Finding the light

Hello friends,

I’m back. Sorry about missing the blog last week! I tried. I came up with one draft, then discovered it was totally over-dramatic and not what I wanted to say. I did another one, but when I read it back over it just didn’t really seem like much of anything! So, here I am with two discarded drafts, no post for last week, overdue for this week and next week is coming around fast! A bit frustrated!

Why am I so stuck? Why am I spinning my wheels? I want to write about suicide, but this time it’s real, somebody that I used to know. And despite however much distance you’d think “used to know” would put between me and this event, it has gotten under my skin.

For people who suffer with mental illness, hearing about another person’s experiences can be a trigger for a worsening of your own condition. We’re so susceptible to worsening when we’re unwell. It’s different when we’re doing well; we’re resilient and strong. This is especially true abut suicide. Talking about suicide, hearing about suicide, reading about suicide can be a trigger for someone who is unwell to start thinking in circles, over and over about suicide. That’s not to say that someone can cause another person’s suicide. But to a person on the edge metaphorically, it only takes a tiny bump to over-balance.

I’m not suicidal. I’ll clear that up now, and relieve any worried minds. I’m actually doing quite well, but this event has given me pause to think about not being well. It’s quite a long time since I have been suicidal. I have been very fortunate that suicidal thoughts have only been a small part of what I’ve experienced over the last 3 years. I tend towards grey days, nothing dramatic. But still, hearing about someone I’ve known, someone who was one of my first childhood friends, someone who I grew up with ending their life creates a moment of questioning of the situation and myself.

Of course there’re so many questions that come with any death by suicide. Thankfully in this case some of those were answered before the last day. The family were well aware of the mental illness and very supportive of their son, including providing a flexible workplace. Relationships were good, things had seemed to be going well. But there was no questioning why he died because the answer was clear: mental illness. Of course there was the question of could we have done more? But the answer is no: medications, counselling, support all given in full. Just an overwhelming sense of wishing it hadn’t ended this way this soon, but feeling that maybe it couldn’t have gone any other way.

Could something have stopped it happening that day? Yes. Would that have stopped it ever happening? No. Could we the long lost friends have done more, kept in touch? Yes. Would it have changed anything? No. Because it’s not about us, the friends and family. It’s about the mental illness battle ground in a person’s head. However much we love someone and want to help them, we can’t climb inside their head and fight the fight for them. We can only do what we can do from the outside.

Someone with mental illness has different questions that are all for themselves. This person had depression, I have depression; he ended his life, so where does that leave me? If it took xyz for my friend to take his life, what would it take for me to get to that point? They took their life this way, could I do that; if not, what would I do? It’s like being inactively suicidal and contemplating ideas and theoretical points of view, but you have no plan to carry them out; no active suicidality (the medical term for being suicidal). It’s like ruminating on whether I’ll get to go on holidays this year, and if I do where will I go, and what luggage will I need to pack? When patients are actively suicidal they will often have their will written, letters completed to their family, plans for handing over the business and literally will have signed themselves out of their life having hoarded enough poison, collected enough rope, built up the nerve to jump in front of the train etc. Then again sometimes it’s pure impulse on a background of ongoing suicidal thoughts that are just eating away at your will to live. A tipping point is reached, and that’s that.

So I’ve had a period of questioning myself: how am I? Am I doing okay? Are things still under control like they were before I heard the news? I run through my “on the edge” symptom check but there are no tell tales signs; maybe I’m a bit more shaky in my left hand, maybe I’m a touch more anxious, a bit more fixated on anything changing. But after giving myself a few days to take the impact of the news, attend the funeral and debrief, things are okay. I’ve gotten through a potential trigger okay.

Which is bully for me! For the family, the friends grieving now and for a good while to come, where is the light? Where are they to look to find something good out of this? One place that I’ve found comfort is to see the men and boys in my old friends life passing the okay sign around on Facebook in a campaign to vow to listen to each other, to talk about mental illness and suicide, and to try to prevent this from happening again. This has to be one of the best ways to commemorate a death by suicide; a pledge to fight it’s influence and talk about it openly.

I know that its difficult for people to talk about this awful thing that’s happening in their heads. And it’s hard for others to hear what they have to say about it! But we have to be brave; be strong and talk about it. Bringing it out into the daylight is the only way to make it less scary, and to take away its power over us. Talk, talk, talk, talk, talk. And remember the souls who couldn’t fight it’s power anymore. It wasn’t their fault, they didn’t mean it or even want it, but they were overpowered. Remember that. They were fighting the battle and lost, through no fault of their own. Remember them. Talk about them. Share their story. There is someone out there that you can help if you talk about suicide.

Check out Conversations Matter for videos, fact sheets and resources for talking about suicide.

Use one of the umpteen helpline services that are available in this country. You don’t have to have a mental illness to call. You can call to talk about a friend, someone you knew who died, or just to learn more about mental health. So many people are reluctant to call, so go ahead and buck the trend! Call! Ask questions, learn things, talk to someone on the end of the line anonymously before you talk to a friend. Whatever you do, do something to improve awareness of suicide and prevent it occurring again.

beyondblue 1300 22 4636

SANE 1800 18 7263

Lifeline 13 11 14 (crisis support and suicide prevention service)

Suicide Call Back Service 1300 659 467 (free service for people who are suicidal, caring for someone who is suicidal, bereaved by suicide)

Kids Help Line 1800 55 1800 (5 to 25 years old)

Victorian State Suicide Help Line 1300 651 251

Mensline 1300 78 9978

Veterans and veterans families counselling service 1800 011 046

Qlife 1800 184 527 (lesbian, gay, bisexual, transgender and intersex communities)

Carers Australia 1800 242 636

Many more helpful phone numbers and web sites can be found at Mental Health Commission’s Get help page

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The end

A medication order comes to the dispensary late in the day. It’s from the adult psychiatric ward, who only have an attending clinical pharmacist for half of the day, and a pager service for the rest of the day. Because the order is up to the 7th day and the bottom of the page is initialed by ward pharmacists from 3 different days that show they have reviewed the whole chart, it seems straight forward to supply with no need to page the busy ward pharmacist. Especially as the last initial was from the day prior. This shows me that all of the  work has been done to make sure the order is safe, appropriate, avoids their allergies, is monitored as necessary and is okay with all of the other medications. Not a lot of people see the work that pharmacists do to keep them safe while they’re in hospital, but those 2 letters at the bottom of the medication chart mean a great deal!

I go to dispense the medication in our software, and it comes up that the patient is in the oncology ward! Confusing, since the order clearly has the psych ward written on it. So I ask the oncology pharmacist and get a story like no other that I’ve heard yet!

This patient has met SCLC. That’s medical shorthand for advanced lung cancer that was possibly incurable from the the start, most likely caused by smoking, which has spread from the lungs throughout the body via the blood stream and deposited in the usual place that lung cancer goes to: the brain. Isn’t medical terminology amazing? 7 letters that tell me all of that!!

When a cancer spreads the medical term is that it metastasises. The cancer clumps that have spread away from the primary, or first discovered/diagnosed cancer are known as metastases, shortened to mets. This patient has brain mets. The cancer has spread from the lungs into the bloodstream and traveled around the body before settling in the brain and growing there. This is now a secondary cancer because it has come from the primary cancer. We can prove this by taking samples of both cancers; they will have the same histology or cell type, and the same structure and growth pattern. Each type of cancer has a typical pattern of where the mets will appear. Patients with lung cancer will be screened for brain mets. Breast cancer patients will be scanned for bone mets and etc.

I sometimes hear or read of people saying that a person has breast cancer and bone cancer and brain cancer, as though they were 3 different types. The odds of that are really absurb; it’s a once in a lifetime patient sort of odds. Much more likely, it’s breast cancer which has spread to the bone and then the brain. That’s nothing to do with the anything, just something that I’d like people to know.

SO getting back to the story! Our patient has advanced, likely to be life-ending lung cancer that has spread throughout the body and has established in the brain. At this point they cannot be cured of their cancer without very extensive surgery to remove the cancerous lung and brain tissue, and severe chemotherapy and radiation therapy…and even then it’s doubtful! And its a very high cost to pay, especially removing part or all of the lung/s and part of the brain!! Brain and lung surgery? And possible transplant to replace them? for no guarantee? It would be a very brave doctor to recommend that course of treament, unless the patient were very young and fit…which is unlikely given this cancer is caused by smoking.

So at this point we offer palliative care, or end-of-life care, or comfort care. Or try to.

Usually we try to get the patient back home with the appropriate supports of doctors visits to the home or at their usual clinic, nursing care in the home if the patient can’t do for themselves, plenty of medications and basically whatever it is that they’d most like to fill their final days or weeks or months with. If they can’t be sent home we at least give them a private room, unlimited family visits, their little dog/cat coming in, vases for flowers, unobtrusive nursing care and medications, comforting doctors rounds, limiting anything not fully essential like blood tests or blood pressure checks, and again, basically whatever they want that is feasible.

Once we had a wedding, in the patient’s garden around the side with the couples children and close family then day leave and permission for one alcoholic beverage. She died 3 days later at 40 something. Everyone cried about the wedding, either at it, or thinking about it, or seeing her come in from home in her wedding dress on oxygen holding her kids hands.

I’ve seen patients is deep distress changing completely when their little dog is brought in. They coo and talk to it, cuddle it, put their face next to it, and just relax so much. It’s such a tear jerking experience! The change in them, that peace, all that matters is they’ve seen their little dog and it’s going to be okay, and all is okay with the patient somehow.

But in this case, that isn’t going to be an option as such. In this unfortunate patient, the cancerous growth of the brain mets has set off a full blown psychosis! The pressure of  the extra growth onto the brain stretching the brain sac, the location of the mets pushing on certain areas of the brain, physical and chemical changes etc can cause different symptoms like confusion, delerium but I’ve never heard of this before. Think hallucinations, delusions, aggression and violence…such that the oncology ward wasn’t able to deal with the patient anymore and they’ve been sent to the psych ward! That’s not the place for comfort care, for a nice big room with flowers and family spending quality time at the end of life. Instead it’ll be sedation, anti-psychotics, possibly restraints, surrounded by other disturbed patients in an environment that’s hardly welcoming.

And that’s how little control we have over the end of our lives.

Medical conditions eventually get us all, one way or another. I think we should recognise that. We will all die of a medical condition, and can I add, or mental health condition. And we don’t have a lot of control over any of it!

Now it’s full psychosis as a result of lung cancer as a result of smoking.

It might be kidney failure and second daily dialysis as a result of diabetes as a result of a fatty diet.

It might be suicide as a result of desperation as a result of depression.

Where is the control?

So wouldn’t it be nice if we thought of them all the same?

I would love to live in a world where no one ever described death by suicide as selfish.

Because if we can call suicide selfish, what on earth would we call the death due to smoking or a bad diet?? We feel very emotional about the unfairness and randomness of cancer, but is that really in line with how we think about suicide? Depression can be very random and is never fair. It distresses us to see patients on dialysis and in the inevitable spiral to death that comes with kidney disease, but isn’t that just exactly how we could describe the progress of an unwell patient with insufficiently treated depression?

I’d prefer there be no blame on anyone.

As a fatty who is struggling to exercise and diet through her medication haze and bipolar up and down blips, am I really going to say I told you so to diabetes, high cholesterol, and all the consequences thereof, stroke, heart attack, high blood pressure, kidney failure to name a few?

As a depressive who has spent 3 years trying, trying, trying through all the low mood, low motivation, low energy, low self esteem, low interest, low care and everything that comes in that huge big black box, I certainly can never blame anyone who just couldn’t take it anymore, and doesn’t know how else to escape but through death.

The smoking one I’m still in debate with myself over. I guess because I’ve never smoked and I’ve never had to quit, I can much more easily see why it’s a bad idea. However, my judgement is reserved for those who didn’t know it was bad when they took up the habit. People who grew up in my era (can I call it an era yet?) know it’s bad, and took it up anywhere. But again, because my mind sees all angles, I realise that there could still be a lot of factors as to why they did take it up: parents who smoked, peer pressure left over from the 90s, depression/anxiety, and a bunch more. Point being, I don’t think you should smoke but I do know it can be incredibly hard to stop, just like the gym is something I should do and find hard to!

My aim for us all: let’s work together to realise that in the end, we quit, we exercise, we try, but that’s not a guarantee, just a higher likelihood of control.

 

Departure lounge

This week was always going to be a week of goodbyes.

After my sister’s wedding last week (photos to follow!!) my cousin, one of the bridesmaids, flew out to France for an open dated holiday in her favourite country on earth. Having been there before and having good French language skills, she is planning to spend this holiday off the beaten track. We’ll miss her at our weekly gathering point, Grandma’s fabulous Sunday lunch roast and dessert! More for us!

Then of course, my newlywed baby sister and her hubby are flying back to Latvia today! I say back because that’s where he was born and grew up. Their plan is to be there for 4 years because they are both planning to start and finish their undergraduate degrees there. So It’s a big goodbye!

I don’t think that any one of us has grasped it yet, especially Dad who wonders why everyone is asking him if he’s sad to see her go! Not much to wonder at, but he’s fixed himself in the mindset that its exciting and happy to see her marry her love and move off into their new life. We’ll see how long that lasts once she has actually gotten on the plane for 4 years!

Of course the two students may scrape together enough money to come back to Australia, and most of us are planning a visit at some point but it’s still a long time. Mum and Dad and her have been the only ones at home since my brother moved to Melbourne for uni 3.5 years ago, so I think they’ll really notice her absence around the house.

Then my teacher brother-in-law is flying to England for a year on Thursday! How’s that, sister and brother-in-law, plus brother-in-law, flying out in the same week! It makes more sense when you know that the school year starts on the 1st September across the UK and Europe. So for a teacher, and two students, it makes sense to move with a few weeks grace to get settled into accommodation etc. A year isn’t so bad, there’s an end point to look forward to. But it’s so hard to imagine his Mum and Dad without him. He’s also the youngest and it’s been the three of them since his older brother moved away to do his apprenticeship YEARS ago. Not sure how many, but it could be eight or so years. They’ll definitely be looking for him around the house!

So those are the scheduled departures. We’ve had the goodbye parties, given them advice, wished them farewell. Everything according to plan and tradition, and everyone has had their part in it.

I want to add one more departure to the list.

This was not a scheduled departure. There was no celebration beforehand where people got together with the person leaving and shook their hand and talked and laughed and got their fill of the person departing that would tide them over til they next met. No advice was given about the next step of the journey about to be traveled by the departing and how to traverse it.

I think that most people involved felt that this was a tragic departure, in the literary sense that tragic means inevitable.

I want to wish my own farewell to RT who departed his life this week. You know when someone starts a sentence and they haven’t finished yet, in fact they’re only in the middle but you know the end is going to be something you don’t like? That’s how I heard about it. There is no other way to hear it, other than someone telling you but the hearing of it is never easy.

Many months of a terrible depression preceded this departure, I heard. A mighty, mighty battle has taken place. That battle involved good friends doing their best, multiple inpatient psychiatric admissions, previous suicide attempts, medications, and more that I don’t know about.

In fact I don’t know this person, only in passing. I would recognise him on the street, we’ve maybe exchanged a dozen words in total in our lifetimes. Every year while I was growing up we would spend 3 Saturdays in October at a farm where our annual Christian convention was held, getting it all ready. Our family was always there, he and his wife were always there. They were the cool, young couple that girls growing up through their teens can admire. That was the full extent of “knowing” him.

But there is this phenomenon I’ve heard spoken about where people can experience grief for someone they don’t know, or have barely met, or celebrities etc that is disproportionate to their relationship with that person. Sometimes it can be as profound and take as emotional a toll as the death of a family member. Like when the news of Elvis having left the building descended on the world. Tears and sobbing from people who “knew” him from a concert, a tape, magazines. It’s valid.

I don’t think that’s what is happening here. I think what is happening is several months ago a mutual acquaintance described to me the suffering this person was experiencing as a result of depression. And it resonated with me very strongly because of my experience with depression. I had amazing support and all the help that I could possible require and there were days when I didn’t think I could survive.

As far as I heard, this person had no one at home, some friends around town and family nowhere near by. I could totally connect with his deep need for support and love and care, and the absence of these needs being met. No amount of psychiatric care can compensate for having a partner, family member, very close friend who “gets” you, who understands your suffering, who can be there for you to help you keep safe, who feeds you with love and care and hope, and reminds you again and again that you can fight this war to a victory and they will help you all the way.

His story just made me want to reach out and say, I feel for you, I’ve been where you’ve been and I know how awful and hard and dark and hopeless it is, and I want you to know that I came through and it is worth the fight. Or something like that.

That’s what I wanted to say. But after his wife left, his whole world crumbled, he had nothing to live for on this earth. Because I think kind honesty is the best way to support someone, I don’t know that I would have been able to say convincingly that it’s all worth it in the end, keep fighting, one day this will be all behind you and be a distant bad dream and you’ll be glad that you fought and won.

When you have nothing to live for on earth, it’s a very hard situation. I had everything to live for, and it was a hard, uphill, difficult road, and still may be in the future. But with nothing to live for, why would you try? Why would you fight for, scrabble for grip to, desperately cling to, and give your all to hang onto life? What for? Giving everything to hold onto life that doesn’t feel worth living, that holds searing pain, awful agony, sorrow, struggle, being alone, without love etc. All that terribly difficult effort while drowning in molasses, and what for? That’s what being suicidal is like.

And so he left us. It was inevitable. It’s sad, because nothing more could be done to hold him here on earth, because he couldn’t find enough to hold him to life. But I strongly feel that now he has peace and rest from so much awfulness. And how blissful will that peace and rest be, after so much difficulty on earth.

I have more thing to say. I believe in God, in Jesus, in eternal life. I’ll write about this point more one day. God’s commandments in the Old Testament were, thou shalt not kill. And I think that would have included ourselves. But the New Testament came in Jesus who has showed his great love and mercy. I believe that although we would want to help someone not to end their ow life, when someone is hurting so much that they can’t handle it anymore, Jesus understands and forgives. He knows what we have gone through and why we have reached such a point of desperation. He offers his help and grace in our lifetime, which is promised to be sufficient for us, but in our agony we can’t see much beyond our hurting self.

I feel that our mental health and our spiritual health are two disparate things. But they get confused. We don’t confuse our physical health with religion. We don’t expect our faith to help our gout. But our mental health has foggier borders. Our religion can be a help to us in all situations, but it’s not a cure for any illness, and depression isn’t a religious issue; it’s a medical issue.

I say this just to make the point that when someone we know hits the threshold of what they can possibly bear and can no longer suffer their daily life, let’s recognise that they have succumbed to a medical condition that was unable to be sufficiently treated with the medications and therapy that we have available these days. Let us never consider that their faith wasn’t enough, or they lost their religion, or they somehow should have found a way to survive. Suicide isn’t a comment on the sufferers ability, but the disease’s severity.

Farewell, fierce fighter. I recognise how much you fought, and I’m sorry that the disease was too strong for you. You will be missed. But I will remember your story. I won’t forget your bravery.

To all of you in this post, til we meet again.

Mania

[Written 20th October 2014, updated along the way, most recently 28th July 2015 ]

There’s a question that I’ve been trying to answer ever since I was first diagnosed with bipolar disorder and experienced the first obvious manic episode: how can I know when an episode of mania is coming on?

I have been working on answering this question for a while. Hence the start date for writing. It’s taken time, experience, reflection and I’m still not there yet. Here’s what I’ve got so far.

It’s not like people imagine. There’s no flash from the sky that strikes you down in the middle of your ordinary day changing you in an instant from deeply depressed to wildly happy.

There’s no sudden chemical reaction that causes an immediate switch from happy Harry to sad Sally. You won’t be mid conversation with me and I’ll sudden lash out with anger or anything dramatic like that. I promise. I also won’t suddenly slump into deep depression.

It’s much more subtle than that.

I have bipolar disorder type 2, or manic depression. As opposed to bipolar disorder type 1, or classic bipolar, which involves intense highs followed by agonizing lows.

In the six months or so before my diagnosis of bipolar, I would exist mostly in varying depths of depression with the odd dilly dally into sub-mania, or half strength, quarter strength mania. So sub-manic that I didn’t even know it was happening for the first few episodes! It was like a partial lessening of my depression, not very distinguishable from my usual depression. It certainly wasn’t the full mania thing; I didn’t get the happy, carefree, superhero mood to balance my sorrows. I actually noticed a worsening of my depression when the lighter mood ended rather than noticing a lightening of my depression. I felt that I was having cyclical worsening of my depression, whereas the mental health nurse in ED saw a recurring very weak mania.

Moods don’t change 50 times a day. I should know. When I was first provisionally (meaning this-is-what-we-think-it-is-but-we’ll-wait-to-see-before-we-commit-to-the-title) diagnosed with bipolar disorder I was in a phase called rapid cycling. As it kind of suggests, rapid cycling is where your mood cycles/changes rapidly! Pretty self explanatory.

What this meant for me literally was about once a week over three or four weeks I would descend into the big black pit from where I could see no possible exit other than stopping living in it. That’s what being suicidal is all about; utter hopelessness. It’s awful and very hard to bear.

But then I’d be a bit better again, and think, oh that wasn’t so bad. If it happens again I’ll definitely tell someone, but I’m okay now so it’s all good. Except that each time I went in it was worse! And worse, and worse until I was done with it! Luckily I had an appointment with my GP on the day I was done with it so that instead of being done, I went to hospital and you know the recovery story after that. Or if you don’t, it’s time to hit the archives!

So rapid cycling. Once a week, not once a day, 10 times a day or anything fantastical. That’s rapid cycling.

For the “regular” patient with bipolar 1…weird statement, I’m sure every one is different and there’s nothing regular about it!…mood changes might be more likely to occur every few months or even once or less per year. Maybe every few years once a person is medicated. But when they come, they can be a serious force to be reckoned with!

So my original question: how do you know when it’s coming?

I’m still not completely sure.

I’ve found that needing less sleep or unusually restless sleep, waking many times in the night and waking for good in the early morning hours is a sign of mania, which doesn’t rest, and wants to be on the move the whole time.

I usually have a couple of days of being more irritated/frustrated/annoyed about small things than usual. Ask my poor husband! I stub my toe and scream in full on rage at the pain and the stupidness of myself to do such a dumb, painful thing. I mess something up and totally lose it, raging at myself for my incompetence. I just can’t tolerate anything less than perfection in myself. I take a wrong turn in the car, get lost, run late and just burn up the road in furious outrage at my incapability to do anything right. I fumble my keys, my phone slips out of my fingers, 1 drop one of the 10 things I’m balancing in my arms while I walk blind down the stairs and write myself off as a useless, worthless human being! When actually I’m a regular human being possessed of a mood that makes me think I can do a lot more than I a) can or b) should.

At this point, the best way to end things and to not keep on getting worse and worse, is to go to bed and sleep. For however long it takes to wear off the mania.

It’s truly a strange disorder. In essence, this is what depression is, being upset and down on yourself, but this time instead of getting melancholy about being useless, I get mad, really mad! Not at you, don’t worry. The majority is forcefully muttering stupid, idiot, fool, dummy at myself under my breathe. The rest is taken out on my poor hubby, who tends to have a bad habit of laughing when I’m this mood and massively exaggerating the events of the day. Of course the more he laughs, the closer I get to bashing him with the rolling pin! Once the mood passes we laugh about it together, but at the time he makes me furious!!! Livid!!!

Then there is getting teary about silly things more than usual, although that can come with the depression cycle too. I’m naturally an easy crier, which goes against my attempt to be cool, calm and collected! I think I can see now that when these PMS-ish symptoms start, it’s time to take a breath and check what’s really going on. I say PMS-ish cause that’s how it kind of feels, although I maintain that I don’t get (much!) PMS…my husband prefers to not answer so who can tell?!?

Add some annoying heart palpitations which make me nervous about being anxious again and you have a pretty complete picture.

I suppose the more important question is, how do I know when I’m a bit manic? Easy! I have had some pretty perfect examples!

One day a while back, I woke up spontaneously at 5am without an alarm, feeling fully rested and completely ready to hit the floor running and get things moving! This from a famously unlover of mornings!
I had motivation, organisation, energy to boot and I’m full on into my job list!!! Check check check check check..what’s next???

All this despite being exhausted for the previous 4 days, not getting out of bed until 5pm one day a few days back and having a 4 hour “nap” two days before missing half of a family birthday! Whatever comes my way, today I’m all over it!
Before 8am I’d been for two laps around the park; most days I wouldn’t even be awake yet! And I never walk! I catch the bus/train/tram/friends car/taxi before I walk, except when Chester’s making an effort to get me out of the house and we do a slow stroll around the park…today I was striding! I was considering jogging! Today I’m on fire!

But I have to keep a careful check that I don’t get too cray-cray, too outgoing and chatty, too effervescent and bubble off the reservation! I don’t want to wander into the real manic territory of getting all spendy with the money I’m not earning, getting over confident with betting/gambling (not really a worry is my theory since I never do that anyway…), being over-enthusiastic/ambitious to the point of being a bit delusional or putting myself in dangerous situations that I think I can handle or just physically burning myself out being bouncy and happy and carefree and all over it!

The other classic manic thing is getting a bit over-affectionate…Chester won’t complain, as long as I keep it within the house!

And one perk: I’m so active, and busy PLUS I don’t get hungry as much and don’t wear out at all! So mania. Love it! Love it more when it stays more than a day or two but it’s usually pretty short lived. Love it the most when it isn’t followed by a big black lump of depression but that can be a common switch. In general, I’d prefer if I didn’t get depressed at all or manic at all. I love the energy of mania but it can also make me irritable, restless and impulsive and I start to get claustrophobic and nervous about all my typical old scary movie type phobias. And there’s nothing much I love about depression. So after an episode of sub-mania it’s back to the psychiatrist for a review and a new opinion of what to do next. I’m guessing there’s a lithium or valproate dose increase in the works…and that’s okay with me! Whatever it takes to get back to a comfortable holding pattern of “normal” moods. The aim is always for the lows to not be as low, and the highs not as high. Middle ground; that’s what we’re chasing. Here’s to it!

So, fortunately/unfortunately this has been the story of my bipolar. Fortunately I don’t get the massive mania with delusions, super hero thoughts and even hallucinations. Unfortunately my mood swings tend to be often, like weeks and months and they do throw me off balance each time. Despite what I’ve tried to learn about my mind and my body from my experience so far, and the fact that I know mood swings will come in spite of my meds, they still creep up and catch me unawares. And so far they do unfortunately seem to be getting bigger and more intense each time…but I won’t borrow trouble before it comes.

The last question is how can other people tell that I’m manic? My husband has some answers for that list! I may be a bit short with you, or seem a bit edgy and I will be less patient than usual. I’ll be more sociable than usual but it’ll be a bit fragile if things go wrong. I try to keep it together for everyone else but sometimes some sharp answers slip through my filter; I apologise in advance!

Swinging from the chandeliers

Sia. She is just amazing! I so admire her intelligence, cleverness, her ability to put her finger right on this issue and talk about un-talked about topics.

Like pageants. Like suicide.

“Chandelier”

Party girls don’t get hurt

Can’t feel anything, when will I learn
I push it down, push it downI’m the one “for a good time call”
Phone’s blowin’ up, ringin’ my doorbell
I feel the love, feel the love

1, 2, 3 1, 2, 3 drink
1, 2, 3 1, 2, 3 drink
1, 2, 3 1, 2, 3 drink

Throw ’em back, till I lose count

I’m gonna swing from the chandelier, from the chandelier
I’m gonna live like tomorrow doesn’t exist
Like it doesn’t exist
I’m gonna fly like a bird through the night, feel my tears as they dry
I’m gonna swing from the chandelier, from the chandelier

And I’m holding on for dear life, won’t look down won’t open my eyes
Keep my glass full until morning light, ’cause I’m just holding on for tonight
Help me, I’m holding on for dear life, won’t look down won’t open my eyes
Keep my glass full until morning light, ’cause I’m just holding on for tonight
On for tonight

Sun is up, I’m a mess
Gotta get out now, gotta run from this
Here comes the shame, here comes the shame

1, 2, 3 1, 2, 3 drink
1, 2, 3 1, 2, 3 drink
1, 2, 3 1, 2, 3 drink

Throw ’em back till I lose count

I’m gonna swing from the chandelier, from the chandelier
I’m gonna live like tomorrow doesn’t exist
Like it doesn’t exist
I’m gonna fly like a bird through the night, feel my tears as they dry
I’m gonna swing from the chandelier, from the chandelier

And I’m holding on for dear life, won’t look down won’t open my eyes
Keep my glass full until morning light, ’cause I’m just holding on for tonight
Help me, I’m holding on for dear life, won’t look down won’t open my eyes
Keep my glass full until morning light, ’cause I’m just holding on for tonight
On for tonight
On for tonight
‘Cause I’m just holding on for tonight
Oh I’m just holding on for tonight
On for tonight
On for tonight
‘Cause I’m just holding on for tonight
‘Cause I’m just holding on for tonight
Oh I’m just holding on for tonight
On for tonight
On for tonight

Holding on for dear life. Just holding on for tonight. Won’t look down, won’t open my eyes. I’m a mess. I’m gunna swing from the chandelier.
Sounds like desperation and suicide to me. I guess it could also sound less drastic; like she’s gunna get rip roaring drunk and swing from the chandelier metaphorically.
I don’t know which of these Sia intended.
All I know is every time this song comes on, I feel it right to the heart; the desperation that I had, the hopelessness that I had, the plans I was trying and failing to make to escape the pain and blackness and hopelessness
.
I don’t relive it; that would be awful and I’d never listen to it again, if that were possible which it probably isn’t. I just feel how strong those emotions were and feel glad that this talented chick understands it down to the nitty gritty detail and can write and sing something so passionately that resonates with all of me about my experience with desperation.
Unlike Sia I didn’t “one two three drink”. Mainly because I was brought up as an almost teetotaler and I just don’t have alcohol in the house, except cheap stuff for cooking. But the weirdest part of my experience with severe depression/mood swings was this intense craving that I got to buy a bottle of whatever and just skull the whole thing. Wine, brandy, anything strongish, my brain wasn’t picky.
Somewhere in humans there is this response to incredible stress to do whatever it takes to just get away and hide for a while. Sometimes going to bed and sleeping works. I guess sometimes getting blotto works; never tried it. But my body was desperately craving an escape and that was the method it chose. It was so strange to me. I’m a one glass for the night girl, if I ever drink which is rare. Why would I suddenly want to be a bottle an hour drinker?? I guess it all falls under the flight or fight. Somehow my brain knew that going to sleep or becoming unconscious from alcohol were ways to keep me alive a bit longer.
Did I ever succumb? No. Not even to a glass. Because I know myself, I’m already living with a chocolate habit that could be classed as an addiction, I’ve been a book and TV series addict and arguably still am, I know that I have difficulty saying no to food.
Basically I think that I have an addicitive personality. And I’m okay-ish with the slippery slope of food consumption, to a point, but not alcohol.
I’ve seen too many ruined lives due to alcohol addiction working in hospitals. And it’s not just the jobless and homeless, I’ve seen lawyers and people high up in powerful positions who have fallen victim to habits involving expensive scotch or champagne rather than rot-gut wine by the litre container. In the end, they all die the same way. Scarring and slow destruction of the liver causing serious bleeding, or slow poisoning of the body with its own by-products, as well as the accompanying incessant itch, delirium and long slow march on the inevitable path to death. This is a TERRIBLE way to die. Be warned.
So my upbringing, my history with liver cirrhosis patients, and sheer lifelong habit kept me from that. But you need something to help numb you for a while. There has to be an escape for however long. For me, chocolate or any food really and a good book, but then I couldn’t concentrate enough to read so it was anything video on replay, chocolate and a brief step out of life to recoup until I could live the next little bit.
Hold on for dear life, there is an alternate ending without swinging from the chandelier!!

Suicide *warning: the following material may be very disturbing*

Author’s note: I wrote this piece two weeks ago. Then while re-reading it prior to publishing I had some reservations. My personal editor (aka my husband) also had some reservations about how it would affect other people so we decided to wait a while and see if we really wanted to publish this.

I’ve decided that I do want to write publicly about this issue. I apologise if it is disturbing, or frightening, or confrontational, or triggers emotions that are hard to deal with.

I can write about this issue openly now that I am past these horror days and now that I feel reasonably confident that I won’t experience them again, at least nowhere near the depths that I did sink to before. Thanks to an antidepressant and two mood stabilisers, and a team of psychologist, psychiatrist, very accessible and caring GP, fabulous husband and great friends!!

But I do feel that the population of the world fortunate enough never to plunge to these awful depths should have some understanding of the suffering that is out and about in the world, walking around trying to contain their sorrow and hurt. My favourite saying comes to mind:

“Always be kind. Every person you meet is fighting a battle you know nothing about.”

lease PLEASE remember that however impossible it feels, severe depression can be survived. It doesn’t feel like but just ask for help and let someone in! Tell your partner, your friend, your family, your colleague, a local doctor or go to the local emergency department. Tell someone; don’t suffer alone!! You know the numbers:

Lifeline: 13 11 14

Suicide Callback Service: 1300 659 467

Men’s Line Australia: 1300 789 978

Kids Helpline: 1800 55 1800

Employee Assistance Program (employees of public hospitals): 1300 361 008

beyond blue: 1300 22 4636

Suicide Line (Victoria only): 1300 651 251

Suicide Prevention Foundation: 1300 465 366

So here we go!

Suicide. Death by one’s self.

We don’t talk about it enough.

It’s taboo. It’s avoided, ignored, swept out of sight.

There can be sense of shame about it. Some consider it selfish.

In some places and in some era’s it is and has been illegal.

Some insurance companies won’t pay out life insurance policies if a death is determined to be a suicide.

Yet, along the death spectrum a ways, people campaign for euthanasia, the right to kill oneself if life becomes physically unbearable.

What about when life becomes emotionally unbearable? Mentally unbearable? Somehow people never consider the rights of a person suffering in this way.

But this is a dreadful, terrible, awful way to suffer.

Why are we sympathetic to cancer patients with terminal illness suffering physical agony but don’t give the same thought to mentally ill people suffering emotional agony without relief?

And to some people there seems to be or is no end in sight; treatments that don’t work or take too much time to work, emotional turmoil with no relief, desperation. What then?

Personally, I don’t believe suicide is right. Morally, that is. I believe what the Bible says: thou shall not kill, including oneself.

But it was a whole different story when I found myself in the grips of severe depression and assailed with suicidal thoughts.

Suicidal wasn’t about self-harm and ending my life. Initially.

It was about feeling terribly awful in the midst of my perfect life, so awful that I didn’t know if I could survive, if I would ever feel good or well again and I just wanted a break!

It was about dragging myself through the motions every day and wondering if I would ever feel like every physical step wasn’t a tiresome chore. It was about emotionally forcing myself through the duties of the day, pasting a smile on my face and coping when I felt like crawling into bed and never coming out.

I wanted an escape, to step into a time warp that would take me out of my life for as long as it took for the depression to go away. Then I could just step back into my life and take off where I’d left off, minus the awful distress.

I wanted the escape, but didn’t know how to get it. I was on two antidepressants, an unusual combination and a bit risky. But that was what it took to get me feeling better and sleeping. To start with, but then I started having odd thoughts as my mood took a steep dive downwards, the first time I experienced what I would later find out was a mood swing.

What would happen if I just stepped out in front of the bus? If I just took one step out…

Would it hurt? Would I just die or would I be injured and gain nothing but more pain?

I’ve always been against the idea of committing suicide by using another person driving a vehicle. I’ve called it selfish. I’ve called it unfair and sympathised with train, bus, truck and car drivers used in this awful way.

Is this karma? To be wondering whether I would actually take that step? To be thinking not about the awfulness that the driver would experience, but to be wondering if I could be that person? Wondering if it would solve my problems? If it would just take everything away so I didn’t have to try to deal with it day by day by day.

I’ve always been nervous about people standing close to the edge at train stations. I’ve always been half-prepared to see something so awful that it would damage me for life.

But then nothing happened and this mental disease arrived, bit by bit. Maybe it was the anxiety in me the whole time, all these years worrying and thinking about such things.

This was my thought process, back then, before I went to hospital.

I could never jump in front of a train. I’ve read ‘Dear Miffy’ by John Marsden. I know what happens when a jump in front of a train is misjudged! I don’t want to be in a wheelchair or completely dependant on someone else.

I don’t think I would jump in front of a car; too small, more likely to end up alive and well with a couple of broken bones. So that’s out.

So that leaves a bus.

Or an overdose. But I know that the medications that I’m taking are relatively safe in overdose. They won’t kill me. I’ll maybe sleep for a while then wake up back where I started. With the added stigma of having tried to kill myself!

I don’t want that for me, but mostly I don’t want that for my husband. I don’t want to leave him with the bill, so to speak. He doesn’t deserve a life of questioning what went wrong, where could he have done something or done it differently, of blame. He doesn’t deserve any of that. No one deserves that. So I came to this: I can’t do any of those things. I have to keep on going, to keep trying, to keep fighting. Because I can’t do that to him. But it’s so hard!

Another day I got to thinking again: what if I just jumped off these rocks into the crash of waves breaking? Would it hurt? How long would it take? Would someone rescue me? Would it just be easy and instant?

What about sharps? One of my horrors is paper cuts to my eyelids, no idea why! But I’m always super careful around knives and I hate blades, which is why I now wax instead of shave; I’ve cut myself enough times as a total accident to give away shaving! And our knife set is new and super sharp, but I don’t think I could ever do that.

I don’t have a gun and I wouldn’t know what to do with it.

What about painkillers? I don’t have any above supermarket strength and I know they don’t work in overdose, it’s just long slow painful illness of liver failure that can take forever and is a terrible idea. Or bleeding, also slow and awful, not at all a solution.

I’m not great with heights, I just know I could never make myself jump.

So, all out of ideas.

And that’s how I came to be in my doctor’s office at midday on a Monday, bawling my eyes out.

The doctor asked me, have you had any suicidal thoughts? Yes, I sobbed.

Do you have a plan to harm yourself? No, because I can’t think of a way that would work! Sobbing harder and harder.

If I let you go, can you promise me that you won’t hurt yourself? I don’t know, I think so but I’m not sure, I feel so terrible! Sobbing, and sobbing, and sobbing!

A terrible, awful point for me in such despair and not even able to come up with a good way out. Still believing that it’s wrong, but needing so badly some relief! Just a few hours off, just a day of rest from the hurt and chaos in my mind!

Which I did get, later. I took a Valium on the way to the hospital, they gave me another one in the emergency department a few hours later. I slept then, for a few hours. That was just what I needed. But then I woke up and they wouldn’t keep me. As desperate and at the end of my rope as I was, they sent me home.

With 2 temazepam, double the usual dose of this sleeping pill. Which gave me another 8 hours of absence until I could come to terms with going on, dealing with a new day, another battle, keeping on keeping on. Until they could send members from the outpatient psychiatry team to visit and help me.

And then they started the long path to bring me back to today.

Starting new medications, changing doses, scrapping that one, starting another one, altering, fiddling, trying and failing and trying again in the long haul to now, a better day.

Today it is 77 days since I was in the emergency department of my local hospital (author’s note: written two weeks ago). Not the hospital I work at, another one near home. I could never have gone in that state to work and shown any of my colleagues the face under my usual coping face.

77 days. None of them spent working. All of them spent here at home. Making tiny steps of progress, going backward, coming forward, a couple steps one way, another few the other way, teetering backward and forward on the scale from deep depression to hypomania and somehow, at long last, feeling like I’ve settled in the middle around a place that I could call home, somewhere around about “normal”.

My husband in fact thinks maybe I’m better than “normal”. He sees now that maybe I’ve never been as good as I am now.

Sure I still get tired, and have the odd afternoon nap. But I’m more productive, I’m more energetic, I’m more engaged, I’m enjoying life, I’m driving a bit, I’m shopping a bit, I’m doing the dishes occasionally, the laundry sometimes, making the bed some days, hosting visitors rarely, doing day trips every now and then, actually living my life 🙂

We know there will still be days that are further toward one end of the scale or the other. The aim of all the treatment is to not go so far toward either end. My personal goal is to never ever in my whole entire life get anywhere near as deeply depressed as I have been. I don’t ever want to see the shape or colour of that place ever again!!

But we’re living life, and enjoying life! That’s something to be deeply grateful for every day. We’re alive, and relatively well, and life is good! Well, better anyway. That’s something.

I want to live life to the fullest. It’s a cliche, but that’s what I want. My aim is to enjoy every day that I can enjoy because depression is not ruling my life with it’s inability to enjoy pleasure, or it’s sadness, and hopelessness, and pointlessness.

Now ruling my life is just…life. Just life. Getting less complicated, more predictable, more fun! Yes, it takes an solid dose of antidepressant and a good going dose of two mood stabilisers/anti-psychotics. It takes weekly visits with my GP and psychologist, and fortnightly visit to my psychiatrist. It takes good doses of friends and hobbies and enjoyable activities. Who cares? What works, works and I have no argument against that!

Link: how to talk about suicide