Mental Illness and Me
In 2010 I was diagnosed with Rapid Cycling Bipolar Disorder I. I had been experiencing extreme swings in mood as a result of this mental illness since I was thirteen. Since my early teens I have struggled with bulimia nervosa, anxiety disorder, panic disorder, and body dysmorphic disorder, but it wasn’t until I was twenty-five that it was diagnosed.
When I was finally diagnosed I thought I would at last have answers to so many questions that had plagued me for years. I thought I would finally be free of the hellish thoughts and feelings that plagued me. I quickly discovered, however, that mental illness does not work that way.
There is no pill to make it all go away, no anti-biotic, no magic bullet.
There are drug treatments, and I have tried some of these, but they are not entered into lightly. They have severe side effects that cause other, equally debilitating conditions, not least of which is obesity.
There was no magical fix for my problems. I had a diagnosis, I did not have a cure.
There is no cure.
There are treatment plans and ways of managing bipolar disorder—pharmaceutical, therapeutic, and lifestyle-related—but there is no cure.
Treatment & Information Wilderness
I realised very quickly that there was an alarming lack of information when it came to my condition. My GP knew next to nothing and made a few choice comments which, in their ignorance, made me worse. My first psychiatrist offered no help. He saw me every three months, spent five minutes asking how I was feeling and told me he’d see me in another three months.
He never made any suggests for how I could improve beyond the vague notion that I might try medication, and I wasn’t ready for that step—it took a lot to convince me that, as bad as I was at that point in my life, I had no other option.
I was initially refused therapy of any kind, despite asking repeatedly for one-to-one time with a psychiatrist (my sister is a clinical psychiatrist, I knew what I needed). Eventually I was granted a CPN (Community Psychiatric Nurse), whose advice was only marginally more useful than my GPs.
She regularly dismissed my feelings with the killer phrase, ‘But everyone feels down sometimes’.
There was precious little information on my condition available to me, and so I began to research it myself. I was alarmed by the lack of information readily available, even to a consummate researcher such as myself. Accounts were limited to clinical descriptions of symptoms and case studies, which told me how others with my condition had presented, how they had been treated, and—occasionally—what had and hadn’t worked. Although useful information, this only went so far. It answered a lot of questions I had about possible treatment plans, but it didn’t give me what I really needed: a means of understanding the root cause of my moods.
I was convinced that in order to learn to manage my condition, I really had to have a full understanding of what caused it, something that went beyond the pat ‘changes in brain chemistry’.
The only other resource available to me were memoirs and other first-hand accounts by fellow Bipolar Bear. Such accounts were predominantly by people focussing on how their condition had shaped their own lives, and the lives of their loved ones. I read extensively, books and journals and blogs and magazines… still I found no answer to the questions that repeatedly ran through me like a lightning bolts, all centring on a single word: Why?
Why did this start?
Why do I feel this way?
Why did I act like that?
Why have my friends abandoned me?
Why are people treating me differently?
And, perhaps the worst one, Why won’t it stop?
The Pen Is Mightier Than The Gourd
One day I put down the book on bipolar disorder I was reading and picked up a pen.
It’s the smartest thing I’ve ever done.
The day in question was particularly bad. I was locked in a severe depression, catastrophizing in the extreme, growing increasingly more anxious with every passing second. I was already short of breath, I knew a panic attack was imminent, I could feel it.
I knew I was headed for another blackout.
In that instant of ‘knowing’, I realised I knew far more about my condition than I had credited. I’d spent so long searching for answers from other people, I’d never stopped to look for the answers that lay within me.
I knew the warning signs for an impending anxiety attack. I knew when I was about to have a panic attack. I could tell when my mood was about to turn and I was headed for a crash and the horrors of depression that comes after it. What I didn’t know (back then) was when I was manic, or headed towards a manic episode. I was especially vulnerable to hypermania and hypersexuality, and had no conscious way of identifying—as it was happening—that this was the mood state I was in.
This was a huge problem, because if I didn’t know I was in a particular mood state, I couldn’t treat myself accordingly. Prior to my diagnosis, when I had no idea what was causing these swings in mood, I only had words and labels for the down times. I had been diagnosed repeatedly with depression since I was fifteen, I knew when I was depressed, I knew this was the reason I felt bad. I had also been through several traumas which has left me feeling extremely sad. There were reasons for all of the bad things. What I had no words for, what I had no reasons for, where the high times.
I was retrospectively aware of the fact that I sometimes went days and weeks without food or sleep. I was also aware of the fact that I could, at times, be completely out of control and, to use my own word, slutty. I blamed this on drinking too much due to being sad all the time—I believed, back then, that I drank to make myself feel better and the alcohol was what caused me to lose control.
I felt inordinately guilty for my actions when out of control. I still do, even now, even knowing the cause. My diagnosis gave me a means of better identifying what was happening to me. I came to understand that I wasn’t suffering from depression alone, it was far more complex. I began to pin down when I was having an episode of depression, compared to when I was having an anxiety attack, or panic attack, or when I was catastrophizing. I knew when I was having a relapse with my bulimia. What I was still lacking was any way of forewarning either myself or anyone else about the manic side of my disorder. This was one of the reasons for my research, as it was in large part the cause of so many of my questions– Why did I act like that? Why have my friends abandoned me? Why are people treating me differently? Are all questions stemming from manic behaviour.
That day, when I realised that I actually knew what I was feeling and why I was feeling it, and could in fact tick off a list of things I was currently experiencing—anxiety, panic, catastrophizing—it occurred to me that I might know far more than I realised.
It was simply a case of finding a way to retain what I knew.
One of the major problems with my manic episodes is that I tend not to remember them or anything that happened during them after the fact. This has caused me no end of trouble, for I have not only been out of control and upset people, but I’ve genuinely had absolutely no idea I’ve done it afterwards. They’re furious and/or upset with me and demand an explanation and/or apology, and I’ve been totally perplexed by their own behaviour and wondering why the hell they’re yelling at me when I’ve not done anything wrong.
Imagine you committed a murder, but during the process were struck on the head. The combination of the trauma of killing someone and a severe concussion causes you to have amnesia. You’ve killed someone, but you’ve absolutely no idea you’ve done it. People start asking questions, you’re arrested, the evidence mounts up, everyone is telling you that you’ve done this horrible thing and have to pay for it but all the while, you’re convinced the world has gone completely insane because, from your perspective, you’ve done absolutely nothing wrong.
You never killed anyone.
I’ve lost count of how many friends have grown tired of me because of this type of behaviour. They found it difficult enough to deal with the original incident, the ‘murder’, if you will, but they find my inability to take responsibility for me actions both insulting and frustrating.
I have grown much better at handling this now, thankfully, but back in 2010, when I’d only just been diagnosed and I first picked up that pen, I had nothing to help me identify when I was becoming manic, nothing to tell me how I felt when I was manic, because I did not recall it after the fact.
In picking up that pen, I changed everything. I did it out of a desire for there to be an account of it that made sense to me, more than anything. If I could write my feelings down, I would be able to read over what I had written later, when I was feeling better, and perhaps come to a greater understanding of my condition as a result.
Writing Is My Therapy
I certainly never expected the very act of writing to make me feel better, but it did.
I decided I would remember everything from that point on, even if I had to write down everything I did for the rest of my life. It was a good time to start, because I was fully aware that I was experiencing an episode, and knew what I wrote would be useful information. I’d never have begun the process while manic, for the other bitch of a thing about mania is that you’re always convinced you’re perfectly fine while in the throes. I wouldn’t have picked up the pen, for I’d have thought it pointless to write down what I was feeling when there was nothing abnormal about it. But I wasn’t manic that day. I was in a bad way and desperate for anything that might help. I began to write what I felt, as I felt it. By that I do not mean I simply wrote ‘I’m feeling anxious’. I wrote extensively, in prose so purple they could best be described as heliotrope.
On that first day, the effect of expressing my tumultuous feelings in written form was instant and profound. I had been severely catastrophizing and spiraling into a deeper and uncontrollable state of anxiety and panic. I was manifesting not only psychological symptoms but also severe physical symptoms, including nausea, dizziness, headache, dry mouth, shaking, what I refer to as ‘falling out of my head’—a kind of detached, out of body experience I often have when depressed—and the increasing feeling that I was about to black out.
Although I have loved writing since a very young age, it was a long time since I’d done it for pleasure at that point. Writing that day was not an attempt to do something I enjoyed as a means of boosting my mood, I was too far gone for that. It was a last ditch attempt to remember what this all felt like before I actually did black out; experience told me that once this happened I’d lose several hours of memory, and I was alone at the time so I had no way of knowing what would happen.
It is a very frightening experience, blacking out. To have entire chunks of your life you can’t account for. It is perhaps even more frightening to see it coming, to know it’s about to happen, that you’re about to lose all control over your body, and that you likely won’t get it back for a few hours.
I’ve self-harmed and attempted suicide and not remembered a thing after the fact when I’ve been in a state like this, so to say I was terrified of what I might do is an understatement. At the same time however, I welcomed the blackout, because it would put an end to what I was feeling. I would either be unconscious for a time, and wake up feeling considerably calmer, or I would – at the very least – not have to remember what was going to happen next.
I had never found a way to calm myself down when in a state like this, even once I had a diagnosis and knew what was happening. On those few occasions when people have witnessed me in this state, they have been utterly terrified and extremely confused, for obvious reasons.
So when I picked up that pen, and began to write, it was not in the hope of calming myself down, but rather in the hope of having a record of how I was feeling when such an attack occurred, so that I might find a way to prevent them at some point, in the future. With each word I wrote, however, I found it easier to breathe. It was as if I was channeling all that fear, all that emotion, all that anxiety and panic, into the words I placed on the page.
And once they were there, everything was somehow…safer.
I discussed the experience with my CPN and discovered that writing therapy is actually a ‘thing’ and it wasn’t just me—there was research into the clinical benefits of writing. I switched my research efforts from generic questions on bipolar disorder to writing therapy specifically, and how it could be used to treat my condition and (by extension) other mental illnesses.
Writing, much like art and music, can be used as a form of therapy.
I have since written extensively as a means of managing my condition. Sometimes I write with purpose—blogging, or works of fiction—at other times I still just sit and write what I feel. This takes many forms. It can be simple, it can be complex, it can read like fiction or it can read like the clinical notes a psychiatrist might take.
Writing calmed me. It soothed some of my anxieties. It gave me a means of pouring out all that pain, of putting it on the page, of writing it and re-writing it, crafting it until it finally made sense to me. Until I could finally comprehend what I was feeling, what had befallen to me, and what my diagnosis meant.
The product of all of that writing was a novel, Chasing Azrael. The characters that populate that novel are my pain incarnate. They are each emblematic of some aspect of myself, my mental illness, my past, my (then) present, but most of all, my pain.
I was in so much pain when I began writing. I will not say that it vanished in the effort and that I was magically cured by the time I finished the book, I wasn’t. The process of writing brought me some measure of peace and clarity. The process of getting an agent taught me even more. I discovered traditional publishers wouldn’t publish it unless I took the focus away from mental health and society’s attitudes to the mentally ill. At the time, unemployed and on Job Seekers Allowance, I thought nothing mattered more to me than getting a book deal. It was the Holy Grail, the answer to all my problems. But when it came right down to it, the thought of changing the book, of turning it into a ghost of itself, of taking away that core of pain, of contemplation concerning suicide, depression, bipolar disorder, and the mentally ill, was more than I could—or rather would—do.
I have found the most effective means of therapy is what I like to call Emblematic Exorcism.
I create a character. I make them the embodiment of a problem or emotion I am struggling to deal with. I let them deal with it for me. The character symbolises whatever issue I am struggling with, Andee for example, the protagonist in Chasing Azrael, is emblematic of my struggles with suicide. By guiding the character through their journey I exorcise from myself the issue I have been trying to deal with. Like a demon being cast from a teenage witch I rip it out of myself and force it into another vessel. It is not, however, simply a matter of creating an emblematic character, one must create a dynamic emblematic character. In literary parlance, the term dynamic refers to a character that undergoes a change of some description during the course of the story.
The person they are by the final page is not the same as the person they were in the opening line. They have faced down their demons, and won, and they are better for it.
This is the key to writing therapy, although it is not nearly as simply as I am making it sound in that brief description.
When I was first diagnosed I struggled coming to terms with what it meant to be bipolar, what it meant to be mentally ill. I struggled with the attitudes I faced from friends and family. I struggled, most of all, with the fact I was still very ill and often suicidal. I have attempted suicide several times in my life, but the last time, the worst time, was within a year of my diagnosis.
I knew I was ill, but I still had no idea what that meant. I still had no help. I still had no hope of it getting better.
This almost made it worse. Previously I had told myself repeatedly that I was overreacting, that I was being silly, that I wasn’t dealing with anything every other person on the planet didn’t have to contend with on a daily basis. They didn’t burn themselves. They didn’t try to end their own lives. Somehow knowing that it actually wasn’t my imagination, that there genuinely was something different about me, something chemical, something that I couldn’t control that was never going to go away, made everything worse. Yes, I had an answer, but it only posed more questions. And the worst part was, I could no longer think, ‘You’ll get over it’.
I had previously blamed most of my mood swings on being severely upset over certain events in my life. Anyone, I reasoned, would be upset having been through what I had. But time is a great healer, all I had to do was wait.
My diagnosis took that away from me.
I could wait an eternity, it wouldn’t change my brain.
There have been some dark, terrible times in my life, but that was by far the worst. I’ve never felt as ill as I did then, trapped in a prolonged period of endless depression that only seemed to deepen, no matter what I did. I felt lost, alone, confused, and utterly helpless.
This is Andee Tilbrook as she appears at the beginning of Chasing Azrael, a character born of all that pain and fear and helpless confusion. A character whose very core is the desire to end her own life.
When I was diagnosed I was lost. Writing saved me in a way that reading and research couldn’t, in part because there was not an account of mental illness that went into enough depth for me. I made a conscious choice: I would rather risk never getting that coveted book deal than change the book that had—quite literally, in my opinion—saved my life.
Writing is my therapy.