My Big Fat Bipolar Pregnancy- feat. the perinatal psychiatry team and The Fear

Mental illness isn’t the bogeyman.

I’ve been quite quiet here. It’s not as though I haven’t been trying.

See?

See?

Those drafts were mostly interrupted by bouts of exhaustion and blankness. I’d tried to write something funny and light, but it felt quite forced.

What’s prompting me to write today is the heartbreaking death of Charlotte Bevan and her four day old daughter, Zaani.  What’s known is that Charlotte had a history of mental health issues- namely schizophrenia and depression, according to her family- was severely sleep deprived and had stopped taking her medication as she wanted to breastfeed. She left the hospital in clinical slippers without a coat, her baby wrapped in a blanket.  They both died, in this freezing December, near the Clifton Suspension Bridge, a common suicide spot.

I’m not going to speculate. I’m not going to say that I recognised- viscerally- the hollowness in her eyes as she walked past a series of CCTV cameras. Nor wax, too much, about my own terror of visiting that lonely place.  I’m not going to pontificate on mental illness or womens’ agency, paternalistic attitudes or breastfeeding.  I’m not even going to post a screed on the woeful provision of perinatal mental health services in this country.

Hint: areas in the red have no perinatal mental health provision. I live in an orange bit.

Services and support which should be available everywhere- to every woman- who is pregnant or has given birth. I’m not going to talk about the senselessness of this when a woman’s risk of suicide is highest in the year postpartum. Nor that it’s any woman- not just a woman with a known history of mental illness.

So what I’m going to do instead is tell you- maybe selfishly- about my own experiences of being a pregnant woman with bipolar disorder, whose mother had postpartum psychosis, who is therefore under the perinatal mental health and considered a high risk pregnancy.  I’m going to explain how that feels for me, and about the kind of choices I’ve had to make.  I’m going to talk to you about what’s happened to me since I peed on the stick and found out I am expecting a son (not a daughter- that was a bit of surprise at the anomaly scan. I have grown a penis. Whole other blog in that and how I shamefully have far more gendered ideas than I thought I had).

One of the reasons I’ve kept my pregnancy related bibblings confined to my Twitter and Facebook is because this blog is, and always has been, a mental health blog.  And my mental health has governed my life for the past decade. Every major life event has been impacted in some way. I only got 7 GCSEs because I had a breakdown. I was then kicked out of college because I was a rambling, nonsensical whirl of mania. I moved to London in its midst. My father’s death was followed by my admission to hospital. A series of job losses, four years on benefits. I dropped out of my mental health nursing degree partly because I had become suicidally depressed. The good stuff, too. I won an award for a play based on this blog. Not me, and not my life, but my own fractured narrative of mental illness. I’ve had writing opportunities because I write about mental health in a way that people enjoy and relate to (thank you). But that’s all anyone has ever really been interested in about my writing. Or about me.

Here I am, pregnant. And it’s such an abstract thing, though increasingly less so over the weeks. 29 have passed- from a feeling, a line, a long stretch of sickness (which is also why I have been more comfortable with the microblogging of Twitter- constantly vomiting and general exhaustion doesn’t render you the most capable of stringing together a….se), to now experiencing flutters and rolls and bumps. It’s still so strange to me that this “being pregnant” will become, “giving birth” (argh!), to a newborn, a tiny little stranger, who will become my son, and I will become their mother. And they’ll have words, mannerisms, be a sovereign human being in their own right, have memories of me, and I’ll have memories of them. Hopefully one day we’ll talk about them together. And they’ll have a name.

And this is mine. It’s all mine.

It doesn’t belong to a doctor, it doesn’t belong to a CPN, a diagnosis, a theory, a plan, a pathology, a movement. It belongs to me, and to my husband, and to the people we love who are sharing in this with us.  Of course, it’s pregnancy, a highly medicalised event. It has its own language, it’s own pathology, its own plans. But they have been so reassuringly, wonderfully, vividly familiar to me. Here is a path my mother walked down. And you. And you. As disempowering as the experience can be, as lonely, as radicalising to my feminist ideas of myself as a woman and a female, it is ordinary.  It is so ordinary that when I vomited my breakfast in a yellow arc onto the black and white tiled floor of my local cafe, the women who worked there didn’t flinch. “It’s okay, we’ve been there, we remember what it’s like”. I felt part of some great tradition, and here was the initiation ceremony.

But Charlotte Bevan’s tragedy can’t help but make me think of my fear of the future.  I haven’t been the perfect pregnant woman by a long stretch. She is slim, she eats organic food (except eggs, cheese and raw fish), she doesn’t drink, nor smoke, nor get stressed. She does 30 minutes of gentle exercise a day (maybe yoga or pilates), she doesn’t dye her hair nor pet her cats.  She doesn’t take any medication, not even for one of the numerous headaches she’s likely to have. She does all this not just because she is told to, nor because she is “good”, but because she became a mother at the moment of conception. She’s the selfless mother, the ideal woman. She’s not a person but a habitat from when sperm meets egg.  That’s the perfect pregnant woman, and she’s still not perfect enough.

I am so far from that ideal that it’s hard not to feel like a failure already. I’m obese from years of psychiatric medications. It doesn’t matter that I have no weight related problems (as rigorous testing, hypotension and seemingly endless urine and blood samples will confirm). It was enough for me to be told, almost accusingly, that I WILL get gestational diabetes and pre eclampsia and that they’ll need to keep an eye on what I eat (which was pretty easy- just check the floor of the train at Tulse Hill station).  I smoked and drank, I drink more caffeine than recommended because for half of the day I am in a fugue from the antipsychotic medication I’m still taking. I get stressed and more than that, I have a diagnosis of mental illness, I am struggling to exercise due to exhaustion and I cuddle my two silly, wildly affectionate cats. I don’t feel like a mother yet, and I wonder when I will. I don’t think in terms of, “little angel”.  I didn’t undergo some sort of transformation as soon as I became pregnant. I still haven’t.

I have been reminded so frequently of my own imperfections as a woman that I have felt that my, “maternal habitus” is a cesspit. I have, at every stage, thought, “This is when I lose it”. Blighted ovum, then miscarriage and now I’m petrified of stillbirth, after that, it’ll be SIDS. So I’ve been afraid to bond with the little Bean in there, even though he’s growing wonderfully, booting away and, usual pregnancy niggles aside, I’ve had a pretty easy go of it.  The anxiety has at times been so bad that my psychiatrist has added a brand new diagnosis to my pregnancy notes- generalised anxiety disorder.  The anomaly scan was supposed to be a turning point, and it was.  It looked like they had a rare and serious birth defect called esophagal atresia. We spent the next few days, waiting for a rescan, in a fog of terror. My husband ran ahead from me as we returned from hospital to hide the little leopardprint coat we’d bought them and to put away the box of baby stuff that had been donated to us.  All our images of taking our baby home after the birth, the mundanity of feeding and changes, were replaced with immediate operations, long stays in the NICU and a possibility our baby would have a potentially life-ending chromosomal disorder. (The rescan was clear. Subsequent ones have been, too, but we still can’t relax).

As much as this does not belong to mental illness, mental illness does belong to me. I can’t, as much as I want to, separate that from the seismic physical and emotional changes I’m going through right now.  The problem with being in the mental health system for a long time is you’re told so many different things are wrong that eventually, you believe nothing is. And you can be a bit shocked when others don’t share that belief.  Initially, I resented their intrusion. Imagine what I would be writing if they didn’t exist in my area.

In the beginning

Due to the, “holy fuck, what is this, am I dying” nausea I experienced until 23 weeks, I knew i was pregnant pretty quickly. I got a positive test at 5 weeks. The first thing I was worried about was my medication- I had no idea if it was safe to take, but also no idea how I’d cope without it.  The first few weeks were the hardest emotionally. We’d just been told we were being evicted and had to find somewhere else to live. That stress coupled with the (happy) shock of being pregnant and the hormonal surge meant I spent the first month oscillating wildly. But it wasn’t really anything unusual- it was a reaction to the situation we were in and biological fuckery. (What is unusual for you? Write that shit down now. Give a copy to the people close to you).

I went to see my GP, who congratulated me, said she couldn’t definitely advise me on my medication and referred me to the perinatal psychiatry team.  She told me to continue to keep taking my medication, and so I did (and still do).  At the moment I’m only on Quetiapine, which is an antipsychotic.  She didn’t seem fatalistic or concerned, which cheered me up. I’ve written before about some of the fears I had about pregnancy. Mostly, they’ve been unfounded, but I’m still afraid. 

The perinatal psychiatry team

Midwife number 1

Risk, risk, risk. You have a high risk pregnancy.  No fancy home birth for you (fuck that, I want TEH DRUGS). Your BMI is over 30, you’ve smoked and you’re mental. The midwife took my history as I shrank into my chair. She wrote, “SLASHES ARMS SINCE AGE 14”, something which shocked me so much I asked her to correct it. It’s inaccurate- I haven’t self harmed in 5 years- and the word, “slash” is such an ugly, deforming word that I didn’t want associated with me, or my pregnancy. She apologised and changed it, saying she wanted me to be comfortable.

A few weeks later, wearing my Baby on Board badge with my sleeves rolled up in the sweltering heat on the tube, I saw people clock- with disgust- my scarred arms and the badge. And realised that I now have the rest of my and my child’s life with this. Flashes of bringing them to the swimming pool and being stared at. School gates. Grief.

Fuck ’em.

The perinatal nurse 

I had to give a different history to the perinatal nurse who came to visit me at home. This was the story of my life, told, lightheaded from nausea, in my garden. It was summer then, and we were just getting settled into our new flat. Robert was asleep upstairs after a nightshift.  I offered tea, which she refused.  She has that light, almost incredulous way of speaking that some mental health nurses do. I’m already familiar with them- I did a few days with the perinatal nurses when I was a student, and they seem altogether more gentle than their CMHT counterparts. She said, “Oh, what a lot you’ve been through. It’s no wonder you’re so anxious and worried about getting attached”. At this point, I was correcting people who said, “You’re having a baby!” with, “No, I’m pregnant. It’s different”.  I wasn’t really sure what to say to that. I know people mean well, but my life hasn’t been that bad and I don’t like it when people head-tilt (the IRL version of italics) or feel sorry for me.

She taught me some breathing exercises for panic attacks (my panic attacks abated somewhat for a while. Being so busy does that. They’ve returned a bit lately) which don’t seem to come close to controlling the death terrors I experience at night, and made an appointment with the psychiatrist for me.

Before she left, I felt like I needed to ask.

Will I be referred to social services?

Midwives can sometimes be a little cautious with women who have mental health issues, she admitted. But no, the midwife hadn’t made that call. “Are you planning to?” No, not at the moment. If we’re worried that you might need more help in coping then it’s something we can talk about.

I still haven’t been referred, though my psychiatrist admitted that when I called them (having to reschedule that first appointment as I didn’t receive the letter with the date), they had considered doing so.  But I am coping, and if I continue to, good. “Will they take my baby away if you call them?” No, that’s not what they’re there for. Sometimes, we can need a bit of practical support.  We want to keep you and baby together, not separate you. It’s usually better for both mum and baby to stay together. We’re here to support you in staying well.

While I’m glad I didn’t get an automatic referral, I know this may be partly due to my diagnosis. My perinatal psychiatrist believes that bipolar I disorder is the right diagnosis, and that’s what we’re working with. I tend (these days) to be okay for ages, then get kicked right up the hole with it. That’s where the, “risk” largely is- bipolar disorder has a high relapse rate during pregnancy, tricky management and is more likely than depression to lead to postpartum psychosis. My mum also experienced psychosis after birth, which kicks my risk up past 50%. So, it’s a pretty shit diagnosis to have during pregnancy. It does have an advantage- throwing medication at it can work quite well (as long as you aren’t stupid enough to throw just an antidepressant in there) Everyone’s different, but depression, mania and psychosis generally have quite obvious triggers, and well tested treatments.  It’s not more or less “real” than other mental health issues. There’s no, “real” one, really. We still don’t know what causes any of them, but some are viewed as more biologically based than others, and that makes them, if not easier, then more predictable to doctors..

Some women I know who are as functioning as I am, but who have a diagnosis of personality disorder, have been referred to social services.   This isn’t fair, and I think it’s partly to do with the stigma surrounding it, and partly because it might be viewed as less predictable than bipolar disorder. It could also simply be their trust, doctor and nothing to do with their diagnosis. I did actually have borderline personality disorder as a diagnosis in the past, but it hasn’t been one I’ve ever been treated for. I don’t believe I have it, nor does the perinatal mental health team, who noted it was historical, not a concern and that I seemed stable. I felt like an arse for being glad about this. It’s partly due to the fact that when it’s flashed up on the screen in the past, I’ve had a lot of irrelevant, tedious questioning about self harm (not in years) etc. You may as well be asking me about a decade-old leg break.

But these means that women who have been referred and monitored very closely might have a different story to me. I’ve been largely okay so far, but that’s the shitpantsingly scary thing about mental illness and particularly mental illness in pregnancy- it can descend with terrifying swiftness and brutality.

The mental health midwives

When I was referred to perinatal psychiatry, my care was transferred from the community midwives to a specialist team called the Brierley midwives. They’re 8 community midwives who specialise in two things:

1) Home births

2) Women who have a history of mental health issues

I felt pretty smug as half the yummy mummies in East Dulwich want the Brierley midwives and I got them automatically for being mental! Some perks of the job, eh.

They’re a small team, split in two. So I essentially have 4 midwives. I have my named midwife, my first port of call. Throughout my pregnancy, I’ll meet all the rest in the team of 4, so when I go into labour, the midwife won’t be a stranger to me. That’s pretty good and a relief for someone like me who has been struggling with anxiety and likes to know things in advance.

I have the normal midwife appointments with them, but can also have a few extra if I’m nervous. They’re not trained in the same way mental health nurses are. They’re more holistic in their approach, and take care of your emotional health as well as the health of the pregnancy. They’ve been great, and are always very keen to let me listen to that lovely little horsehoof heartbeat sound. They’re not hugely different from ordinary community midwives.

The perinatal psychiatrist

The perinatal psychiatry team are situated in the same hospital as the maternity unit. It’s a rather unpleasantly long walk down a thousand blindingly shiny corridors that seem to swim and shimmer to the exhausted, teary-from-vomiting eyes. The reception area has always been empty when I’ve arrived. There’s only about six seats and my burgeoning behind means I need two.

I’m instinctively, defensive around psychiatrists. I’ve worked with them professionally so I know they’re human beings. Mostly, they’re also compassionate human beings. As doctors, though, they are drawn to the mechanical and the explainable. It’s sometimes disturbing to feel you’re a puzzle to be solved rather than a human being, too. They have so much power over the lowly mental that it’s extremely hard to let your guard down.  This time was, at least, quite different from when I’ve seen psychiatrists attached to the CMHT. I hadn’t been summoned there like a naughty child to the headmaster’s office. I was well and there to take advantage of their support- conversely, it meant I was also a little resentful of having it forced upon me.

Alongside quite a few leaflets. I keep them in the living room for easy reading for us both. Got a spare minute with a cup of tea and want to terrify yourself?

Ta-da!

Ta-da!

Can I take psychiatric medication throughout pregnancy? Can I breastfeed?

When talking about medication, I told her that I’d tried to come off it numerous times but suffered such awful withdrawal (insomnia, itching, eventual quasi psychosis from sleep deprivation) that I’d always returned to it.  She frowned and said Quetiapine didn’t have any withdrawal symptoms. As I tried to elaborate, she picked up a copy of the BNF and began flicking through it to disprove me. That was a strike.

As fat as I am due to it (Quetiapine doesn’t cause weight gain, she said. Strike 2! Tell it to the people suing the company that makes it for their diabetes), it’s the one medication that has helped me stay sane, and largely because it means I can sleep. I am a natural insomniac and very prone to hypomania and hyperactivity because of it. Getting regular sleep has been the lynchpin. Although I went into the appointment to argue my case for coming off it, I was secretly hoping she’d tell me it was okay and I should stay on it, as the thought of going through withdrawal and insomnia was unbearable.

She did.  Quetiapine is a category C medication in pregnancy. It means risk can’t be ruled out, and it can’t be ruled out because it’s unethical to test on pregnant women.  Case studies so far indicate the risks are gestational diabetes and diabetes 2 (I have been tested twice for GD- I don’t have it and won’t be tested again) which can cause a high birthweight.  Confusingly, the consultant obstetrician (I get one of those due to being a high risk pregnancy), says it can cause low birth weight. So go figure.  There’s also evidence that it can cause slight respiratory problems after birth, sedation and babies may be a little behind developmentally for a few months, but catch up. Their APGAR score is generally 9 or 10, which is great.

These are all scary sounding things and I’m still scared of them. I do feel a sense of failure and wish I was, “normal” and didn’t take psychiatric medication. I think about how sedated and dopey I am and feel a huge sense of guilt for what it might be doing to my baby. And because there’s no long term studies, I also have no idea what it’s doing to their developing brain.

But. I have to try and put my faith in…something. Myself to keep well, which cannot be done by willpower alone and especially not now.  In the perinatal team.  As much as she initially rubbed me up the wrong way (I warmed to her a lot in subsequent appointments. It’s never easy to go in and tell your whole life story to a stranger), she is the consultant and I trust her opinion. Most importantly, I’m being closely monitored- and so will Bean when they’re born and afterwards.

So, breastfeeding.

Breastfeeding is great. Boobs make milk! How mad is that? You’ve had them your whole life and then, when you’re pregnant (or taking Risperidone), they inherit this magical superpower. MILK! It’s food! Holy shit!

But some women’s boobs don’t make milk. Some women find it too uncomfortable, painful or downright weird to breastfeed. Some can’t, some don’t want to, and that’s all fine. Because you know what else is great? Making our own choices about our own bodies. Breastfeeding is not the be all, end all, and the medical establishment- and frankly, other women- have a lot to answer for in downright shaming women about breastfeeding.

It’s better than formula in some ways (and not as good in others- formula has added vitamins our bodies don’t make, formula is very convenient too). It does help with things like shrinking your uterus back (ping!) and as for bonding, I don’t know. You can still do skin to skin contact with a bottle and bond that way. Breastfeeding doesn’t give you nor your baby immortality. But I can understand why women- even if you sort-of discount that intense societal and medical pressure- really want to breastfeed. I do. I want to do to it because I haven’t done it before and it’s a new experience. I want to do it for the benefits it does have.  I want to do it because it’s cheap and we’re skint. I want to do it because boobs, milk, weird.

The general blanket advice for women taking medication, particularly psychiatric ones, is don’t breastfeed. Please get a specialist opinion on this if you can. Some resources include Drugs in Breastmilk from the Breastfeeding Network.  If you know someone who is facing this question who isn’t getting good advice, try to help them find it. Because it’s a big one. Women are being encouraged- and deciding themselves out of pressure, desire, guilt, complex, personal reasons I would never want to judge or belittle in any way- to stop taking medications which are potentially keeping them safe and stable so that they can breastfeed. This is wrong. I don’t mean medically, I mean morally. Women should be encouraged to put their health first. Believe me, I understand that, especially when you’ve struggled with your mental health, you so want to do the, “right” thing, the, “natural” thing, the thing to bond and connect. But formula is not going to kill a baby, whereas a relapse could kill the mother. That’s as brutal as it gets, but it’s true.

I got specialist advice from my psychiatrist who says I can breastfeed. A very tiny concentration of the medication will be in the breastmilk. This study reports 0.1% of my dose and no adverse effects. I’m on the lowest dose of quetiapine I can get away with, but it’s likely that’s going to increase as it’s working less effectively as time goes on. So again there is a little risk with breastfeeding. I’ll be monitored (awful word) and if it’s having effects on the babe, then I’ll switch to formula. Will be upset and disappointed? Probably. But what I am repeating to myself, in my rational mind, is my health first.  I can’t look after my baby if I’m unwell.

The Birth Planning Meeting- making a mental health advance directive

I last saw my psychiatrist about 10 days ago.  I’m doing pretty well so we won’t have any more appointments individually, nor will I be seeing my perinatal nurse again unless I ask to. I will be seeing them on the 15th of December to have a birth planning meeting.

This is essentially where your whole “team” (including your future health visitor) gets together to talk about your birth plan and what you want to happen afterwards, especially if you become unwell.  As rationally as I’m writing this, as ticking-along as it’s been, that’s a possibility. What do I want to happen, what do I not want to happen? Would I be okay with an increase in antipsychotics, and if so, are there ones I don’t want to take? (This may largely be out of my hands if I do get sick, but my wishes will be taken into account).  We’ll also discuss treatment options should I get sick, such as the mother and baby unit. There will also be general discussion about labour, like with any woman.

I’ll know more about this when I actually attend it, but I feel quite reassured by it. Robert will be there too, and no doubt find it all quite bizarre.

What will be happening is that I will continue taking medication after the birth. And there is a huge concession here- it means my husband has to give up work when the baby’s born. You can imagine how financially shattering this will be, it’s maternity leave (I can only take 6 months at the very most, and that’s a huge struggle) on one salary. But he works nights exclusively, and hasn’t been able to find a day job. I work full time and want to return to work. The “team” agrees that although I’m likely to have sleep deprivation like any new parent, it is completely essential that I get as much sleep as possible to stay well, and this means Robert will have to stay at home with me and do nights with the baby so I can take my medication and sleep.  My doctor and midwife are pretty worried about me going back to work so soon, but I don’t really have a choice as we can’t afford otherwise. I only get 3 months maternity pay and have been saving up otherwise.

The Fear

When I got home from work tonight, I broke down crying for the first time in months. Despite all this planning and all this support, I am terrified of becoming unwell after the birth, terrified of it happening now, too. It does feel so frighteningly out of control, even after writing 5000 words as to how it isn’t. I feel like I don’t really have control over anything.

I am scared of how quickly women become ill after pregnancy and scared it’ll be me. Scared I won’t be able to ask for help, scared I’ll be beyond even recognising I need it. Scared Robert won’t be able to cope, scared of being alone (it is the loneliest place in the world), scared of not being able to care for my baby. Scared of being a failure. Scared of not being able to bond. Scared of feeling trapped, scared of what I’d do if I did.  Scared of the fact I have made the one irreversible decision of my life.  Scared of a lot of things a lot of women are scared of.  That spiky sea urchin in my brain is a saboteur and a liar and I make a conscious effort not to listen to them.

But having support does help. It does make a difference. I have a partner, which is support a lot of women don’t have. I have an understanding workplace, too. I have the perinatal team. I have these clear things in my head, here, and in my notes. It isn’t the quivering inarticulate terror of when I became pregnant. It isn’t the kind of fear and uncertainty I imagine many women who don’t have support feel. I don’t know what support Charlotte Bevan had. I hope her family have some support right now for what they’re going through.

All women need and deserve support when they’re pregnant and afterwards.  A check up at 6 weeks is not good enough. A questionnaire will not cut it when we are so ashamed of how we’re feeling and so afraid. Feel free to ask me anything here or on Twitter- ms_molly_vog. If you’re pregnant right now, or thinking about it, please reach out if you’re struggling. To someone- your GP, your midwife, a friend, even a forum or Twitter if you need to talk.  I apologise for you in advance if your GP or midwife are shit, if your mental health provision is shit. It’s not right, it’s not fair, and it’s not how it should be.

It’s 1am now. Tears largely dried. Time to sleep, if searing heartburn allows. I am feeding Bean a fine selection of curries when he’s 18. Sweet revenge. Night.

*bump*

*bump*

The last October snowfall in London was in 1934 so I celebrated with my camera, a cigarette, a can and a complete stranger

Which probably indicates something apocalyptic about climate change but I don’t care.

I’ve just had one of those lovely experiences that makes me grateful for both life and London.  I have a big smile on my face.

Firstly, I should say that thanks to your incredible generosity (see a previous post for what was going on), I paid my bills (two yesterday, two on Friday) and had enough left over to pay half (one half being Rob’s) of a second hand camera.  That felt a bit cheeky but it was £verylittlemoney.  I felt like I’d lost a limb when I lost my camera.  Well, a finger, maybe.  So thank you from the bottom of my granite pebble heart for helping me out. Things are settled and back on an even keel now.  My bills being sorted is such a load off my mind, I had really been panicking over it and eyeing up things to sell (my body, for example.  A packet of crisps and a some cigarettes, in all likelihood.  But I like crisps.  It’s a fair trade).  I was going to post that yesterday but wasn’t sure how to crowbar it in between zombies and Kerry Katona. Thank you too for understanding how uncomfortable it was for me to make that post and being very tactful. And everyone seems to love Dead Set, even amongst my contrary circle of friends I have yet to see a bad word about it.

Secondly, sorry for yet another off topic post.  After an extremely traumatic fortnight, I’ve really needed a break from the intensely analytical mentalist posts.   I have a lot to talk about on Thursday (The Reckoning, oh dear), so it’ll be back to business as usual.  I’m sure that you’ve, er, missed the posts about mental illness?  It must be dull…not reading about it?  Really, what’s the etiquette for mental health blogs?  When people feel better and spend their days flicking through books rather than streaking down the street in their flimsy underwear, do they apologise for it?  It’s a tricky medium.

It’s bitter winter here now, and I’d had my thick drapes shut all day, warming my hands on cigarettes and strong cups of tea.  Then Rob called, telling me it was snowing.  I opened my curtains, and there it was, fat flakes storming to the ground.  When it snows in London, due to the heat of pollution, it’s just farty, feathery little scraps that dissolve as soon as they touch solids.  But this was proper snow.

I threw my coat on, without any socks, pulled my hood up and tore downstairs with my camera swinging around my neck.  I live on the Holloway Road, possibly one of the least picturesque locations in London, but it was beautiful, the snow was swirling around the street lights and I must have looked slightly odd standing in the street, laughing my head off, with my arms outstretched at 10.30pm.  The insurance with actually being mad is that you never mind if someone stares at you, you’re used to it. People were shuffling by clutching umbrellas, and then a man wrapped in a tartan scarf walked past, spotted me and gave this great, big beaming smile, and we looked at each other and laughed with pleasure.  I love the fact that snow brings the child out in some people.  (I know that at twenty three I am technically a foetus.  I find new nubs of flesh every day). Some people sneer at it, but fuck ’em.

While I was snapping and giggling, a blonde girl appeared and commented on the brilliance of the rare London snow.  I’d never seen or met her before, but it turns out that she’s my neighbour and lives next door to me.  We chatted for a minute, introduced ourselves and then made the snap decision that we should go to Highbury Park.

We were both fagless, since we’d just leapt out of our flats in the spur of the moment (and the streets were pretty dead), so she ran indoors and grabbed some cigarettes, then reappeared with gloves for me (my hands looked like cuts of meat) and some cans of booze.  Then off we went, smoking our fags and swigging our beer, looking like tramps.

It was still snowing by the time we got there, and looked beautiful.  Highbury Park runs incognito behind the main road into Finsbury Park.  It’s lined with expensive looking houses that belong in a Richard Curtis film and black Victorian streetlamps.  The snow had settled on the grass and cars and a few footprints muddied the white asphalt.  Our hands were frozen as we clutched our beers but only one other person was around and we were alone the haze, and the park was untouched.  Only the heads of the blades of grass peeked out The snow had started to lessen and sleet, so we would be the only people to see it like this, carpetted and lovely.

I wrote my name on a car windscreen (childhood habits haven’t left me; I also valiantly attempted a three line cock) expecting the alarm to go off and for us to end up sprinting and sliding home.  It was so quiet, and everyone had their curtains shut.

We were freezing so had to turn back onto the main road with cars slooshing by.  It was a drizzle by then, with people hurrying home.  We had a victory cigarette, wiping wet hair out of our eyes.  By the time we reached our doors, it has almost stopped.  We said cheerio and hurried inside.

I’m glad I ran outside and played in the snow before it disappeared. It’ll be gone in an hour, and it might not snow again all winter.  And what a lovely way to meet your neighbours.  It’s made me really happy, even though I’m freezing and I’m using the cats as slippers.

Here’s some blurry, excitable, shaking hand photos.

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Photobucket - Video and Image Hosting

Photobucket - Video and Image Hosting

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My Review of The A-Z Guide To Good Mental Health: You Don’t Have to Be Famous to Have Manic Depression

…and other such delights are available in the new issues of “One in Four” magazine. 

One in Four fights stigma and exclusion by challenging negative images of people with mental health difficulty, dispelling myths and increasing understanding.

Go and look, it’s the Bran Flakes of publishing, full of good stuff!  

For those who cannot be bothered to click the above link (and shame on you), this is what I wrote (the edited version).  

Oh, what I didn’t mention is that it had a foreword by Stephen Fry.  So it has a forward by Stephen Fry.

When I was first diagnosed with manic depression, also known as bipolar disorder, my well-meaning psychiatrist adjusted his geography teacher cuffs and penned an extensive reading list that he hoped would help educate me about my condition. I found myself lost in Waterstones, too nervous to ask the shop assistant which book would be most helpful. I skimmed the titles, sidestepping at least five Madnesses ‘, a few Angels and, worst of all, How to Love Someone With Bipolar Disorder , as though people like me were an exotic subspecies who required our cages cleaning out every two days.   There was also the bafflingly titled How to Survive Bipolar Disorder: What You and Your Family Need To Know , a book crying out for a Protect and Survive style television marketing campaign.

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Libido

Cocks and boobs immortalised in tiny soaps.  I have no idea where I got these from.

It’s really embarrassing to admit to this, but…

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The Motherland

Hello.  I’ve returned from the Motherland.  How I wish it were the Fatherland.

Belfast was great.  It was lovely to have us (my siblings, anyway) all together for Orlaigh’s sixteenth, which I still refuse to believe has come to pass.  I spent not as much time as I would have liked to with my siblings since I also wanted to briefly catch up with my three remaining friends there.  On Friday, I nabbed free food at Paula’s work and spent the rest of the day watching rubbish TV with her (which always makes me happy) and playing with her black Tonkinese cat, imaginatively called “Cat”.  Given that my cats are called “Boy Cat” and “Girl Cat” (and Hobbes, who lives with Rob), you can see the poverty of original thought that exists in my family.

My little brother, Liam, was there before donning his rags (not so much “glad”, he’s a crusty punk with a pungent yet not unsettling aroma) and heading out.  I have never met someone who is so confident in his appearance as my little brother is.  He is, naturally, gorgeous, as are all my siblings.  He knows it, though, but it’s disarmingly charming rather than irritating.  He kept me up until five in the morning to show me photos of himself.  An actual quote from him was, “Stay out of that mirror, that mirror is all ME!” It was tongue in cheek, but only just. If I have Body Dysmorphic Disorder, my brother has some sort of inverse.

On Saturday I extracted myself from sleepiness in order to be a tourist in a warzone. I took my camera and my friend Stephen onto the Falls Road, my stomping ground when I was growing up, as I went to school there. The Falls Road is a working class, ostensibly left-wing Republican area, full of interesting political murals and daubings. My own politics- unsurprisingly, lie upon the far left, and I do correct those who refer to me as British, as I’m from Nationalist West Belfast and was raised with Republican ideology and the Irish language.

It felt quite strange taking photos of things that I used to see every day and think nothing of, but I always regret not doing so.  Here is an example; it’s one of the murals just past my school.

That mural depicts the Easter Rising (which is what Éirí Amach na Cásca translates to), and that building there is the GPO in Dublin, which was the site of the uprising against the British Army. It was unsuccessful, obviously, or else the “Troubles” would not have been.

For those interested in politics, murals, art, myself, Belfast and etc, I have uploaded a whole set of photographs that I took of murals, my old school grounds and my friend here at Flickr.  I am too tired at the moment but when I’m more awake I will write descriptions so you know what you’re looking at. For the extra nosey, I’ve uploaded two more sets- one of my sister’s birthday and one of photos of my old haunts in Belfast, featuring me holding some scones.  (I have been feeling especially hideous lately, but am putting these up for memory’s sake.  Please don’t poke the soft bits with sticks).

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Inside the Iron Maiden

I don’t like self pity.  Least of all my own.

“Bravery”, in terms of illness, is will. If you don’t challenge your own negative thoughts, you lose.  The trouble with depression is that you tend to keep the thoughts to yourself.  Positive thoughts don’t squeak through.  There is no challenge.  You swallow up whatever your mind is serving you.  You have no allies.

It’s a shock, for a second, in the room, with its large windows spilling light onto a bricked up garden incarcerating spindly, infant trees anorexic from lack of sun.   My head is almost between my knees I am so slumped.  I examine the detail of my shoes, count the hairs on my hands, anything to pull my thoughts elsewhere.  The chair is comfortable, the fabric is blue with scratches upon the arms.  And then there is a human voice slicing through the inhuman one-

“It controls you, but it’s not all of who you are.  You are more than this.”

faraway-

“The voice is wrong”.

Quietness, for a long time.

“I know that depression is difficult and you feel as though you’re a burden on other people.  But that’s not why they stay around…”

It feels almost like a dream-

“It’s because of who you are, all the good things about you, because they love you”-

My head rises, a millimetre.  I feel like I want to cry.

“There are no good things about me.  If you could see their faces.  How disappointed they look. They are so tired of me, and I am tired too.  My family, my friends, Rob.  They don’t know what to do.  I have put them through so much.  I hate myself.  I make their lives worse.  So what is the point? I don’t want to be this way anymore.  I hate talking about this.  I hate it”.

“Has anyone ever told you this?  Has Rob ever told you that you’re too much for him?  Why would he stay with you if he didn’t love you?-”

“He is depressed now, too.  And the others”-

I almost break into sobs as I force this sentence out.

“Are so ashamed of me.  I am so ashamed of me.  I am useless.  I could have been so much more than this.  I fucked up everything.  Everything people hoped for me. This never ends.  It never will end.  For the rest of my life.  I could get better for a few months.  Maybe a few years.  But it will happen again.  It always does and it is so easy. What is the point?  Why don’t people understand that saying, “You’ve got through this before?” is not comforting?  It is damning.  How many more times?  I’m twenty two years old.  How much longer?”

“You have so much to give to the world.  You are more than this.  It’s depression that is telling you that you’re not. It’s not true.  When you get through this-”

I smile, for a second.  But it’s not what she said that made me smile.  It’s what I was about to say.

“There’s a building opposite my flat.  It’s high, higher than the top flat in this building.  And I see it at night, the gates are often open with people coming in and out.  I could get to the roof.  In the night, I could climb up to the roof and jump off.  It wouldn’t work from my window, I’d just break something”.

This in monotone.  We make another appointment, soon.

I told her that I am afraid to die but that I still find the thought of suicide comforting.   I told her that I hated myself for that as Vicky’s suicide, Brendan’s suicide and my dad’s slow suicide are, to me, the most painful experiences of my life.  I am angry at them and for them.  Still, I think about it constantly.  I am under no illusions, I don’t think I am going to arrange myself beautifully on eiderdown with a bottle of pills and a tearstained poetry book.  I don’t go in for that kind of melodrama. It is just an end to something that feels completely unending.

I need to view my illness as a separate entity or else I could not cope.  If it is just me, then there is no fighting it because I will never be my own ally.   So there is “it”.

Sometimes I imagine that my ribs are made of steel and that inside is my heart in a dull metal box.  It is like being locked inside an Iron Maiden.

The placid, public face that gives no indication of what lurks inside.  If you move, it hurts.  If you shout, no-one can hear.  How long for you can withstand it, with your eyes shut, pretending to be somewhere else.  When you open them, blackness.

The thing that almost wrecks me with sadness is that I don’t think I am this person.  It is alright to say that this is not the entirety of who I am but it is the most obvious, most recognisable thing about me simply because it is always there, when many other things are not. Things that other people might say are fundamental to who I am (my sense of humour, for example) are simply not there a lot of the time.  Because the one big thing that chips away at me is.

I think I might be an optimist.  So many bad things have happened to me, in my life.  I have forgiven everybody.  I am angry at people rarely and even then it’s easy for me to stop being angry. When other people are sad, I am there with my freshly baked batch of upside.   I still love people who hurt me, I probably love people who don’t love me back.  But I don’t mind.  Love is always positive.  I am funny, I think.  I think I have interesting things to say.  I see things in a different way than most people.

Am.  Was.  Might not be.  Definitely not at the moment.

I miss the “upside” of my own illness.  At least before it went to rot there would be times, wonderful times, of wallowing in sunlight, intense, glorious joy. But I can’t have one, or the other. If I have one then I will have both. The “happiness” needs to be natural for the depression not to exist.  If I had the choice, none of this would ever have existed.  My basis for comparison would be a happy day, and a sad one.  There would be no illness, there would never have been.  I’d never have met my CPN, never have been in hospital, never have been kicked out of college, never wrecked my exams after being off for six months, never have been so psychotic and sick that people thought I was fictional.  I don’t deal with this with “bravery”.  I want it to never have existed in me.

I am just locked inside. It is difficult to articulate this without melodrama. It is not sepia with my moon-toned face peering from a dusty window. It is just flatline. Dull. Very dull.  Dull voices that float through paper and glass.  Dull lights.  Noticing blonde hair.  And not caring.

Therapy Assessment

Or, “One hour of me feeling defensive and being asked questions like, “Why do you use labels like manic depression”?

Because I have this treatable illness called “manic depression” and you were asking about it? I’m fairly well read when it comes to psychiatric diagnosis, mostly because I write this blog and like to be informed. Using the “label”of manic depression comes naturally to me, because I write about it so often. I also find the whole thing easier to understand and explain if I can use the bloody words that describe the illness. I hate this about psychiatry- I do my best living with this, but it does affect my life significantly. I don’t “let it”, I’m not weak, it just does because that’s what it does to me. Just because it affects me and I acknowledge that, it doesn’t mean that I define myself by it. I use the phrase, “I have manic depression” rather than, “I am manic depressive”. If I had another illness that significantly affected my life, nobody would call it a fucking label. People are always very suspicious if you know anything about psychiatry. I have the internet, a library and a curious mind- if I’d been diagnosed with any illness I’d have found out everything about it by now. It is how I make sense of it and deal with it. If it was still this faceless thing, like it was, it would be harder.

They also asked if I was showing them my scars. I wasn’t, I was fiddling with my bracelets because I was nervous.

I did talk about eating issues and body issues (which I find nigh on impossible talking about in the flesh- manic depression, fine, it’s almost my job to talk about that) but fucking hell, that was so traumatic and I feel completely shaken and tearful. I really didn’t expect for it to be so hard, and sitting there in front of two impassive faces was just fucking horrible.

They asked me what I wanted out of therapy. I told them Rob was worried about me, and I wanted to make an effort to try and sort out my eating and body issues as much for him as for myself. And because dysphoric mania is too easily triggered by antidepressants, I’d like some help in coping with depression since I can’t take medication for it. In short, just some help coping with things.

I just hated that whole hour and feel shaken by it. They were nice, it’s just so fucking hard to talk about that kind of stuff in front of strangers when you’re not absolutely pissed. Here’s why I prefer to write than to talk.

I’m repeating the experience next week.  Ah fuck.

At least I went, though! I was so nervous beforehand that I chainsmoked for two hours.

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