Changing woman

As the seasons change it’s hard not to notice the dark nights and wet and windy weather. I feel like I’m changing too. Until very recently I felt trapped within cycles that felt as closed and inevitable as the shifts in the seasons. I was very much in a state of learned helplessness; it felt pointless to try at anything, knowing it would just slip away as the circle turned again.

Cycles within cycles, within cycles. There have been symptom loops, mad hamster wheels of suicidality, of paranoia, of the even smaller cogs of rapid cycling. I got stuck in the Home Treatment Team’s revolving door, sometimes grateful for the familiarity, sometimes despairing. HTT? Really? Again?

Now it feels like I’ve come out of much bigger loop, a loop so large that even now I can only perceive part of it, so it appears more like an arc. It’s taken me until now to see those smaller loops as not simply spinning fruitlessly. They were part of that bigger picture; there was progress even though it was very slow. The cycles were more like coils in a long rope rather than independent closed systems. Every time I weathered a loop I ended up a little further along this rope, but I didn’t even know he was there.

I see other cycles at play. In 2012 and 2103 the role of mental health activist was something I fully embraced. I’d left my job in March 2011 and eventually had to accept that I would never return. It was a painful process and those small chances to make a difference were precious. I became very bound up in my role as “expert by experience”, sharing my story on Mind training courses, attending events on behalf of Mind and Rethink Mental Illness with health policy makers and strategists, MPs, the DWP and the media. It was a good way to claw back some self-esteem.

Sometimes I’m asked how I’d prefer to be referred to in a document or on a name badge. Like many freelancers, I struggle to pin my job title down. Some have recently suggested “campaigner” or “activist” and once I would have had no hesitation. These days I think I’ve moved on. Attending the Mind Media Awards this week was illustrative. Two years ago I knew so many people. This year I knew almost no one. And that’s OK. I still work for change and against stigma every day, just through different routes. I still do the odd bit of campaigning, as I hope to with Rethink next week, but it’s not central to who I am. I have found other communities in research, in patient and public involvement, in writing.

Aspects of myself that have been parked for years are now reemerging. What a slow, long loop they must be on – and what a contrast to the tiny frenetic coils of rapid cycling. Until recently I had no sense of control, unable to predict what would be happening to me next month, next week. Slowly I am daring to sign up for things without always adding the caveat, “If I’m well enough”. In fact I am daring to dream big. Maybe in a while I could manage a Master’s degree in research. Maybe even one day a PhD, giving me access to more opportunities in the research field.


During this same period I had little control over my body. A combination of quetiapine and overeating caused the most rapid and overwhelming changes to my body since pregnancy. I’m beginning to be able to be kinder to my body now, and to be kinder to myself on the days when I am not. I’m eating less sugar. I’m eating less meat and less processed food – not a conscious choice, more of an inclination. I am doing in a lot of yoga right now, 5-6 classes a week at The Power Yoga Company (you can read more about it here over at the BBC and here on the studio’s blog) and it’s probably changing me more than anything else. I am physically stronger. I have muscles I hadn’t known existed. I am more mentally focused and stable too, or so says Tom. At the heart of this is that I am in my body and not just dragging it around.

I feel slightly awkward about this next bit. I was raised in a non-religious household in which asking people about religious beliefs was impolite, but I am once again able to explore my spiritual side. I am squeamish about the trope, “spiritual but not religious” but it probably applies here. I’m a bit of a magpie when it comes to belief, something that will probably make some people turn up their noses at my lack of consistency.

As in earlier parts of my life yoga is making me more inward-looking, more meditative. Although I am resurrecting my sitting meditation practice, it’s early days so I’m seeking mindfulness in my daily life and in the moving meditation that is yoga. To aid mindfulness I am trying to have a day every so often where I just do what I am doing. I eat without having music or speech radio on. I try not to tweet and particularly not to deal with work emails. I am quiet, hardly speaking during the day until Tom comes home. And the mindfulness links to Buddhism and for me the whole caboodle links to Quakerism, something that has been sustaining me throughout this episode with its cheerful recognition and acceptance of varied spiritual paths.

As I become more inward-looking I don’t need the same kind of instantaneous emotional support. For years I have had my iPhone glued to my hand, unable to give my full attention to tasks, conversations or TV shows because I needed in a very physical sense to hang onto my support network. I don’t love my online friends any less but I just don’t feel the need to tweet as much. When I’m on the verge of a panic attack or when I experience a sudden and unexplained mood drop then I do elicit help. But mostly I can be happily out of contact with my phone for hours, only noticing its absence when I want to send a text or check the weather forecast. Only today my daughter texted a worried, “Mum??” because I hadn’t responded to her initial message.

I feel more rounded and more grounded. I am a person who can do things (for the moment at least). I don’t know where this long, slow loop will take me. I really hope I can build better foundations so that I am less easily knocked over. There were so many points in 2010 where I might’ve been able to lessen the blow of this episode but I didn’t have the tools and I didn’t understand what was happening anyway. So somehow I need to adopt a “never forget” attitude, whilst at the same time following one of favourite pieces of Quaker advice: live adventurously.


A note on my association with The Power Yoga Company. In the light of the whole “blogger blackmail” thing I thought I’d let you know that the writing I have done was in no way “payment” for the pass they gave me. This was a genuinely a shared project of mutual interest as to what could be achieved; if I’d managed three classes and dropped out, that would’ve been fine. They are the good guys.

Posted in exercise, Mental health, Mental health services, Mindfulness, Mood disorder, Recovery, Self-management | Tagged , , , , , , , | 2 Comments

Busy doing nothing: in praise of purposeless activity

I’ll declare a couple interests before I begin. First, I like JoJo Moyes. Her books have touched me, and when I tweeted about one of them I got all fangirl when she replied. The After You sample is sitting in my Kindle to be read “pile”.

Secondly, I like colouring in. I also like what I’ve seen it do for people who are struggling, so I created the hashtag #colourtogether, a mass colouring event. Twitter users were invited download an image, colour it in any way pleased, then share it using the hashtag. It proved immensely popular and I lost count of how many people contributed, many having joined on a friend’s recommendation. The Storify “gallery” is a thing of immense beauty and I still enjoy looking at it.

So it’s not surprising that several people drew my attention to a piece by Moyes earlier this week on colouring in (I would’ve blogged about it way sooner, but I was occupied with all the lively feedback from the BBC article about my wedding). Ultimately there’s not much more to Moyes’ piece than someone being baffled by something they don’t get and deciding that it therefore has no value. She does (rather perfunctorily) recognise that colouring may be of value to people with mental health problems, but the thing that bugs her is that “there is a whole raft of women who, apparently, just like to spend their hours colouring stuff. And it’s these who make me oddly uneasy.”

Moyes frets that colouring in leaves no room for imagination, for “genuine creativity” or for “working out who you are and what you are capable of creating.” It’s a shame Moyes feels that way; there is actually more creativity than you might think in colouring. Unlike painting by numbers you need to really engage with the task, looking closely at the patterns and choosing your pencils or pens with care. Some people enjoy the challenge that comes from choosing a pencil at random and seeing how they can incorporate it into the page. Either way, it’s not finger painting.

But here’s my real issue with colouring snobbery.

Not every activity has to have a purpose. Purposeless time is not “wasted time”.

I guess it boils down to this: I don’t want everything I do to need an outcome, to be defined by what I produce. For sick and disabled people, it’s a very dangerous model. The DWP is hell bent on bullying those with chronic health problems and lifelong disabilities into productivity and appears to have talked itself into the belief that with the right “support” we can all be slotted back into the workplace. How much tidier it will be when we can be measured in terms of our economic output! Sadly many so-called treatment models focus narrowly on occupational recovery. People for whom work or volunteering is impossible are either invisible or lazy

Because we live in an age of relentless productivity. We go from task to task, doing and achieving. There is a constant pressure to get things done. We do it to ourselves, creating stress through our own “to do” lists. Who, Moyes asks, has the time to colour? She believes that people’s (women’s) precious leisure hours should be filled with “a pursuit that both relaxes and stretches you, encourages you to learn something about yourself and claim some space in the world”.

I’m not going to get into mindfulness too much (again) other than to say that I believe it is intrinsically necessary for our health to take time just be or do. No active verbs. No planning, deciding, achieving, competing, resolving, generating, innovating, assessing, organising, delivering, completing, processing. No producing. Claiming your inner space in a society that is so outward facing is actually a rather radical thing to do. Tuning out the chatter by doing with no particular goal challenges our beliefs about how time “should” be spent.

I’ve recently rediscovered the art of purposeless walking. It actually started off as very goal-directed; I was trying the reach the 10,000 steps per day recommended by the American Heart Association to maintain cardiovascular health. But then I got into the habit of just walking everywhere. I started by striding home when I could have hopped on the bus but the habit has grown into walking for walking’s sake. I do a lot of it out of curiosity. Exactly how far away at street level is the two-minute tube ride? What’s up that long road I only ever pass the end of? Why is that green space on Google maps called what it is? Now when I travel to a health appointment team or go to yoga class or to a meeting I check out the local area instead of just shuttling to and from. Walking. Purposelessly. Because I enjoy it.

I guess I don’t understand what Moyes thinks is the main product of reading a novel. I’ve loved several of her books, but they don’t fall into the category of “relaxing but stretching”. I promise I’m not being catty here. I wept buckets on the plane home from holiday because I’d just finished The One Plus One. But I read her novels precisely because they are emotionally resonant but not really a stretch for my poor bewildered brain. I’m not sure that for me at the moment reading can be both. The Goldfinch was stretching. The Bone Clocks was stretching. Enjoyable actually, but ultimately too stretching. I couldn’t finish either of them.

It’s hard to see how reading for pleasure differs substantively from colouring in. If you read a novel, you get lost, just as you can in an intricate colouring page. You can always stretch yourself after reading a novel by writing a review, but check out the Amazon page for a popular colouring book like Secret Garden. Reading novels can become a social activity through swapping recommendations/ books, or by joining a book group. But #ColourTogether was a social activity. Not only did people come together for the final gallery, they passed the recommendation on.

Maybe I’m reading too much into a lightweight piece. Maybe everything I’ve said is exactly what you’d expect me to say, but I will defend my right to walk down (physical and written) cul-de-sacs if I want to. It’s been suggested to me that I should resurrect #ColourTogether during Advent. Nothing too Christmassy, but something people might like to focus on knowing that other people are just as absorbed in their own interpretation of the image. I hope as many of you as possible will join me so we can waste our lives together. Quietly. In glorious colour.

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Don’t rock the boat!

A week since my last post and I am still feeling stable. I’m beginning to answer, “How are you?” by saying that I am well, or even good. I still do it with a slight sense of trepidation. Is this hubris? Am I fooling myself? Is there some hidden power out there after all, waiting until I think I am well before striking me with a bolt of psychosis or rapid cycling? Of course the next thing people want to know is: why? Or maybe how or perhaps what has brought this thing about about. And I wish I knew, I really do because then I could write it down as a prescription for wellness and then I never need be desperate again.

I was thinking about all the things that have been recommended to me over the years or that I had read about or learned about in a class as being helpful for “recovery” (I”m going to keep putting that word in quotes, because I don’t believe that it is a helpful thing for me to aspire to or label my progress). I decided to put a fun spin on things and make a word cloud just to see the scope of advice I’ve received over four and a half years. Many things I have tried already to no avail. Some are just – no. Not going there (especially not seeing my bipolar as a genetic advantage). Many seem sensible and at least unlikely to do harm but at the same time appear too minor to have significant impact. Amusingly, the cloud has split up a phrases and created odd juxtapositions like “oily faith”, “low walnuts watch” and “sugar advantage”. I don’t know, maybe some of those could be more useful than a number of the suggestions I have encountered in my life.

                   Screen Shot 2015-09-28 at 16.20.00

You could point to many of those words and ask if it is something that’s helped me. Has mindfulness helped? Yes. Somewhat. What about spending time with friends? Of course. Routine? Yes. Singing? Definitely. Being out in nature? Yes. Yes! Yes, but…I did these things six months ago, a year ago, and they did not have the same effect. I’m on the same mediation I’ve been on for six months. There is no magic lever that has been pulled, drawing up a curtain to show a happier scene.

Also, there are a whole bunch of chicken/egg scenarios in the mix. Right now I am taking more exercise than I have in a while. Lots of walking, where possible within London’s leafy spaces. I’m doing cardio at home and I’m just about  to take up yoga again. But do I feel better because I am exercising more, or am I able to exercise more because I’m more stable? Similarly, I’ve improved my diet adding lots more fruit and veg and reducing sugar intake. That ought to make me feel well I suppose, but at the same time there is no way I would be able to keep to this if I were unwell, desperately craving fat and sugar.

However it has occurred, I am being to have more and more of a life worth living. Work has picked up and I am revelling in freelance writing, in ensuring expert patient input into health strategy, in going out into the field as a service user researcher. In my spare time I am starting to undertake activities that I think of as nourishment. When I am very unwell it’s impossible to “feed” myself with rich life experiences; all I can do is grab at whatever scant snatches of emotional food that I can find. Even when things are improved it is often too much to do anything that feels like it’s doing psychological good unless Tom’s with me, guiding me through. Now I feel able to take charge of life-affirming experiences. Lunch with a dear friend. A solo walk in an early autumn park. Taking myself off to a restored Edwardian cinema where the afternoon showing is almost empty and I can relax on velvet seats, a glass of wine in hand. Going to a gallery on my own (last week I adored “Wanderlust“, the Royal Academy’s Joseph Cornell exhibition). These things are like taking on superfoods which are both delicious and full of the nutrients I need to develop my wellness and enrich my life.

So I don’t know what’s going on underneath my mood, but if it’s a combination of medication, exercise and improved diet then I’m very loathe to change any of that. Sometimes I grumble about the diet and exercise bit because I’m not really losing weight – but then I remind myself that whatever I am doing is obviously helping (and will be good for blood pressure and reduce the risk of metabolic syndrome, something I worry about as I have been on a high dose of atypical antipsychotics for years now). In other words, I don’t want to rock the boat. If something appears to be helping, I’m going to carry on doing it. Now is not the time to follow the original plan to taking the lamotrigine to the max and gradually withdrawing the quetiapine; I plan to stick them both as well as lithium, pregabilin and thyroid augmentation. Now is not the time to go back to comfort eating because winter is coming up and I am grumpy and cold.

The thing that bothers me is that for a long I have been waiting for therapy. Specialist CBT was recommended when I first saw the specialist affective disorders people in November, alongside the aforementioned drug regime, and for most of this year I have been pushing for therapy. At one stage I felt that we were just pushing the combination of meds up to higher and higher doses without any real benefit and I felt that therapy would be a better way of addressing my problems. Only now I have the option of starting therapy and I no longer know what to do with this. Part of me feels too late, too late; where was it when I needed it? Part of the problem is that I have grave reservations about the therapist, because after all that waiting we really, really didn’t click at the assessment and I left feeling devastated. I also have grave reservations about the therapy as I had forgotten until I was given mood monitoring charts that actually I really dislike CBT.

Six months ago I would have grabbed onto the offer like a person down a well offered a stepladder to the surface, regardless of the treatment, regardless of the worker. But now? Now I don’t want to rock the boat. I don’t want to add anything into the complex and only little-understood system that is making me well. And therapy, any therapy, upsets things, brings difficult stuff out into the light. And I don’t want to do difficult stuff. I can barely bring myself to think about how awful the first half of this year was, let along look at past horrors. And those are the issues with therapy per se, never mind the therapist issue and the fact that it’s CBT. But this is all that’s on offer. I’ve asked to work with another therapist on the team and there is none. I could be letting a vital opportunity go. And I know that there is an argument that you have to be well enough to do therapy, but I don’t think I’m as well as all that that just yet.

*crouches down and keeps very still at the bottom of her little boat*

Posted in Bipolar, CBT, Cognitive Behavioural Therapy, exercise, Medication, Mental health services, Mood disorder, NHS services, Recovery, Therapy | Tagged , , , , , , , , , , , , | 8 Comments

I don’t ask for the moon

So here I am in this… zone. It’s a zone that I’ve been in before, although not for as long this in years. I’m scared to write about it actually in case drawing attention to it bursts the bubble.

I’m OK.

I’m not brilliant. I’m not asymptomatic. Things can throw me off course. I’m looking over my shoulder all the time. But I’m OK. I am (relatively) stable and I am (relatively) productive. And I would like to stay here please. I just want to stay here.

I’m not asking to be back to full functioning. That’s a kind of a dream my psychiatrist still has for me but one that I let go of years ago. I have accepted that I will have a limited range of functioning for the foreseeable future and that in order to maintain this I will have to carry on taking 12 pills per day as there is no way I dare rock the boat. But within this limited range I feel that currently near the top of the window. In other words, this is the best it’s going to get. And I don’t mind that, I really don’t.

I’m not asking to be 100% free of bipolar symptoms. My anxiety is much reduced but in certain situations can still overwhelm me. I still have scary delusional thoughts, but far fewer than before and I am more able to put some distance between the myself and the thought. I am no longer scanning the pavement for banana skins. A recent family emergency resulted in me crying continuously for six hours. I have the odd low moment when I worry I am sliding down, the odd euphoric moment when I wonder if I’m heading up. But I don’t think I am.

And I’m OK with being OK. One of the first ever self-help books I ever read (this was right after the bipolar diagnosis was restored in 2011) stressed the value for bipolar people of seeking contentment, of detaching from the thrill of the roller coaster ride and seeking something more sustainable and less damaging. I kind of knew what the authors were getting at but it seemed completely unattainable. It is something I am only really experiencing now, and I’m relishing it. I’d rather be snuggled on the sofa with Tom watching TV or wandering around a National Trust property (because I really am that middle class) than whirling around like a Tasmanian devil cleaning, writing, exercising, singing, arguing, banging out tweets every few seconds. I’m thankful that I’m not conscious of using the TV programme as a distraction, that when it ends I won’t have to face suicidal feelings.

This new zone is safe yet allows for some challenges. It’s making me think about what goals I could have, and whether they are reasonable within my current limits. Now I’m OK, what do I want to feel more fulfilled?

There’s a lot I’m really not asking/hoping for. I’m not asking to be the dedicated full time professional I used to be, the one who juggled a lot of unpaid overtime in addition to the 37 hours. I realise that I am still a long way from even being able to work at a regular part time job for an employer. I’m happy enough to go on as I am, self-employed and undertaking research, training, consultancy, freelance writing. I don’t go out and aggressively pursue work, I let it come to me and I try really hard not to work more than two days per week, preferably non consecutively, because more than that and I start to become overwhelmed. I get as tired by two days’ work outside the home than used to after a full week. And of course I don’t earn that much. I am in the very fortunate position of being pretty much supported by Tom, but it’s hard for me to feel OK with that as I have been economically independent ever since the children were small. Earning a little bit more now is good for my self-esteem. As well as buying my wedding outfit and the kids’ I was able to pay for the cake. Not much, not in the wider context, but it meant something to me.

I’m not asking to have the kind of active (hectic?) social life and hobbies that I had in the past. I used to sing in three choirs every week, one a tough, audition-only a cappella group. I’m not expecting to ever be able to go back there, but I really would like to just slot back into my friendly local choir where I have friends who know about my condition. Looks like I missed the boat again for this term – my sight reading’s pretty atrocious, so once the first two rehearsals have passed it’s very hard for me to jump in. At least this year it was for reasons unrelated to my mental health as wedding/honeymoon stuff took over. I’ll wait for January and in the meantime I’ll try and play my ukulele more! Meanwhile I have lots of friends that I don’t see very often, so I’m making a conscious effort to meet up with people. Only a couple of times a month, and not for dinner or cocktails these days. And I might not be up with the latest movie releases any more but I did enjoying to the cinema on my own one afternoon a couple of weeks ago, and I’ve just booked to see the Royal Academy’s Wanderlust exhibition before it finishes (again, alone, but I’m honestly fine with that – another thing I’m content with).

I’m not asking to be the woman who trained to run a 10k race on top of the unpaid overtime and the three choirs and the cocktails and the films. But I am enjoying doing aerobics DVDs three times a week and I’m really tried to walk more. I would like to explore  whether other form of exercise are something I would enjoy and find helpful right now. I’m just about to start yoga classes after many years and I’ve ordered some swimsuits for the um, fuller figured woman because I want to see if I still enjoy swimming. When I was first on sick leave I got into walking 8-10 mile walks from the Capital Ring and I’d like to do some other parts of the route I’ve not yet explored.

My other goals are similarly modest. I would like to learn how to make rag rugs. I would like to meditate again, even if just a couple of times a week for a short period. I would like to make better use of my colouring book. I would like to shake mealtimes up a bit and make better use of the lovely cookery books I was given for my birthday. That’s about it, I think. Struggling to think of anything more.

I don’t ask for the moon.

Posted in Activism, Bipolar, Depression, Employment and benefits, Medication, Mental health, Mindfulness, Recovery | Tagged , , , , , , , , , , , , , , , , , , , , , , | 17 Comments

We’ve been and gone and got married!

I’ve been absent for a while, but with good reason. Tom and I decided some time ago to get married and we chose do it in style! We got married a couple of weeks ago in a group on the stage of the Royal Festival Hall as part the Southbank Centre’s Big Wedding Weekend. It was… amazing. Aside from my children’s births it was easily the happiest day of my life. I won’t say too much more. I’ll let some of our pictures do the talking (some pics look a little weird in shape have been cropped to protect the privacy of family and friends).

I’ll be back blogging when I’ve stopped thinking how wonderful it was :)

Royal Festival Hall stage ready for the ceremony

Royal Festival Hall stage ready for the ceremony

Exchanging vows in front of the Registrar

Exchanging vows in front of the Registrar

Curtain call - seven just married couples

Curtain call – seven just married couples

Cutting the cake - we we're going for a 1950s look

Cutting the cake – we we’re going for a 1950s look

Prosecco in the bar! Start as you mean to go on

Prosecco in the bar! Start as you mean to go on

The Big Wedding Weekend was part of the Southbank Centre's Festival of Love, here celebrated with neon lights

The Big Wedding Weekend was part of the Southbank Centre’s Festival of Love, here celebrated with neon lights

And this about sums the whole thing up...!

And this about sums the whole thing up…!

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Review: The Other Side of Silence by Linda Gask (plus author Q&A!)

It’s always tricky reviewing a book written by a friend, which is what I hope Linda would call me although we have only ever met online, so of course I  come to this review admitting bias. If someone asks me to review a book I suspect will be bad I simply say no, as I would hate to have to tell someone that I think all their hard work has resulted in something that wasn’t very good. But I didn’t think twice in this case and reading The Other Side of Silence: a psychiatrist’s memoir of depression has been an honour and a pleasure. I’ll share my thoughts below but after that I want to try something a little different so I’ve set Linda some questions for a Q&A. Once I’ve hit publish the “floor” will of course be open for comments but I will be out of the country for the next week or two so I may be slow in responding.

Linda is a psychiatrist by training and spent years in the NHS, working her way up the ranks before moving into the academic world. She is now semi-retired, giving her more time to write (you can visit her blog here). The sub-title of her memoir explores what is so unusual about her situation – she has practiced psychiatry for most of her adult life despite suffering from severe depression. Research tells us that doctors have a high rate of depression and that many hide their suffering from colleagues, with staff in mental health teams particularly fearing the consequences of disclosure. It is clear that being a mental health service user and a psychiatrist has been a very tricky tightrope to have to walk on a daily basis.

The book weaves together Linda’s lived of depression, the ghosts from her past that have  contributed to her condition, the treatments she has sought, her life as a clinician and the learning she has taken from patients. I hesitate to use the phrase “case studies” when referring to the patients described as that sounds too cold. Perhaps “stories” would be better, but in any event Linda has shared her experience with a number of patients, some of whom she saw decades ago, which are woven into her personal narrative. Patients with whom she felt out of her depth as a newly qualified doctor. Patients who taught her what it means to listen properly and carefully. Patients who took risks, opening up in the consulting room, sharing their stories of past abuse, inability to love, or unresolved grief. All reminders that doctors have as much to learn from patients as patients do from doctors. learning that Linda passes on to junior doctors bound for psychiatry or general practice.

I don’t really like it when people call my writing “brave”. I don’t know how Linda feels about the word but it is a brave piece of writing. Even in life writing many people consciously or unconsciously present a less flawed or less damaged version of themselves. To focus as much on therapy as Linda does in the book is to acknowledge being a work in progress, that no matter successful a person might appear they are very much human and very much fallible. Linda however goes further, turning over a some very heavy stones and examining what is underneath, things that were at the time (and perhaps still remain) a source of shame, difficult to admit even to a therapist. Linda continues to be very open online as @suzypuss) not only about her personal difficulties but about her use of antidepressants. quietly but firmly seeing off those who see psychotropic meds as a dangerous plot cooked up between Big Pharma and psychiatrists.

I won’t say too much more, because I would encourage you to head on over to Amazon to buy a copy to read yourself! But to give you more a few more reasons yo do so I’m going to put Linda on the spot by asking her about the aspects of the book I found most interesting.

Doctors can often appear quite impersonal to patients. Did you set out to make doctors appear more human, or was this just a side effect of sharing your own experiences?

I didn’t set out to do that. I tried to be honest about the kind of interactions I’ve had in my life,  both with the doctors who treated me, and with my own patients. If that makes doctors appear more human, that’s good- because we are! However, not all doctors I know seem human (I’m pretty open about the fact that there are quite a few of my colleagues I would not wish to consult) and I suspect I’ve not always appeared that way to patients either. Appearing human without sharing too much of yourself inappropriately can be a difficult balance to achieve.

Quite early on in the book a colleague notes that you will be a good psychiatrist because you were the most sensitive person he had ever met. At the time you wondered whether you were sensitive or just thin-skinned. Is this a question you have ever resolved? And do you think now that sensitivity did play a part in having a career in psychiatry?

I think am both! Quite easily on I realised I was able to pick up on how people were feeling and that helped me in deciding to do psychiatry. However I am also thin-skinned. A thicker skin would have been helpful in my career- and I might have lasted longer in it, and been more successful as an academic and manager. But I’ve come to terms with who I am.

You make it clear in the book that you consider depression to have complex origins including biological vulnerability and particularly unresolved grief and loss, themes that run through the book. Could you say a little more for readers about how depression differs from a normal grieving process?

Grief is a normal human process we all go through when we experience loss. Feeling low and depressed is a normal part of that – but it usually resolves over time. We cry, desperately miss the dead person, and feel unable to do much other than think about the person we have lost and what has happened. There is no rule about how long this last before we begin to take up our lives again and don’t let anyone tell you “you should be over it by now.” Crucially it just gradually feels a little easier as time passes. If grief however is complicated the process can get stuck. You begin to feel worse, have ideas about suicide, wanting to join the dead person. This then becomes very hard to distinguish from depression – and is usually treated in a similar way. Grief can get complicated if you have had a difficult relationship with the dead person, like I did with my father, or, for example, if it was a sudden or really traumatic death or the person was never found.
If you are vulnerable to depression – for example if you’ve had it before or have a family history, the loss alone can also result in a relapse of your depression. The depression associated with grief resolves as you move through the process of grieving. A person who develops depression experiences more persistent low mood, sleep problems, weight change and all the other things we recognise, along with lack energy, hopelessness and suicidal ideas. If these continue week after week, or become very severe, thats not grief, that’s depression.

You’ve shared some deeply personal things about yourself and your family, especially your father and your brother. Did you discuss the writing of your memoir with any family members still living?

You may be surprised but – no. While I was writing the second draft, my mother died. I haven’t mentioned it in this book. We had been estranged for many years, and I’ve seen very little of my brothers in my adult life. Apart from my husband and friends I’ve been very much alone. I’m in touch with my youngest brother now a little, after decades, and I’m not sure how he will receive it, as he was closest to my mother. However it was a therapeutic exercise for me to write it, and completing it has been an important task for me. I will let you know in time!

I was struck by how often you took on patients for psychotherapy rather than just offering medication or self-help skills. It seems quite rare now for psychiatrists to administer talking therapies. How do you feel about that, and do you feel it’s a component of the exceptionally long waits service users face for therapy?

When I was in training, and in my early period as a consultant I did see patients for psychodynamic psychotherapy with supervision, and I supervised trainees. I wanted to be a psychotherapist then, but got tempted into academia instead. Many of my psychiatric colleagues are trained in therapies which they do not have time to practice – they are increasingly expected to refer on to others and simply review medication. I think this is a terrible waste of their skills. However if I had become a consultant psychotherapist I may well have had problems retaining my job. Psychotherapy services have been savagely cut – and its almost impossible to get the longer term psychodynamic therapy I practised as a trainee, or received myself in the past, without going privately now. There’s been a huge loss of expertise, and I think that is so short-sighted. This contributes to the long waiting time for therapies other than CBT [cognitive behavioural therapy] such as dynamic psychotherapy and DBT [dialectical behaviour therapy]. Even CBT is hard to get, because many people who are waiting for it, might benefit from other short term help – but instead end up on long waiting lists with no support at all. You can see what gets me angry!

You describe having found antidepressants helpful and indeed having taken them for decades. What reaction have you experienced to this openness?

All types of reactions! I’ve had a lot of support from many colleagues over the years especially when Ive not been very well, but I’ve had others who look embarrassed when I reveal I take them as though I really shouldn’t be talking about that. I’ve had a person on twitter tell me that I would be positive about them, wouldn’t I, because I’m a psychiatrist! I found that reaction the hardest one to accept! I haven’t stayed on antidepressants for any other reason other than I need to take them to stay well – certainly not to prove a point. Some colleagues have told me how comforting it has been to know other mental health professionals take them too especially  if they work in settings where there are strong beliefs that medications don’t work, and find it hard to admit their own experiences.

So there we have it! Big thanks to Linda, who I hope enjoyed answering the questions as much as I enjoyed writing them!

Posted in Books and reading, Depression, Memoir, Psychiatry | Tagged , , , , , , , , , , , , | 6 Comments

Black bags in the night

I haven’t posted in a while. Somehow I find it very hard to blog when I’m doing well, and in fact I have been doing very well since returning from holiday. Four or five weeks of stability!

Until this week. Now I’m scared that things might be unravelling.

Firstly there is the small matter of voices. I say a small matter because their presence is small, although very unusual in I have never experienced anything like it before, and because compared with so many people I know who hear voices my experience is as nothing. Just two voices, each only uttering a single word. It would be easy to write them off as mishearing background noise, but they felt very clear and very definite and feel significant.

I have in the past felt that certain thoughts were not mine, that they’d been dropped into my brain like someone dropping a pebble into a pond, but I did not hear them as being outside of my own head. But now on two occasions a voice I can genuinely hear has felt as if it comes from a particular place outside of my body, a place I can kind of feel with my brain right now although I know that’s silly. It’s about 30cm away from my skull, behind and slightly above it, so almost as if speaking directing into my right ear. If that zone was somehow to be pulled from its place outside to touch my body it would end up at a certain spot on my head. Right now I can feel that spot kind of pulsating and I’m afraid to touch it.

The first voice occurred in Italy, when I was coming out of a mixed episode. I woke up feeling awful and very bipolar irritable, describing my state to Tom as like having a box of bees in my head. “Well,” said Tom, “we could cancel the walking tour we’ve planned. It would be a shame to come here and not see the sights, but it’s up to you.” And so I had to decide whether to push through the bees in the hope of enjoying the planned activity or just go back to our hotel room.

We set off, rather reluctantly in my case, but only got a few metres from the hotel before Tom realised he had forgotten his camera. I stood in the sun alone, wondering if I was doing the right thing, when a male voice said “Sí”. That’s all it said. I experienced it in that zone I’ve mentioned. It spoke clearly and distinctly. I looked around. There was no one near right ear, or indeed near me at all. Ahead was the thick wall of the 18th century hotel building. I looked to the left and the right; nobody was walking up the narrow, cobbled street. I looked behind me but there was nothing except a thick wall the colour of saffron a good two metres away. Tom came back and we went on our excursion and it was wonderful because I made the right choice. I said “Sí” to the opportunity. I don’t really know whether the voice influenced me or not, but I was so glad we went.

I thought nothing of it. OK, I thought something of it but it wasn’t scary and there was no repetition. But then yesterday I was in a shop trying to decide what to buy. I won’t get too detailed here but suffice it to say I was in the family planning section. Anyhow I was vacillating and a voice (of no obvious gender, but possibly female) coming from that same spot above and behind said very distinctly, “Hmm.” Again I looked around. There was nobody else in the aisle. There were people in the aisle behind me but certainly nowhere near close enough to speak so intimately near my ear, and in any case they were engaged in conversations of their own. Initially I thought that “Hmm” represented my indecision, but when I left the store I began to feel it had been critical, that it expressed disapproval at anything to do with sex, that it felt like it thought less of me for having sexual desire. That wasn’t a comfortable thought.

So much for those small voices. I’m more concerned by what happened to me a couple of nights ago. I’d gone to bed ahead of Tom and was lying in the darkness when I heard a rustling. I didn’t know what it could be. My heart started pounding and I didn’t want to get out of bed, so I turned on a little torch I keep on the bedside table and shone it around the room. I immediately saw that there was a large black paper bag with handles on the floor, a relic from our recent trip to get Tom’s wedding suit (for those who don’t follow me on Twitter, yup, we are getting hitched!). I say this because that bag should have been a benign item, something with positive associations, but straightaway I knew it had to be the culprit. I turned off the torch. The rustling resumed. Terrified, I switched the torch on again, only to find stillness and silence. After one final round of the darkness and the rustling and the torch and the silence I couldn’t stand to have that bag in the room so I grabbed it by torchlight, bundling it out of the door and into the hall (where Tom was bemused to find it later) saying to it, “Fuck you! Fuck you!”

There are really only two ways of interpreting these events:

  • I am slightly unwell and need to somehow balance the fact that these things really happened to me with the fact that they could not have happened to me. This creates a huge amount of internal conflict but is better than…
  • That they are the handiwork of THEM.

So things could be worse. I am lucky that I am in the realms of 1, not 2. The wedding is just days away and being psychotic would be supremely unhelpful – as would the alternative, being high sedated with antipsychotics. I am a bit high, which is disappointing after my period of stability. I’ve been struggling with compulsive hand scratching and wringing, which only happens when I am high (in fact, it’s actually worse than it’s ever been). I can only assume that the wedding planning, as fun as it has been, has been a source of stress, even if that stress is positive. I just keep thinking, “Please, please don’t let it get any worse.” No psychosis. The only break I intend on having is my honeymoon.

Posted in Bipolar, hallucinations, Psychosis | Tagged , , , , , , , , , , | 20 Comments