I’ve been delivering talks to delegates on Mind training for almost a year now. I’ve been invited to speak at a range of different courses run by Mind – many have been “open access” courses that anyone with an interest can book themselves onto, others have been held in companies that need mental health training for their staff. I generally speak for about 45 minutes about what it’s like to live with bipolar disorder, with additional time for questions. I’ve spoken to service users, carers, and people in frontline health and social care roles, as well employees at large private sector organisations.
One of the questions people most often ask is, “When you feel you are going high, are you able to stop yourself?” It’s an interesting question, because two years ago when I was re-diagnosed with bipolar, I would have responded with a definite, “No.” At that point, I didn’t really feel my mood shifts were anything to do with me. It seemed like a slide into depression or a flip into hypomania “just happened”, regardless of what was going on in my life. The changes felt unexpected, as well as downright unfair, and I looked entirely towards mental health professionals for answers. I believed that if my Consultant could just find the right drug, I would be fixed. It seemed like my life had been hijacked by bipolar and I felt like a victim, but I was sure I could return to how I was pre-relapse and get back into my job, and all would be well.
I first started seeing a clinical psychologist in autumn 2011, after six months under Consultant care. I was still searching for the perfect drug, and becoming frustrated that I had tried three meds already without “success”. At assessment, the psychologist suggested that one of the things we might need to work on together was acceptance of my condition and what I needed to do to manage it. I though she was talking rubbish. I happily identified as bipolar. I even had a “BipolarBlogger” Twitter name and email address. But wasn’t my job just to take the meds as directed? I didn’t believe that I could manage my own moods, and didn’t see why I ought to take any personal responsibility for management of my bipolar when I had a Consultant psychiatrist on the case.
It probably took me another six months to come to terms with how things really were, to accept that my moods, in fact, generally had a trigger, a kind of a seed that under the right circumstances blossomed into a full episode. It took another major step to accept that although I couldn’t always control exposure to triggers, how I reacted once my mood began to change could sometimes impact on whether it fizzled out or carried on moving in that same direction. I began to admit that a self-management plan was going to be just as important as taking meds, perhaps at times even more so.
Hypo/mania is the area where I had to put in the most work. I honestly don’t know why, but after decades of depression having the upper hand, in this episode lows have come a poor second to highs. Having little past experience in hypo/mania, I have often had to make my responses up as I go along, experimenting to see what works and what doesn’t. And I have finally come to the place where I can say, “Yes.” Yes, if I really put my mind to it, and if I can catch it when it is small/early enough, I can pull back from a high. I always feel that a high is a bit like being put in charge a train. At first, being allowed to drive a train is fun. I feel rather special, because I am in charge of a train and other, more ordinary, people aren’t. It’s exciting to whizz through unfamiliar countryside and I feel exhilarated, energised. As the train begins to go faster, I fail to notice the scenery outside the window has become slightly blurred until I begin to feel a little bit sick. And then there comes a moment when I realise the brakes are off and it’s too late to put them on. The train has now gathered a horrible momentum of its own – and I say horrible, because elated mania is not in my emotional repertoire. It’s at this point that I remember there is only ever one destination for the train, and that’s dysphoric mania, an unholy mixed mood of manic energy and depressive despair. Now I look desperately around for an emergency exit, a way out, because feeling so horrendously out of control is unendurable. I would happily chuck myself out of my train and in front of one travelling in the opposite direction. But I’m stuck in the cab, and the only way out now is to douse the fire in the boiler. And things have gone too far for me do that alone.
It’s not unreasonable, I always thought, to want to have a try at being a train driver. Why shouldn’t I experience that thrill? Think of all the people who wish they could drive a train like that. Think of how jealous they must be! I didn’t see it was for me to control the train’s speed. Someone else, I used to think, should take responsibility. Someone else should have checked the brakes before I got on. Someone else should tested the speed gauge. And someone else should edge the tracks with crash mats, just in case I do need to dive off just when it begins to all be a bit much.
I’ve been on the train a number of times now, with the same outcome. The euphoria of the early stages of a high are deliciously seductive, but I now have to accept that I have a narrow window between stepping onto the footplate and that moment when I start to feel sick. That is the absolute last point that I can get down from the train, before it runs away with me. And if things carry on and become out of control, the dampening effect I need can only be achieved by high doses of strong antipsychotic drugs, something I hate almost as much as the high itself.
I have said that I can’t always control triggers and indeed sometimes I will find myself getting onto the train before I’ve noticed. So what do I do differently now? I don’t shovel on any more coal. The fuel for a high can be anything that gets me “emotionally aroused” – and it doesn’t have to cause elation. Anything that makes me agitated, jittery, irritated or excited can be fuel. Rushing to an appointment can be fuel. Watching a scary movie can be fuel. So can having an argument or confrontation, attending social events, or listening to fast tempo music. Exercise can be a kind of fuel, and at times writing can too. The basic rule for stepping off the train is: whatever I feel like doing, do the opposite. Switching the fast music for relaxation music is like throwing a lump of coal out of the window. So is switching running for yoga. Swapping a day of social engagements for one of relaxation exercises and aromatherapy baths ditches several pieces of coal at once.
I still resent having to slow the train down. I still complain and whinge about it, because I’m only human. I’d like to have my cake and eat it, enjoy the early, elated parts of the journey without things getting out of control. But it’s an inescapable fact that the longer I am on, the harder it is to get off, and shovelling on more coal can (for me) only lead to dysphoric mania. Not only does that kind of mixed mood state feel indescribably awful, it is also thought carry a particularly high risk of suicide. So I have finally had to accept that if I want to stay as well and safe as I can, I have, reluctantly, to get off the train.