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#NaNoWriMo2016 - Day Twenty-Six

11 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

26. Descent

She could hear the car crawl to a slow and follow her at walking pace. She had grown accustomed to the sensation of being stalked, stared at. She could feel a pair of eyes burning a hole in the back of her head. With the subtlest of movements she looked out of the corner of her eye at the road. She didn't recognise the vehicle or the driver. There seemed to be somebody in the passenger seat too. The car drew level with her and the passenger wound down their window. She glimpsed short hair full of styling gel, a white tracksuit and prepared herself for unwelcome sexual advances from a dimwitted numbskull.

"Hey!" came a surprisingly hushed call.

"Psst!"

This was not how things usually went. Normally lecherous creeps would lead with their best line, full of false flattery and often beer-induced bravado.

"Hey you!"

It was irritating, but a different and more measured approach from what she was used to. She was sure that as soon as she even acknowledged their existence, they would launch their full chat-up offensive. This was just the preamble.

"Hey!"

She was sure that their patience would quickly evaporate and she would be loudly cursed as a "stuck up bitch" and the car would roar off into the distance with its loud exhaust and bass-heavy music thumping out from their souped-up boy-racer chariot.

"Nah, she doesn't want to know" said the passenger. It looked as though he was addressing somebody in the back seat. Lara risked another glance backwards and sure enough, there was another passenger, slumped low with their coat pulled up high around their face as if they were trying to hide.

"He says he knows you" the passenger tried again.

"Who?" asked Lara, now looking in through the car window and surveying the scene, while keeping walking.

"Sam" said the passenger, pointing his thumb at the back seat. "He's sick. He needs some help getting into his flat."

"Why can't you do it?"

"We're just giving him a lift home. We've got to be somewhere else, pronto. We ain't got time."

"Some friends, you are." Lara mocked.

"Look, just help make sure he gets in OK, can you? We could just dump him nearby, but there's no telling if he'll get into his place on his own in the state he's in."

"What's wrong with him?"

"He's just had too much to drink."

"That's a really shitty thing to do to your friend. To just dump him like that."

"He's not exactly a friend. We hang out, but it's not like that. We're doing him a big favour driving him home."

"Yeah, BIG favour" said Lara sarcastically.

She couldn't help herself peering in the back windows at Sam. He was very dimly aware of what was going on. His head drooped and his eyes were closed, but he wasn't asleep. He didn't look boisterously drunk or like he was going to throw up. He was just intoxicated.

"Alright how far away is it?"

"Just down in the town centre. Jump in."

Sam was reasonably well co-ordinated and not slurring his words. He didn't even smell of alcohol. He could walk and talk without staggering, but he kept slipping into a catatonic state. His sentences would tail off and he would be half-asleep on his feet. As long as she kept repeatedly reminding him where they were and what they were doing, she could coax him towards his front door.

"Come on, Sam. Nearly home!"

"What? Eh? Oh" he said, as he seemed to remember what he was doing and take a few more steps, opening his eyes a fraction. He leant on the front door, dozing.

"Get your keys out, Sam. We're at your flat. This is where you live, right?"

"Yeah, uh. Right" he fumbled in his pockets and unsteadily directed his key at the lock.

With the door flung wide open, Sam made a bee line for his day bed and collapsed on it face down, before rolling into a slightly more comfortable position. Lara was still stood at the threshold, gazing into the large loft apartment, taking it all in.

"OK, I'm going to close this door and go home now."

"Don't go. I need you" Sam said, holding up a hand and beckoning her in.

Lara took a few steps towards the day bed.

"What do you need me here for? You're home now."

Sam patted the bed next to him. Lara didn't get the sense that he was trying to get her to sleep with him, but that he wanted her to sit. She sat awkwardly on the edge of the futon.

"You're home safe now. You can go to sleep. You'll feel better when you wake up."

Sam now opened his eyes much wider and tried to look at her. There was a kind of fear that played across his face.

"You can't let me sleep. I'll die" he said.

"What are you talking about."

"If I fall asleep, I'll stop breathing."

"If that's true it sounds like you need an ambulance."

"No!"

"Why not? What's wrong?"

"Overdose." he said, with the effort of his honest admission seemingly causing him to slump. He relaxed. His face was tranquil. Lara leant over him. He was breathing, but very shallow.

"I'm going to go phone 999. You need to go to hospital" Lara stood up and walked towards the door.

"Nooo! Stay with me" Sam called out, reaching towards her from where he lay. She hesitated at the door and looked back. "I'll be OK soon. Just stay with me a little while."

Babysitting him while he fought through a near-fatal overdose, Lara was torn. She could see his lips getting slightly purple as she fought to keep him conscious enough to keep breathing. In waves, he would get so relaxed and comatose that he would sleep peacefully and could barely be roused. She would be close to running for help. Then, he would come round a little, gasping for air and she would plead for him to stay alert and keep breathing. She knew instinctively that in the time it took her to go away, find a phone and give the address, he could very easily slip away. It took little more than an hour before he started to come round, but it felt far longer.

The experience shook them both and Sam said that he never wanted to risk dying like that again. At first, he was resolute that he needed to quit heroin and that the close call was the wake-up call he needed. He was so grateful to Lara for keeping him alive and for avoiding a hospitalisation. Then, he explained that his body would start to go into a painful withdrawal and he would feel like he "needed" his next fix. Quitting wasn't so easy and he'd need to wean himself off. Would she help him?

He genuinely meant everything he said.

In reality, Lara became his regular babysitter, so that Sam could shoot up big doses of heroin, knowing that there was somebody there to keep him safe if he overdosed. At first, Lara didn't know it. She felt that she was helping him to get cleaned up and off the dope, but after months going round to his apartment almost daily, it was clear he wasn't giving up any time soon.

She adored his tortured soul and his fascinating life. She loved their asexual relationship, which still had a kind of comfortable intimacy. Sam's first love was heroin, but Lara didn't mind being his mistress. She felt like she could make a difference.

Eventually they quarrelled. He had no intention of ever quitting, she said. He did, but it was hard, he explained. He said he'd try harder, but he started to be more secretive. He hid his habit and Lara knew it.

"You'll always keep using if I stay with you" were the last words she ever said to him. He didn't even reply. His eyes were filled with tears, but he knew the truth. Perhaps he would quit one day, but that wasn't the path that their relationship had followed. He used and she was there to keep him safe. That was the way it had been since day one and that was the way it was always going to stay.

She'd gone back to the apartment on the pretence of picking up some things she'd left there, but really she was checking up on him. Making sure that he was OK. He was so alone. His mum had left when he was little and his dad had died leaving him the inheritance that paid for his apartment and his drug habit, but he had no real friends: only drug dealers and addicts hoping to mooch off him. He was no fool, so he didn't indulge the parasites. He had nobody.

Lara knew right away that it was different from the other overdoses that she'd witnessed. There was no life left in his body. He'd been dead for some time.

Poor little rich boy. He had a kind of infamy amongst the local drug users, with many plotting to rob and cheat him out of money. He was even known to the police as a tragic addict: a dead man walking.

By the time she had left him, she was prepared for the worst. Or at least, she thought she was. Of course his death was more traumatic than she could ever have imagined, but she knew that the burden of his life was more responsibility than she should ever have been asked to shoulder. She could forgive herself, but always wondered if things could have turned out differently.

Neil's behaviour was completely different. He seemed in control, even though he was unhappy. It was Neil's desperate wish to be happy and productive again that made him so different from Sam. The addiction that she'd known had no end to it. Without a doubt, Sam would take heroin forever, given an unlimited supply and no consequences. Neil was different. He only ever took his pills begrudgingly and always talked about "recovery". His mental health problems were just a blip, in his eyes. Medication was a means to an end: like a plaster cast on a broken limb, helping it heal.

It seemed unthinkable to Lara, the idea that Neil had lost control and was slumped somewhere, dead from an overdose. She'd known so many years of him being steady and dependable. She'd seen him go through depression and psychotic episodes. However, he didn't seem to be hiding a drug habit and it seemed unimaginable that he could have been consumed by an addiction so quickly that she would never have seen it creeping up. The evidence suggested that somebody flicked a switch and her fiancée went insane. It was impossible to know somebody so well and for them to hide a whole other side of their personality. She knew what addicts were like when they hid their habits.

She confronted Colin.

"You're not telling me everything."

He sighed. "What you don't know can't hurt you."

"If there's stuff you've found out, I want to know."

"I think we just need to let Neil go and keep our best memories of him intact."

"What do you know?" asked Lara, now looking horrified.

"It's a lot worse than we thought" replied Colin with a grim expression.

"I really do want to know absolutely everything."

"He was taking some highly addictive drugs. I'm sure he's gone now. We should probably talk about some kind of memorial service."

"I guessed as much. I've been reading about those legal highs and they're nasty. Not many deaths though."

"Yes, but he was getting some really dangerous ones direct from China at 99% purity. I'm almost certain he overdosed."

"How do you know?"

"I found some traces at the house. I'm so sorry, Lara. I've been waiting and hoping that the body will be found, so we can grieve properly, you know?" said Colin, his eyes pricking with tears.

"You're a good man, Colin. I don't blame you for not telling me" replied Lara, hugging him.

 

Next chapter...

 

#NaNoWriMo2016 - Day Nineteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

19. The Hospitals

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

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

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

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

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

"Are you joining us for music therapy?"

"Yes, I was going to."

"Well we're starting right now."

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

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

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

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

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

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

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

"What happens now?"

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

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

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

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

"No I have to pour it for you."

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

"Are you OK?" she asked.

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

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

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

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

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

"Gravy?"

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

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

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

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

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

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

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

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

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

"Uh. Hungry?" Neil replied.

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

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

"Neil. Can I borrow you please?"

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

"Come" came a voice from inside.

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

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

"Oh.. kay..."

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

"Alright" Neil tentatively offered.

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

"Yes, that's right"

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

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

"Antipsychotic?"

"Atypical."

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

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

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

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

The psychiatrist was now scribbling in his prescription pad.

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

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

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

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

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

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

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

"I want to come off the quetiapine."

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

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

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

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

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

 

Next chapter...

 

#NaNoWriMo2016 - Day Eighteen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

18. Psychosis, Madness, Insanity and Lunacy

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

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

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

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

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

"Did you get the mirtazepine?" asked Lara.

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

"Two medications?"

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

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

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

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

"Did you get a new diagnosis?"

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

"Who are the crisis team?"

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

"Are you still having suicidal thoughts?"

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

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

"Can I have the crisis team number?"

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

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

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

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

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

"Why are you using my name?"

"What do you mean?"

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

"I don't know what you mean"

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

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

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

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

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

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

Two days later, Neil had disappeared.

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

"Have you rung the crisis team?"

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

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

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

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

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

"Yes, Hi"

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

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

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

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

"Yes, Lara"

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

"That's fine."

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

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

Lara noticed that Neil was hovering by the door.

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

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

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

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

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

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

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

"Do you know what day it is today?"

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

"Do you know who the Prime Minister is?"

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

"OK, and where are we?"

"We're in my house"

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

"No"

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

"No"

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

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

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

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

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

"I want to die"

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

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

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

"It's on my bedside table."

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

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

Lara returned with the medication and a drink.

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

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

"Dan, we've got to go."

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

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

The front door closed, Lara returned to the snug.

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

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

 

Next chapter...

 

#NaNoWriMo2016 - Day Seventeen

12 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

17. The Holiday

"What do you mean you're not offering the service anymore?" Neil asked as courteously as he could, although he was aware that his question was put through gritted teeth and a fake smile that looked more like a grimace.

"It's not something this post office is doing anymore."

"But when we spoke, you said you were able to receive my mail."

"Yes, but then I discussed it with my manager and he contacted the regional manager and we decided that our branch was too small to offer the service."

"So what's happened to my mail?" asked Neil.

"We had to return it to the sender."

"OK. Thank you" Neil said curtly, tapping the counter top lightly as he turned and left. There was no way he could conceal his annoyance but he knew there was no sense in kicking off, creating a scene. He knew that if he pressed the matter further it was likely that the other post offices in the area would be told they couldn't accept poste restante mail.

It wasn't a complete disaster but having to wait a couple of weeks for two envelopes to wing their way around the globe would be agonising.

"Why didn't you deal with this earlier?" he muttered to himself under his breath on the street outside.

The town was filled with market day traders and shoppers and he was drawing unwanted attention to himself as he walked slowly along the pavement. His cheekbones stood out prominently on his face and his eyes were sunken in dark hollows. He'd been able to do little more than smear dirt around his face with a wetted rag and his baseball cap did little to hide his greasy matted hair. Now back in the open, his odour wafted away in the breeze, but the person who had queued behind him in the post office had left a considerable gap because Neil desperately needed a wash.

Neil had not planned on buying more than a plastic bag full of food & drink as soon as he had collected his third envelope. He hadn't really got a plan B. He'd been worried that there would be a problem at one of the post offices, but he was also desperate for things to go his way. Today, they hadn't. He was still dealing with his disappointment and annoyance. He wasn't thinking clearly.

Walking all the way back to the van, he cursed under his breath.

"Fucking hell. What a fucking shit. What a fucking pain in the arse. Shit. Fuck. Piss. Bollocks."

He'd started to walk more briskly now that he knew what must be done, but he had none of the energy and sense of urgency that he would usually have when returning with his envelope. He stared down at the pavement a little way ahead of him, blinkered to everything around him, lost in a world of his own.

"What an absolute shit. What a total fuck up" he muttered.

Finally reaching the van, he opened the back doors and got out a small blue rucksack. He slammed the door closed and locked it. He raised his eyes momentarily, realising he was drawing attention to himself on the quiet residential back street where he had parked. There didn't seem to be anybody around.

Jumping in the driver's seat, he got his laptop out and powered it up.

"Fuck. Fucking idiot country bumpkins. Fucking backwards cocksuckers" he said to himself, hitting the steering wheel and slamming the lid of the laptop closed.

Stepping out of the van and locking it, Neil now walked back into the town centre.

"What a waste of fucking time. What a waste of fucking energy" he muttered over and over again. He was passing people on the pavement again and held his tongue, knowing that a wild looking man talking to himself was liable to be alarming sight for the local people.

Entering a pub, Neil approached the barman.

"Excuse me. Do you have Wi-Fi?" he asked.

"Yep. For customers" the barman replied with hostility.

"Half a lemonade, please."

Unplacated, the barman poured the drink.

"And a packet of salt and vinegar crisps, please."

"That'll be two pounds fifteen. The Wi-Fi password is on the blackboard in the back by the pool table" the barman said, now satisfied that Neil had spent an adequate amount of money to be considered a customer. Too many people used the pub's toilets without even buying a drink on market day and he was not in a good mood.

Whipping out his laptop, Neil positioned himself with his back facing the corner of the room so that nobody could see the screen. Connected to the Internet wirelessly, he plugged in a memory stick and opened a password-protected document. Pasting links, usernames and passwords from his document into the web browser, he did everything that he needed to do within ten minutes. His lemonade and crisps were untouched when he left the pub.

The Chinese working day was over and it would take the postal service 7 to 10 days to deliver, which meant he had at least 8 days to wait. Envelopes usually cleared customs without any delays, but he was dreading the day when something went missing in transit or took much longer to be delivered than expected. 

Feelings of exhaustion and depression swept over him as he trudged along, walking the same route for the 4th time that day. He felt tearful. He felt anger and frustration. At times he would look up and glance at the people he passed. Was he angry with them? He was angry with somebody, everyone, anyone.

Driving back to the caravan he had the heater turned way up. He was sleepy and he wasn't concentrating. He got lost a couple of times on the back lanes.

"Stupid fucking time-waster. What a waste of fucking space" he yelled at himself.

Eventually he parked up in the forest. He didn't really want to turn the engine off because he was cosy and warm. He sat in the van as it got darker and darker and the warmth seeped away before stiffly easing his way out of the driver's seat and staggering back to the caravan. In the bedroom he wrapped himself up tightly in the sleeping bag and curled up in a ball. His hands and face were freezing and he was trembling. His whole body ached.

He woke up knowing he'd slept for a long time but he was still really tired. He was hungry and thirsty and he needed to go to the toilet. He felt cold but he really didn't want to get out of the sleeping bag because he knew it would be even more cold. He wasn't comfortable, but he wanted to lie there on the bed, curled up.

Eventually, the discomfort in his bladder drove him to get out of bed and go outside to urinate. He hopped lightly back into the caravan, hugging himself to keep warm even though he was fully clothed. Going to his rucksack, he went to the top pocket and pulled out a strip of pills. Popping two pills out of the blister pack he paused for a second and then popped out two more. He paused again and then popped out a fifth. Necking the tablets, he then looked around for a bottle with any liquid left in it. There was a water bottle with barely a mouthful left, which Neil snatched up, unscrewed the cap and tipped into his mouth with his head back, swallowing.

After a cursory glance around confirmed there was nothing else to drink in the caravan, he returned to bed. Soon, he fell into a comfortable drugged sleep. He woke up feeling groggy and hung over. His thirst and his hunger were now unbearable, but he slowly surveyed the scene of the caravan with one eye open, groaning as he rolled over in his sleeping bag. Eventually, he dragged himself out of bed.

Unsteady on his feet, he straightened out his clothes and sighed. Rummaging in his rucksack, he pulled out the black duffel bag and left the caravan.

In the car park by the convenience store in the first town he'd visited, he knew he was taking a huge risk, but he desperately needed supplies. He felt hot and cold flushes and his joints ached. He was weak and he shuffled along, but he didn't have far to walk to get to the shop and to drag his bag back to the van.

In the shop he bought a 5 litre bottle of mineral water, shower gel, deodorant, disposable razors, toothpaste and a toothbrush, toilet roll as well as 10 cans of caffeinated energy drink, a large bottle of cola and several Cornish pasties.

"Big night last night?" the young shop assistant chuckled.

Neil replied with a grunt. He swayed a little at the counter as he waited for the items to be scanned.

"Are you OK?" the young man asked.

"I'm fine. How much is it?" Neil replied.

Packing all his shopping into the black bag, Neil was slow and clumsy. Other customers were waiting to pay, but he didn't notice: his mind was cloudy; he was sick and exhausted.

In the van, he downed an energy drink which slaked his thirst. The brief boost to his blood sugar meant that he felt OK driving back and he managed to drag the duffel bag into the caravan. After three bites of a Cornish pasty, he curled up by the dining table and fell asleep.

For four days he felt too unwell to leave the bedroom except to eat, drink and go to the toilet. He had cold sweats and his whole body ached. Waves of nausea swept over him, but he managed to avoid throwing up and held his food down.

On the fifth day he felt a little better and he thought about going home, to his home town, his house. Maybe he could get in contact with Lara. Maybe she would come and look after him. He knew it would be a horrible journey on public transport when he was still feeling very unwell, but he could manage it. Perhaps his journey was at its end.

He ate his remaining food, drank the last of the cola and had a couple of energy drinks. With the help of a couple of sleeping pills, he managed to get a good night's sleep.

Waking up, he felt refreshed and a little energised. It was a cold day, but he knew that he had to wash. Rinsing the soap out of his hair with freezing water gave him an ice-cream headache, but it felt nice to be taking care of his appearance after so long. He flanneled himself with a soapy rag, getting rid of the worst of the dirt and smell from his body. Brushing his teeth and spraying deodorant all over his body, he felt like a new man. He put on his set of clean clothes.

There was no doubt in his mind about what he was going to do next.

"Hi. Is there any post for me?"

With the envelope in his hands, he wasn't going to make the same mistakes this time. He rushed to the hardware store and bought some self-adhesive plastic to obscure the caravan windows, a stanley knife, a staple-gun, a bolt for the bedroom door, a screwdriver, a hammer, some masking tape, insulation tape and duct tape. He drove to the supermarket on the edge of town and parked in the car park. He bought 6 large bottles of mineral water, 6 large bottles of cola, 5 tins of baked beans, 5 tins of spaghetti hoops and 6 packets of salted crisps.

Driving home, he was struck with the urge to stop outside the fish & chip shop and get a takeaway. He bought a large cod and chips and a pot of curry sauce.

"You're looking well" the woman behind the counter said.

"What do you mean?" he asked.

"I saw you in Axeton the other week. You looked like death warmed up"

"Yeah, I wasn't very well" he replied.

"Well, it's good to see you're on the mend. All the colour has come back into your cheeks"

Sitting down at the caravan's dining table with all his purchases, Neil unwrapped the paper of the first hot meal he'd had in over a month. The food had gone a little cold but delicious smells wafted up: battered fish, golden chips, salt and vinegar. He ate quickly and soon he felt uncomfortably stuffed, because his stomach had shrunk.

Why hadn't he just gone to sleep and then gotten himself away from there?

Now he lay contemplating his fate. He was a little appalled that he threw away such a great a chance to escape; to run for his life. For a brief moment, there had been a glimmer of hope, of redemption, but he hadn't cared at the time. He hadn't given it a moment's thought, but now he considered how close he had been to avoiding his current predicament, if only he had made a different choice that night.

 

Next chapter...

 

#NaNoWriMo2016 - Day Six

9 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

6. Into the Unknown

Going to university as a mature student had been hard work but a lot of fun. Lara was only a few years older than most of the other student nurses and their training wasn't like a normal degree course. 50% of the time the nurses did their university work in a building that was a long way from the main university campus. The other 50% of the time was spent in the clinical environment of the local hospital. Lara's university days weren't spent partying and skipping lectures - the workload was relentless and she was soon doing long shifts to gain all the necessary hands-on experience she needed to qualify.

With Neil's salary, savings, some money from her parents and a bursary, Lara and Neil managed to keep their home life relatively unchanged after Lara quit her office job to retrain. A little bit of belt tightening was necessary, but the couple managed to struggle through 3 years without Lara's salary.

Although she avoided living in a dirty and messy student house, Lara didn't miss out on any of the social bonding with the rest of her course-mates. During those three years at university, she made a lot of good friends.

After qualifying Lara's friends had been scattered all over the country. Some of them wanted to specialise. Some of them wanted to get jobs in particular cities or closer to family. There were a lot of jobs in London, which attracted many friends to move there, but Lara wanted to stay in the local area. For a lot of her friends, they were bored of the unremarkable university town they had spent three years in.

Working at a big hospital as a general nurse, there was a lot of variety in the day-to-day challenges. There were a lot of staff. There were a lot of departments. There were a lot of different procedures that could all happen within that large hospital building. The NHS had been closing smaller local hospitals, in preference for larger facilities, so that fewer items of expensive equipment had to be purchased nationally.

One of the few things separated from the general hospitals was mental health care. While the hospital had a handful of mental health specialists, they were in a psychiatric liaison role. Any physical health issues would be treated at Lara's hospital and then the patient would be transferred if they required inpatient care for mental health issues. There was a clear demarkation between general medicine and mental health and the few people Lara knew who had specialised in that area had followed a very different career track from her.

As a medical professional, Lara felt frustrated that she didn't know more about mental health issues and there was little opportunity at work to have a casual conversation with any of the doctors. The doctors in the hospital had specialised in the treatment of physical ailments, disease, surgery. She only knew a few doctors who she should speak to if a patient was behaving strangely. In Accident & Emergency the hospital would treat drug overdoses, alcoholics and people who had physically injured themselves while in a crazed state, quite often accompanied by police officers. The police normally had a better idea of what psychiatric issues the patient suffered from than the hospital staff. It seemed as though the police were at the front line of mental health issues.

Although she had bandaged lacerated wrists and dealt with patients who had swallowed handfuls of pills or poison by treating them with activated charcoal, Lara never really knew the story behind what had brought them to the brink of suicide in the first place, or what happened to them after they were physically healthy enough to be moved to a psychiatric facility. The patient notes for the nurses contained details such as blood pressure and medications. Very few details about the psychological problems that troubled these people were in the notes she saw.

When the weekend arrived, Lara found herself turning to the Internet to find out more about depression and how it was diagnosed and treated. It seemed strange that despite her training and experience, she should have to turn to websites for information, but she didn't know who to speak to. She knew friends had suffered bouts of depression, but it felt insensitive to phone them and say "Hey! You've been down before. What can you tell me?" Those friends who had become depressed never discussed the details of their prescribed treatment openly.

Lara knew her mum had become depressed after giving birth to her little brother. Her mum had sought help from the family doctor. Lara's mum said that a little time talking to the doctor about her feelings had been exactly what she needed. That was over 20 years ago. GPs didn't have much time to talk to their patients anymore. At the local doctor's surgery, Lara seemed to see a different doctor every time she visited.

Therapy conjured up images of whiney New Yorkers, self-indulgently talking about how their daddies didn't love them enough, on a psychotherapist's couch, spending hundreds or even thousands of dollars. Lara thought that to suggest counselling might make Neil more upset. Many people derided therapists as "quacks".

Having spent the week without socialising amongst their usual circle of friends, Lara now faced further isolation all weekend, as the couple cancelled their plans. There was little that Lara could do to help at home. Even asking Neil "are you OK?" could be a barbed question, when clearly he was not. It was very British to say "I'm fine thanks" as an automatic response whenever anybody asked how you were, no matter how dreadful life was feeling at that moment. Neil and Lara's parents had been raised in an environment of post-war austerity, where stiff upper lip and concealment of any inner emotions was considered the preferred way to conduct yourself. The touchy-feely stuff was not dealt with well by either family.

By Monday morning, Lara was relieved to be able to immerse herself back in her work. Throughout her shift she barely had a moment to herself to dwell on personal issues. For the sake of the patients and her team, it was imperative that she was positive and upbeat, concentrating, not distracted. She was expected to be a pillar of strength and exude confidence when patients were scared, in pain and discomfort. Context switching was surprisingly exhausting, but it didn't hit Lara until she left the hospital.

As the week wore on, Lara found that she was less and less able to carry the caring face she wore all day at work into her home. She felt like she had lost the support of both her partner and her social group and she could barely keep her own head above water. By Friday, some tiny slip of the mask must have betrayed how truly drained she felt, because the Ward Manager called Lara into her office at the end of her shift.

"Is everything OK, Lara?"

"My fiancée hasn't been very well for a couple of weeks, but I really didn't want to bring my problems with me to work, Judy, sorry" replied Lara.

"It's OK. You just look a little under the weather. I hoped you weren't coming down with something. Your work has been fine this week. No complaints from me" said Judy.

"Yeah, I'm fine. I'm just going to sleep all weekend and let my batteries fully recharge" said Lara.

"Well, look after yourself. Are you getting the support you need at home?" asked Judy.

"Yeah. We're getting by. I'm sure Neil's going to be feeling better and back to work soon" replied Lara.

"Neil. That was it. I remember you saying you'd got engaged, but I must admit I'd forgotten your fiancée's name. Any news on the wedding?" asked Judy, turning the conversation more light and casual.

"No, we haven't even started planning yet" replied Lara.

"Oh well. No rush" said Judy, glancing down at some paperwork on her desk.

"See you Monday. Have a good weekend" said Lara.

"You too" replied Judy, busily scribbling notes onto a yellow form she had been filling in when Lara had entered the office.

Lara fetched her coat and bag with some sense of relief, but also the nagging feeling that she had somehow trapped herself. Next week at work, she would have to work hard to keep a brave face on things. It would be harder now to admit that she wasn't coping well. All she could hope for was that things would be getting back to normal sooner rather than later.

Anne was hurriedly pulling on her coat as she jogged along the corridor to catch up with Lara, who was making her way to the lifts.

"What was that all about?" Anne asked.

"Oh, she was just asking if I was OK" Lara replied.

"And are you?" Anne asked.

"Not really" said Lara.

 

Next chapter...

 

#NaNoWriMo2016 - Day Four

11 min read

Poste Restante

Contents

Chapter 1: The Caravan

Chapter 2: Invisible Illness

Chapter 3: The Forest

Chapter 4: Prosaic

Chapter 5: The Van

Chapter 6: Into the Unknown

Chapter 7: The Journey

Chapter 8: Infamy

Chapter 9: The Villages

Chapter 10: Waiting Room

Chapter 11: The Shadow People

Chapter 12: Enough Rope

Chapter 13: The Post Offices

Chapter 14: Unsuitable Friends

Chapter 15: The Chase

Chapter 16: Self Inflicted

Chapter 17: The Holiday

Chapter 18: Psychosis, Madness, Insanity and Lunacy

Chapter 19: The Hospitals

Chapter 20: Segmentation

Chapter 21: The Cell

Chapter 22: Wells of Silence

Chapter 23: The Box

Chapter 24: Jailbird

Chapter 25: The Scales

Chapter 26: Descent

Chapter 27: The Syringe

Chapter 28: Anonymity

Chapter 29: The Imposter

Chapter 30: Wish You Were Here

 

4. Prosaic

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

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

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

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

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

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

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

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

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

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

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

"Still?" Anne asked, slightly shocked.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Next chapter...

 

Only Smarties Have the Answer

2 min read

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

My pills

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

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

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

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

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

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

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

 

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

 

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WAKE UP SHEEPLE!!!

5 min read

This is a story about liberal arrogance...

Black Sheep

Ah, caps lock, my old friend. Also, exclamation marks: you can never use too many. Do you think if there was more caps lock typing and sentences ended with multiple exclamation marks, we could wake the sheeple from their coma? The sheeple are clearly sleepwalking [or is it shleepwalking?] towards disaster.

While this is self-deprecating humour, it's also mockery of the same old liberal lines that are trotted out instead of any kind of nuanced counter-argument.

During Brexit, I noticed that people on both sides would say "I can see you're far too intellectually inferior to be able to have a debate, therefore this argument is over and I won". I lament the loss of anybody who can actually be bothered to have a proper debate, without being so childish.

Your white-trash, redneck, poorly educated person is now incredibly bored with the tried and trusted liberal short-cuts that supposedly immediately discredit an opponent in a debate. "Bigot" is a particularly charged word, and guarantees instant disengagement by the disenfranchised members of the public, being browbeaten by a group of elites who consider themselves morally superior.

I'm as guilty of it as anybody.

But, I've also noticed a kind of pathetic infighting amongst the intelligentsia.

Firstly, one must overcome the snobbery of the grammar Nazis. For your argument to even be considered it must be deemed to have attained certain standards. The most innocent spelling mistake will become the focus of commentary, rather than the points raised by the original author, no matter how eloquently the central argument is presented.

Having established oneself as 'a cut above the rest' there is one kind of ad hominem attack that succeeds where all others might fail. All one has to do to win the argument is write "WAKE UP SHEEPLE!!!" in mockery of your opponent's attempt to make a reasoned argument and reach a sensible conclusion. Essentially, you're accusing somebody of being a nutjob; a raving madman. Case closed. End of debate.

Our asylums are stuffed full of 'visionary' people, and those seized by absolute conviction that the end of the world is nigh. However, do we not also laud that tiny handful of individuals who successfully predict recessions, stock market crashes, credit crunches, housing crises and other cataclysmic man-made events?

Why is it that a stock market trader or hedge fund manager, who might make a good living from short selling - betting against the market - is considered a highly intelligent person - cloaked in the mystery of mathematical models - while others who also forecast negative events, are dismissed as lunatics?

Humans always err on the positive side. There is a psychological test where participants bet money and win precisely as much as they lose. In this randomised gambling experiment, most test subjects will report that they think they're making a profit, even though they're breaking even. Even when the experiment is adjusted so that the participants are losing money, most will still think that the course of events is in their favour.

It's undeniable that we do see a herd mentality amongst groups of humans. The accusation of sheep-like behaviour is entirely valid and well supported by evidence. Stock market crashes are created by market sentiment not by external events. When investors collectively lose confidence, there's a rush for the door. The sheep line up for slaughter, even though by selling their stock, they're going to lose money.

Bank runs are another great example. The FCA underwrites deposits - your savings are safe - but we still saw long lines of people queuing up to withdraw cash from Northern Rock, during the credit crunch. That's a bank run, and it's driven by sheeplike behaviour. The panic is not rational. It's animalistic behaviour, not calculated and logical.

The well-educated middle classes have turned on one another, in this zero-growth second Great Depression. Research grants are at stake. Well paid middle-management jobs are at stake. The baby boomers are trying to collect excessively generous pensions. For God's sake don't even breathe, for the whole house of cards may come tumbling down at any moment. We are so highly leveraged - indebted - that one hiccup and we're all screwed. 

We should remember that the working-class are more numerous than the middle-class. While the working-class wail inarticulately about their poverty and lack of opportunities, the middle-class lock themselves into an echo-chamber of Facebragging and snobbery. Whenever somebody is critical of the status quo, we quickly shut them down by typing "WAKE UP SHEEPLE!!!" to bully them into submission.

Personally, having safely circumnavigated the City of London - and profited - during the dot com crash, 9/11, the commodity price boom (and bust), the credit crunch and Bitcoin's ups & downs, I feel rather like Cassandra.

Dismiss and ignore me at your peril.

 

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The Doors of Self-Perception

14 min read

This is a story about being objective...

Yardsticks

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

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

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

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

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

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

Defining "happy" has started to get really hard.

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

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

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

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

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

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

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

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

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

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

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

A friend made the following amusing observation:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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The Dark Web

14 min read

 This is a story about drug dealers...

Dark Web

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?

 

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