Every single day since I was first diagnosed (labelled, classified, boxed, categorised) in August 1979 I have taken some sort of medication for my condition, and sometimes a lot of it.
It’s a weird thing to get used to. When the stuff works well, you feel so good you don’t see why you should take it. Because you’re clearly fine, and you are prepared to fight anyone who tells you otherwise.
One of the many things about psychiatric medication is that not only does it work on only 50% of patients, is that they all have what’s called a “side-effect profile”. Sometimes you can be on a medication that seems to work very well, and you feel quite okay, except your mouth is always dry, and you have no saliva. Or which works well, but every time you stand up you get dizzy and nearly fall base over apex.
Or, if you’re on, say, lithium carbonate, which was my first psych medication way back when I was 16 and scared out of my mind, one of the things scaring you is that these big white tablets with the metallic aftertaste come with a requirement that you have quarterly blood-tests to monitor the level of the drug in your system, because it’s poisonous.
I was on lithium for a long time, years and years. It made my hands shake with a tremor so visible people would ask me if I was all right. And with that visible tremor comes a self-consciousness that makes you feel monstrous. That you’re a freak and a weirdo. Bad enough that you’ve been labelled “psychotic” (see previous post), but you are only too aware, all the time, that mental illness is not a cool thing to have wrong with you.
For one thing, it’s invisible. You “don’t look sick”. You look more or less fine. Someone else with a background in the world of mental illness might see the hand-tremor, the way your leg won’t stay still, the haunted and drawn look around your eyes, the way your pupils are either too wide open or too closed shut–that person will know who you really are. But to everyone else you’ll look okay, but perhaps you had a big night last night, eh?
Medication is a proper bastard of a thing, but better, in my opinion, than the alternative. And there are alternatives, especially these days. Medication, when it works, makes you feel more like yourself again. It might even make you feel like a better, upgraded version of yourself.
But for some people, it makes them feel blank or numb, or like they’re wrapped in cotton wool. It takes away all their feelings, not just the ones urging them to hurt themselves. For people in my line of work, the scribble caper, you hear of people worrying that medication will take away their way of writing, or distort their personality in such a way that their writing will be affected. Or, if they’re writing while taking medication, how much of what they produce is them, and how much is it the medication? People get extremely upset about this worry.
I’ve had six books published since 2004. I wrote all of them under the influence of medication. I also wrote another 15-20 books since I was about 18, all of which were terrible, again all under the influence of medication. I never worried too much about the drugs messing with my ability to write. For me, I could see that the drugs allowed me to write. They gave me enough clarity to use my creativity and artistic judgement so that I could, over time, improve my skills, such as they are.
I also know for a fact that mania and depression, distort not only your perceptions of the world around you, but also take away that sense of artistic judgement. Mania, in particular, provides boundless energy and excitement, and seems like the greatest, most amazing feeling ever, and you can write and write and write for days on end–
And it’s all crap. It’s just like when you have a really great dream full of brilliant ideas and insights, but when you wake up you realise it was all nonsense. The creative work you do under the influence of the illness (manic or depressed) is like those dreams, but you’re awake when it happens. Your artistic, critical faculties are simply not there. So you think all your ideas are fantastic and insightful. Not only that bit you’re funny, so funny! So funny, and for so long, that you wonder, idly, why people around are looking at you all uncomfortable and even a bit scared.
Some bipolar patients love the creativity burst that comes from the euphoria of mania and hypomania that they either refuse medication or they only take it sometimes. I have heard of people saying they simply can’t work while medicated. I’m not one of them, but I understand the point of view.
Other than medication there are other options for treatment. The one perhaps most commonly offered, usually in combination with medication, is the so-called “talking cure”, or meeting with either a doctor, psychologist or counsellor to discuss what’s going on in your life, your emotional state, and your troubles in general. Psychologists and counsellors also offer their clients much more time per visit than a typical psychiatrist can offer, which is good. The combination of medication and talk therapy can be highly effective, and I recommend it especially for people given to deep introspection and reflection, thinkers and artists of all kinds. Lately I’m seeing my psychiatrist each fortnight to discuss my medication regimen, and I see a clinical psychologist every two to three weeks for long talks about thoughts, feelings, memories. It was her suggestion that I try journalling like I’ve been doing.
Other unmedicated forms of treatment also include ECT (electro-convulsive therapy, which I’ve not tried), and a newfangled treatment “modality” called “rTMS”, or repetitive Transcranial Magnetic Stimulation. This latter I have tried, and am likely to be having another course of it soon (which I’ll report, if so). You sit in a chair that reminds you very powerfully of being at the dentist, and a machine on an articulated arm is positioned against the side of your head. The idea is that the machine produces an electromagnetic field which interacts with the electrical activity in parts of your brain, and brings about a therapeutic effect. You need up to 20 daily treatments, each one taking about half an hour. The experience is not unlike what a woodpecker attacking the side of your head might feel like. It’s loud, making a repetitive snapping or clicking sound, as each “train” of zaps occurs. It sounds unlikely, but this treatment has been shown to be effective for many patients, especially those for whom medication is not an option.
I don’t know how many medications I’ve tried in my life as a patient. First I was on lithium and a drug called Doxepin, but after several years the lithium seemed to have stopped working, and my doctor and I embarked on an epic search for a new combination of drugs (usually an antidepressant and a mood-stabiliser: this latter would prevent manic phases, while the antidepressant lessened the severity of depressive cycles). I tried all kinds of things over a long period. We worked systematically through the MIMS catalogue, trying to find something that would make me feel normal, while having the least intrusive effects. It was very much like what happened to me last year, only it took longer because I was an outpatient, so things couldn’t be rushed.
Because with these medications, it takes time to ease onto them, and further time to phase them out. If you start or stop suddenly you’ll be hit with diabolical side-effects. The point of putting me in hospital last year was to enable a faster approach to this than would be possible if I were an outpatient, since I would be in a safe, controlled environment with lots of support and staff monitoring how I was going. And yet, despite all this, it was hellish. First the full depressive cycle that was like a new full-scale breakdown just like the one from when I was a kid, then it turned out the new drug, Zyban, did nothing for me, leaving me still exposed in no-man’s-land while the doctors scrambled to find something else they could give me.
It took me a long time, when I was a kid, to adjust to taking medication every day, and especially on days when I felt fine. I didn’t understand the idea of “chronic illness”. That I would have good days and bad days. That you had to take the stuff, no matter what, to prevent hell-days.
Then one day I realised: it’s no different from diabetes. Diabetics take insulin every day to keep themselves going. People like me were the same. That did it. I stopped resisting at that point. The argument made sense.
The real problem is that bipolar and its related illnesses are physical illnesses, just like anything else, but they are known as “mental illnesses”. That qualifier makes them seem somehow less serious, less real, of less consequence than, say, diabetes. After all, “it’s all in your head”. But the fact is these are real, physical illnesses, as real as cancer, and in many cases as life-threatening as cancer.
One of the reasons I’m writing these posts is to help demystify the whole “psychiatric patient” thing. I’m a middle-aged man with a chronic illness. My medication is no different from what a diabetic would take. It’s a psychopharmaceutical walking stick. Imagine me gimping along with a walking stick. That’s me and how much I depend on my medication. It keeps me upright. Keeps me from falling over. And gives me a weapon, should I need it! 😉