I became unwell suddenly, unexpectedly and severely 5 years ago. I was working as a full-time GP at the time with a growing list and four small children.
Initially, I had days when I was intensely irritable with my family and suffered from episodes of anxiety and tension headaches. I put these down to the long hours I was working and a full social life at the time. Then driving down the motorway one day I decided it would be appropriate for me to crash the car and end my life. This was the start of very strong suicidal thoughts and impulses that would pop into my head unbidden and needed real mental energy to resist acting them out.
In the meantime I was also having difficulty working, at times literally dragging a deeply fatigued body and an equally befuddled brain into the consultation, managing by treating one person at a time, rather than look at a whole fully-booked surgery. On other days I found work a useful distractor from the milder symptoms of my depression. Then again, at other times I was full of energy, enjoyed patient contact and was continually looking round for extra things for myself and the family to do.
Gradually, I noticed that working long nights and weekends became intolerable, which I initially put down to having young children rather than believing that I might be ill.
As my mood fluctuated so widely and on a day-to-day basis it was difficult for me to see that I needed help. In the end my husband encouraged me to make an appointment with my GP.
My GP wisely referred me straight on to a psychiatrist, unwisely she started me on an antidepressant not having asked about symptoms of elevated mood as I was clinically so depressed at the time.
My psychiatrist signed me off work initially with depression, but eventually with bipolar disorder, and thus began several years of treatment.
Antidepressants, mood stabilisers, ECT, antipsychotics, thyroid hormones, lithium, psychotherapy and hospital admissions made no difference to the unstable pattern of abrupt mood swings, rapid cycling, bipolar depressions, and mixed mood states with psychotic features woven throughout.
WHAT IS IT LIKE TO LIVE WITH THIS CONDITION ON A DAY-BY-DAY BASIS?
This illness is about being trapped by your own mind and body. It's about loss of control over your life. Bipolar disorder is multipolar affecting not just energy levels, but behaviour and physiology. To onlookers it seems that your whole personality has changed; the person they know is no longer in evidence. At times they can be sucked into believing that the changes are permanent.
My mood may swing from one part of the day to another. I may wake up low at 10 am, but be high and excitable by 3 pm. I may not sleep for more than 2 hours one night, being full of creative energy, but by midday be so fatigued it is an effort to breathe.
If my elevated states last more than a few days, my spending can become uncontrollable and I have to hand over my credit cards to my husband, which takes a great effort of willpower otherwise I make purchases I will later regret. I remember being entranced by 18-metre lengths of coiled yellow extension wire. In my heightened state of awareness the coils of yellow looked exquisitely beautiful and irresistible. I wanted to buy several at once.
I will sometimes drive faster than usual, need less sleep and can concentrate well, making quick and accurate decisions. At these times I can also be sociable, talkative and fun, focused at times, distracted at others. If this state of elevation continues I often find that feelings of violence and irritability towards those I love will start to creep in. Concentration and memory start to wane and I can become hypersensitive to noise. The children making their usual noise and my husband singing can drive me to distraction.
My thoughts speed up and I can lie in bed for hours at a time watching pictures on the inner sides of my eyelids. Sometimes words are present and I read them as if engrossed in a good novel. If I were asked to read them out loud they would not make sense. They are a fascinating blur of words and pictures, snatches of poetry and music. I become impatient with myself and those around me who seem to be moving and talking so slowly.
I frequently want to be able to achieve several tasks at the same moment. I may want to read two novels, listen to music and write poetry all simultaneously becoming rapidly frustrated that I cannot do this.
Physically my energy levels can seem limitless. The body moves smoothly, there is little or no fatigue. I can go mountain biking all day when I feel like this and if my mood stays elevated not a muscle is sore or stiff the next day. But it doesn't last, my elevated phases are short, mild and generally manageable, but the shift into severe depression or a mixed mood state occurs sometimes within minutes or hours, often within days and will last weeks often without a period of normality. Indeed I often lose track of what normality is.
Initially my thoughts become disjointed and start slithering all over the place. I will feel that I am physically trying to pin them down in my brain, trying to run ideas together in a coherent way. They will sometimes remain rapid and are accompanied by paranoid delusions causing an inner tension that can only be relieved to some extent by physical activity such as pacing a corridor. I start to believe that others are commenting adversely on my appearance or behaviour. I can become very frightened and antisocial.
The children will detect the mood shift early on and play by themselves as I become more isolative and angry. My sleep will be poor and interrupted by bad dreams. I will change from being the person who has the ideas — is the decision maker — to not being interested in anything at all.
The world appears bleak and a pointless round of social niceties. I will wear my most comfortable, often black clothes, everything else grazes and chafes at my skin.
I become repelled by the proximity of people, acutely aware of interpersonal spaces that have somehow grown closer around me. I will be overwhelmed by the slightest tasks, even imagined tasks. I will see dirt on every surface, weeds all over the garden, and grubby children and feel solely responsible for improving these things.
Physically there is immense fatigue: my muscles scream with pain, an old nephrostomy scar plays up. I ache down to my bone marrow, my joints feel swollen. I become breathless weeding a small patch of garden and have to stop after 2 minutes. I become clumsy and drop things. The exhaustion becomes so complete that eventually I drop into bed fully clothed. Sometimes I will vomit, my digestive processes halted. I will often sleep without being refreshed for up to 18 hours. At times every muscle in my body will tense up and be totally resistant to relaxation. Sweat will pour off me or I will be caught in an attack of shivering unrelated to the ambient temperature. I will shout over and over again in my mind for help, but never get the words past my lips.
Food becomes totally uninteresting or takes on a repulsive flavour, so I will lose weight rapidly during a long depressive phase. Sometimes, I will crave only sweet foods in small quantities. It will often be difficult to bother to drink adequately, which can affect my drug levels and my bowels do not function.
I become unable to concentrate to read a novel for pleasure, for escape. Even a newspaper or magazines become impossible to follow. I start to feel trapped, that the only escape is death. At this point or earlier it becomes a rational decision.
My brain slows right down. I become stuck, unable to answer a simple question, unable to establish eye contact and unable to comprehend what is being asked of me.
I avoid answering the phone or the door. My voice deepens and slows sometimes to the point of slurring. My skin becomes pale and grey in hue. I feel the cold more readily. I will look in the mirror and fail to recognise the person there.
As I begin to slip into a more psychotic state of mind I become unable to recognise something as familiar as the palm of my hand or my children's faces. My sense of space alters and rooms that are familiar appear to have changed dimensions. Simple objects in a room can take on sinister meanings for me.
At this point the world begins to take on a malevolent aspect, which is difficult to describe. Those I love around me become part of a conspiracy to harm me. Their faces will alter and their voices develop a mocking ring. I will hate my husband and other loved ones.
Images just out of my field of vision will be waiting to pounce leaving me in a constant state of vigilance. I have been under the impression that I was rotting under my skin, that my bone marrow is being gnawed away by evil spirits.
Soon the voices and images in my head start telling me what to do.
Stop taking my medications, injure or kill those I love. Destruction. No other way out.
Ultimately they tell me that everything would be better if I killed myself.
I am evil, a burden; I deserve only punishment.
Twisted tales and delusions.
I become passionate about one subject only at these times of deep and intense fear, despair and rage: suicide. The suicidal impulses and images can come at any stage of the illness, even in mania, but are at their most intense and irresistible during psychotic phases.
For months at a time I have carried ropes, blades and enough tricyclic antidepressants to kill me twice over, in the boot of my car. In the past I have had access to a fatal pharmacoepia of emergency drugs through my general practice work.
I know where to buy a gun. I know the fatal dosages of the drugs I take. I have considered railway crossings, bridges over rivers, driving off roads into valleys and electrocution. I have made close attempts on my life by hanging and drowning over the last few years.
Sadly, the impact of suicide on my children does not avail me when I am ill. I consider myself to be such a huge burden to them at these times that I believe suicide to be a relief, a final gift to them from a mother who can do no more. A person who has reached the limit of endurance.
At times I will experience images of extreme violence towards others, often family members and those close to me, but on occasions complete strangers. Occasionally, I feel completely detached and dispassionate and compelled to act on these images: more often they are extremely distressing to me. When in a normal state of mind I find these images abhorrent in the extreme.
Fortunately, those who care for me have been able to recognise these unsafe states and admit me to hospital. Then inexplicably, my mood will shift again.
The fatigue drops from my limbs like shedding a dead weight, my thinking returns to normal, the light takes on an intense clarity, flowers smell sweet and my mouth curves to smile at my children, my husband and I am laughing again. Sometimes it's for only a day but I am myself again, the person that I was a frightening memory. I have survived another bout of this dreaded disorder.
It's a continuous round fought on a daily basis. If I'm lucky I will get a few days every few months when I am completely normal and don't have to make continual allowances for my mood state.
So why am I still here? I don't know. Possibly luck. Possibly the tiny scrap of humanity that remains even in my most psychotic and suicidal states, which allows me to express the desperation and loss of control that I am experiencing, so that caregivers and treating clinicians can respond appropriately and keep me safe. A little hope. Some denial.
I have lost my job, intellectual stimulation and my social life. Sometimes I wonder how my marriage holds together and I am continually anxious about the effects of my illness on my children and whether I will end up like too many other people with severe bipolar disorder, separated from them permanently.
There have been relationships broken and distorted, and relationships that have held fast and true through the worst of its manifestations. Making new friends has often been too difficult. Those who know of my illness have sometimes become accommodating and flexible, others have not.
I have had to tolerate opinions from all sorts of people who think that if I only did something differently I would be restored to full health. This has varied from advice to take multivitamins, regular massage, a holiday, a return to my country of origin, meditation, regular prayer, church attendance to the avoidance of atmospheric pollutants and negative thinking.
It's taught me that even with the best psychiatric care some people do not respond to medication, do not get better. However, I am grateful that I have had the best care available to me throughout and that I had completed my family before the onset of this illness. I am also grateful that I was able to take out income protection insurance several years prior to becoming ill, otherwise like many other mentally ill people we would be impoverished.
This illness is about having to live life at its extremes of physical and mental endurance, having to go to places that most people never experience, would never want to experience. It has been about having unthought of limitations placed on your life, your career, your family. For my family it's been about adjusting to totally altered dynamics, having a mother who is often unable to be there for them, for them to have to live with the flux of my moods and the disturbance that comes with recurrent hospitalisations.
It's about having to rely on others for help when you are feeling at your most vulnerable and exposed. It's about being stigmatised.
It has become about trying to stay alive and living life fully in the brief periods of normality or mild elevation that occur from time to time.
Otherwise, rapid cycling bipolar disorder is an unrelenting scourge.
