Well into my twenties, I thought I would always be ill. Years of experience had taught me that the best I could hope was to have an acute mental health episode only every other year, rather than yearly. And the older I got, the worse the episodes seemed to get. In 2001, I had my most destructive episode to date, ending up in a medical ward where doctors worked to try and prevent long term organ damage from the overdose I had taken.
Somehow, things got better after that. It’s very difficult to say exactly what did the trick, because I made so many changes to my life – I changed relationships, I changed careers, I change psychiatrists, I changed meds. Maybe it was a combination of things. All I can say for certain is that from 2002 until 2010, I was pretty much asymptomatic. Of course I had wobbles. I found it hard to cope after a relationship breakup and I struggled to adjust to living without a partner. But that was OK, because I felt low for a reason. That in itself was a revelation; so very different to the depressions that had descended upon me throughout adolescence and early adulthood, depressions that seemed to have no obvious cause and, therefore, no meaning. I still saw myself as psychological vulnerable, however, and was quite content to carry on taking my prescribed medication.
As the asymptomatic years passed, I grew more confident. I started taking risks, going forward for promotions, pursuing the kind of relationship I really wanted, relocating from where I grew up to London. I took on new hobbies, successfully auditioned for an a cappella singing group, trained for and ran a charity 10k race. I started to feel that I had somehow really cracked it, that I was cured and would never now go back to the dark days of my earlier life. I even began to feel that I was a bit of a charlatan to have declared a disability to my employer under the Disability Discrimination Act (now superseded by the Equality Act 2010). Because I was so well!
A lot about mental health is chicken and egg. So I can’t now tell you whether I started to become unwell in July 2011 because I had been tinkering with my meds, or whether I started thinking that I could manage without the meds because I was already slightly hypomania. I can tell you that there was definitely some grandiosity involved, that by this point I had moved into thinking that I had cured myself. I began to think semi-seriously about writing a self-help book for all those poor, unenlightened people who remained depressed because they didn’t have my magic formula. I was the furthest away I had ever been from thinking of myself as “a disabled person” or “a mental health service user”.
In April 2011, I went to my GP. I was finally ready to admit that after around eight months of trying to hold it together, I had lost control and was sliding rapidly into my first depressive episode since 2002. I was happy to be referred on to a psychiatrist, because I knew what I wanted: a medication review that would help me get past this blip, and get on with my life. By “my life”, I meant everything I had built over the past eight years; a solid relationship, an ability to parent more consistently, rapid career progress and salary increase, absorbing hobbies and a vibrant social life. Initially, I asked for a medical certificate for just two weeks. The sooner I got back on track, the better.
18 months later, by mutual agreement my contract with my employer is about to end. The DWP may have found me fit for work, but my workplace cannot accommodate someone who still has weeks, rather than days, when they are unable to come in, nor someone who is very sedated until 11am. I am yet to find a medication regimen that even dampens my symptoms, let gives me complete relief. In spring of this year, I started to feel that I might finally be making some progress; yet over the summer, I feel that things have worsened. Part of the suicidal feelings I struggled with over the summer arose from a realisation that this may be it. All this time, I have been thinking of my 8 years’ remission as the norm, as “the real me.” But my moods have now been unstable for more than two years. What if the remission, and not the relapse, is the anomaly? What if I have been holding out for “recovery”, only to find it never arrives?
A few days ago, I got up in the night to quench my thirst (thanks, lithium!). As I blundered about, bumping into walls (thanks, quetiapine!) it suddenly occurred to me that I needed a radical shift in how I saw recovery. “Recovery” is perhaps the buzz word in mental health at moment; mental health teams are being renamed “recovery teams”, and are expected to employ the “Recovery Model”. For over eighteen months now, I have been using the word “recovery” to mean “getting back to exactly how I was before I relapsed.” This has got me to a point where yearning for, striving for, my version recovery is doing more harm than good. As long as I use “the real me” of 2002-2010 as the yardstick by which I measure myself, I will continue to fall short, and from there it is a short hop to feeling that my life is over.
So I have made a conscious decision to instead embrace “recovery” as the Model defines it: a recognition that “while people may not have full control over their symptoms, they can have full control over their lives. Recovery is not about ‘getting rid’ of problems. It is about seeing beyond a person’s mental health problems, recognising and fostering their abilities, interests and dreams.” This sounds to me like “radical acceptance”, a concept drawn from Buddhist meditation practices I was first introduced to during a course of Mindfulness Based Cognitive Therapy. Radical acceptance involves seeing things as they really are – no matter how painful – and simply accepting, rather than trying to resist, deny or change, them. The best-known exploration of radical acceptance is the book of the same name by Tara Brach, but it is also a key part of Dialectical Behavioural Therapy (DBT).
What might it mean if I began to practice a recovery model based on radical acceptance? For a start, it would mean beginning to see myself as worthy of love and respect, even if I don’t have an income; even if I never return to a full time job; even if my I never get my moods under complete control again. It might mean looking at how I might seek out alternative forms of work that I can manage even if my moods are still fluctuating. It might also mean trying to figure out what my limitations are and how to live a good life within them, rather than constantly willing those limitations to melt away so that I can resume my old life.
That really does feel radical.