Living with a long-term mental health condition is a lot like living on a geological fault. Even when things are quiet, you know that sooner or later, that is going to change – perhaps catastrophically so. When I was younger, in my late teens and early twenties, my geological fault was active on a regular basis. At least every other year, I had a major depressive episode, but I managed to complete a degree whilst working part-time and coped surprisingly well, with only minor depression, after the birth of my first child. I had a difficult early second pregnancy, narrowly escaping hospitalisation due to a bout of hyperemesis (excessive, all day “morning sickness”), and we moved in the middle trimester. These factors probably contributed to the antenatal depression I developed in the final trimester. I didn’t tell anyone, not even my husband, that I was moderately depressed and idly contemplating suicide; it seemed wrong, almost blasphemous, when I had a planned new baby growing inside me. But this was a minor quake which should have alerted me to the potential for something much worse. I had no mental health management plan in place, and no mental health input from a psychiatrist or GP.
After the baby was born, in a wonderful, low-key, non-invasive home-birth, things went critical. The first night I didn’t sleep at all. I was filled with elation at having given birth at home and having a beautiful little girl to complement my two-year-old son, and lay there bathed in waves of amazing joy. Over the days that followed, I didn’t sleep much, not just because I was breast-feeding through the night; I didn’t feel I needed that much sleep. In fact, considering I’d just been through childbirth, I had a lot of energy. People told me I should be resting, but I didn’t feel the need. I cleaned, I cooked, I entertained numerous visitors, I put up the Christmas tree. I laughed about the fact that I had no “baby blues” on day three or four, and put it down to having given birth at home.
Nowadays, I would recognise that pattern of behaviour as hypomania, and a signal that I needed immediate treatment. Back then, I saw no danger until on the 12th day, my mood suddenly plummeted. I can remember the exact moment that the depression descended on me. There is even a photographic record: a close friend poses, smiling, with my newborn at one end of the sofa; at the other end of the sofa, I am looking away from the camera, my eyes and nose red from weeping, a tissue crumpled in my hand. That depression did not lift for months and until I’d tried a number of antidepressants. Being at home and responsible for a toddler and newborn, when all I wanted to do was curl up in bed all day, made those months some of the most difficult of my life.
Within a year, I had recovered enough to return to the workplace, and was overjoyed to obtain a place to study midwifery. For the first six months, I was attached to a community midwife and working pretty much 9-5, with the very rare exception of being called out to a home-birth at night. I did well at the academic side of the course, and loved my practice placement. There were stresses, however; I had to put in a set number of practice days, and any day missed had to be made up somewhere else. With the children new to the environment of the hospital nursery, one or other them seemed to be constantly sick, and I was always chasing my tail trying to recapture missed practice hours. There were money problems, too. My student bursary was classed as income, although every penny of it went on childcare, so we lost most of the tax credits we’d received when I was an at-home mum.
Trouble set in when my placement moved into the hospital environment. Knowing what I do now about bipolar and sleep patterns, it comes as no surprise to me that working shifts (a mixture of early, late and night shifts, with no predictability or pattern beyond what suited the unit) had a terrible effect on me. Again, I loved the work, especially delivery suite, but my sleep patterns were of necessity all over the place. Within a couple of weeks of returning to my community placement I again experienced a very sudden descent of acute depression. I remember the last home visit we did, and how I came home, took off my uniform, and got into bed. I emerged from that episode about 5 months later, and knew I could not go back to midwifery.
Since then, I have been mostly very well. I have completed another degree, built a new career and developed an active social life. I have always been honest with my employers about my mental health, and worked constructively with them to manage my condition. I have had little “blips”, lasting days or weeks, but with the blessing of my employers took small amounts of leave to try to forestall anything worse. My managers have always been happy to grant me a few days or a couple of weeks’ breathing space, in order to prevent a long-term sickness absence. In the back of my mind was the fear that one day “the big one” would hit again, but for ten years the minor tremors have been just that, and by last year I had almost started to believe that just maybe the fault had corrected itself.
And then I got some minor shocks last autumn. Once again, disruption to my sleep patterns was involved; on-going noise problems coming from a nearby business (immortalised on Twitter as #mysterybangingnoise) woke me several times a night for more than a month. We were short-staffed at work, and I worked long hours on the minimal sleep I was able to obtain. I knew it was bad for me, but it felt necessary to keep my workplace afloat. I received a swift warning in terms of a minor episode of tearfulness and anxiety, and I took a little time off. But not enough. For the rest of the autumn and winter, my mood was rocky; a seismogram would have shown a jagged pattern of shallow ups and downs. By March, I was having nightmare and panic attacks, and crying every day before work, yet still suppressing the knowledge that all the pressure was building and a very big quake indeed was about to hit.
When I first went to my GP to say I couldn’t go on, I asked for a two-week medical certificate. I was still clinging to hope that things could be turned around and I would be able to go on as before. Three and a half months later, I am still off work. I have lost the temporary managerial post I had held for 16 months. I still have a job, but I’ve lost a great deal of status and income, and my CV will show a backwards step, rather than the steady career progression of the past 10 years. I’ve had more sick time in this episode than the past 10 years put together. With a major medication change looming, it’s not likely I’ll be able to return to work until the end of the summer. The big one has hit, and the aftershocks are still happening.