Admission

My admission was precisely that. A public admission that something was horribly wrong. But it took me a long time to get to that stage. I denied it, faked it, hoped that it would just go away on its own. Three medical professionals on five separate occasions recommended hospitalisation. But I shrugged it off, wiped away my tears and convinced them that I was ok. I wasn’t.

They call it a mental illness. But I believe in an inextricable link between the mental and the physical. Just as a physical illness may spawn mental distress, a mental illness can have profoundly physical side effects. In fact, to call it a mental illness surely denies how physical the mental can become. Before my hospitalisation I had shook, vomited, hyperventilated, lost weight and bled. But nothing like what was about to happen.

One day, a few weeks before I was admitted to the mother and baby unit, I was suddenly struck down with the most unbelievable abdominal pain. I managed to stumble into the living room where Steven sat, and cry out ‘something is not right!’ before collapsing. The pain was intense, comparable only to childbirth. I screamed at the top of my lungs. I lost all feeling in my limbs.

I spent four days in hospital in a narcotic haze. Eventually I underwent an investigative surgery, and the usual post operative pain was a blessed relief after the horror of the previous pain. The surgery showed nothing except some pre-existing endometriosis. Nothing ‘physical’ to explain my phantom pain.

I know now that that hospitalisation was the pivotal point in my journey. It was the moment where my body simply shut down, the mental strain having been too much for too long. It was the moment where I realized something was very wrong. I screamed out of physical pain, but also out of mental torment.  What was mental had finally become physical. Becoming physical was the only way I was spurred to seek help.

The problem was that just because I was ready to accept help, didn’t mean I would be offered it. I paid a visit to my GP and psychologist, and they both agreed that I needed urgent assistance. However, despite popular belief, unless you are outwardly behaving in an extreme manner, psychiatric hospitalisation in the public sector is remarkably difficult to achieve. To obtain a referral to the MBU it seemed I had to be first referred to my local mental health service. From there I would be assessed by a community officer, who would determine whether I needed a psychiatric assessment. The psychiatrist, who would be meeting me for the first time, and would only talk to me for an hour, would have complete power over my treatment plan.

I was frustrated by the seemed bureaucracy of it all, but I comforted myself by believing I would be receiving help within days. Instead I was offered an appointment for a weeks time. Now a week may seem like nothing, but by this point I was deep within a mixed state, and I was desperate.

Psychosis had set in and I peered out the windows, sure that the police were after me. I searched Steven’s desk, his belongings for evidence. Evidence of what? I’m not sure. I paced around the house, unable to keep still, forgetting to eat, forgetting to sleep. Steven had locked away anything I could use to hurt myself, so I sat on the bathroom floor staring at the toilet cleaner, wondering if it would do the job. I kept crying to Steven “I can’t do this, I can’t wait a week, I can’t keep going”.  Looking back, I don’t know how I did.

But I didn’t have much of a choice. I could present to the emergency department, but I knew I would be hospitalised in a general psychiatric ward without David. My best option was to wait it out, to get through the days, and to get a referral to the MBU.

Finally the day of my appointment arrived and I sat down in the psychiatrists office prepared to be as open and honest as I could. Calmly, I told him everything that had been happening, all the symptoms I had. I didn’t mince my words, and I didn’t leave anything out. At the end of it all he looked at me and said “I don’t think you need to be hospitalised, Rachael. I think your problems are to do with sleep deprivation, I can prescribe some pills to help you sleep”

  I was stunned. Had he not read the referral from my GP and psychologist, which clearly stated “it is in my opinion that Rachael be hospitalised”. ? Had he not just listened to all the symptoms I had described? I tried to tell him that I didn’t think my problems were to do with sleep, he told me that I was “overriding his professional opinion”. At that moment I realised that if I wanted help for being ‘crazy’, I’d have to stop acting sane. So I let the psychiatrist have it. I raised my voice and argued and cried. Soon enough he was printing out referrals and calling up the hospital. Funny that. Before I left he told me that he thought I would only be in the MBU for a few days, a week tops. Of course ;). 

Finally a few torturous days later I walked into the MBU for an assessment, wondering if they were going to turn me away. I can’t remember what I said, or what my doctor said, or how I acted. All I remember is my doctor standing up and saying “You clearly need to be hospitalised Rachael, we have a bed ready for you down the hall”. After the appointment with the psychiatrist I was so doubtful that I would be admitted to the MBU that I hadn’t even packed a bag. So we needed to go home first and collect some things.

Finally I lay down on the hospital bed. It was the end, or was it the beginning? I had done it, I was safe. I was relieved, scared, and everything in between. But most of all I was exhausted. I went to sleep – for the best part of three days I’m told.

And that’s all I can remember – for the first 3 weeks anyway.

The Dark Side of the Mood

Mania is like a whirlwind romance with someone who is no good for you. At first everything seems wonderful. You giggle, you make plans, you forget to eat because it just feels that good. It’s a sudden ego boost. Before you know what has happened you have eased into it, you have fallen in love with it, you have committed to the high. And once you reach that certain point, you can’t turn back, not without a fight anyway.

I read recently that one of the tell tale signs of mania is a complete denial that anything is wrong (when it is obvious to others around you that there is). I was irate when the doctor told me that she thought I may be experiencing a manic episode. I think part of the problem is the name of it. I mean manic? Really? I was so against the term ‘mania’ when I was in hospital that the nursing staff used to refer to my highs as ‘productivity’ instead. When I was depressed I was incapacitated. When I was ‘productive’ I had ideas, felt creative, completed tasks, and generally just got things done.

And how, I tended to think, is that a bad thing? How is it unhealthy to be productive? How can something that feels good possibly be an illness?

Retrospectively I realise now that I have experienced manic episodes in the past. But of course then I had no idea what they were, and I welcomed them. Now, occasionally I feel a slight twinge of mania wash over me. I feel the euphoria, or the confidence. I become engrossed in a project to the point of obsession. Or I just plain become ‘productive’. In that moment when I realise the rise in my mood I need to make a decision. I can sink into it, encourage the euphoria, and ride the wave. Or  I can attempt to stop it. Remove myself from any risky situations. Calm myself down.

But you have to understand, refusing that mania is like refusing a drink when you are on the cusp of intoxication. Are you going to get drunk tonight? Or are you going to stay sober?

But like many drunken experiences the aftermath of a manic episode often involves embarrassment and regret. And like intoxication, once you reach a certain point it is very difficult to remain in control. Mania, despite its allure, has a dark side.

In hospital I was protected from any kind of physical injury during my manic episode. But even so, I did walk out in front of a car, and was found standing on top of window sills. I was also largely protected from any kind of later humiliation. The staff who dealt with me were accustomed to mania, and my euphoric and antagonistic behaviour was really just another days work for them. Steven was the one who bore the brunt of my mood, and I know that if I were to continue the way I had been our relationship would begin to suffer. There is only so much patience a man can have.

But in the past, where I wasn’t protected by the hospital, my mood placed me in potentially dangerous situations, and hurt the people around me. For me, the euphoria, the creativity, the ideas and the confidence is just not worth that risk. Don’t get me wrong, I’m still happy, I’m still content, and I still allow myself to be so. The manic euphoria is distinctly different from everyday happiness and pleasure, and I’m able to recognise the difference.

So a few weeks ago, when I finished my shopping only to realise I had been singing out loud as I pushed my trolley, instead of giving into the euphoria I went home to bed instead. Then I completed the most mundane everday tasks you can think of. Cleaning the house. Doing the washing. And that night, when Steven and I sat down to watch TV together without fighting over my mood, it was worth it.

I’m sure there will be times where I am unable (or unwilling) to harness my moods in the way I have been recently. The memories of hospitalisation are still fresh in my head, and perhaps in a year or ten years those memories will fade. But I hope I always remember the trade off, the dark side. The dark side of the mood.

Driven to Dissociation

For most of the time I was in hospital, and for many weeks before hand, I experienced a curious sensation that the medical staff referred to as ‘dissociation’. I found dissociation to be a remarkably strange experience and very difficult to explain or describe to people. I could tell you that from a clinical perspective dissociation is an altered state of consciousness where the individual experiences a detachment from reality. But that doesn’t really say much does it? Perhaps I could tell you that my dissociative experience involved distorted vision, and an overwhelming feeling that nothing was real. But that doesn’t describe it well either.

I guess the best way to describe my dissociative experience would be to first imagine you are really really drunk. It’s hard to walk because everything keeps tipping and turning around you. You’re wading through thick mud. Everything is too loud and too bright. The colours hurt your head. You can’t read, because all the letters seem to dance around the page.  Somehow you are behind yourself, watching yourself, like some kind of strange mixed up movie. It feels like a dream. You pick up an object or touch a surface...anything to remind yourself that you are real. Are you real?

At first the dissociation frightened me. I would sit, gripping onto the chair. Willing my vision to steady, telling myself over and over ‘You are REAL Rachael.” But soon enough the abnormal became the normal, and dissociation became merely a part of my everyday experience. I learned how to hold conversations, complete tasks and even care for my baby all the while dipping in and out of reality.

  “Why?” I asked my doctor. As with any psychological state, dissociation can occur for a number of reasons. With me it seemed to be almost a defence mechanism. I was so unwell, so stressed and so unhappy that my mind was literally attempting to shut down for preservation. I began to notice that dissociation often occurred when I was upset, stressed, or tired. Unfortunately for me, given I was at that point a stressed, depressed insomniac, dissociation was a regular occurrence ;)

Of course they taught me strategies to deal with the dissociation, and they did work. But try as I might, I just didn’t seem to be able to prevent the episodes in the first place.

Nevertheless everything has it’s time in the spotlight, and it’s time in the shadows. One day, a few weeks after I was discharged from hospital, I sat down in a noisy crowded cafe and suddenly realised that I hadn’t dissociated in almost a week. I was astonished. The dissociation had disappeared and I hadn’t even realised it was gone!

Now I occasionally get a little tingle of dissociation. Sometimes I’m standing behind myself. Others I’m watching my life like a film. Like a twinge in an old wound, it warns me to slow down and reassess my situation. Am I stressing too much? Am I too overtired?

A demon now tamed, my dissociation watches over me. A lesson now learned, I listen to my mind.  

My Mania

I have put off writing about my manic episode for a while. For starters my mania, I find, is very hard to write about. How can I begin to describe an experience that was so fast and loud and bright? It’s hard to remember, let alone describe, in what order events occurred. And can I even rely on my recollection of events anyway? I’m not sure. Steven and I joke a lot about this particular manic episode. But in no way do I mean to make light of manic episodes. I was in hospital, safe and protected from any kind of danger. In other words, I was lucky. Manic episodes can be extremely dangerous. Indeed I fear mania far more than I fear depression. This was not my first manic episode, but it was the most extreme episode I have experienced. It all started one morning when I woke up with a ZING! The first thought in my head was “I’m cured!”

I felt good. Better than good. Brilliant! For the first time in months I had energy. The blackness had gone! I had ideas and plans racing around in my head so quickly that I could barely keep up with them. I called Steven at the uncivilized time of 5:50am to tell him that I wanted to go to a restaurant and bake a cake. Afterwards I bounced out of bed and raced in to tell the nurses that I had been cured. I then informed them that I wouldn’t be attending meditation that morning, because I didn’t want to sit still. I had decided to go for a walk instead. My nurse that morning wasn’t terribly impressed warning “don’t get me into trouble Rachael!” as I waltzed out the doors. 

I   got no further than the park next to the hospital. The trees, the leaves...everything was so beautiful. I couldn’t believe I hadn’t noticed it before! I lay down in the grass under a tree marvelling at the beauty that was surrounding me. The feel of the breeze on my face, the grass under my skin, the sun...the beauty was literally overwhelming. Finally I stood up and made my way back to the unit. I was so focused on the beauty around me that I very nearly got hit by a car.

Back at the unit I started to tell a student nurse about my experience. Well. ‘Tell’ is a nice way of putting it. The clinical term for it is ‘pressured speech’. I myself prefer ‘verbal diarrhea’. I talked and talked and talked, not pausing for a breath. I told her about the trees, and the leaves, and how I wanted to write a book, and where I wanted to travel..and...and..and...and! I’m sure she was cursing the moment she had initiated a conversation with me. But she was far too polite to tell me to shut up.

It was then time to see the doctor. I sat down on the sofa and waited until I had the attention of both doctors and my nurse before dramatically proclaiming “I’m cured!”.  Then I talked and I talked. I remember at the time watching all three of the staff looking at each other, raising their eyebrows. But I didn’t care. I was having a fabulous time holding court.  And man, I had some interesting stuff to say!

 When my doctor was finally able to interject, she told me that I seemed to be  ‘high’. I agreed and told her it was fantastic, before launching on a rather random tirade about how I should have never been put on ‘special’ supervision. I think after a while the staff  realised that it was absolutely pointless to try and have a sane conversation with me. It was at that point that my doctor snapped my file shut and turned to the second doctor. “I’m canceling leave”. She said firmly. I was devastated, I had been supposed to go home that weekend  for leave. I burst into tears, I pleaded and begged, but no amount of tears were going to change my doctors mind.

After the appointment I decided to call Steven to tell him the tragic news. What I wasn’t expecting was:
“GOOD! I’m glad they cancelled leave. I’m not saying you have Bipolar, Rachael, but there is something not right about you at the moment.”

Yeah, that pissed me off. From that moment on I started waging a war. A war of ‘us’ against ‘them’. And in my opinion Steven had very firmly planted himself with ‘them’.

At this point I must say that the nursing staff in that unit must have the absolute patience of a saint. From this point on I became, for lack of a better term, a thundering pain in the neck. Someone who can’t sit still, can’t concentrate on any activities, doesn’t sleep and won’t shut up is annoying enough. But someone who does all of this in addition to making it her mission to antagonise as many people as possible must have been a complete nightmare to deal with.

I went to group and attempted to derail the topic of conversation with inane questions and comments. I interrupted private conversations between staff and patients to have my say. I concluded that some flowers that were delivered to the hospital were evil, and asserted this to everyone who commented on how nice they were. And Steven, poor Steven, I took my frustration out on him the most. I’m not surprised that he was glad that I was not coming home that weekend!

As the days went on I just seemed to get higher. I didn’t seem to need to sleep, I didn’t feel hungry. I felt sexy, and confident,  powerful and in control. Given my lack of need for sleep I  started to suspect that I was, in fact, superhuman.

 I was allowed home for an hour or so and I selected a short little dress to wear (I hadn’t thought to bring cocktail attire to the hospital). While at home I put on some music, took off all my clothes and danced around the house. Unsatisfied with this I decided I should go out to the street and dance naked in the rain.  Surprisingly, I felt, Steven was less than impressed with this idea and decided it was time for me to go back to the unit. I then refused to put my clothes on until Steven started dialing my doctors phone number. Beaten, I put my little dress back on again.

But what goes up must come down, and come crashing down it did. Back at the unit I held my crying baby, trying my best to comfort him. Tears ran down my cheeks as I watched him cry, all I wanted to do was help him. Steven saw that I was getting upset and offered to take David from me. Something flipped inside me and I became angry, telling him that “I was his mother, I should know what to do”.

Sensing that things were escalating Steven left then returned with two nurses. I shouted at them to stay away, they tried to take David away, but I held onto him. Finally the nurses grabbed my arms, physically restrained me and took my little boy away. I know that I was aggressive and out of control, I know that the nurses did the right thing, but I will never ever forget the feeling of my baby boy being ripped from my arms. My heart shattered into pieces.

I was then, quite literally, frogmarched into my room to be shouted at. Finally I was left alone and I cried and cried and curled up in a ball on my bed. After a while the nurse came back and invited me to come out of my room, I declined. She came back again and again, trying to tempt me with hot drinks, movie’s on the telly and coming to see what my baby was doing. But I was terrified of leaving my room. I was so embarrassed, so humiliated of all the silly things I had said and done. I didn’t feel powerful anymore, I felt tiny.

But eventually I tiptoed to my door and looked down the hall. Steven was standing there holding David, he grinned at me and beckoned for me to come and join him. Taking a deep breath I left my room and slowly walked towards him.

“I’m so sorry” I said, both to him and to David. He could have embarrassed me, or told me off, said he was ashamed of me, he would have the perfect right to have done any of this, considering the way I had treated him. But instead he just said the three words that I desperately needed to hear.

I love you.

Oooops!

So here’s a word of advice for anyone taking psychoactive medication. DO NOT SKIP DOSES. EVER. I’ve always wondered what would happen if I didn’t take my medication. Well now I know.

Yesterday for some bizarre reason I forgot to take my morning meds, and didn’t realise I had forgotten until the evening. My doctor had warned me against doubling up on doses, so I just took my evening dose and figured I’d be ok.

Boy I was in for a shock. My sleep was strange and fitful, full of nightmarish dreams and dreamy nightmares. I was flying to the moon, then falling back to  earth.  I woke up more tired than when I went to bed. And then the agitation started, then the irritability, then the despondency. I was frightened...these symptoms seemed all too familiar. Eventually the agitation lessened but I was hit with terrible nausea, headache and fatigue. I curled up on the couch under a blanket cursing myself for being so stupid.

It’s only now, almost 36 hours after my last dose that I’m finally starting to feel ‘normal’ again. On one hand I’m angry that I’m so chemically dependent. But on the other hand I’m so relieved that I have medication that works so well for me.

 Needless to say I will not be forgetting my dose tonight!

Thank You.

I would never want anyone to think that I hold any abhorrent feelings towards the mother and baby unit (MBU), or to the people who have helped me along this journey. While I was in the unit I did occasionally feel imprisoned or resentful. I would be lying if my time as an inpatient was full of rainbows and butterflies. It is a hospital after all, and I was very unwell. But now as an outpatient I understand why I was treated the way I was, and I am profoundly grateful for the help I received.

I was hanging on by a thread when I was admitted to the MBU, and with open arms the unit allowed me to collapse and then taught me how to build myself up once more.  They protected me when I wasn’t able to look after myself, and encouraged me when I was ready to stand on my own two feet.

The staff at the MBU are some of kindest, gentlest and most patient people I have ever met. Psychiatric nurses must put up with a lot of bullshit. I know I must have been difficult at times – particularly when I was manic. But somehow they know when you need to cry, and when you need to be told to wipe your tears away and carry on. With a gentle authority they kept control, and managed to ensure I participated in activities and tasks that I didn’t want to do. I would look up, halfway through finishing my meal, then think indignantly “Hey! How did they get me to eat this? Oh well...tastes pretty good”.

We were patients, but we were human beings as well. The staff asked about our interests and shared their own. With the encouragement of the nurses I began baking. When I wasn’t able to go to the shops for ingredients, the nurses did it for me and they collected recipes for me to try out. A few of us patients started to knit, and suddenly more needles and patterns started to appear. In the evenings, like a strange eclectic family we watched TV, patients and nurses laughing and joking together.

I hold a very high regard for my doctor. She is a breath of fresh air from the traditional psychiatrist stereotype. She has always kept me involved in the decision making process for my treatment, and I trust her judgment implicitly. She is the type of person you feel comfortable with immediately, and I am very thankful that I am under her care.

The unit itself only has 8 beds. Eight. For the whole state. For the whole eight weeks I was there, there were very few vacancies. It is an extremely busy unit and highly sought after, and I am grateful that I was offered a spot. The alternative option would be a hospitalization in a general psychiatric ward, where they would have no facilities for baby, and a more limited understanding of the needs of new mothers. The mother and baby unit is the perfect therapeutic environment for vulnerable mothers.

The unit focuses on being family oriented, husbands were invited – even encouraged – to stay overnight as often as they would like. On the weekends the staff often organised family barbeques or dinners, where the staff and the patients who were well enough would cook. Steven came every single evening to see David and I, and occasionally stayed on weekends too. The staff made sure to include him in my treatment, and also check in with him and see how he was doing.

All in all I am very satisfied with my stay at the mother and baby unit. They showed me how to turn a corner, and helped me find myself again.

So from the bottom of my heart...Thank you.

The Wood and the Trees

Something strange happened the other night. I had had a lovely day lunching with my best friend. David was in bed and I was curled up on the couch watching TV with Steven. I was happy and content and relaxed. Bliss.

Then suddenly I started to feel like I was lying down on a wooden board. That’s the only way I can describe it. I shifted around and tried to get comfortable but everything just felt hard. I stood up and walked around but the horrible wood feeling followed me. The molecules in the air surrounding me seemed to turn into splinters and I felt a huge pressure, like I was being pushed into the ground. I started to feel like I was encased in a coffin of wood, and I started to panic.

Sounds crazy right?

 While it was happening I kept trying to explain to Steven what was going on, but he just couldn’t understand it. How could he?  I suppose that’s what being ‘crazy’ is like – having horrible things happen but no one being able to understand what you are experiencing.

He tried his best of course. Bless him. He told me there wasn’t any wood around me (“I KNOW there’s no wood, I just feel like there is!” I snapped back). He suggested that I ‘calm down’, which unfortunately had the opposite effect. “Would YOU be calm? If you were trapped in wood?!” I asked him. He didn’t have an answer for that one! Finally he asked if I wanted to go to hospital to which I vehemently declined. A Friday night at the hospital attempting to explain my plight to a physician really didn’t appeal to me.

In the end I took a few extra anti-psychotics and went to bed, willing the hardness to disappear. In the morning I woke up, minus any wood, but I was annoyed. It simply wasn’t fair. I had been taking my pills religiously, I had been keeping my stress down, I had had a damn good day, why would something like that happen?  What did happen? I mean, seriously....wood?! What the hell?!

My confidence was knocked. I thought I had been doing so well. This was just reminder that the blackness...the craziness...could come back at any time. “Hi Rachael! Remember me? Just popped into say ‘hi’ and remind you that I’m still here.”

But I guess it is naive to think that I have completely exorcised a part of myself that has been around for so long. Do I even want to do that? I don’t know. If I’m happy, but have a few crazy moments is that ok? Maybe.

It has been about six weeks since my discharge from the mother and baby unit. At the end of the day after what I went through before that, I think one slightly odd evening in six weeks is pretty damn good. It passed quickly, no one got hurt and it even makes me chuckle now.

I guess sometimes weird things happen, things you just can’t explain. But I’m not going to dwell on it, or analyse it, or worry about it. I’m still doing well. I’m still happy. I’m still laughing. I’m still me. And as strange as the experience was, now I can see the wood through the trees ;)

Onwards!

Yep! ;)