I’ve just been for a walk. This was a bit of an achievement, given that it took a tremendous effort to get out of bed and dressed, let alone to get myself outside (I didn’t manage to have a shower before leaving the house, but that can stay between us). Sounds like I’m depressed, right?
Yet last night I felt like my brain was running so fast after a fun, busy weekend that it was like being on a centrifuge. The sense of internal pressure and intolerable speed made me feel like I was going to fly apart, mentally and even physically. Sounds like I was manic, right?
Well, sort of. It’s complicated.
Before I had my last round of Home Treatment my Consultant thought that I was in a “mixed affective state”. A mixed state is when your brain decides that it’s not enough to just be hypomanic or manic. That’s it’s not enough just to be depressed, oh dearie me no. That would be too simple! So, often for no apparent reason, the brain decides to shake up the old brain chemistry a bit so that someone experiences both symptoms of a high and symptoms of a low in the same episode or even at the same time. It’s happened to me a few times now, and when it’s intense I find it incredibly hard to cope and have needed to seek emergency help. The one time I have attempted suicide was when I was in a mixed mood state, and it recognise as the most risky of bipolar mood states.
But a mixed mood can be very difficult to separate from ultra rapid cycling. When my Consultant suggested that I was in mixed mood, I wasn’t sure; I’d thought it was more that I was just cycling really rapidly. After the whole delusional thing blew over I remained confused about how to identify what was going on. I certainly wasn’t experiencing normal mood. There were high bits and there were low bits but whatever it was seemed fairly low key and manageable. And I was really looking forward to my holiday. I had in the past experienced mixed moods on holiday (one of which was quite disastrous) but Tom and I thought we had it cracked by making sure we didn’t replicate the conditions of those trips. So instead of choosing to be part of a big group, we go alone. Instead of staying put in a villa, we travel around, stopping for a few nights here or there. We allow for some relaxation time, but also do enough stuff to keep me occupied. So I was fully confident that as soon as I settled into holiday mode my mood would settle too.
Getting up for an early flight was hard. I was a med zombie and Tom had to walk me through everything. I was a mess during security, dazed and unsure what I supposed to be doing. I held everyone else up and felt anxious and miserable. Somehow the anxiety dissipated on the short flight. By the time we landed I was excited; when we picked up our hire car I was somehow elated. “I fucking LOVE the med!” I shouted, looking through my sunglasses at prickly pears, pine trees and bougainvillea. We were making use of a villa this time, but only for a few days either side of touring around. Nearing the village we spotted a Lidl and decided to stock up on things for the next few days. I threw stuff into the trolley with abandon. It was fun, it was like a game, buying whatever I fancied and knowing we had 14 wonderful days ahead of us. We explored the unexpectedly, delightfully large villa and its amazing garden and unpacked the car. That evening we ate outside and shared the bottle of wine our hostess had left for us.
The next morning I wasn’t sure how I felt. If I was being honest with myself, I was a tiny bit low, but didn’t want to tell Tom that so I kind of… squished it. Yet when I stepped out into the garden I felt that the expanse of clear blue sky was all the medicine I could ever need. I simply could not understand how residents of countries with a sky like that could ever be depressed. So I sat outside all day, reading, writing, looking up at the sky and listening to the sound of the sea breeze in the huge pine, cedar and palm trees. I was going to be OK.
On day three I got up, got dressed, ate breakfast and then… ran out of steam. I went back to bed, fully clothed. I didn’t feel I had choice. I felt that if I just lay there, very still and undisturbed, I might be OK. Of course eventually Tom came looking for me and touched me and asked me how I was and immediately that sense of maybe, possibly being OK dissolved. I think Tom could tell that I was feeling really rough as he let me be. Normally he would encourage me to get up fight it. But he didn’t. And as I lay there I knew that because of me we weren’t doing the fun things he’d carefully lined up for the day and I felt awful. I was messing up our beautiful holiday. What a fucking idiot.
As we set off on our round trip I was most certainly in mixed mood and totally consumed by it. I had the all physical and mental agitation of a high coupled with huge guilt about being ill on holiday and continual thoughts of self-harm and/or death. Previously in mixed states my body has seemed to know my thoughts or intentions before my conscious mind has even processed them. In just the same way I felt like a puppet, my mind causing me to jerk or twitch towards danger. I lurched towards the car door, suddenly unable to stop thinking about throwing myself from the vehicle. Maybe I could even manage to do it so that I would fall down a ravine. I was plagued with fantasies of going to the beach alone and filling my pockets with rocks. Suicide Virginia Woolf style.
When we got to our next port of call I had a total freakout in front of countless surprised Italian people. The awful energy made me feel that no, I could not sit down and talk, I could not stay the night here, I could not stay in Italy, I needed Tom to drive to Bari or Brindisi so I could myself a ticket home while he carried out the rest of the holiday plans alone. Tom pointed out, not unreasonably, that he wouldn’t find much joy in carrying on alone while worried sick about me at home on my own. He coaxed me into taking 5mg of diazepam and sitting in a park with me to see how things went. Within three hours I was bouncing off the walls, impatient to go out and explore the amazing mediaeval town centre and eat dinner and buy ice cream. I dressed up. I put on makeup. I posted a happy selfie on Twitter. I had an amazing evening.
Well, whether it’s mixed mood or whether it’s ultra rapid cycling my problem is the same: how on earth am I supposed to manage it? This is what kept running through my head on my walk this afternoon. Walking is good to fight low mood. Walking can be good to reduce agitation. But walking, especially fast walking, can sometimes feed mania. Which means whatever I do could be wrong. Staying at home more as a tool to reduce hypomanic overstimulation could be the right thing to do. Or it could make low and isolated. Mixing with supportive people over the weekend just led to me feeling high in a desperate, desolate way. And meanwhile I’m aware that psychotic thoughts could pop up again at any time and I’m powerless to stop that.
And so I am finding myself back at a place of learned helplessness. There is something ahead that might help me: five months after my consultant formally requesting that I start specialist CBT for bipolar (which was originally recommended back in November) I have an assessment at the end of the month. What I will do if I am not judged suitable, I have no idea. What I will do if I start the therapy and it doesn’t help or I don’t manage to develop a rapport with literally the only therapist around who can deliver, again I have no idea.
I think I’ll leave it there. I don’t have any neat endings, or anything else to say.