TW: suicidal thoughts and planning
On Monday afternoon I sat in a glass-walled consulting room with my Consultant psychiatrist. Out in the waiting room I had felt so weary, sick to the back teeth of coming to this building over and over again; in about three months’ time I will have been attending that same clinic for four years. I thought back to my first appointment. I remembered how confident Dr X had seemed about stabilising me on the right drug and getting me back to my job as quickly as possible. I wondered how many more months or years I would carry on coming here in the hopes of that elusive stability.
I started to cry as soon as Dr X asked how I was doing. The last time we met I’d been so well, better in fact that in years, all thanks to the cocktail of meds we’d arrived at with the help of the National Affective Disorders Service. I knew it was ridiculous, but I felt that by going into a tailspin I had somehow let him down. As I explained how I had lost my cherished equilibrium and had a sudden, very deep mood drop I sobbed, covering my face or my eyes with my hands. I couldn’t look at him. I said that I felt I had got sucked into yet another bipolar loop and I simply couldn’t cope with that. I sobbed from behind my hands that not only had I reanimated my suicide plan from the autumn – which had turned out to be dormant, and not at all extinct – I had gone further, writing lists and calculating budgets to try to make things to pan out the way I wanted to.
Dr X, as he always does, said he was very sorry to hear that (can you tell that even though I think he’s great and by far the best psychiatrist I’ve ever had, I have appointment fatigue?). He told me, as of course I knew he would, that he was confident we could get me out of this blip and back to better functioning. I thought, but could not say, that this repeated dance of ours was part of the problem. Dr X asked what I wanted to do. Did I need more support? He could make a referral to the Home Treatment Team. I groaned and pressed my palms into my eyes. No. I did not want to be referred to HTT. Although I had come to know the team well and found them hugely supportive, after spending half of 2014 under their care I just couldn’t face going back. I was beginning to feel like a HTT revolving door case, with no hope of ever getting out of services. So we compromised. We would up the lamotrigine and I would come back in two weeks to report on progress. I would ask Tom to manage my meds again. If within that time I decided I wanted HTT, or if Tom was concerned, we should contact Dr X immediately. If at the end of the fortnight I was no better I should reevaluate my options.
Since then I have felt confused, anxious, miserable, detached, terrified, exhausted, guilty (sometimes all at once) and above all despondent about my life and its limitations. I am back in a place where I can see into my future of relapse after relapse, no matter how well I do in between, and as before I feel I do not want this life. It is not tenable going forward. I often tell people that I wouldn’t want my bipolar taken away, because it and I grew up together, and it is true; I have no idea who I would be without it. So it’s not simply that I want rid of my bipolar. I have had enough of us both.
Right now I am juggling four quite compartmentalised parts of my brain. There’s the ordinary bit, the bit that thinks according to accepted logic. The bit that can say, well, I was in remission for some years before and it’s true I was doing well lately. Dr X is right, Tom is right, if I’m patient with the dose increase it could lead to me catching another break. The good times are worth the difficult times.
The anxious part works to a differently logic. It reacts to a drop in mood with sheer panic, with desperation, with a belief that it always, always comes down to this and there is no hope, that I am a terrified hamster running round and round in the same wheel. So of course there is only one answer to that, and that is to exit the wheel.. The anxious part would kind of like HTT involvement, because they are familiar, because I want an NHS comfort blanket, but fears that nothing will help and that referral back to them emphasises the fact that things will never get better.
Then there’s the sneaky suicidal part, which I’ve written about here. I’ve been experiencing a lot of dissociation this week. Not just feeling spaced out and floaty, but seeming to lose chunks of time, finding I have done things I don’t really remember. The dissociation is closely connected to the sneakiness. My guess is that this is the only way my poorly brain can cope with my situation – by opting out. This part of me is almost like sleepwalking or autopilot, more like an app running in the background that a series of conscious thoughts. In the supermarket buying soup, that part of me clocks helpful items and squirrels the prices of them away for later use. It begins to attach tremendous importance to certain, potentially useful, objects around the house. It notes that although Tom has taken away almost all of my drugs, I have ways of getting others. But it does all this well behind the logic and the panic.
The last section is simultaneously critical and fearful. It worries that there is nothing wrong me, that I am a fool and a fraud to even be thinking of Home Treatment, that all this suicide planning is not a response to distress or history but some form of attention seeking (even though I am extremely resistant to telling and never ever disclose the details to anyone who could help). It thinks that despite a Consultant psychiatrist being worried at me people might laugh at my minuscule problems.
I don’t really know how to re-integrate my mind. I suppose I’m waiting for conventional logic, perhaps helped by the med increase, to take over. A good friend said to me recently that she was worried the dissociation puts me at risk of sleepwalking into harming myself. Part of me doesn’t want that, wants to live, only I am so weary of everything that I can’t be bothered to nurture that desire. I literally don’t know what to do with myself.