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Psychosis.

“I don’t remember, I don’t recall,

I have no memory of anything at all”

Peter Gabriel – Shaking the Tree

—–

When I was 24 years old I became psychotic. I believed that the IRA were trying to recruit me. Their medium of communication was the radio. Certain songs had subliminal messages embedded in them and I would have to act according to their(IRA) orders. It went on for months and was the most terrifying experience of my life. I was finally admitted to hospital and the symptoms regressed.

I think I am psychotic again. I say that with a very heavy heart. I am hearing voices in my head. I think it is my own voice primarily but I’m not sure. The voices shout insults at me and try to order me perform certain acts. I am doing my best to ignore them but it is difficult.

This morning I was sure that some sort of transmitter had been placed in my left ear during mastoid surgery in 2006. This is how the voices were talking to me inside my head. This afternoon, that idea seems a little far fetched and as the hours go on, it seems to be less and less logical or probable.I haven’t given up on it completely.

I am very paranoid and think that the nurses and patients are trying to give me subliminal messages. I’m not even 100% sure that my wife isn’t in on the act. I just don’t know.

I don’t know what happens from here. If I completely lose my grasp on reality, I will be transferred to a lock-up ward. It is the most undignified place I have ever been and, yes, I was there before. It might be a while before I get to write again. Keep your fingers crossed for me…

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Ballyheigue.

I envy people that say they had a happy childhood. I don’t mean to say that my childhood was particularly bad. It wasn’t. It’s just that I have to concentrate to remember the happy bits. I’ll try to share one happy memory now.

Every summer, when I was young, the family would pack the car to vital capacity and head for a little village in County Kerry. It was a ritual complete with necessary ceremony. The car was so full that it was impossible to see out the rear windscreen, multiple bags squashed our feet and the pillows, we would sleep on all summer, were under us.

We would take the coast road, eschewing the more direct route through Tralee, via Glin and Tarbert and on to Lisselton. Nothing much happened in Lisselton but there was a shop. Fondly known as the “Stop Shop” due to the necessity to halt and get ice cream. There was the mandatory warning not to spill any in the car but we cared less, repeat offenders. And on to Ballyheigue.

Every summer we spent two to three months in Kerry. We had a mobile home caravan that provided ample space and we entertained ourselves. What I remember most is the absolute freedom. Days spent wandering the sand dunes with friends, playing games and causing mischief. We knew the dunes intimately and never got lost. We were the masters of our own destiny.

In the evening, the imagination once more was lit. Card games and charades, story-telling and jokes and frequently, hours sunk in books. Each week my mother would do the groceries in Tralee. It was a family outing. And, an allowance was provided to buy books in the second hand store. Every week a new book, every week a new adventure. “The Three Musketeers”, “Robinson Crusoe” and many more including the jewel of discoveries, “The Lord of the Rings”.

We read because we didn’t have a television and we were better off. Eventually we got one but the reception was rubbish and we gave it little attention save my mother’s obsession with “Coronation Street”. Otherwise, it lay dormant.

My father stayed at home and worked the week so that we could afford our holiday. He came at weekends and once a summer for a fortnight for his annual leave. My Dad would play games on the beach with me and take me fishing. Prior to chasing fish, we would have to dig for bait. My Dad would dig lugworm on the beach with such strength and vigour that he could bend the spade he used. He simply reinforced the blade with metal bars and continued to catch the worms with skill and power. He was immensely strong.

Our holiday was simple but it lasted the entire duration of the school year, every year until I was in my mid-teens. It was a privilege but it came at a cost. My father spent the summer alone toiling to allow us afford our break and likewise my mother was mostly alone in Kerry. I shudder to think of that much time away from my wife. My parents sacrificed a great deal to send us to Kerry. They never holidayed abroad, never went skiing and were generally very frugal.

I’ve read that to be truly grateful is to encourage recovery. I hope it’s true. I am grateful for many things, my wife, my family and my good fortune. I have issue with many memories of my childhood but I am genuinely grateful for Ballyheigue and the part it played in shaping my life.

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Meditation.

Meditation helps me. It’s as simple as that.

I was slow to consider the benefits of meditation and mindfulness. It was suggested by my psychotherapist as a possible support years ago. But I am a scientist and baulked against what I perceived as touchy-feely mumbo-jumbo. I was very wrong.

I’ve noted before that bipolar disorder affects all aspects of my life. Accepting this is difficult but even more arduous is grasping the effect it has on me spiritually. I am only getting a sense of this element recently. I realise that I can be fully well only when I attend to spiritual healing with the same intensity I heal the body and mind.

Mindfulness is receiving a great deal of attention in the media these days. It’s trendy and it is good to publicise it. Everybody who is prepared to set aside the time to meditate can reap the rewards. However, I believe, even greater rewards await those with mental illness.

Mediation and mindfulness are inextricably linked. The practice of one leads naturally to the other. I use a mindfulness app on my phone, “Headspace”. It is free to trial and subsequently one can subscribe for a month, a year, two years or for life. For a relatively small price, I am guided through meditation whilst sitting in the comfort of my own home, just listening to my phone. It couldn’t be easier.

When I meditate, I’m advised to focus on my breathing, take note of the physical sensations in my body and acknowledge my thoughts as they come and go. There is no room for judgment or criticism, just awareness of what is going on. Sometimes I connect with darker, unpleasant thoughts and feelings but I do not have to engage with them. I just realise that they are present and carry on.

Meditation is very relaxing. When you make a habit of it, you develop the ability to let all the stress and strain go free. The mind gets to soften and unwind. It is very refreshing and some of that renewed energy follows you for the rest of the day.

With practice, it is possible for me to be more mindful during my day. To be more present in my activities and by pausing and checking-in with myself, I have a greater understanding of what is happening for me in that moment. Then I can decide what to do to support myself. I can decide what I need.

Happily, most of the time, I feel good and the answer is nothing. But if there is a change of mood brewing, or if I am struggling for some reason, awareness of my inner thoughts and feelings often reliably indicate my next course of action.

My greatest stumbling block is frequent repetition. It is suggested that you meditate daily and at times I do. There are other times I forget and, more often, times when I’m not in the mood. Ironically, when I’m not in the mood, but push myself to meditate, are the times I get the most relief. I think it’s similar to exercise. When you don’t feel like getting out and energy levels are low is when you, sometimes, get the greatest sense of achievement. Well, meditation is a bit like that.

It’s not always easy, and it doesn’t happen overnight, but maybe you should give it a go.

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Exercise.

Today, I feel depressed. I’ve been struggling with depression for the last while but thought it was lifting. The past week was reasonably good but I awoke this morning feeling miserable. I haven’t been released just yet.

My wife wanted me to accompany her on a walk with the dogs but I didn’t feel in the mood. She insisted, gently, and not so much agreeing to it as being cajoled, I finally joined her.

The benefits of exercise in improving and controlling the symptoms of mental illness, particularly depression, are well described. It has been argued that regular exercise can compete with antidepressants in relieving depressive episodes. I can only describe what it does for me.

I discovered exercise comparatively late in life. I started smoking at fifteen and continued for twenty five years. Undoubtedly, I have significantly damaged my lungs and when smoking I was unable to run for a bus. In fact, I wouldn’t have had the breath to run, much less, the inclination. Now, I use an electronic cigarette. It is not ideal but is definitely the lesser of two evils.

A few years ago, my wife suggested I try cycling. She had started herself and thought, maybe, we could take a spin together. It wasn’t an immediate success, but I quickly came to appreciate a regular jaunt on my bike. I prefer it when I have company but have learned also, to enjoy cycling alone. I don’t overdo it. Typically, I cycle along the coast, stop for a coffee and return home. A distance of twenty five to thirty kilometres takes approximately an hour and a half. It is time well spent.

The improvement in mood is most noticeable during times of depression. I find it very difficult to motivate myself when feeling down but I always feel relief once I get on the road. The fresh air, the sun and the sight of other people living their lives picks me up. The release of endorphins, nature’s feel-good chemicals, with moderate exercise, is proven to rejuvenate. The main obstacle to these rewards is the difficulty in getting started when you really don’t want to move. But if you can make a start, not only will you begin to feel better, you will also have a sense of achievement. The feeling that you didn’t succumb. At least today, you beat the beast.

Cycling helps me through hypomania too. It burns up excess energy and gives me focus. It appeals to the obsessive trait that emerges when I’m elated. I don’t go any further on my bike, I simply go more frequently.

There is another advantage to regular exercise. It helps control your weight. Weight gain is an unfortunate side-effect of so many psychoactive medications and the result can be so demoralising. I’m not saying I’ll ever be as thin again as I was at twenty, but exercise keeps the flab from taking over.

I need to exercise a few times a week. During the winter, when weather conditions are unsuitable for cycling, I go to the gym. I like Spin Classes and can spend a little time on the treadmill. I look forward to a softer climate and the chance to use my bike once more.

At other times, like today, when energy is low, a simple walk with the dogs will suffice. My wife dragged me out today and I’m glad she did. A little exercise later and I feel more human.

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Sleep.

“Sleep Hygiene” the experts call it. Paying attention to my sleep cycle is an important part of keeping well. My pattern of sleep can be a strong indicator of my current mood state. Restoring a healthy pattern can be key to restoring a balanced position.

When I’m hypomanic I have little need for sleep. I might go to bed at the usual time and toss and turn for hours, my mind hyperactive, precious sleep evading me. When finally I turn off my brain, I sleep restlessly only to wake again within a few hours. I am compelled to rise and often sit before my computer in the early hours of the morning completing needless tasks in an effort to be occupied. I become impatient and frustrated as nothing seems to match my furious thoughts. It easily becomes draining and energy sapping. Within days, I feel exhausted.

I am finely tuned to this disturbance in my sleep. A speedy consultation with my psychiatrist and prudent manipulation of my medications ensures that these anomalies of sleep don’t last too long. I know the dose is right when the amount of time spent sleeping increases and the compunction to get up early recedes. Ultimately, I am able to take a nap in the afternoon and recharge the batteries following accumulated hours of sleep deprivation.

Depression can be just as damaging to my sleep cycle. Once more, it can be difficult to find sleep though not as much as during hypomania. I usually wake early but not as early as when I’m elated. Far from being quick to leave the bed, in depression, I must drag myself out to face the day. I have often remained in bed for hours when there was nothing pressing to do. But I never sleep again and the fitful sleep of depression is unsatisfying. I never feel refreshed.

Once more, a meeting with my psychiatrist is indicated and the result is usually a reduction in the sedating, anti-manic medications that I take. Within a short time, my sleep pattern improves until one day I wake at a reasonable time and the fog starts lifting.

But I can do a great deal to help by trying to regulate my sleep habits myself. I try to retire at the same time every evening. I avoid staying out too late and I try not to dwell in bed too long in the morning. Naps in the afternoon can be deleterious to a good nights sleep later. I keep them to a minimum and reserve them for the times I am truly exhausted, most often following a period of hypomania.

My sleep patterns oscillate frequently and are harbingers of imminent mood states. My prescribed medication fluctuates in accordance, and observation of my sleep prompts me when to look for help. Caring for my sleep reduces the severity and duration of mood swings. Ultimately, restoration of balanced sleep patterns rejuvenate physically and mentally and prepare me for the next battle. Sleep is a very powerful ally.

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Psychotherapy.

In common with medication, psychotherapy is essential to my wellbeing. Psychotherapy allows me to observe and study myself. It allows me to adapt. It brings cohesion to my life.

I’ve met with a number of psychotherapists over the years. I was introduced to the first a little over twenty years ago. He was a good man and he tried to help me but I was too young and arrogant. My mind was closed and I derived slight benefit from our time together. Later, I tried my hand with a man in Cork. I didn’t get on well with him and stormed out of his office, never to return. A lady kept me company for a few years when I moved to Dublin but she then retired and the search continued. A short trial with a hypnotherapist followed but it wasn’t for me.

Finding the right psychotherapist, not unlike medication, involves a degree of trial and error. For the relationship to work there must be compatible personalities. The work requires trust on both sides. And there is no quick fix. You will be together for a long while.

Three years ago I found the psychotherapist that I continue to meet to this day. I think I was finally mature enough and sufficiently open-minded to start getting well. We have achieved more in the last three years than all the previous years of therapy put together. He knows me better than anyone, except perhaps my wife. Together we have examined the hidden corners of my mind, the deepest recesses of my soul.

I have read a little recently about the concept of making friends with your demons, embracing them and thus coming to understand them. Ultimately to accept them. I don’t know how that works yet but I can assure you it’s not easy. Allowing yourself to sit with your deepest emotions is terrifying and draining. But when you have the right pilot leading and you have the courage to explore, it can be done safely and successfully. Moreover, there is great satisfaction and even relief awaiting you.

Sometimes I don’t have the energy to delve into my various woes. Then my therapist and i just chat and we usually make time for a laugh. We discuss simple things, my wife, my sons, my work. With him, I have learned a greater understanding of my relationships and my journey through life. Most prized of all, I have learned gratitude.

When entering this most recent phase of psychotherapy, I wanted to focus on managing my anger. Whether hereditary, learned behaviour or a manifestation of my mood disorder, my temper was causing me to hurt the ones who loved me the most. To say I was difficult to live with doesn’t really come close to describing it. But I quickly learned it wasn’t going to be that simple. To get to the core I had to peel back all the layers around it. Guilt, fear, grief and loneliness were in the way. But I wasn’t alone. My guide was beside me all the time. And it was worth it. I am certainly less tempestuous now and everyone in my life reaps the rewards. Especially me.

Recently, I proposed a new voyage with my therapist. I want to set sail in a different direction. The destination is far away and I don’t have a map but it is the most worthy of goals. I asked my friend to teach me how to love myself. I’m looking forward to getting there.

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Psychiatry and medication.

In my opinion, the two most important things you can do to stay well (when you have a mental illness) is attend a Psychiatrist and meet with a Psychotherapist. Medication can help you control Bipolar Disorder, Psychotherapy can help you live with it.

I first attended a Psychiatrist in 1994. I was psychotic and he started me on antipsychotics. It was exactly what I needed. I spent a short time in hospital but would remain on medication for about two years. I don’t remember exactly how long but I got my life back and recommenced my medical career. In retrospect, this episode probably signified the clinical onset of Bipolar Disorder but it would be a few years before I was diagnosed for certain.

I had a severe attack of depression in 1998. My first son was just born and I had begun training in Anaesthesia in Cork. I didn’t want to see a Psychiatrist. I was convinced that if it became known that I had a psychiatric illness, my medical career would be over. Instead, I was prescribed antidepressants by my G.P. and I improved. I took a maintenance dose for years after but I never felt quite right. Life was a constant struggle, my relationship with my wife was strained and I was drinking heavily at weekends.

My current Psychiatrist first saw me in 2003. I was coming off the rails and had become very destructive. My wife persuaded me to meet with him and I reluctantly agreed. It was one of the best decisions of my life. I was admitted to hospital for nearly two months and diagnosed with Bipolar Disorder.

I remember crying when I was told. I knew enough to know that Bipolar Disorder isn’t easy to treat but there was also a great sense of relief. Now we had a focus and could plan to improve things.

Antiepiletics and atypical antipsychotics formed the backbone of my medication. The effect wasn’t immediate but life got easier eventually. I continued to have frequent mood swings and, with reservations, I started Lithium. That’s when the worm turned. Lithium is the key to my well-being. By taking Lithium, I finally admitted that I was Bipolar. Acceptance took much longer.

Over the ensuing years, my Psychiatrist and I tried a number of medication combinations with varying degrees of success and failure. We finally landed on my current regime about three years ago and life is definitely much easier. It takes a long time to get the recipe right. I still have mood swings but they are not as severe nor last as long as previously.

My Psychiatrist has supported me through some of the darkest days of my illness. He listens to me, he believes me and he includes me in the choices we make. That element of self-control is important to me. It empowers me and helps me to believe that I am greater than my illness. It is not the whole.

Through the depressions and the hypomanias, through the hospitalisations my Psychiatrist has guided me. He has also seen me when I’m well and done his best to keep me there.

I would be lost without him.

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Why a doctor?

I started to learn about science when I was twelve years old. I enjoyed chemistry and physics but it was biology that really fired my imagination. It seemed to me that medicine was the logical way to learn more about it and have a career immersed in subjects that I liked and for which I had an aptitude. I decided then to become a doctor and I never changed my mind.

It was not an easy path. There was no history of medicine in my family and I was repeatedly told of how difficult it is to gain entry to medical school. I was advised to consider alternatives. But my mother in particular, and my then biology teacher, encouraged me to stick to my guns and I began to believe I could do it.

I can still remember the day, after my Leaving Certificate results had been decided, when the offers of college places were published in the news paper and I was given a position in UCC. I barely made the grade but it was enough. I had my foot in the door and that was all I needed. I ran all the way home from the shop where I bought the paper, full of excitement and delight. I think my parents were very proud.

The next six years had their ups and downs but I started work as an Intern in 1994. I had a psychotic breakdown within the first four months of starting work and I was to be out of action for a year. I repeated my Internship in 1996 and after a brief spell as a Medical Senior House Officer, I commenced specialist training in Anaesthesia in 1998. It was the same year my first son was born.

While I was training, I was diagnosed with Bipolar Disorder. In truth, I think it was with me all the way. Bipolar slowed and altered my career path but I was able to continue. I passed my postgraduate examinations and completed my training in 2006. I have been working as a Consultant Anaesthetist ever since.

Being a doctor is a huge part of my life. It is part of my identity. When I am well, I love my work. When I am unwell, it gives me focus and distraction. I have to put the needs of my patients before my own and frequently this takes my mind away from my own thoughts and problems. I am convinced that being Bipolar gives me an advantage. Having lived through fear and anxiety and surfaced at the other side, when an emergency arises, I can cope better with the stress and think clearly and act decisively to rectify the situation. Of course, there have been times when I wasn’t in a position to help others and needed help myself. The trick is to be able to recognise when that is the case and take some time out.

I’ve been fortunate. Some people suffer mental illness so severely that they have to abandon their careers entirely. Some people don’t enjoy the support that I do. For me, I try constantly to remind myself that the debilitating symptoms of being Bipolar have a finite half-life. The bad times pass and it’s possible to live a relatively normal life if you learn to cope with your illness and take care of yourself.

I love being a doctor. I love the contact with people, the challenge and the satisfaction it brings. But most of all, I love it because it’s my chance to give a little back.

 

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What is Bipolar Disorder?

Bipolar Disorder is very difficult to explain to anybody who doesn’t suffer from it. There are excellent descriptions on the websites of the Irish support organisation Aware and the British mental health charity Mind. I’m not a psychiatrist and everybody experiences mental illness differently. I can only tell you what it means to me.

I think Bipolar Disorder is typified by exaggerated mood swings. Everybody feels changes in their mood with the passage of time and changes in circumstance. But when you have Bipolar Disorder the severity of these moods can be extreme and the duration prolonged. Sometimes the change in mood can be so severe that it becomes difficult to function. Occasionally, normal function become impossible.

I have experienced and survived many varied moods. The main ones are depression, elation or hypomania, mixed state or dysphoria, mania and balanced or euthymic.

When I get depressed everything slows down. The simplest of tasks become Herculean labours. I eat little and sleep poorly often waking early and struggling through the long day that follows. Loneliness best describes what I feel. I am filled with fear and anxiety. Often I become quite paranoid and convinced  that something awful will happen. I withdraw from social contact and sit dark and desolate for hours at a time. Work is hard and it is difficult to remember a time when I didn’t feel so terrible and impossible to envisage that the nightmare will ever end. Suicidal thoughts come and go. But I’m fortunate. Depression, for me, only lasts for a month or two and then it lifts. I believe depression represents a state where my soul is low on energy. I just need to try and remember the ways I can recharge it.

I find the early stages of elation or hypomania can be exhilarating. I have immense energy, periods of increased productivity and little need for sleep. I tend to toy with computers when I’m high, sometimes having two or three booted up simultaneously. It’s also a time I might decide to buy a new car and hence I rarely own a car for longer than a year. But the pleasure doesn’t last and I soon become drained. This often leads to a mixed state.

Mixed state or dysphoria is the mood state that I dread the most. It is a mixture of the energy of hypomania and the darkness and misery of depression. I become irritable and severely uncomfortable often rocking in my chair to find release. It is the time when I become angry and I am most likely to hurt and offend the ones I love. I carry great guilt for things I have said and done while dysphoric. For me, depression is more debilitating but dysphoria is the hardest with which to live.

I’ve only been truly manic once and it was the worst experience of my life. I think things just got so bad that my mind took a holiday and I lost touch with reality. I had crippling paranoid delusions and ended up in a psychiatric hospital for the first time. I’ll tell you more another time.

So that’s my opinion of Bipolar disorder and how it affects me. It’s not going away, I have this for life. The key is learning how to understand it, how to cope with it. How to survive.

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New Ideas.

Hi there.

As you’ve guessed by now, I live with Bipolar Disorder. I’m recovering from an episode of depression and I’m getting better every day. It takes time, you can’t rush it.

I’ve decided to start this blog primarily for myself. It might give me an opportunity to make some sense of my life. And just maybe somebody will read it and find it supportive. They might relate to some of my experiences and it might give them a different perspective. Maybe it will help. That’s enough for me.

I was diagnosed with Bipolar thirteen years ago but I was first hospitalised when I was twenty four. I’ve had quite a few admissions since then and it hasn’t been easy. But I’m still here.

Not only that but I have a wonderful wife, whom I love deeply, and three beautiful sons. I have been able to maintain a professional career as an Anaesthetist despite needing to take time off occasionally. And over the years I have better learned to cope with my illness.

I guess what I’m saying is that I have been lucky. I have managed to survive a debilitating illness and prosper. I needed a lot of help and guidance along the way. Sometimes I was simply carried. But it can be done.

Up to now, I have been very private about my Bipolar Disorder. Very few knew about it except for my family, a few close friends and a few colleagues at work. The silence that surrounds mental illness is lifting and I see it as a change for the better. I’m not going to be so silent anymore.

Over the next while I will share my experience and thoughts with anyone who cares to listen. Bear with me, I’m new to this.