Category Archives: Bipolar

The Shape of My World

The shape of my world is splinters of depression, mania, mixed states, and odd periods of something close to normality. The shape of my world is held together with duct tape and superglue and falling apart at a moment’s notice anyway. The shape of my world is love and care, but the jagged splinters of everything else cut and I bleed no matter what cushions there are around me to soften them.

The shape of my world is moulding the soft parts of myself around the shape of other people in order to make them more comfortable. It’s padding the shards so they only cut me, if I possibly can. It’s service and care and love while I bleed inside.

The shape of my world is lopsided and confusing, and I’m the only one who can negotiate it with any safety. People who come into my world can end up confused and hurt and even scarred, and I don’t want that any more. I want to keep the people around me safe. Happy. Comfortable. I need to try and right my world before I let anyone too far into it again.

The shape of my world is ephemeral, ever-changing, wispy and smoky and insubstantial. It could be blown away at a moment’s notice, and grasping at it achieves nothing. I try to capture it in moments, in hours of pleasure, in little glass bubbles made of experiences. But glass is fragile, and a sudden wind can send them all crashing from the shelves that barely hold them to the concrete floor of reality, and in that wind I will be gone. If you hold a bubble of my happiness, hold it dear, it may be one of my last anchors in times of storm.

The shape of my world is bounded by my fears, my hopes, and my dreams, and when those fade the boundaries of me bleed into the nothingness, until the blood loss is so bad that I pass out of reason and into a living death, and I need rescuing before I bleed to death.

The shape of my world is unstable, shifting, changing. It is difficult to deal with, challenging, confronting. This is me. I lay myself raw before you. Enter the mists at your own risk. I will try and pad the splinters, I will do my best, but there are so many, they are so scattered and disparate and sometimes I don’t know they’re there until they’ve sliced me or you to the bone.

I see, I remember, I imagine

CW: Suicide

I see

Washing that has been hanging on the clothes horse for nine days. It speaks to my skill as a housekeeper – now that I live alone, only the barest minimum gets done. The dishes get rinsed, but they pile for three or four, or maybe five or six, days before I wash them. The floor that I lie on gets vacuumed perhaps once in a month.

Summery air flows around me, slowly turning cool with the evening darkness. The taste of Port Royal lingers in my mouth, a reminder of a habit I keep swearing I’ll break, until the next crisis comes along. I sigh, and roll another . . .

The air out on the porch is cooler, and the darkness wraps around me like good dark chocolate around a ripe strawberry. I smoke a slim cigarette, rolled deliberately thin to conserve tobacco. Taxes on tobacco are getting wildly out of hand, but still I keep the habit. The comfort of half a lifetime is hard to break.

I see the lights of the west of the city, stretching right back to the hills. The trig point on the top of the hills flashes red. On, off, on, off, I have no idea why. The men watching over me do not come out to accompany me. They both hate smoking equally. I don’t care much. It gives me space from their difficult and overpowering presences.

The men in my living room are a mass of past and present. They look quite alike, ten years apart, and are similar in many ways. One is my ex-husband. The other is the boy I’m sort-of-not-really seeing. They are both here for one reason only. To see that I live through the night. You see, I’m a suicidal wreck.

My ex-husband knows me well. He knows that he cannot sleep until I am asleep, because I will not be safe. The boy, not so much. He cares for me deeply, but he’s not got much of a grasp on what he’s putting himself in the middle of.

I finally wander back into the living room, to find them discussing politics and online voting. The boy is being thoroughly schooled by his elder. I try to stretch out on the floor and do a writing exercise, but I can’t stop the floods of memories. So I go back to my room and lie in the dark, and let the memories come.

I remember

Hours upon hours of men sitting in my lounge, drinking beer and discussing all sorts of things. The faces and the topics change, whirl, meld into one long string of regrets. These are all men I have cared about in some way, all gone from my life, mostly through poor choices in periods of unwellness on my part. I have been more a spectator in most of these discussions – I do have a bit of a shy streak in me. Plus, men tend to talk over me anyway.

Tears flood down my cheeks as I remember all the people who have passed through my life. I have loved so many of them so dearly, and they are all gone. Gone, because I’m so messed up. I make terrible decisions, I push good people away, and I lose everything. Over and over again. My bipolar disorder is a reason, but not an excuse. I have to take some responsibility.

I sob.

It takes the men a good ten minutes to notice that I’m gone, so absorbed are they in their discussion. There’s a moment of panic – not a long one though, as the apartment is so tiny that it takes all of thirty seconds to locate me. The boy sits on the bed beside me, momentarily at a loss, before wrapping his body around me. My ex-husband turns away.

“I’ll be in the living room if you need me”

The boy holds me until the flood of memories passes and the sobs still. It’s sweet of him, and the comfort is welcome. I turn to face him, kiss him, draw a deep breath, and return myself to calm. We return to the living room, and I calm myself further by rolling another cigarette. Pulling out the paper, wiggling the filter out of the little hole at the top of the bag, pinching out the bare minimum of tobacco, patting it into shape, rolling, placing the filter, licking the gum, rolling it all together, all the while concentrating only on this task and breathing steadily . . . peace returns to me.

Again I smoke, and again the men do not follow me, but I am included in their conversation this time as I stand close to the door. As the cigarette burns down, I realise that I am weary beyond belief. I have been holding this pose of being fine, being ok, being normal, for so long, and it’s starting to break down.

The boy and I tuck up in bed, but my ex-husband stays in the living room. I return to the living room a couple of times for various things, and in that time the boy falls asleep.

The pose breaks.

I don’t remember much. I remember sobbing, screaming, begging, over and over,

“Let me go. Let me die. Please”

To which, the answer was always,

“No.”

Eventually I take some lorazepam and fall asleep. I don’t know if my ex-husband slept at all that night.

The next night was similar, except that the boy was not present. I begged, I pleaded.

“Let me go”

Lorazepam gave me sleep again. My ex-husband sat on the bed and watched over me until the drugged sleep came to me.

The next morning, Thursday 2nd March, I was admitted to the ICU of the Auckland City Hospital psychiatric unit under Section 10 of the Mental Health Act 1992. I was transferred to the main psychiatric ward the next day, and I have been there ever since.

I imagine

Being free from here. I’m allowed leave now, two hours at a time out in the world, and I die a little inside every time I walk back through the doors of Te Whetu Tawera (the Maori name for the ward). I know that discharge is only a few days away now, maybe around a week or so, but my soul is being crushed. I cry every day in frustration, wanting my own things around me, my own bed, my own damn unvacuumed floor. Out there are many pressures, but at least I have some control over my life out there. In here is regimented and my soul is dying.

There are plenty of people that worry about me leaving this place and just killing myself. It’s not going to happen. I’m reminded every day how much I mean to people, and how much it would hurt them if I died, so I will continue on in spite of my problems, for everyone else. It’s not ideal reasoning, but I am not a selfish person and it’s enough to keep me alive until I find my own joy in living again – something that I’m never going to find inside the confines of Te Whetu Tawera.

 

And the shit sprayeth further still

TW – suicide

When I wrote my last blog post, I at least had a head space that was fairly strong. Well, that’s dissolved to the point that my ex-husband says I’m more fragile that he has ever seen me. I’m millimetres from being inpatiented, after a stint in respite last week. I can’t keep myself safe any more. They took my stash of medication, so I’ve come up with a couple of much more lethal plans.

I planned to end my life on October 31st, but I broke down and told my partner, and he convinced me to seek help, which led to the stint in respite. But he’s not around to save me from myself again. So today, after a medication change set me to less than five hours sleep, I decided to make a go of dying.

I made a series of promises of what I would do before I died, and I started on the checklist. I called the Taylor Centre, my local community mental health centre. I was trying to tell them that I was going to go and step in front of a train as soon as I’d completed my required steps. I was advised to make a cup of coffee, have something to eat, and read a book, and they’d call in a couple of hours.

Ahem. What?! Apparently this is something to do with distress tolerance, but I was beyond sitting with my distress and letting it subside. I’ve been doing that for a good month now. I’m beyond that capacity, I was reaching for help, and I was told to make a fucking cuppa. So I made a cuppa, and went on to Stage Two – writing to the people I love and telling them they are loved, individually and personally. That’s where I’m currently at – it’s a longish process.

Meanwhile, my partner, who’s overseas now, knew what was going on and convinced me to reach out – to Mum, and to my ex-husband. Both came through for me – my ex called and didn’t hang up until he was on my doorstep, and didn’t leave until Mum arrived. He supported me, good man that he is. Meanwhile, Mum called the Taylor Centre and repeated verbatim what I had said to her, which was that I was going to write what I needed to, make the calls I needed to, and then go kill myself. The Taylor Centre, to their credit, decided to send someone over in the next couple of hours. And so the process with them begins again.

When the Taylor Centre people arrived, Nigel was there. I spoke to them, and they started talk of how I needed to practice more problem solving. Nigel intervened and told them that he had never seen me so fragile before, and that keeping myself safe was just not going to be practical. It was only when he spoke that they took me seriously.

What is it with mental health services and minimising the voice of the patient unless they have an advocate?

They Taylor Centre said they would talk about my case and get back to me in the evening. Which they did, but they smoothly talked me out of the hospital where I would be safe, and elected to give me enough benzos to knock a horse off its feet. I took those benzos at 9pm, and here it is, midnight, and I’m writing this to distract myself from writing goodbyes.

I don’t know what to do here. All that’s in me screams to keep writing, so I can check that off the list and it’s shorter so I can through more of it next time the impulse and the opportunity arise.

It’s very simple really. I want to die. Life’s downs are far more common that its ups, and the ups that I get, the hypomanic highs, destroy my life over and over. What does it matter whether this low is the one that kills me, or the next, or the next? I may as well go before I hurt more people. Yes yes I know, dying will hurt people, but it’s inevitable sometime and living is hurting a fair swathe of people too.

I’m going through all the motions of rebuilding my life, but I don’t believe in any of it. The black dog alternates between sitting on my shoulder and gripping me by the throat with iron jaws, shaking and trying to rip that throat out. One day he’ll win. Why not now?

What about major depression?

Today is mental health day at work. By that I mean, I’m delving into the depths of the Ministry of Health’s Mental Health section, looking for information. It’s better than yesterday, which was infant mortality day. Anyway.

I found a neat wee Q&A about the National Depression Initiative, a project which I’ll talk about more when I have more time. For this quick post, though, I saw one question with an answer that really bothered me. It reads:

3. How is depression best treated?

Different types of depression require different types of treatment, and there are effective self help strategies for mild to moderate depression, such as regular physical exercise, relaxation and problem-solving techniques and positive social activity. Information about these approaches can be found on the main National Depression Initiative website.

This is an . . . interesting answer. In a way it’s really good, in that it can encourage people that are wary of medicalising what they just see as a case of the blues, and gives them the idea that they can be treated with just some small changes to life. Learning a relaxation technique or going out and seeing people a bit more sound just fine as methods of treatment, and it can encourage many people who wouldn’t otherwise to seek help.

It ignores a couple of things. First, that the first-line treatment for most people presenting with mild to moderate depression in many GP practices is to prescribe an SSRI. That might come as a shock to people who are looking for a Green Prescription-type intervention. Even if a doc makes the call to treat with non-medical intervention, there is still a chance that medication will be required, and I think it’s a little dishonest to not even mention the possibility of it.

Bigger than these for me is the fact that major depression is simply left out of the answer altogether. Depending on which doctor you ask, I have either Major Depressive Disorder or bipolar disorder. Either way, the depressive episodes I have are catastrophic. Looking in the National Depresion Initiative and seeing that depression is addressed by simple life changes, and then trying to apply that to my screaming disaster of a depressed self, would be terribly disheartening. If I worked out that I was majorly depressed, I think it would be worse – the first-pass look at resources for depressed people simply do not include me. That’s really really bad for my depressed brain, which goes ‘see, you’re untreatable. they don’t even have anything about you here. You’re just screwed, and no-one can help’. Depressed brains are jerks like that.

I get that they’re trying to make mental health treatment less scary and more accessible to all, to relieve the burden of disease that mental illness lays on society. That doesn’t mean that they can’t be inclusive of people going through more than just moderate depression – after all, they jump right in to talking major depression and suicide a few questions later. That’s a cheery thought for a depressed brain. They can’t tell me about treatment, but they can talk about suicide risks for people like me. Insert idea into depressed brain, blend, and pour out poison.

For an initiative designed to help depressed people, there’s a bit of a lack of thinking things through here.

Maternal mental health – treatment options in NZ

Maternal mental health is a big thing (most of my data comes from that link this time). Around 15% of pregnant women and new mothers will have some form of mental illness during the perinatal period (from conception through to baby’s first birthday). Floating around 60,000 births per year, that means a lot of mental illness for New Zealand women. 9,000-odd women will have some form of mental illness in the perinatal period. I’m not talking about the ‘baby blues’, either. This means serious mental illness – depression, anxiety, bipolar episodes, schizophrenia, and so on.

To deal with this there is a primary health care plan in place. General practitioners, lead maternity carers, Plunket nurses, and the like are trained to identify maternal mental illness and in many cases treat, whether with reassurance, various forms of support referral, or medication. For many mothers that’s what they need.

What happens when they need more? Well, that’s when it gets a bit hairy. There is no national secondary maternal mental health service co-ordination. Each DHB is on its own, and some do quite well, but some are all at sea. Many leave maternal mental health care at secondary and tertiary level to their regular emergency mental health teams, which does not really cover the special needs of a mother and child.

At the extreme end, some mothers really need inpatient treatment. There are two options for this, one vastly superior to the other. On the crappy hand, you can separate mother and baby while mother receives inpatient treatment – which can last weeks or months. On the better hand, you can have dedicated mother and baby mental health beds. This option is so much better for both mother and baby, as it keeps them together during a crucial phase of attachment and bonding.

We have five mother and baby beds here. Here being the entire country. Five.

Those five beds are located in Christchurch, and they are available to Southern DHB cluster mothers – women from the South Island. Around a quarter of New Zealanders live in the South Island. Northerner? Well, tough.

Around one or two in 1,000 mothers will experience post-partum psychosis. this is an incredibly serious mental health issue, one that really requires inpatient treatment, as the woman can be a danger to herself and others around her.

How do we deal with this? Honestly, I don’t know. Do we separate mothers and babies or do we leave seriously ill women to the care of their families – or lack of care, as the case may be? I suspect the former, but the latter would be horrifying. Some hope is on the horizon, though – maybe. The Healthy Beginnings paper that I linked to, released mid-2012, advocates the establishment of between 16 and 33 mother-baby beds around the country. On the other hand, the paper recognises that there is no new funding for any of its recommendations, so moving forward with them may be rather . . . doubtful.

The number of beds proposed for the country is still problematic. It’s enough to cover the national cases of post-partum psychosis – maybe. Just about. Where does that leave the mothers suffering from schizophrenia or a severe bipolar episode? They’re acutely unwell. And what about the severely depressed? They’re not able to care for themselves. Here, the families must come in.

Let me tell you a little story. When I had my first daughter, I ended up with pretty severe depression. Like, can’t dress myself not eating can’t care for baby depression. My partner was at university full-time, and worked weekends. My family were miles away (literally in Africa). In the evenings things were ok, I managed to cook for my partner and my flatmate because I had to, and somehow I pulled it together enough for that. During the day, though, I just couldn’t do it. I remember just holding my daughter and both of us crying until we were exhausted, then sleeping in a heap on the couch until it was time to do it all again.

My grandmother travelled an hour each way once a week to take me to do my groceries. But that was the extent of the support I received. I desperately needed care of some kind, but it was left up to my family and my family just could not provide the care I needed. And mine was bad, but not as bad as many. There are women who lie in a darkened room all day, feeding baby when it cries and managing little else, every day. They need better.

How do we deal with suicidal women? The ones who have come to the conclusion that their baby and their family is better off without them? The current answer is, we leave them to family care and hope, or we split them from their child. None of this is a good solution.

We don’t have mother-and-child respite care, where mum can go for a few days and be looked after a bit by nurses or social workers, and feel supported and start getting things back on track. There are some day programmes for mothers and babies run by Plunket and others, but there aren’t enough, and they’re not accessible to women who are too unwell to leave the house unaided.

We are failing the mentally ill mothers of this country. We have the beginnings of a good programme in that primary interventions are in place and work well, more or less. But we need higher level interventions to be available, and I’m sick of hearing ‘we don’t have the money’. We find the money for flag referendums, and we waste money on by-elections that didn’t need to happen. We fund a military, perks for retired MPs, ever-escalating MP salaries. Gather together some of these hundreds of thousands, these millions. We can find better uses for them.

Parenting Throught Mental Illness

I’m a mother of two girls, currently aged 5 and 9. My struggles with mental illness have been going on longer than they’ve been around. They’ve always had a mum who has mental health problems.

When I’m well, raising them is pretty easy. They’re amazing kids, most of the time they’re very well-behaved, self-sufficient, and generally ‘easy’. Even their rougher patches are fairly easy to deal with – more often than not, problems are resolved with a quiet chat and a hug, or a wee bit of time out.

When I’m not so well, things are harder. Sometimes I’m so on edge that I snap at the smallest of things. Sometimes I can’t cope with anything, and the only way to deal with life is to withdraw for a while. Sometimes I just can’t get myself up off the couch to do anything. None of these things is any good when you’ve got two little girls to care for.

There are two things that make it manageable. The first is good support and help with their needs – these days this is from my partner, but before we were together this came from my mum or my friends. The second is talking to the girls. Much as I don’t want their lives to be marred by my mental illness the way mine was by my stepmother’s, I can’t change who I am. But if I talk to them, tell them what is going on (in an age-appropriate way), and apologise for the things I do wrong (snapping at them, or collapsing in tears for no reason), then maybe they won’t be scarred by it the way I was.

Parenting through mental illness is a unique challenge, but I have two lovely girls that I can be very proud of, despite my own illness. We’re making it work.