a bit more calm and moderate, and I don't think we should risk throwing the baby out with the bathwater. However, I suspect that the fuse has been lit for quite a long time now and there's no escaping the fireworks which are coming. Too many damn metaphors and idioms. These past years have been too damn hard on my mental health, and indeed vast numbers of others too.

 

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Treatment

10 min read

This is a story about making people better...

Ward

I remember the days when I thought that there were magic buildings full of magic people with magic potions who could make magical things happen. I remember the days when I was naïvely optimistic about the abilities of people, institutions and organisations who make highly alluring claims: we can cure you!

If I had ruptured a major blood vessel, or my body was losing its battle against a bacterial infection, you can be damn sure that I'd want somebody to stop the bleeding or give me some antibiotics. If I had an operable cancer, you can be sure that I'd want somebody to cut it out of my body.

Some areas of medicine are comparatively new. Some areas of medicine don't have a great deal of success - the data doesn't show significantly better outcomes for patients who are treated, versus those who are untreated. Medicine is actively losing its battle to save lives in some areas, such as suicide and opioid addiction. Mental health problems and addiction have been declared medical emergencies; epidemics.

Sometimes I wonder if it's useful to think of myself as having a chronic illness, and to expect that problems are just around the corner. I can have a good day, a good week, a good month... maybe even a good year. However, it's probably dangerous to start thinking of myself as "cured" or "recovered" and begin to consider myself "normal". Complacency will no doubt lead to repetition of past mistakes, which can result in an incredibly fast chain of disastrous events, destroying every semblance of a normal life, which was so convincing that I and other people were completely convinced that I'm just another ordinary bloke... not some ticking time bomb.

I fought very hard to get treatment. There was a great deal of reluctance to diagnose me as bipolar, and there was further reluctance to treat me. I seemed very functional. My problems seemed acute. Everybody hoped that I'd go away and get better without intervention.

wanted treatment. I knew I was getting sicker. I knew that my situation was deteriorating. I could see the car crash that was about to happen.

I believed that treatment was effective.

I just had to find the right treatment.

I tried so many medicines. I also believed in the "magical healing powers" of hospitals and doctors. I was indoctrinated by the medical establishment's dogma: "we are the experts and we are the only ones who can cure you".

Of course, I'm not such a fool that I believe in alternative medicine. I critically examine all the claims of all charlatans, quacks, healers and others who promote themselves as miracle-workers. Desperate people are suckers. People are also lazy and gullible. Many of us will be scammed in our lifetimes, because we are so desperate to believe in the existence of things that are too good to be true.

It would have been good I could have avoided that period of my life when I was desperately searching to find the right specialist, hoping that a stay in hospital would be my salvation, or trying a heap of different medications in the hope that I would stumble upon the right one, but it was a necessary education. I needed to learn what was possible, and what was not possible. I needed to see with my own eyes and experience those things first-hand, to learn the limitations of psychiatric medicine.

Psychiatry is young. Mainstream psychiatry - the prescribing of psychiatric medications on a massive scale - is an experiment that's barely a few decades old, which is no time at all, when we consider that anatomical studies of the human body and surgery are parts of medicine which are hundreds of years old. The present-day situation, where at least half of us will take a pill for depression or anxiety at some point in our lives, and so many of us have been taking psychiatric medications for years and years... this would have been unthinkable before Prozac successfully normalised the practice of dispensing mind-altering drugs to tens of millions of people across the USA and Europe. Nobody really knew what the long-term consequences and long-term outcomes would be.

I've lost interest in having any contact with doctors now. I've lost interest in any new developments in the field of psychiatry. I've lost interest in the idea that there will ever be a miracle pill to cure depression, anxiety or to stabilise moods. The brain has proven a far more complex organ than the blunt instruments of psychoactive substances are able to have any precise effect on. Pills are useful for curing a bacterial infection, but they are of no use in an organ which has been evolved to specifically resist attempts to alter it - the brain's ability to maintain homeostasis is incredible, and all psychiatric medications are fundamentally flawed, because they affect a plastic organ, which can simply adapt itself and return to its original state.

Hospitals can offer welcome respite - sanctuary - from the unreasonable demands of the world. Hospitals have their place as a controlled, safe environment, full of caring people. However, psychiatric care has changed radically in the short time that we have been practicing it as a branch of medicine. Those who are ill-equipped to cope with life outside institutions cannot expect to live in an asylum forever, which might sound like a good thing for those who believe that people can be cured and rehabilitated. However, in my experience, it is the horror of the "real world" which is the very reason for the epidemic of mental health problems, and it's often infinitely preferable to protected with the safe confines of an institution than to be fending for oneself in the big wide world. The idea of losing your freedom might sound terrifying and unpleasant, but for those who are struggling to cope - struggling to be functional - freedom is a small price to pay, for the comforting reassurance of life inside an institution.

When you are a child and you hurt yourself, you run to your parents to "kiss it better" but often the injury remains painful for sometime and there is nothing that can be done to alleviate your discomfort. We learn that sticking plasters, stitches and plaster casts can help our bodies mend themselves, but there is nothing to be done to speed up the healing process. There is little that can be done to take away our pain. There is little that can be done when we are suffering mental anguish.

Although my life was very badly damaged, I'm now part of a large organisation where I'm known to a lot of people, and they'd be concerned if I went AWOL. My home city is still very new to me - and I know very few people locally - but I also think that somebody would ring my doorbell and check on me if I went AWOL. I have a routine. I have put things around myself that are structured and stable, even if that rebuilding process is very far from complete.

I've been here before... so very close to a fresh start; a complete life. About a year ago, in the blink of an eye I lost most of my new friends, my new girlfriend and my new job. The year before I nearly died, and I regained consciousness to find I'd lost my girlfriend, my home and my job. I'm aware that my life is very fragile. I'm aware that my existence is precarious.

I wrote positively yesterday about my life and how far I've come since the very deepest depths I sank to, but I know that I have a difficult job trying to stabilise myself and find a way of living my life that's sustainable, and tolerable... pleasant even, one hopes.

It's strange that I've been so much and ultimately reached the conclusion that I was doing a reasonably good job of looking after myself, but I simply had some very stressful life events to deal with. I thought that I could turn to doctors and hospitals to make me better - and indeed my life was certainly saved when my physical health was severely damaged - but now I feel much happier doing everything on my own: I prescribe my own medications, adjust my own dosages... but mainly I just try as best as I can to create a tolerable set of circumstances to allow myself to thrive; I've come to recognise that my family don't care about me and have abandoned me. I've been incredibly lucky to have very loyal, generous, kind, caring friends and wonderful girlfriends, who've believed in me, and looked after me, and stuck by me through the difficult times.

When you see the finished product - a functional man - then we might assume either that he never had any major difficulties in his life, or that treatment was a success. I'm grateful for the hard work, effort and dedication of those who work in psychiatry, but my ultimate conclusion is that it's a flawed branch of medicine. Things could have ended very badly, but those friends who bothered to come and visit me in hospital, check on me when I went AWOL, look after me when I was sick, believe in me, support me... that's the thing that was the key to giving me a chance at getting my life back. Those who've read my blog and are kind enough to reach out to me - to be in contact - have helped me to feel like I have some value, and to feel some self-esteem.

My colleagues don't know how sick I've been, and they don't know how much it means that I'm able to be treated like a normal person at work. My colleagues don't know how important it is that I have the structure and routine of office life. My colleagues don't know how great it is for my mental health to have the social interaction that we have, even if it's just office chit-chat.

We might conclude that the doctors I saw 11 years ago were right - I'm not really very sick and I'm quite capable of living a fully functional normal life - but they're also wrong, because everything had to get smashed to smithereens and rebuilt from nothing, before I could reach this point. I nearly died so many times. Was it avoidable though? Probably not.

That's my conclusion: I've learned a hell of a lot, but it would be wrong of me to start telling people that I have the answers, because what I discovered was that I had to learn everything first-hand. If I had a time machine and went back to tell myself everything I've learned up until now, I don't think I'd believe myself and I'd end up making exactly the same decisions, much like children have to make mistakes even though their parents warn them about everything and try to protect them.

Does this mean that I forgive my parents for abandoning me? Nope. If your kid is sick in hospital, you go and visit them. Period. No ifs. No buts. You don't abandon your children, no matter how old they are.

 

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Microcosm

10 min read

This is a story about paranoid schizophrenia...

Bedroom

I've lost my mind in all kinds of places, but the place where my sanity most eluded me was in this bedroom. I moved into this almost-ready-made perfect home, which only required a few bits of bedding and storage boxes to turn it into one of the most tidy and well organised places I've ever lived. I had stability and eventually I had security. I had my own front door, which I could lock and double-lock and be safely protected from the outside world and anybody who wanted to intrude.

The story begins in the midst of an unhappy relationship, several years earlier. A toxic mixture of mental health problems and drug abuse combined with an abusive relationship, to leave me barricading myself into rooms for my own protection, while my long-term girlfriend and later wife screamed abuse, kicked and punched the door which was my flimsy defence from the onslaught, which was seemingly unending.

The situation got so bad that I retreated to my summer house, where I drank water from a hosepipe and defecated in a bucket. I had no food or access to anything other than cold water. I couldn't take a shower. I was cornered.

To her credit, my ex-wife relented and I was able to come out of the summer house unmolested, unharassed and somewhat reassured that she was a safe distance away. We separated, but I was badly traumatised. The psychological torture had lasted for nearly 2 years and I was deeply damaged.

The extent to which I had been traumatised was not apparent to me. I moved away from the area to be away from her, and I assumed that my mental health was intact enough for me to start a new life without any problems. I assumed that having escaped from that abusive situation where I was cornered, I would be quickly on the mend.

What I discovered was that I carried a kind of post-traumatic stress which was thinly concealed by my generally sunny and upbeat positive mental attitude. I set about rebuilding my life and didn't think too much about the past. However, stress, exhaustion and drugs all had the capability of plunging me back into flashbacks of those awful moments when I was cornered. I experienced episodes of extreme paranoia about the kicking and punching of the flimsy door that protected me, and the torrent of abuse and violent anger which was a constant source of threat on the other side of whatever barrier I could find to protect myself.

It seems obvious that drugs are bad, and certainly the problems I had with drugs unleashed the very worst of the psychological trauma I had sustained. One might be tempted to say that the paranoia was caused by the drugs, but in fact the origin of my paranoia was much easier to explain. Few people would be psychologically strong enough to withstand the torment of being trapped somewhere with only one exit, and an angry violent abuser screaming and hammering on the single door with punches and kicks. Few people would escape without post-traumatic trauma from such events.

It seemed obvious in my perfect safe protected stable microcosm that nobody was going to hurt me. It seemed obvious that my front door was sufficiently robust to resist kicks and punches, and that I had escaped my abuser. It seems perfectly obvious in retrospect, but you have to understand that the trauma was deeply ingrained in my subconscious.

While I was able to function reasonably effectively and act mostly normal, I struggled with paranoid thoughts, unusual beliefs and strange behaviour, when I came under great financial pressure and and had a great deal of stress in my job. When I became exhausted, physically and mentally, I began to form paranoid beliefs. I struggled to maintain my ability to be objective and grounded in reality. My sanity suffered during moments of great difficulty.

I had a long period of drug abuse which demonstrated to me - beyond any reasonable doubt - that my original paranoia was no longer grounded in any past trauma, but instead had grown into something which was self-fuelling. While the original seed of my traumatised behaviour - barricading myself into rooms - was well understood, I had a lengthy period of time where I would suffer dreadful paranoia, only to eventually have to face the fact that my feared abuser was never going to turn up.

Strangely, that period I spent barricaded into my bedroom, hundreds of miles away from my abuser, did actually 'cure' me of my paranoid psychosis. Every time I desperately piled up furniture against the door and could never quite manage to create enough of a barrier to satisfy myself that I was safe, I eventually realised that nobody was battering on the door. I took down my barricades and I was surprised to find that my tormentor was nowhere to be found.

It was incredibly dangerous, and it cost me very dearly, but eventually I was left with nothing except drug-induced paranoia, which went away as soon as I stopped taking drugs.

I'd had periods where I'd been clean and sober, but they'd never cured me of my paranoia. My post-traumatic stress was still very much unresolved and the psychological damage was a deep and bloody wound. Even after long periods where I had been abstinent from booze and drugs, my mental health was fragile as hell and I could be tipped into insanity by relatively trivial stressors.

Two years in my lovely apartment, barricading myself into my bedroom and my ensuite bathroom, and I was cured by the most unusual and unlikely of things. The very behaviour which an outsider might assume was the root cause of all my problems, turned out to be a cathartic exercise which rid me of both the paranoia and the drug addiction.

I expect today if I were to spend several days and nights abusing powerful stimulant drugs, I would begin to suffer from paranoia, but I have been through some incredibly stressful events lately and my mental health has been reasonably robust. In comparison with the many days which I would spend not eating or drinking, barricaded in a room with only one exit, fearing for my safety, the few problems I've had in the last year have been nothing... hardly worthy of consideration.

A breakup and a house move were enough to unseat my sanity and cause me to be absent from work for a week. My brain chemistry was messed up for a couple of weeks following that episode, but the damage was contained and I've been able to hold onto the substantial progress that I've made, without slipping too far back down the greasy pole.

The demands placed upon me are almost unthinkable. I live amongst unpacked boxes of my stuff and furniture that needs to be assembled. I live with all my suitcases of clothes strewn around my bedroom, because I haven't built the furniture to put things away yet. My mail piles up and administrative chores are left ignored, because it's taken an unimaginable amount of effort to get myself from the point where I was homeless, jobless, penniless and detained against my will on a psychiatric ward, to where I am today, with a house, a car, a job, money in the bank, my reputation and my liberty preserved. The tasks which still lie ahead, such as making new friends and finding a girlfriend, plus putting in place the hobbies and interests and weaving the social fabric which will make my life worth living, is not something that should be underestimated.

Not all those who wander are lost, and I have decided that I wish to make this city my home, but it's not as simple as just deciding. There is considerable effort involved in surrounding yourself with the things which meet your human needs, such as the web of relationships which support you.

I'm convinced that the very worst of my mental health problems were caused by the circumstances of my existence. Psychiatrists would refer to my condition as adjustment disorder which is just a fancy way of saying that human beings will struggle under incredibly stressful conditions. My problems have been acute - not chronic - and can clearly be seen and understood in the context of the extremely toxic circumstances of my life. Certainly, quitting drugs and staying clean are essential to any hopes I have of continuing to rebuild my life and improve my circumstances, but drugs are just a small piece of the puzzle, which is mostly about having secure housing, financial security and a support network. Anybody would crumble to pieces if they were put under the kinds of stresses and strains that I've had to endure in recent years.

I now live in a brand new place. I've had a clean break. My home is untainted. This city gives me a fresh start.

London is big enough that you can lose your mind and nobody will notice or remember. London is big enough that you can go completely crazy and you'll never manage to screw up your life, because there are so many people that you get lost in the noise. It was good to be in London during those difficult years where I was barricading myself into rooms for no reason, except that I was so post-traumatically traumatised that I simply had to do it as part of my recovery.

I face the difficulty of starting afresh from almost nothing, but I don't carry a single bit of paranoia that somebody knows about my difficult past. I really feel like I have a chance to totally start anew without anybody knowing anything which might prejudice me. I'm judged totally as the man I am today, not at all on who I was during the dark moments I endured in the past.

It might seem crazy to write and publish this, given my opportunity to escape my past and re-invent myself, but I don't want to run away from my own history. I need to acknowledge that bad things happened in my life, and they have shaped me. I need to acknowledge that even though I am healthy and functional today, I will carry a lifelong risk of problems if I become complacent. I need to make sure that I keep my stress levels and energy levels within safe ranges, and I need to put in place the things that will help and protect me when there are inevitable hiccups in life.

My bedroom looks nothing like the neat and tidy bedroom in London, pictured above, but my mind is far more neat and tidy, ordered and robust. I feel far more in control of my behaviour and my thoughts. I feel far less troubled by anything even remotely like paranoia. To all intents and purposes, I have very good mental health, but still very poor life circumstances, but at least there are practical remedies for things like my lack of local friends.

It's a somewhat positive outlook, especially considering how frequently I suffer from suicidal thoughts, but despite my tendency to become depressed and overwhelmed by the enormity of the task ahead, at least most things seem to be within my control. I can choose between going on dates or trying to make new friends. I can do things to get the stuff I need in my life. I feel relatively safe from traumatic events that are beyond my control.

 

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Bipolar Medications

8 min read

This is a story about tailored medicine...

Different tablets

It's a subject I've written about at length before, but I was writing about my experiences with different mood stabilisers earlier today and I thought I would re-purpose that content for my blog, because I'm tired and I'm stressed, and it seems like a logical thing to do: To take something I wrote earlier and re-use it.

What I've written is in the style of advice given to somebody who's perhaps newly diagnosed as bipolar, or perhaps suspects that they have bipolar disorder. What I've written is from my own personal experiences. What I've written is not meant to be completely authoritative and factually correct, but I'm aware that it's my general writing style to present my opinions in a persuasive manner.

So, without further ado, let's get onto the list of bipolar mood stabilising medications I have known and loved (or hated, more like).

Quetiapine (Seroquel)

Horrible side effects, including weight gain, daytime sleepiness, dry mouth and constipation. When it takes effect, it's so strong that it's very hard to get to bed, or use the toilet in the middle of the night. Cannot be mixed with alcohol - the alcohol makes you feel very unwell.

Overall, this medication feels like being "heavily sedated" and it would be very difficult to carry on a normal life at dosages above 200mg. At dosages of 300mg or more, you'll be sleepy and dopey all the time. At dosages over 400mg, you'll be a shuffling zombie, good for nothing except dribbling in front of daytime TV.

Not compatible with having a job.

Aripiprazole (Abilify)

This medication had a strange side effect, where I lost fine motor control of my lips and seemed to produce excessive amounts of saliva. It was impossible to have a conversation with somebody without spraying them with spit, which was a horribly degrading experience for me.

Aripiprazole is very long-lived in the body, so it can take a week or more to wear off and get back to normal, even after taking this medication for only a couple of days (i.e. if you try it and you get bad side effects immediately, you'll have those side effects for a whole week at least).

Because of its very long half-life, I would have serious reservations about trying this one, except as a last resort.

Lamotrigine (Lamactil)

No side effects at first, but the dosage has to be increased very slowly with this one. Migrane headaches are a very common side effect, which I got, so I decided to stop taking it. The headaches are tolerable, I guess, because this is the medication with the fewest side effects.

Some psychiatrists might not consider lamotrigine to be a mood stabiliser, but in fact more of an antidepressant which is safe for bipolar people to take. It improves sleep quality so I think it's a good choice from amongst the fairly bleak options.

Also a good choice if you plan on attempting to have a normal job and work.

Olanzapine (Zyprexa)

Side effects include weight gain, daytime sleepiness and a general feeling of being drugged, but nowhere near as bad as quetiapine.

Very good at quickly stopping a manic episode, so it could arguably be used only when entering a manic phase, and then stopped a short while later, but this would require discipline.

Not recommended to take on a long-term basis.

Not compatible with having a normal job.

Sodium valproate (Depakote)

Dreadful side effects. Will turn you into a total shuffling, dribbling zombie and eventually you will get an irreversible kind of brain damage, which will cause you to make involuntary facial movements (a bit like a tic).

This is an awful drug, given to paranoid schizophrenics who are very severely sick (paranoia, hearing voices, hallucinations etc).

If you're on this, it's probably forcibly injected into you in a psychiatric institution. The injections last for 3 months. Don't ever let yourself get so unwell that this becomes necessary. Exhaust all the other options first.

Lithium

Very hard to get the dose right, and requires regular blood testing, which is annoying and inconvenient. Very effective and side effects are tolerable if you can get the dose perfect but it might take many years to find exactly the right dose, and it will be very destabilising if you start going too low with your dose - i.e. you might end up triggering manic episodes when you're simply trying to avoid side effects.

Lithium causes irreversible health damage when used long term, and is therefore "life limiting" in a way - it might reduce your lifespan by 5 years or more, which is obviously a high price to pay.

General Comments

Psychiatrists will tell you that you need to commit to a medication for at least 3 months, in order to feel the therapeutic effects and for the side effects to wear off. I have tried all the medications listed above for 3 months or more, and the side effects never wore off. The side effects were intolerable for all the medications, except lamotrigine.

If you take these medications for longer than a few weeks (with the exception of lamotrigine) then you cannot stop taking them abruptly. If you suddenly stop taking these medications, you will have horrible rebound mania and possibly psychosis too (hearing voices etc). However, I have successfully 'weaned' (i.e. tapered) myself off all these medications, without too many problems.

The worst manic episodes I've had have been when stopping quetiapine and olanzapine abruptly. When I've tapered off the medications slowly, my mood has been fine and I've not had any problems. In fact, every time I've stopped taking a medication, I've felt much better, because the side effects are so awful.

I would advise you to consider olanzapine as a treatment for acute episodes of mania... i.e. you should have some ready to take, and when you start to go manic then start taking it to make sure your mania doesn't spiral out of control.

I would also advise you to consider lamotrigine as first or second choice. I believe many busy working professionals with bipolar disorder find lamotrigine to be a good medication, because it has few side effects.

Psychiatrists will probably pressure you to be on a stronger medication, which is likely to be an atypical antipsychotic (quetiapine, aripiprazole, olanzapine, sodium valproate, risperidone, clozapine) but all of these will have very profound side effects, most notably making you feel tired and sleepy, lethargic, foggy-headed, confused, increasing your appetite and reducing your sex drive. It's personal choice, but I find those side effects unacceptable.

Alternatives to Medication

Alternatively, you can use good lifestyle choices to manage bipolar: no alcohol, no caffeine, strict bedtimes, strict work:life balance, exercise, good diet. You will probably need some trusted people around you who can let you know when your speech is becoming more pressured, you're getting irritable, perhaps you're getting a little obsessive about projects, becoming more impulsive and taking more risks... essentially, when you're heading into a manic episode, which could escalate. I find that getting 8 to 10 hours sleep each night, no more and no less, helps me to keep my mood stable. I also find that my manic episodes are much less of a problem since I quit caffeine. Recreational drugs are a terrible terrible idea, and completely incompatible with bipolar, unfortunately, especially the stimulants: legal high powders, speed, coke, crystal meth, meow meow, M-CAT, mephedrone, monkey dust etc. etc.

Stressful life events can be very triggering for mania, as well as the temptation to work hard because of a job change, promotion or exciting project. It takes a lot of careful planning to ensure that stress is kept to a minimum and work:life balance is preserved. If you want to get obsessed with anything, make it exercise and the great outdoors.

In Conclusion

I'm living a functional and complete life, with a full-time job, managing to have good relationships, managing my money, not engaging in risky behaviours or otherwise suffering many problems with my bipolar disorder. I have depressions, which are sometimes bad enough to cause me to take some time off work, but only a few days here and there. I have hypomanic episodes, where I can spend a lot of money and make impulsive decisions. However, considering that I don't take any mood stabilising medications for my bipolar disorder, my mood is remarkably stable and almost everybody would consider me to be successfully managing my condition, without having any particularly adverse effects on my quality of life.

I can highly recommend trying to go medication free, or spending a lot of time trying different medications and tweaking the dosage, because life is so much better when you're not drugged up to the eyeballs with powerful psychiatric chemicals, which radically alter you and your personality, with horrible side effects.

I'm not antipsychiatry per se, but I would advise people to make very well informed decisions and remind your clinicians that it's your body, so it's your rules, and like with every profession, there are people who are brilliant at their jobs and there are people who are not so great. You need to educate yourself so that you know whether you're getting good advice or not. You can't just trust everybody who calls themselves a doctor.

Mental health is complex. Bipolar disorder is complex. People are complex. We are all individuals and we have individual needs and individual unique circumstances. Tailor your solution to meet your needs.

 

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