Don’t fence me in: 10 signs of hypomania you won’t find in a textbook

Whenever I tell a new doctor that I’m hypomanic they ask me to describe what I mean when I use that word. I hate the question, because it’s glaringly obvious that they’re assessing my answers against criteria they have in their heads, probably derived from the big diagnostic manuals (DSM-5 or ICD-10). Obviously when hypo I do display classic indicators like decreased sleep, increased energy, increased libido, increased productivity and so on. And of course I understand there are core set of experiences people in a hypomanic state may share which is why they they tend to appear on mood monitoring charts or apps and in self-help books.

The problem with being measured against a general checklist is that accepted symptoms are not usually what I find herald hypomania. There are a whole a range of deeply personal things that I consider much more important in making my own assessment. So the risk of giving an honest answer is that I won’t match the checklist. I will not fit in the prepared box, so the clinician will conclude is that I don’t really know what I am talking about when I explicitly state that I’m hypomanic. This causes me huge frustration; I have worked and worked to be acutely aware of my mood states and to have that expertise dismissed because it’s unorthodox is upsets me every time it happens.

So I think I’ve decided I’m giving up on truthfulness with new professionals because I’m sick of my consistent, reliable signs of hypomania being seen as irrelevant. So I think I’ll share them here instead, and if I get up enough courage I might even pop a copy in the post to the psychiatrist ;)

Funny fingers. Whenever I’m going high I get this thing where I have to scratch or rub my fingers, especially the outsides of my little fingers. I have never successfully conveyed this experience to anyone. I tried to explain to the team registrar recently that it is something that I do it because my need to feel something there. He misinterpreted that and it’s written on my discharge letter that my fingers are numb. Not a bit of it. My fingers feel and function normally, but they need more sensation. I have to do it, I have to meet that need and give them more, otherwise the agitation builds.

Swagger. I’m hardly the sort of person that swaggers around the streets of London. In fact I’m often quite timid, scared of people when I’m depressed, ashamed of my body size and dreading the next time I’m asked me if I’m pregnant (no, just a quetiapine baby). Throw a little hypomania into the mix and I couldn’t be more different. Suddenly I walk in a completely new way. I stride. I sashay. I swagger. It’s a mixture of confidence, the certainty I am sexy, a touch of arrogance and a readiness to engage in confrontation. The best I can describe it is to suggest that you walk along to the track Battle Without Honour or Humanity and see how that feels.

Necklaces. When high, I dress differently – or as the registrar recorded, with more panache. It’s not just that I think more about my clothes than I would when I am depressed. It’s not that I go out and buy new clothes. It’s that apparently great outfits I hadn’t noticed now leap out of my wardrobe. Because my self-confidence is high I am also certain of my own attractiveness so it never occurs to me that I might not be able to “work it”. Most noticeably, the necklaces come out to play. Now, I will readily admit that I am a necklace fiend, if not a hoarder. I have about 50, all of them beautiful, and yet days or weeks can go by without me wearing a single one. In comes hypomania and suddenly the biggest and boldest, the “statement” necklaces, are also leaping out at me (and the compliments I receive of course reinforce my belief that I have great taste in jewellery and should hang on to every necklace I own, so yay).

Pointy teeth. For me one of the earliest indicators of a high is having pointy teeth. Of course my teeth aren’t really any pointier than usual; a quick check in the mirror proves that, as does the knowledge that this isn’t Bon Temps. But they feel much more pointy and I can’t stop running my tongue over them. This is part of a broader package of enhanced senses; my feet are more conscious of the interior of my shoes; things sound louder; colours seem brighter. But it’s always the teeth thing that tips me off.

Asinging and adancing. Based on my Twitter connections, this is a pretty common indicator but I’ve definitely never seen it on any mood chart. On an upswing I find myself travelling from room to room via the medium of Zumba-ish dance moves. When I would normally stand still – washing up, hanging the washing out, cleaning my teeth – I am side stepping or bum kicking or scooping (sorry, that probably make much sense if you’ve never done aerobics!). I chair dance while writing. I get up and start dancing when I should be working. I’m also very into singing, loudly and confidently, loud enough for my son to complain that he can hear me through two walls and a pair of headphones. At least he says I’m good.

Comely commuters. Often I will sit on the Tube and be oblivious to my fellow passengers, buried in my phone or my Kindle. Sometimes I will plug myself into my headphones and do a little people watching. But sometimes, hypomanic times, I find that the carriage is filled with unfeasibly attractive strangers. Everywhere I look there’ll be someone hot. I know I’m staring and that some people have noticed that I am staring and look puzzled and uncomfortable but I can’t help myself. They are literally mouth-watering and my breathing gets shallow, my pupils dilating. Luckily I am never quite manic enough to proposition anyone.

Sunsets. On an upswing, sunsets become almost unbearably beautiful. On long summer evenings when the pressure is high and the sky changes from blue to lemon to streaks of intense pink, I almost cry at so much splendour and the elation spikes and pulsate.

Tweet rate. I do type pretty fast – I learned in the fast-paced chat rooms of the very early noughties – and I do tweet a lot. But hypomanic I tweet a lot more, bam, bam, bam, one tweet after another and another. Online friends sometimes (with good reason) check in with me when they see how fast I am getting my tweets out there, but of course if I feel great I’m unlikely to want to tone things down. But I will probably note what they’re saying somewhere in the back of my mind.

Head music. Head music is another one I’ve frequently heard from other with bipolar but have never seen “officially” acknowledged. It is, I guess, a pseudohallucination – something that is “heard” within the head, but not as an actual sound as someone might experience if they hear voices. For me, it’s usually a loop of a particular song or piece, a particular musical phrase, a snatch of melody or, at its most annoying, a single word over and over again. It can easily be linked with a switch to mixed mood as I become very agitated by being unable to stop the music.

In the loop. Strangely the head music often has no connection at all to what I have been listening to. Which is a good thing, as despite the fact that I have 219 Spotify starred songs when I’m high I will play just one over and over, all day long (hoping the neighbours are at work). When Tom gets home and opens the door there is sometimes a very audible “Uh-oh!” as he clocks what I’m listening to. Again.

I’m not asking anyone to change any diagnostic criteria or mood apps on my account. In fact, I’m asking clinicians to do less work. I want them to sit back and trust that I know something about my condition and remember that I’m monitoring myself for the 23.5 hours a day while they get a 30-minute window. Now, I’m willing to bet that pretty much anyone who experiences hypomania has something weird and quirky that they know they need to watch that’s outside the diagnostic box. This is the stuff that professionals should value; they should be learning from our quirks. Don’t fence us in.

Posted in Bipolar, Hypomania, Mania, Self-management | Tagged , , , , , , , , , , , , | 24 Comments

I asked for help

I asked for help when I was 12.

I looked, alone, in my middle school library

at a teenage health book. It told me that

depression is an illness. It is real. You can be helped.

It took me days to summon up the courage

find the words to say, “I think that I’m depressed.”

“Everyone’s depressed!” was the response.

I left it there.
I asked for help when I was 13, 15,

already suicidal, finding school a torment.

“All teenagers have mood swings.”

“It may be PMS, so track your periods.”

I asked for help when I was 17.

I got propranolol. Whatever that meant.

I didn’t feel it did much, but someone cared.
I asked for help when I was 20.

The psychiatrist, the first I’d met,

portrayed me as a liar and implied that I might drink.

He sneered at my choices

of university

of course

of fiancé

and gave me fluoxetine, which sent me high.

He didn’t care.
I saw another guy who thought I had bipolar.

Lithium, he said, was the drug of choice but

it can cause thyroid problems

renal problems

seizures

coma

death.

You need blood tests

ECG

chest X-ray

and you must not get pregnant, no matter what.

No one talked it through with me.

No one helped me understand what it might mean to have bipolar.

No one gave me options.

It was lithium, or nothing.

I chose nothing.
I asked for help when I was 25.

I filled in a depression scale.

No, I cannot cope

and yes I cry a lot

and yes I think about death.

My toddler’s behaviour is out of control

my newborn’s crying is out of control

my depression is out of control.

The Health Visitor frowned.

“You’re score is very high.

I think it’s just because you’re self aware.”

And I had thought it was because

I was so depressed.
My GP tried to help.

With sertraline

and paroxitine

and trazadone

and venlafaxine

with no onward referral

and I remained in a kind of hell

an empty of husk of a mother

an empty husk of a person.
I asked for help when I was 27

if by asking for help you mean

spewing the contents of my medicine cabinet

from my stomach to the floor

of a curtained A&E cubicle.

When my vital organs were deemed well 

I went home

five pills of chlorpromazine

in a brown childproof bottle.

They sent a CPN.

“What do you want from me?” she sighed.

“This service is for people

with serious mental health problems.”
And she left.
They sent me for assessment with a clinical psychologist.

At last my problems, the overdose, seemed taken seriously

and my name went on the waiting list.

We didn’t hear and didn’t hear

and so we phoned.

“Oh, you’ve been taken of the list.

We had a case conference and

you were not in sufficient need.”
I asked for help when I was 28.

The psychiatrist looked into my file

but did not look at me.

Every session was the same:
your GP seems right

your current medication seems right

so see you in a month, then.

Repeat in August, in September, repeat repeat repeat.
I asked for help when I was 30.

and received a new and inaccurate diagnosis

something that I only knew when a letter came my way.

I did not recognise this version of the assessment

this description of my “psychopathology”

I did not recognise myself.

The unexpected upside of being told

that my personality was partially disordered

was I got the therapy I had needed 18 months ago.

I was profoundly grateful. I was profoundly angry.
I asked for help when I was 37.

I received it.

Posted in Bipolar, Child and adolescent mental health, Depression, Mental health services, Psychiatry | Tagged , , , , , , , , , , , , , | 18 Comments

She took to her bed: safe spaces and danger zones

Today I have been trying to explain to my Consultant that I feel that there are a number of zones in which They have more chance to get at me, where their power is stronger. Places like what I am now calling “Banana Alley”. Seriously, apart from streets that are used as markets, never have I seen so much fruit um, detritus, on a pavement or in a gutter. Today there were skins from about three satsumas or clementies (I did not take time to ascertain which), plus a whole manky one, plus a lone, heavily bruised apricot. This in a distance of perhaps 250m, a “passage” from tube to bus.

It’s becoming clear that although it’s often quite neutral, a lot of what I experience in my home happens in the hall/passage. Mostly I’ll walk back and forth without giving it a second thought, but when I start to become afraid it becomes a danger zone; inconvenient, because it is necessary to pass through the hall to get from any one room to another.

One of my earliest experiences with Them occurred a couple of years ago as Tom was driving us along the North Circular. Obviously we all know that the North Circular is hell. That’s a given. However, there’s a certain section which feels downright dangerous, a stretch between a certain bridge and a certain building. Once, on a tube train, I saw an ad for a product made by the company in that building (I hadn’t even known that they made anything) and I was flooded with anxiety. Still, we passed through it yesterday with no ill effects, holding my breath the whole time.

All of these spaces are liminal, a zone between or an intersection of safety and danger. Or maybe they are littoral, places where the terrifying and the pathological smash against the normal and the ordinary, I don’t know. In the case of the hall, well, I have to move through it. It’s that or buy a commode and have Tom bring all my food to me and give me bed baths. In the case of the North Circular, it is the most direct way home from many trips out but I am sure if I felt really distressed Tom and the satnav would find us another route. When I was explaining about Banana Alley to my consultant he asked me if there was another route I could take. I was astounded. I am familiar with the area well from my past work, so I on one level I knew perfectly well how to catch the bus without hurrying down the Alley, my eyes flickering from gutter to hedge on high alert for fruit. Yet on another level it really hadn’t even occurred to me. (On the way home I went one better and took a different bus. It took me about twice as long to get home but I felt I was making a statement.)

I was asked today whether I thought I needed to be in hospital. I didn’t think so. I am not at any physical risk. I am despondent at this change in my symptoms, the fact that this means I can’t up my game, can’t defend myself against whatever bipolar throws at me because it’s different with every crisis. My mood also dips when I have had a very difficult or distressing day, but that’s understandable. I am not of low mood in the clinical sense. Being admitted now would actually take me away from the points of safety in my life. Firstly, Tom. When he’s around, things are OK. I get confused and muddled about whether things really happened and if so when, but They don’t trouble me much. He’s like an amulet. Or, I don’t know, a sort of protective bubble of safety. There are places in my home too that are safe zones, even if I have to cross the hall to get to them. Twitter followers will know how much time I spent in the bath, and that becomes even more important when distressed, an enclosed space that I can fill with relaxing music and scented oils that provides a period in which something like diazepam can get to work.

The safest place of all is my bed. And the more ritualised and specific “bedtime” is, the safer it becomes. The bed has to be made, properly. The scatter pillows on top need to stay there, although the serve no actual function. The sheet and the duvet and the bedspread must be as straight as I can make them. Extra safety points are accrued by going to bed immediately following a bath; extra extra points by putting on a clean nightgown or PJs. Getting into bed in this state, especially in the day, makes be feel born again, cleansed, and not just on the outside. It gives me the best possible chance of surviving a period home alone. There is one problem, however. Although I’m not remotely suicidal at present, this feeling of being newborn is slightly risky because it is exactly what I was aiming for in some anonymous hotel where I intended to spend my last night.

So no, I don’t think it would be beneficial for me to be in hospital. The only bed I am interested in accepting is the king sized one in my room. I don’t even know what could be achieved in hospital in terms of medication that can’t be carried out in the community.

This is another post I don’t know how to end. I only meant to write a couple of hundred words. I should link to some other posts but I am too tired, sorry.

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In two minds

So apparently I am having to live with a dual reality. One is about logic, “facts” and what I “know” to be true (or more accurately what I previously knew to be true). The other is a different sort of truth and it brings understandings that feel genuine, authentic and often very scary, but don’t match the reality I usually experience. They both feel true, and they both feel untrue, at the same time.

I don’t know how to hold the two together. I have one skull and I don’t understand how I am supposed to be able to keep them both inside it. There are times when I don’t think I’ll ever be able to, when they are in constant competition and one swells to fill the space but it quickly displaced by the other (something like water balloons being squeezed?). Yesterday I found myself in a foetal position on the hall floor with the recurrent thought that I was being watched/monitored/recorded from above. Every time the thought burst through I… I’m not sure how to describe it. Although I was crying, it wasn’t a sob. The closest I can get is to say it was a kind of yelp. The thought came and I yelped because I did not want to have it. I tried to push it down with my rational mind, telling myself, no, that’s not true and that thought shouldn’t be there, but then the thought popped through again and there I was, curled up and yelping on the carpet. Quite quickly this progressed to me punching myself in the head with every paranoid thought, not because I wanted to hurt myself but because I was desperate for those thoughts to be removed from my head.

As usual, I feel it is all down to “them”, although that is a word I am becoming more and more cautious about using. I certainly don’t want my friends using in text, for their safety and mine. It feels that “they” might be scanning communications for mentions of them, and so use of the word might draw their attention (I know it won’t, I know there is no “them”, I know, I know). A couple of days ago I went into my local town centre to pick up some dresses I had ordered, something I was really quite excited about. Opposite the shop I was waiting at the kerb when a bus came by with an advertisement for the new Poltergeist film. I honestly do know how these things work; advertising “creatives” sitting around a table or reclining on beanbags or whatever these people do, throwing out potential straplines generated by the blue skyness of their thinking until they have one that sticks. I KNOW THIS. Yet the strapline on that bus was, “They know what scares you”. There could not have been a more perfectly targeted message for me and I instantly felt as if I might throw up, right there in the street. I shed a few tears of fear and fury and went to collect my dresses, thinking bitterly that they even know when things will make me happy and do their best to thwart that. I also had the depressing thought that I would never be rid of them, because as they had just demonstrated, they can pop up anywhere at anytime. It was a moment of pure despair.

Other strange events have included seeing the cursor on my laptop move as if accessed remotely. Olfactory hallucinations have come to bed with me despite neither bedding nor PJs or my own skin smelling that way. I have been disturbed by the persistent creak of floorboards as people walk around upstairs – only there is no upstairs. I found a lump in my breast but knew it might well be to do with the increased Q, which often causes painful breasts and/or milk production after a dose increase. But I had to ask Tom whether he could feel it because I simply couldn’t be sure it was really there. When it vanished within three days I found it to be difficult to be sure whether it had even been there in the first place, or whether it had but I had I brought it into being by recent unfounded worries about breast cancer.

I’m still seeing “visions”, and as I become more paranoid they tend to take the form of angry eyes or screaming faces. I am also having intrusive thoughts of extreme self-harm; no urges, just images of bizarre awfulness. I wouldn’t class as these features as psychotic, but they do tend to pop out whenever my brain is that way inclined. They like this particular neuro soup.

This morning I set off to see Home Treatment Team in a grey fug made of overtiredness and sedation. I just can’t hold it all together. I don’t know how to achieve a balancing act between competing realities and it’s become really exhausting. I’m trying to keep busy, employing simple distraction techniques like a bath, casual gaming, TV, although as usual I can’t concentrate on telly alone so Tom has to be there. Going out alone seems better than staying in the flat alone, but as the bus thing shows, there is risk attached to that too.

I’m seeing my own consultant, on Monday. This will be a relief, especially as someone from HTT will sit in and talk about where we go from here. I don’t know where there is to go. I’m been carrying on the increased Q as per his advice but my symptoms are clearly not under control. I can’t face any more Q because I am already so sedated, and I’d be getting near the max outpatient dose anyway. There remains little progress on my attempts to access therapy at the National Affective Disorders Service as the funders want more and more information before agreeing to treatment. Curiously, although feeling somewhat hopeless and helpless, I don’t really have suicidal thoughts, my usual “presenting problem” in referral to HTT. Which is wonderful as far as I am concerned, because how I would cope with that as well as everything else that is happening I do not know. I don’t even want to think about it.

I don’t know how to finish off this post, other than to say it’s been a good distraction for the past hour or so. Time to find another one.

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When you’re strange

I feel strange. I don’t think I’ve been acting particularly oddly so it’s probably not noticeable to most people, but I’ve been having strange experiences that make me feel a stranger to myself. After the Great Banana Skin Episode I felt I was escaping the world of “unusual ideas” and “unshared experiences”. I had no evidence for this. Perhaps I just wanted to feel… well, not strange for a bit. But the truth is that experiences like this, which only emerged in my late 30s, have changed me, and changed me forever. I can never be “unstrange” again.

Aldous Huxley famously used William Blake’s phrase “the doors of perception” to illustrate his mescaline-induced psychedelic experiences (a phrase which in turn gave the band The Doors their name). I feel that my psychotic-type experiences over recent years have flung open a door in my mind that can never be pushed shut again. Even the glimpse that I have had – and of course my symptoms are very minor compared to many – has destroyed the boundary between what is real and what is not, making me unable trust my own senses or beliefs. Even three years ago I would have laughed at the idea I might need to ask somebody else work out what was real and what was not but this is now a regular occurance. Asking makes me feel like a child, perhaps because we expect the barrier between reality, fantasy and dream to be more porous in children.

Since the banana thing I have had a gustatory (taste) hallucination, which is a complete new one for me. On two separate occasions I have not only seen blood (because I continue to be very clumsy on lamotrigine and cut myself more often than I used to) but tasted it. I didn’t imagine the taste of it, I tasted it, strong and metallic, without having brought the cut to my mouth. I could not rid my mouth of it for a good while after the tiny wounds had stopped bleeding. I don’t usually get visual hallucinations either but in a ladies loo recently looked at the stainless steel lock and it was slipping. Not melting away like a Salvador Dalí painting. It retained its form perfectly, it was just sliding down the door. I moved around the cubicle, casting a shadow in case it was a trick of the light. Still the lock slid down and down. I put the tip of the finger about a centimetre under the lock. I could feel nothing, yet when I took my finger away the lock continued its slow, continuous movement. It was moving. It was. But it wasn’t.

Harder to cope with has been the return of paranoia and the sense that They are after me. I had a text conversation with my dad that was longer than usual and in which he referred to a prior conversation I did not recall having. I struggled to grasp what he meant and the exchange began to feel like a guessing game I could not win. The texts also felt wrong; they were shorter and used a “text speak” contraction I didn’t remember my dad ever using. At this point I began to get really frightened, feeling played with, toyed with, that They were enjoying hijacking the conversation to make me doubt my own memory and mind. I ran into the living room, crying. “Help,” I said to Tom, “I need help!” and he held me tightly against him. Taking a look at the texts he could see what I meant, but that it seemed to him more likely that my dad had sent short messages because he had been busy. Well, I don’t know about that because I can’t look at those texts again, not even to delete them. When my dad rang later that week I couldn’t bear to ask him about whether he had really sent them. I am terrified he might say no, and to be honest I’d rather not know.

I also have a sense of a looming “presence”, a dangerous, evil presence, in my flat. Last week when Tom was at work I heard a voice that sounded like it came from another room. I have written before about feeling like I am a character in a horror film I didn’t audition for and this was the same, me treading gingerly down the hall as the stereotypical horror movie “girl in apartment” who checks rooms and cupboards until the baddie jumps out at her. I felt almost as if I was being filmed and a thought came to me – I say “came to me” as it did not feel like the product of my own mind, it felt like it was dropped in there like a pebble, a thought unlikely to occur to a Quaker. It was, “I wish I had a gun”, delivered in a very neutral way. There was no emphasis, no stress on any word. No emotion.

A couple of nights later I got up to visit the bathroom. The thirst that lithium engenders makes this a nightly occurrence. Usually I take a torch so I don’t have to subject my eyes to the ridiculously bright hall light. I went to kitchen and got a drink; it has to be flavoured to slake the lithium thirst yet calorie free for the sake of my teeth, so I usually drink Fanta zero. I finished the bottle and went to hall cupboard to get another bottle, which I popped into the fridge. I tell you this so you know that while I was really quite sedated I was very far from being asleep or sleepwalking. On my way back to bed the light from my torch began to flicker on the walls around me like cold, white firelight. I knew this couldn’t happen with an LED torch, so I switched it off and switched on again. It was fine then but I when I repeated the action the flickering returned. I suddenly had a sense of a very dark presence and I ran back to bed, shutting the door firmly behind me. I could not lie on my left side because I was afraid of turning my back on it. I couldn’t lie on my right side because I did not want to show it my face. I lay on my back and tried to sleep but was troubled with images from psychological horror films, actual or created by my own brain, I couldn’t tell you.

Maybe you now understand how difficult it has become to separate dreams, hallucinatory/delusionary experience and reality. As part of my attempts to be more physically active I have where possible been taking stairs instead of the lift or escalator. In a tube station I saw a sign to the stairs, so I followed it and found myself on a wide, tiled staircase, alone. With every turn I reached a small landing and as I wound my way down I passed landing after landing, all empty except for me, all looking exactly the same. There was no sound. I reached a point where I genuinely did not know whether I was awake or dreaming or hallucinating and I began to feel as if I might be trapped in there forever, walking on and on in some kind of stupor. One further turn spilled me, bemused, out onto the station platform.

I have never tried Huxley’s beloved mescaline. Once as a student I took acid (something that now looks like a pretty stupid thing to do in the context of having a recent diagnosis of bipolar). For a time in what I now feel was a rather tedious, “wow, man!” kind of way I felt it had been tremendously significant, a life-changing “door opening” experience. It wasn’t, although it did teach me something about how the human brain can pull together something bigger that its parts out of almost anything around it. No, what really gave the door an extra kick open was not LSD but a prescription drug, sodium valproate. An antiepileptic, valproate has for some time been used to treat bipolar and in 2011 it seemed a good idea to try it instead of the highly sedating quetiapine. You can read all about my experiences here, but the short version is that I had a very, very rare reaction and started hallucinating. These definitely weren’t psychosis; I had no belief that anything I saw was real. They mostly swam out of the dark when I closed my eyes, popping like soap bubbles to be immediately replaced by other images. They were mostly of three types: faces; geometric patterns, very much like the tail end of my one and only acid trip; and segmented things like worms or ladders. Most side effects resolve themselves once the medicine is stopped. Not so my “visions”. It is now three and a half years since I went back onto quetiapine instead yet whenever the more psychotic type-stuff recurs, so do the visions. Never with the same intensity as that first time, thank God, but they can become distressing. They “pop” so quickly it’s hard to record them but today I have had some kind of tribal mask, faces of people screaming or melting, animals’ faces, a snaking bridge made of boards.

So I am strange. I am a stranger. Faces come out of the dark, some of them ugly. I fear being trapped in an endlessly descending zone of altered conscious where I won’t remember my name. And I don’t how to predict, let alone stop it.

Posted in Bipolar, Medication, Mental health, Psychosis | Tagged , , , , , , , , , | 8 Comments

Control

**TW: contains references to weight, dieting, eating issues**

There are many things that come and go with the ebb and flow of bipolar. Energy levels, creativity, ability to work, self-esteem, amount of sleep, and so on. But across the mood changes there is a pervasive lack of control, which I have sometimes described as feeling like a piece of flotsam. I can try to manage early symptoms and tackle them before they grow, but despite trying very hard I can’t really control what my mood will do, whether I will have psychotic features this time, whether my anxiety will lie dormant or spike from the moment of waking.

Viewed through a long telescope stretching back to my childhood, there is a clear pattern of the gaining or loss of control being intertwined with food, overeating and feeling out of control or trying to regain control through restricting my food consumption. This game of dietary ping-pong is written on my body for all to see – in fact others probably see the changes better than I do. At 19 I was an evangelical vegan and yoga bunny. I was very, very uptight about what I ate and felt a sense of moral superiority about my food choices. My weight and BMI dropped to an unhealthy point, my periods stopped and people started asking if I was anorexic. This enraged me as I felt that my restriction was all about ethicals. I had zero insight into the fact that I was very depressed and lonely and that I was attempting to exercise control in any way I could.

Over recent years of being unwell I have been almost unaware of my body, dragging it around with only the odd moment of horror as I catch myself in a mirror. I have not let Tom see me naked for a very long time. I have just been doing whatever I needed to survive each day, overeating and binging, binging and overeating. I would promise myself I wouldn’t make sugar the focal point of my day, that I wouldn’t build it around going out to the Co-op to buy a Coke at lunchtime, that I wouldn’t go there again later for my “afternoon treat”, that one treat would not become three and that I would not hide in the stairwell, pushing the chocolate into my mouth without even tasting it. I promised myself I would not have to hide wrappers I‘d torn off with my teeth in a frenzy of desire for what is inside. Unlike may who binge, I experience no desire to purge because for me the payoff is the comforting feeling of the food heavy in my stomach. And so slowly, slowly I haven gained a stone, two stones, then three, the overeating combining with the quetiapine and the sedation to create a “perfect storm” for weight gain.

And now as I am unexpectedly, and probably tenuously, well I am suddenly able to address it. I have thrown myself into the use of my FitBit, which has lain forlorn and dust covered on the chest of drawers for many months. I am using it as encouragement to take more exercise and have used it to develop an eating plan, which requires a fairly slender intake of calories a day. I am doing more and more exercise, and have begun to get very agitated and irritated if I am prevented from working out. I have form for this; when I used the WeightWatchers system about 10 years ago I consistently exercised more and took in fewer points that recommended.

Presenting the Mental Health First Aid slide on eating disorders makes me squirm. Services aren’t interested in my subclinical eating issues but terms like “compensatory behaviour” make me wince. I see the potential for me to take things too far. Just as I once concealed suicidal feelings from Tom, I am already fudging how little I eat, how much exercise I take, scared he will want to take it all away.

Because for the first time in ages I feel in control. I have found a coping mechanism in the face of all the uncertainty in my life. Part of me feels like a rubbish feminist for wanting to more closely resemble an “acceptable” body shape and I tried to like the shape I was, I really did, but I could not do fat acceptance. I just can’t help the delight at the reappearance of my waist, the looser trousers, the somewhat (OK, not very) more muscular abdomen. And in a way I feel that I have to lose weight right now, in this moment while I am well, because who knows what tomorrow may bring? I want to exercise control while I still have it.

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Where the damage is done

So much has happened to me since I last wrote a personal post that I find it difficult to link this one to the one before. Filling you in by writing it down now will diminish how very terrible things were, but here is the essence of it.

I had a suicide plan that was extremely developed. I had covered every base that I could think of to prevent being discovered until it was too late. I obtained the materials I needed. I set a date. I did not say a word to Tom. I was operating on that sneaky, kind of dissociated level. I did not directly lie to him, because he did not ask whether I was suicidal, but I did lie to him, many times over, by omission. He walked past what was essentially a suicide kit, because I had hidden it in plain view. It was a bit like the bag you’re advised to pack in late pregnancy; everything you need to just pick up and go when the time comes.

Not long before That Date I had a conversation with a wise friend. She was concerned that the dissociated part of me was sleepwalking into a suicide attempt. She reminded me that I might not die and might end up in intensive care. She also reminded me that I might be discovered before that, and that then hospital would become compulsory rather than an option on the table.

So I forced myself to tell. I told Dr X, and he got me quickly back under Home Treatment Team. I told Tom, and he came with me to the first HTT appointment. He explained to the team that he was shocked. He had had not had the slightest inkling of what I was planning, because of the high level of what Dr HTT rightly described as my “deviousness”. It forced us to realise that the idea that Tom could take leave and keep me safe was fantasy. It was sweet, the belief that he could be my protector, and it makes me sad to let go of it, but it is not realistic. So I gave the whole lot of it over. The planning to HTT. The means to Tom.

My lamotrigine was put up, and put up again. Then suddenly I found myself hypomanic, really quite hypomanic, and in an elated way. Everything seemed to fall into place. I deserved this hypomania after such a horrific few weeks and to be honest, I didn’t care if it was risky. I didn’t care if it turned nasty later, I just wanted more of it. All kinds of things amazed me. I lay in bed after the light was turned out and looked into what felt like the infinite darkness and felt pulses of euphoria. Music felt like a drug. People in shops and on the streets seemed incredibly congenial. The proportion of attractive people on the tube seemed to have increased. I danced my way around the flat. I sang and sang until I genuinely damaged my vocal chords, and still I had difficulty not singing on public transport.

I was bubbling over with thoughts. I pitched writing ideas. I had just starting using a colouring book for grownups and was inspired. I suggested some online friends all coloured the same image, just to see the variety and diversity of our interpretations. This became the project #ColourTogether and more and more people asked to be involved. Then I wanted to set up a charitable foundation to get colouring books into inpatient units. I started a crusade against Facebook’s suicide report button. I also felt pulled towards certain things. I almost offered to by a lady’s purple sparkly hat on the bus. Every time I was in my local town centre I felt pulled by the thought of going to the rum bar, which was offering two-for-one cocktails, and could not shake the thought. I frittered away a chunk of the only money I have this month on God knows what.

My brain got faster. Things began to become a little out of kilter. I started to have a fear of banana skins. Not a fear of slipping on one, like a character from the Beano, but a fear of what the represented, although I wasn’t sure what that was. I had (have) a feeling that they have been placed. The problem was mainly on the short walk between the tube and the bus stop on the way to HTT. There seem to me to be an inordinate number of banana skins for such a short walk and I began to get very anxious about them. There were rules: greenish banana skin, not so bad; dried up, old brown banana skins, mainly OK; yellow with or without brown spots, scary. Once on my return journey someone had left a banana skin on a wall at eye level, and I recoiled and gave an audible yelp of fear.

The there were the perceptual changes. I had my first olfactory hallucination for ages, a stink of sulphur that seemed to be wherever I went (and I was pretty damn sure it wasn’t coming from me!). It’s never anything nice. Past experiences have been of dog shit, skunk weed and the inside of butcher’s shops. My hearing and sense of rhythm and pace seemed off. Songs that I chose to listen to because they were fast and I wanted fast appeared much slower than usual, others appeared to lag and get slower and slower, like listening on a Walkman with dying batteries.

It was good, it was all good, until it wasn’t. The banana thing got worse. My sleep began to be disrupted. I was incredibly proud of how #ColourTogether had grown and the lovely feedback and requests to participate I was getting, but it all became a bit much. I felt obliged to keep my eye on the hashtag, reply to queries, give out the link again. It was all too fast and sending me faster.

And then came the day it all went terribly wrong. When I was much younger, and didn’t know what hypomania was, let alone how to manage my symptoms, I would often become obsessive about someone who was not my husband. I would lie awake at night, thinking about this person, or fall briefly asleep only to have erotic or romantic dreams about them. Sometimes I would go so far to genuinely believe that my husband would in fact welcome this third person into our household, that their friendship (because it was almost always one his friends) would in fact be strengthened by sharing me and sharing the care of our child. It would often take someone being almost brutally blunt with me to dispel this belief.

I didn’t think it would happen again, not now I was older and much wiser in the ways of bipolar. I don’t want to say much more except it has, and it’s something I am incredibly disappointed about. It was much the same in the nature and intensity of the erotic obsession and it has cost me the intimacy of a friendship that was incredibly dear to me. Which is why a few days ago I tweeted that while I understood why people who are depressed often say that they wish they were bipolar, because “at least you get the highs” – they shouldn’t. Because the highs are where the damage is done. To people’s friendships. To people’s relationships. To their finances. To their sexual health. At their workplaces. And it sometimes feels  that people can be tolerant of, even affectionate towards, the more likeable aspects of hypomania, the wit, the creativity, the confidence. The less attractive elements attract reduced warmth and support, despite the fact that the person is probably more unwell at that stage.

A few days on and I am still struggling with agitation. Last week I told the Registrar that there were three ways my hypomania could go: the bizarre thoughts and perceptions could edge towards true psychosis; my mood could totally crash; or I could move into mixed mood, with all the energy and agitation of a high but panic or despair instead of euphoria (not that he did more than write this down). My hypomania is never benign, it will not peter out into normal mood. So here I am, in mixed mood, as predicted. In the waiting room at the hospital today I paced round and round on the varnished flag stones, round and round and round even though the receptionists were looking at me, not because I felt compelled to but because it gave some respite from the agitation. Moving, walking, feet tapping, hands wringing, knees jiggling all bring a sense of blessed relief.

Sleep was broken last night, but the night before was perhaps the worst I had had in a few years. And now it’s not just banana skins; apple cores are starting to scare me, something I only realised after there had been an apple core in the stairwell. When I had the thought that I had left it there, almost on my own doorstep, oblivious to the danger, I freaked out. I wasn’t due to see the doctor today, but I rang a HTT nurse in a panic and asked to be put on the list to see the consultant. I have to say he is great. He treats my bonkers fears with respect, and the content as being meaningful, for which I am profoundly grateful. So now I am back on daily HTT visits, and I have some lorazepam to try and take the sting out of the agitation. I have done all the “right things” this past month in terms of complying with treatment, turning up for appointments and telling HTT absolutely everything.

But still the damage has been done.

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