In early 2008 I had a near complete mental breakdown. Suffering with depression, anxiety, paranoia, obsessive compulsive disorder, along with other complications, I collapsed into an all-consuming, alternative reality consisting of more anguish than I thought it was possible to endure. I had no insight into what was going on and why. To most eyes, I’d just stopped taking my meds and relapsed, but there was more going on under the hood. I’d had years of mental illness, a disruptive life history as well as stopping my meds. I’d also split with my girlfriend and descended into a Hell I’d never got remotely close to before.
Some people say that a breakdown is the final admission that a way of life, a way of adapting to the world, has failed, and that this signals a time to make changes. To this way of thinking, my collapse was a blessing in disguise. No meds, no appreciation of the context of my condition, suspicious of everyone, no problem identified, so no solution available, I failed to see that I needed help urgently. I’d been in similar situations before, but this time the extremities of it all made it a new experience I was unprepared for. A blessing in disguise.
After deteriorating for some time, in April 2008, with my behaviour becoming increasingly bizarre, I was eventually given a Mental Health Act assessment. I failed and was put on a conventional psychiatric ward, but, when it became clear that I may be functioning, but in a world that was separate to the one everyone else was in, I was finally admitted to a psychiatric intensive care unit, which meant that I was officially one of the three illest people in my county. The frightening thing was that I was in an entirely different league to my fellow patients.
Many people have got a notion of paranoia where they believe that it’s just where you think people might be talking about you behind your back. It can go further than that. Much further. Your life can be taken over by it. It’s a 24/7 job. You work overtime, processing and reinterpreting all information, assessing and dismissing any evidence that conflicts with the new world you’re in, because it’s the world you’ve always been in – you just didn’t know it. In fact, there isn’t any conflicting evidence to save you, because any new information is swamped in the totalizing philosophy that’s flooded your brain.
In the ICU I saw a number of doctors, all of whom were deeply concerned for how far I’d gone. I was way out there. It was decided to put me on a drug newly-licensed for my condition, called Abilify, or Aripiprazole. This non-sedating, non-weight gain medication is an anti-psychotic and anti-manic agent. My condition means that when I get too elated, or high, I can lapse into psychosis, entering into delusional thinking. The theory would therefore go that if you regulate the mood, you’d cut out the psychosis.
I was put on a high dose. Too high a dose, we all agree now. Again, I had no idea what was going on, but my depression and anxiety plummeted to new lows. I could barely function at all now. The fear was incapacitating. The lows were life-threatening. But we continued with it. After a number of weeks I was transferred from the ICU to my local hospital and remained on Abilify. My paranoia continued, but it was decided that, to prevent institutionalisation I would be discharged.
Back in my flat, I deteriorated even further. This is when things got really tough. I finally, gradually, became aware that splitting with my girlfriend was what had triggered me off, but imagined that the solution was to get back with her. This lead to a painful reunion. Despite an ability picked up over the years to mask the excesses of my condition in times of crisis, she realised within minutes that there was something seriously wrong. Her reaction would change everything. It was barely noticeable, but her voice faltered in such a way that it was clear that she was intensely upset at the state I was in.
Abilify isn’t like most other medications. They dull your senses, whereas this opens you up to everything – every painful memory, every shameful experience. There’s a good chance that the life of someone with a diagnosis of bipolar was always heading that way. Implicated in that is a psycho-social history that hits you like a train when you’re no longer able to run or fight or deny it. It’s this, as much as the stated side-effects of Abilify, that can put some people off. Facing painful truths can seem to be too much, but it’s this very pain, this essential component in recovery, that starts you back on the right path to a life worth living.
If anything could make me angry, it was seeing my ex upset. I returned to my flat and remained there, effectively isolated by my mental state. She’d triggered off an attack on myself and a reassessment of everything. First off my paranoid thoughts about her behaviour came under scrutiny, then, once I realised how wrong I’d been, everything else was up for grabs. For about two weeks I sat in a state of shock rapidly replaying everything I’d experienced during my paranoia, bombarded by a multitude of memories, unable to comprehend how I could have been so wrong for so long. Peoples words, flowing back to me, now made sense. Events transformed, they became how they were. They made me see my behaviour as it appeared to people who could only see a man turning mad.
At the end of this re-evaluation, I was in psychological turmoil as I realised the extent of the problem. I was faced with a simple choice that I confronted without drama, practically. In a situation like that music or film is dead. All you’ve got are straight words. Live or die. Not even realising that this was part of my recovery, I thought I may never regain my sanity. I might not come back. Do I continue living, or give it a go? One more throw of the dice. I couldn’t return here again, but could I recover from this? Against the evidence I could see and my own gut instincts, I decided to give it a go, to live, and to try to find a way out of the mess I was in.
First off, I had to get some distance from the doctors. When I put this to them, and effectively became the lunatic who took over the asylum, for some reason, they decided to take the massive risk of backing off and letting me do my thing. I ordered some books and set about discovering how my different symptoms worked. It was helpful to read that what I’d been through was part of the human experience. Extreme, but still part of what a lot of people go through at certain crucial moments in their lives. I was not a biological or psychological freak. Then, it helped to understand the mechanics of the symptoms to find the problem so I could work on a solution – how symptoms work and how to overcome them.
Piece-by-piece, I dismantled the framework of my madness. First, regain clear thinking with the techniques of Cognitive Behavioural Therapy. Then, using other therapies, look at my life and figure out why I ended up with bipolar. For example, looking at my upbringing, my family, my friends, my thought processes. It was a process of self-awareness that was so insightful that I wondered how I could have functioned without really knowing much about myself. Know why you are who you are and what you do makes sense. It’s not that difficult to do, but so few people do this effectively. It’s a slow journey, but it pays off. I’m not completely out of the woods yet, but the progress I’ve made has been remarkable.
What about the future? I was heading towards becoming a revolving door patient. I’d go on meds, gain weight, get depressed, come off meds and relapse because the illness and its components were never directly addressed, but sedated out of consciousness, kept in the back of my mind for future relapses. What was different now was that I was learning the how and the what and the why. I was looking at my life in an historical, psycho-social context.
In the early stages of taking Abilify, the side effects can be horrific. You can’t sit still, you’re tired, you’re dizzy, you vomit, you have symptoms like you wouldn’t believe. This is where most people quit and run back to their former meds. A mistake, in my opinion, but a mistake the medics are learning from. I had to play around with my dose to get it right, again sending my team into panic, but eventually settling on the lowest therapeutic dose available, so that it curbed my excesses of mood without hitting me with the worst of the side effects. That, too, has worked in the long-run and is revolutionary considering the variety and quantity of meds I’ve been on in the past.
Knowing what I know now, I can easily say that most people should be able to look towards huge long-term improvements on this medication, and properly assess the concerns of people who never stuck it out because they were going on easy thinking about meds and their effects. Never expect to pop a pill and have life sort itself out. You have to be active in analysing your history and the psycho-social to make productive changes.
It can be difficult to break long-standing habits of thought and behaviour. This takes time. It doesn’t help, either, that people with conditions like bipolar are often faced with a social environment that is unwittingly detrimental to their health. It’s a society thing, where I’ve come across mental health professionals who are dangerously naïve in their approach to the diagnosed. The successful bipolar on Abilify has to take an holistic approach, looking at making changes in every aspect of their lives because the chances are that it was the life you led that brought you to the brink.
Today, I’m still in recovery, but the medics are very optimistic about the future. But to get here takes time and education. Bipolar can be an impatient condition: you want things to happen in the here and now. But substantial recovery takes time and effort and sometimes even pain. It’s not easy to take an objective look at who you are and remain as compassionate to and realistic about yourself as you need to be.
Society doesn’t often give the criticism to most people that it should. We can be intensely resistant to the kind of change that’s needed to get people as healthy as they can be. Sometimes it’s necessary, like with old thoughts and behaviours, to break off from some people. We’re all different and have different ways of relating to others. I’ve found that some of my closest friends were also some of the most damaging and limiting people in my life. They were part of the old me, since I’ve come to see for myself that they cling onto old ideas – bad ideas – simply because it’s all they know. But they are part of the problem because while you can change, the people around you usually don’t want to change along with you, or wouldn’t know how to if they tried. Sometimes it’s best all round to make painful short-term changes in the long-term interests of everyone.
Mental illness is essentially about bad ideas. For the diagnosed, there needs to be a reassessment of how we think about our conditions, our lives and our environment. We need to take a longer-term view of how we get back to being fully-functioning members of society. That’s implicates the general public, too, because if it’s ill-informed such a recovery is difficult, if not impossible.
We’re essentially now in an information age that is not serving us well enough. There needs to be improvements in the quality of information about the importance of personal history and the psycho-social. We need to improve how such knowledge reaches people and work on improving the public’s ability to use such data effectively.
Abilify is a good medication, but it’s only a pill. There are so many other things to consider and work on in recovery. Take it, by all means, but be prepared for a long, hard slog and a lot of work.
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