A Bipolar Doctor

March 17, 2016March 21, 2016

Day 9.

“Stuck in a moment, and I can’t get out of it”

——-

Today I feel better. I slept well last night. I was a bit sedated this morning but that’s just the increase in medication kicking in. The sense of paranoia is not as bad but still there. It’s uncomfortable but it will pass. I’m convinced it will.

It strikes me that mental illness is a very private disease. It is isolating and lonely. My family support me and know I’m in hospital. A few colleagues have been very helpful in organising time off work. But that’s it.

I use Facebook all the time in here. It is like a connection to the outside world. I’ve noticed that people will “Like” the most trivial of posts. They are often meaningless. When I post about bipolar disorder or a piece of music which is helping me to cope, I am lucky to get two or three acknowledgements. It’s very disappointing. Is mental illness not important enough, or is it just embarrassing?

I know it may be my paranoia taking over but it feels like no one cares. Not really or deeply. Loneliness is crippling and by staying silent about my bipolar disorder, I am simply propagating the stigma.

I am inclined to shout it from the roof-tops. I want to break free. I want to be seen.

If you read this post, give me your opinion. I won’t go public until I’ve given it some consideration.

March 15, 2016March 21, 2016

Day 7.

I had the best sleep in days last night. I got about six hours, infinitely better than previous nights. Sleep deprivation starts to unhinge the mind and when you add a mood disorder the result is very volatile.

I feel I have more energy but I’m going to need it. Two old friends have come to visit. Paranoia and racing thoughts.

I have touched on paranoia before. Essentially it is rooted in fear. Fear of threats where no threat exists. It is often directed at the most benign thing. Occasionally, the focus is someone I love.

The perceived threat gives rise to feelings of anxiety and panic. Tremor in the hand, pallor of the skin and even chest tightness. It is important to keep reminding myself that the danger is imaginary.

Racing thoughts are more difficult to explain. Imagine taking the verse of a song you like – say “Masterplan” by oasis. The verse gets into your head and repeats in a never ending loop in your brain. You might sing the words but it doesn’t bring relief. It is an irritating idea isn’t it.

Now, imagine every thought you have has the propensity to go around and around your head in a perpetual cycle. Imagine the thoughts are negative, upsetting or bizarre. I can’t even fall asleep to escape them. I can’t shut down my brain. It drives me crazy.

So I’m exhausted, depressed, paranoid and my thoughts are racing. It’s not very pleasant. But the reality is that this isn’t one of my worst days. Not even close.

The good news is that all of these symptoms will settle as I get better. Strap yourselves in. It’s a long flight and the Captain expects turbulence.

March 12, 2016March 21, 2016

Day 4.

“Turn, turn away

From the sound of your own voice,

Calling no one, just a silence”

“Turn Away” – Beck, Morning Phase.

—–

Life is getting easier. I don’t feel so miserable this morning. I’m up since 5.00 and there have been no tears so far. It’s an improvement. That’s not to say I can get complacent. I might feel good today and wake feeling shite tomorrow. It’s early days.

Hospital is like a cocoon. They build a scaffolding around you to support and protect you, they erect a force field. There is nothing to be worried about except your recovery. Everything else is taken care of for you.

But they do treat you like a baby. Over the sink in my room is a little sticker on the left reading “Caution – Hot Water”. That drives me mad. But then I remember that the poor bastard next door might not be able to remember which is the hot tap. It’s sobering but I know I’ve scalded myself on previous admissions.

You need a sense of humour to survive this place, a twisted black sense of fun. The other day, one young man was complaining that there wasn’t enough activity for men in the hospital. He asked another patient’s opinion. He answered that he would like to do woodwork. I thought that seemed sensible. He asked me what I’d like. Is said lap-dancing. I’m still smiling. I’m thinking of starting a petition 🙂

Routine is mandatory. I wake, eat, take medication and sleep according to predictable timetables. It’s easy to become institutionalised. But routine is important. It reduces anxiety. I wake early these days and try to establish my own patterns. Shaving is important – quintessentially masculine. Washing, brushing your teeth, just remembering to use aftershave. All these little actions, little victories, serve to make me feel more human. They help me face the day.

But I also need to maintain an element of control. I skip a meal every now and then or turn up late for my medication. I like to mess around a bit, fuck with their heads. I’m depressed, no one said I was dead.

I’m lucky. There are plenty here in worse condition than mine. But, I have to accept that I need to be here too. No one sends you in here for a holiday (it would need a pretty awful travel agent). You have to earn it. I think we all fight our demons differently in here but the suffering is just the same.

The ward is quiet. Many of the patients are on weekend leave. But I don’t mind. I have my music and enough sparkling water to supply the ward. My eldest son is coming to visit soon. I want to be in good form for his arrival. I want him to know I’ll be okay.

March 11, 2016

Hospital.

“Let me go,

I don’t wanna be your hero,

I don’t wanna be a big man,

Just wanna fight like everyone else.”

“Hero” – Family of the Year.

—

I’m back in hospital. Incarcerated. Again.

It’s about three years since I was here last. Things haven’t changed much. The ward is the same, the nurses are the same, unfortunately, some of the patients are the same. It’s a grim reminder that the entrance has a revolving door. I never escape for too long before I return. I invariably violate my parole.

It’s hard to accept these new conditions. The lack of freedom, the admission of defeat, the sense of failure. I have been fighting a long time now and I am out of energy. I’m scheduled for a twelve round fight and it’s only the top of the tenth. My legs are like jelly and my vision is blurred. I can’t wait for the sound of the bell.

Acceptance is the key. I haven’t reached it yet, but it life is much easier once you grasp it. I know this from previous admissions. Coming to hospital is a necessary evil. It’s recognition that I am in trouble, that the fight is going on too long, that energy is low. It is submission but not surrender. It’s giving permission to allow support and help to come from the corner. It’s giving your body, mind and soul a break.

Recharging the soul takes time. It isn’t easy. There needs be tears and pain along the way. But it’s worthwhile. To finish the last two rounds might require a steroid injection but you get the chance to win the fight. There will always be another one, there are plenty of powerful contenders for the title. But, if you fight clever, dodge the blows and defend when needed, you just might keep the belt.

March 8, 2016

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.

March 5, 2016

Anxiety.

One morning during the week, I sent my wife a text – “I feel anxious”. Simple, but describing exactly what was most important for me in that moment. She replied that she would call me in a while. That’s all I needed. Something to keep me going. The knowledge that I was not alone. The ensuing conversation eased my nerves and I continued with my day, albeit a little subdued.

Anxiety and depression go hand in hand. If you live with bipolar disorder you will be no stranger to this combination. Occasionally I feel anxious in isolation but typically it coexists with depression. I’m not saying that I am crippled by anxiety all day long for weeks on end. It is usually worst in the morning and I have learned to cope with it. I can function and do what needs to be done that day. But, I am always conscious of it. I’m aware of it lurking in the background. It is very uncomfortable and always unwelcome.

I believe that anxiety is the physical manifestation of fear. The tension in the stomach, tightness in the chest and trembling hands are but the external signs of fear. Fear is at the root. Some of the medication I take serves to alleviate the symptoms but do nothing to treat the cause. The source is deeper.

I came to know fear at an early age. I was predestined to be afraid. Both my parents were afraid all their lives. Their fear leaked out and diffused throughout my home and touched every member of my family. I encountered fear away from home too. I never quite fit in with my friends. I was cautious and timid. I was ridiculed frequently and made to feel different. In school, I was bullied. It went on for years and was to have a profound effect on me.

I was academically bright and the expectation was always that I would do well in exams. A natural progression was “Fear of Failure”, a fear that persists today. In childhood, I taught myself a damning delusion. I determined that if I was good all the time, if I did everything right, if I was “Perfect”, then only good things would happen. But how does that make me feel if bad things happen? Does that make me bad or evil?

Catastrophising and paranoia are extensions of anxiety. Fear that something terrible is going to happen. When I’m depressed, I can become really upset that a dreadful accident is going to befall one of my family. A recurrent theme is that my wife will leave me or has found another man that she prefers to be with. These delusional thoughts can be very powerful and equally destructive. They only deepen my depression and put a strain on my relationship with my wife. Paranoia can be perceived as lack of trust.

Fear is essential to survival. It allows me to recognise danger and react appropriately. My work as an Anaesthetist is mostly repetitive and mundane. But during rare episodes of emergency, I am able to ignore my fear, think clearly and proceed in the best interests of my patient. This ability to disregard fear, and control any sense of panic, comes with long years of training and clinical experience. However, I believe that my familiarity with fear and anxiety, over the years, augments my capacity to react in these situations.

I experience fear a great deal. Mostly I suppress it, cope with it but I’ve done very little to resolve it. I cope in different ways. One response is anger. Anger is energetic and can be a tool to overcome fear. It works for a while but, when persistent, in my experience, it becomes destructive. Meditation helps and likewise exercise. Sometimes, all I need is to hold hands with my wife, have a hug.

Fear is deep within my soul. I fight my demons every day. Guilt, shame, loneliness, anger and fear engage in frequent battle. Mostly I win but occasionally I lose. The war has been ongoing most of my life and suppression is a poor weapon. There is a better way. Meet the enemy, attack the fear, in the citadel where it lives and derives it’s power. I must go to the source. But, I know that is easier said than done.

I just want to call a ceasefire to hostilities. I want a little peace.

March 2, 2016

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.

March 1, 2016

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.

February 26, 2016

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.

February 25, 2016

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.