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There has much much activity today on Twitter regarding mental health using the #whatsigma hashtag. I won’t go in to the whys and wherefores of the tag but basically the point of it is that you write your own mental health experiences and hashtag them for all to see. Of course, I joined in as I am always open about my past experiences:
I have bipolar II and had a nervous breakdown just over 4 years ago. #whatstigma
I thought it might be useful to write a little more about it as I firmly believe that the only way to get rid of the stigma surrounding mental ill-health is for more people to be open about their experiences and to stop being ashamed of it and then hopefully one day people will be less embarrassed by it and might seek help earlier? Rob Delaney has written a great article on his experiences and it has prompted me to do the same. I am very fortunate at the moment that I am mentally fairly healthy, though physically I am far from it. I am going to write about my past mental ill health and my current mental health but not my physical ill health as this is not the time or the place. This is quite a tome, so I’ve put in a page break thingy to break it up a bit.
Before I begin, I am not going to go into all of the details as some of them are things that I still keep very private, some of them involve other people and it would not be fair to write about them and some of them are just downright boring. Prior to my breakdown four years ago, I will admit that I never understood depression and thought it was “all in the mind” and was “just weakness” and that it was never something I’d ever suffer. I had experienced times when I had felt “down” in the past and I had assumed those to be something like depression however, I was very wrong. Depression hit me when I wasn’t in a state that I could physically or emotionally cope with it and happened very fast. To date, it has never come back, though I am now aware that I have bipolar II and I am much more aware and in touch with my emotions, moods and thoughts than I was prior to the winter of 2006. To that end, my breakdown had an overall very positive effect on me. That which does not kill us makes us stronger, some of the time.
“Nervous breakdown” isn’t a medically defined term. It’s something people say to mean a period of depression and anxiety or when “it all gets too much”. A nervous breakdown is what happened in Enid Blyton books when “Mummy has to go into hospital for a rest”. I don’t know a lot about how long they last or what the symptoms really are (in medical terms) but I knew exactly what was happening to me when it hit.
My breakdown happened in the middle of Kensington Palace Gardens in December 2006. It was a Tuesday, it was about 1pm and it was Denise van Outen who set it all off. There was no crying. There was no screaming. There was no running about and ranting like a madman. There was no writing on the walls in my own excrement and I didn’t think anyone was out to get me. I’d just had enough and couldn’t cope anymore. I didn’t want to kill myself - I have never wanted to do that at any point in my life. I have no idea what it feels like to feel suicidal.
The background to it is pretty boring and the usual story really - I’d had a stressful few months and had been physically quite ill. I don’t trust people easily - never have done my entire life. For me to trust someone and really open up to them takes a lot of time, though I’m getting better at it. For some reason I had put a lot of trust in someone around that time and found out in around the October kind of time that it had been a big mistake. They were not the person I thought they were and they were certainly not someone to trust. Since this, I have become very good at spotting manipulative people and have become much better at avoiding them. So this all left me feeling rather anxious and upset and ordinarily I would have just brushed this off, ploughed on with my work and distracted myself but for some reason, it wouldn’t go away. From the moment I woke up in the morning, I was immediately filled with unhelpful thoughts and constant cycles of anxiety and panic. As the days went on I found myself physically shaking walking down the street and having to leave the table when out for drinks with friends as I wanted to vomit.
I saw my (then) GP and asked for diazepam (Valium), which is an anti-anxiety drug and muscle relaxant that I was familiar with having been prescribed it before by my wonderful dentist who helped me to (partially) get over my dental phobia (that’s another story and maybe I will write about that too one day?). Diazepam is a very good anxiolytic - that literally means “that which releases anxiety” - but it also has a fair number of side effects (one being that it sends you to sleep - but that can be a great thing if you’re suffering from anxiety and can’t sleep at night) and, above and beyond anything else, it can be very addictive. My GP at the time was quite pro-active and sensible and gave me a script for 84 5mg diazepam tablets and I remember her very clearly telling me:
You have a choice now - you can either take 3 per day for 1 month or 1 per day for 3 months. That is entirely up to you and work it out based on how you feel but I am not giving you any more of them when this lot runs out as I don’t want you to take it long term.
So, off I went and took them 3 per day for a month and felt quite a bit better but still “not right”. I was off my food, I still felt uneasy in social situations and so I stopped going out and on top of all of this, my physical health had been quite seriously declining over the previous few months and I had been taking medication with some pretty nasty side-effects (namely anaemia and weeing blood, in my case). I just wanted to sleep for several months and wake up when it was all over. I didn’t want to die, I just wanted to get away from it all.
One thing I will say about diazepam is that it is very moreish. I managed not to get addicted to it but it’s easily done (Patti LuPone talks about her diazepam addiction in her autobiography - she had 9 months of withdrawal symptoms back in the late 70s after taking it for anxiety when she was playing the lead in Evita on Broadway). So anyway, I ran out of diazepam at the end of November and immediately felt anxious and on-edge all the time. Because I had these feelings of distrust springing from having my trust in someone broken, I started to lose faith in everyone and became quite paranoid. I was also quite aggressive and even more hot-headed than I normally was - I think in hindsight that this might’ve been diazepam withdrawal symptoms to some extent.
As my physical health declined further, it was arranged that I would have a round of treatment as a day case in London at the hospital that used to treat me as it was not a common procedure and few hospitals seemed to do it at that time. So off I went and booked my train tickets and planned to book-end it with some “me time” in London. At that time I’d only left London a year before and London still contained some of my closest and most trusted friends, so I was looking forward to seeing them too. These are the people I can phone at 3am and they’ll pick up. That close.
So, off I went to London and once it was all over and done with I had a few days in a hotel in Kensington as a Christmas pressie to myself. I don’t like staying with friends because I am so used to my own space and my own routine that I feel very awkward and I get scared that my keeping of weird hours might get in their way so I like hotels because I can do what I like. So, one afternoon I decided to walk up to Oxford Street for a bit of shopping and got myself an inanely big overpriced coffee for the walk and off I went, listening to music en route. For some reason, I was listening to the Denise van Outen version of Tell Me On A Sunday - I remember that much - but I don’t remember which song it was that set me off, but suddenly, I felt very, very anxious and on-edge but at the same time very much wanting to get out - I’m not sure what I wanted to get out of exactly but something. Not life per se - I didn’t want to die, but I did want to change my life massively - these were thoughts like “I want to quit what I’m doing and move somewhere new” etc. I don’t remember much else now but I do remember feeling in a way I’ve never felt before or since and just feeling so very strange and disconnected with the world and myself.
Having worked with students for many years, I’ve seen the signs of depression in other people and I can spot them a mile off. Could I see them in myself? Nope! Not at all - not until that afternoon in the park. I went into a bookshop soon after and looked in one of the For Dummies books on depression and there was some kind of checklist of symptoms and I could tick pretty much all of them. I called my GP and booked an appointment for the following week and then called one of my closest friends and went to some pub near Blackfriars Bridge and got shitfaced on Hoegaarden and talked until it closed. It was a weird kind of celebration in a way - I knew what was wrong, at long last - after a long period of feeling “wrong”, I knew what it was. There was physical pain too - mainly in my chest and also “butterflies” in my stomach - although not so much “butterflies” as “wasps” - it was pain, not excitement. My chest felt tight all of the time and I had headaches and a generally “I am about to get a cold” kind of feeling all of the time. It was horrible.
When I eventually got back home and saw my GP she did point out to me that one of the drugs I had been taking for the last few months can bring about mood changes and issues so that perhaps could explain why I reacted the way I did at that time. These were all scenarios I would “normally” have been able to deal with, after all. It was some time mid December that I made friends with The Little Green Pill - fluoxetine, aka Prozac. Love it or loathe it - it’s one of the oldest and most trusted SSRI antidepressants and worked very well for me. I started with 20mg per day and on the first day I came home from the lab at 5pm, went straight to bed and slept until morning! I had some very up-and-down times when I started taking it. I spent most of the Christmas holiday doing the following daily routine:
- Take Prozac. Get out of bed. Drag duvet to sofa.
- Drink gallons of tea, eat too many Maryland Chocolate Chip Cookies and watch as many movies as possible on DVD.
- When any of the above run out, go to Tesco or Fopp (remember them?!) and buy more supplies.
- Go back to bed.
I procured so many DVDs that month that the staff in Fopp knew me by name. Escaping into films helped me a lot but I put on a lot of weight from being so physically inactive and suffered several other side-effects (tiredness, mainly but also a raging sex-drive (though anorgasmic because of the drug, which I think only made the desire stronger), an extreme need for comfort food and drinks - I ate so much crap!). The new year came and with it, many resolutions. I re-arranged my flat, I put 2006 behind me and pressed on. I learnt that you must never miss a dose of an SSRI - it can put you back quite a long way and you feel like hammered shit. I used to wear a silver bracelet (from Monsoon back when they still did menswear!) and I used to put it on each morning when I’d taken the Little Green Pill to remind me that I’d taken it.
I ended up moving to 40mg Prozac within a few months as it stopped working but that dose worked well. I ended up taking it until January 2008 simply because you have to take it for 6 months after you feel well again and you need to stop taking it at a non-stressful time. The 6 months would have ended in September but I work in academia - September is the worst time of the year, so I waited until January. I didn’t needto take it after September but I could not have coped with all of the side-effects of coming off it at that time. To come off it, I used the drug in liquid format as it is easier to reduce the dose slowly using a syringe to measure 0.5mL smaller doses each day. The stuff tasted foul and I used to dissolve it in that cheap pre-mixed UHT strawberry milkshake every morning whilst still in bed to take the taste away. I used to call the liquid version “Prozac Junior”. The major issue I had with Prozac was that it took away my creativity and imagination and left me unable to have any ideas - as a scientist, that’s a very bad thing.
I have been mentally healthy ever since, though I now know I have bipolar II - the version called cyclothymia, which is what Stephen Fry has. I sometimes have a miserable few days and sometimes have a hyperactive few days when I get overexcited about things and sometimes do stupid things like spending £200 on books or clothes. I have never been medicated for this and I hope I never need to be. I can live with it now that I understand it and can recognise what is happening. I tried CBT (cognitive behavioural therapy, not cock-and-ball torture!) and it worked to some extent for me. I did it at home using a very good, NHS supported CBT website. I have never tried counselling. I don’t think talking about things would help me at all. My depression was partially due to my physical health declining, medication that buggered up my moods and then something that set off anxiety attacks which buggered up my serotonin levels, leading to depression. Why do I now have bipolar II? Did I always have it and not know? I don’t know and I don’t care - the simple fact is that I have it and I live with it and I have learnt to manage it, just as I manage my physical illnesses.
I firmly believe that depression is an illness just like any other. It is nothing to do with moods or feeling low - feeling low is a symptom of depression, but not necessarily the cause. I would like to see “clinical depression” re-named as something like “serotonin deficiency” or some such, since it is known that brain chemistry is altered during bouts of depression and things like hormone levels and medication and all manner of other things can set it off - none of which are directly to do with mood. I do feel that a lot of the social stigma of depression is because a lot of people don’t think it’s a “real” illness and that it’s just people being silly and coping badly. The brain is an organ, just like any other. A chemical imblance in any organ will set about some manner of disease or syndrome - I don’t know why the Daily Mail readers of this world seem to think that the brain cannot be a party to that and that imbalances in the brain causes things like epilepsy, not depression. I don’t like the term “mental illness”. It’s “illness” and doesn’t need a qualifier. You don’t say that a diabetic has a “pancreatic illness”, you say that they have an “illness”, if anything at all.
So, there you have it. This has been harder for me to write than I thought it would be. I might write more on this subject at a later stage, but that’s all for now - quite a lot actually. I’ve written so much that I doubt many folk will both to have gotten this far down but if you do, thank you for reading it. I hope you will understand that depression is a very real illness, I have had it and I am not ashamed of that. I have no qualms about talking about it really. People who have beaten cancer are proud and happy and are supported by their families and friends - I hope the day will come when those of us who have beaten depression can be so proud of ourselves and will really be able to say “What stigma?”.
I have now written a follow-up to this post. (20:47, 11th February 2011)
Editted: To remove a few typos - 21:38, Wed 2nd February 2011.
Editted: To remove some weird formatting anomalies - 00:57, Thu 3rd February 2011.
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