Fresh out the nut house: reflections on my recent bipolar episodes in three British psychiatric wards

This year’s Good Friday, a Christian observance commemorating the crucifixion of Jesus Christ, fell on 30th March - also World Bipolar Day. While I was acutely aware of the former throughout my Catholic childhood, I hadn’t been as conscious of the latter until I was diagnosed with bipolar affective disorder last May. Almost a year since my diagnosis, I’d like to posit some reflections on my time in three different psychiatric wards in the UK. An exercise of catharsis and exposure, I'll discuss both the positives and negatives observed during my time in the system. 

What is bipolar disorder?

Bipolar affective disorder (also known as manic-depression) is a complex brain disorder causing problems with the way the brain regulates moods. It has been explained to me that the parts of the brain that usually control mood and behaviour are slightly out of kilter - kind of like a malfunctioning mood thermostat. Those with the illness experience debilitating mood swings between depression and mania that usually last several weeks or months. They are:

Low or 'depressive' feelings of intense depression and despair

High or 'manic' feelings of extreme happiness and elation

Mixed for example, depressed mood with the restlessness and overactivity of a manic episode

 

Bipolar disorder

There are two main types of bipolar disorder: type I and II. Type I, my diagnosis of bipolar disorder, is diagnosed if you have at least one episode of mania which has lasted longer than a week. The diagnosis for type II requires at least one episode of severe depression and symptoms of hypomania: a milder version of mania that lasts for a short period (usually a few days). Around one in ten people with bipolar disorder also experience rapid cycling, where you have more than four mood swings in a 12 month period. 

Everyone has variations in their mood, but in bipolar disorder these changes can be very distressing and have a big impact on your life.
— Mind

WARD ONE

It makes sense to begin with what is lovingly known in my family as ‘Mary Anne’s Funky Christmas Special’. In November 2016, I was admitted to Ward One while visiting my parents in Scotland. I had originally intended to come up from Sheffield for a couple of weeks to recuperate from my thorny PhD upgrade meeting, regroup with friends and family, and visit my gaggle of godkids, but by the end of the first week I had stopped functioning properly.

A month prior to this, my GP in Sheffield had changed the type of antidepressant I'd been taking for my obsessive-compulsive disorder (OCD), diagnosed when I was a teenager.  I had become increasingly concerned about the quality of my short-term memory for which I assumed the meds were responsible - I now know that it was my undiagnosed bipolar disorder causing the problems. Without any questioning, my GP wrote me a prescription for another antidepressant from a different group which I started taking immediately. I have been told by several medical professionals since that this was a very irresponsible move on the part of my GP and was the main cause for the onset of a severe episode of bipolar depression a month later. 

While I wasn't diagnosed with bipolar disorder until Ward Three, I now retrospectively know that I was experiencing a mixed depressive episode. None of the pleasant symptoms of mania were present but psychosis and dangerous impulsivity snuck their way through everything, body and mind, snapping me up and suspending me in still air, dangling over myself. I had a strong delusion that I was an abusive person coupled with an impulsive conviction that I must die immediately. This was fortified by starvation and sleep deprivation and my insight became progressively obscured. Mixed episodes are particularly challenging to manage as it can be harder to identify and communicate what you're feeling and the help you want. Those experiencing an episode of mixed depression may be more likely to act on suicidal thoughts and feelings due to the presence of risky behaviour, psychomotor agitation, and impulsivity. It appears contradictory if we think of manic symptoms such as euphoria paired with depression, but it makes more sense if you keep in mind that it's not as simple as a happy/sad divide; not all symptoms of mania are pleasant. 

Some common symptoms of bipolar depression and mania are listed below but it's important to note that this list isn't exhaustive and that each person with bipolar experiences the illness in a slightly different way. 

 
Symptoms of depression.jpg
 

If an episode of mania or depression becomes very severe, you may develop psychotic symptoms. Psychosis is when you perceive or interpret reality in a very different way from people around you. Delusions are false beliefs that nobody else shares and which you believe even if they're illogical or untrue. 

  • In a manic episode - these will tend to be grandiose beliefs about yourself - that you are on an important mission or that you have special powers and abilities.
  • In a depressive episode - that you are uniquely guilty, that you are worse than anybody else, or even that you don't exist.

As well as delusions, many people experience hallucinations in both manic and depressive states, where you hear, smell, feel or see something that isn't really there. Delusions and hallucinations can feel so real that you are unable to understand others' concerns about you. Many people with bipolar also experience a form of psychosis called disorganised thinking and speech where you may have racing thoughts. These are usually accompanied by flight of ideas, where your thoughts jump very quickly from idea to idea, making links other people can't see. You may also link words together because of the way they sound  rather than what they mean. This may make your speech sound jumbled and nonsensical to others, sometimes known as word salad

 
Symptoms of mania.jpg
 

I had been used to intrusive thoughts all my life from my OCD, and while repugnant and unwanted thoughts (or 'obsessions') plague the minds of those with the illness, a grain of sanity always remains intact, no matter how small and difficult to find. Throughout my teens and early twenties I’d received courses of cognitive-behavioural therapy (CBT) to challenge a range of disgusting thoughts, most of which began as "What if I'm a...?"
What if I'm a racist? What if I'm a paedophile? What if I've killed everyone in the world who died of lung cancer? What if I accidentally ran over someone in my sleep even though I don't have a car? 

These sorts of irrational thoughts are very common to those with OCD and the illness will often try to cruelly convince you that you are the thing(s) you hate the most. CBT had proved impressively beneficial when I was younger and I'd made significant progress throughout my twenties in managing my obsessions. The delusions of my Funky Christmas Special, however, were of a very different breed and couldn't be contained by the tools I'd cultivated in therapy.


My admission to Ward One was for the purposes of “keeping me safe”, a concept which, in my opinion, was largely contradicted within the psych ward walls. As I slumped into bed on my first night, one of the other women in my dorm told me that the ward had faced allegations of abuse a few years previously. I looked further into this case after my Christmas Special and learned that, in 2013, the mother of a former patient on the ward complained that her son had been restrained and forcibly treated, incurring an injury and transfer to the locked-ward Intensive Psychiatric Care Unit (IPCU). In February 2012, the young person was locked in a seclusion room through the night, with an untreated broken hand and no access to water or toilet facilities. Mother, Chrys Muirhead claims that "no nurses appeared in response to his shouting so he had to defecate on the floor of the cell, in the dark, light switch outside in the corridor". When they eventually appeared and saw what had happened, the three nurses held him "face down in his own excrement, rubbing his face in it", resulting in glandular infection, according to the activist. Muirhead also claims that her son was sexually assaulted. 

My initial concern with these horrors quickly dissolved in the microhorrors of the ward. The first morning I was woken by one of the other female patients in my dorm, holding my hand and shushing me gently. Night-terrors and sleep paralysis were common among many of the patients so she understood how to handle my screams as I tried to wriggle back into physical wakefulness. The nurses seemed indifferent to our screams of different flavours but, just as you learn to recognise the different meows of your cat, we were soon able to recognise the various types of cries in Ward One. The ones during the middle of the night were the worst. Waking up on the second morning wasn’t as comforting when a male nurse flung back my privacy curtain without any warning, aggressively shouting Bah Humbug! at me. I’d forgotten that it was nearing Christmas and while I usually welcome festivities with joy, I could only assume that the nurses’ choice to blast Christmas songs at full volume at 7am in a ward full of people requiring reduced stimuli wasn’t to provide us with festive warmth.   

It seemed that the primary job of the psychiatric nurses was to sit around a large formica table, drink Diet Coke and eat take-away. Meals and medications were distributed at set times but this wasn’t always straightforward. Shuffling up to the medication distribution counter on my first night, I was handed a little paper cup with pills which I was just about to swallow, before realising that they'd given me the wrong dose. The second night they told me that they'd run out. I watched others around me denied the medication they’d been prescribed by their psychiatrists to relieve distressing symptoms of their respective illnesses, such as hallucinations or severe anxiety. Whether or not this was because they’d run out, I don’t know, but I can confirm that I witnessed a female patient be told to “Go away” when she was pleading desperately with a nurse for her prescribed anxiety meds.


The first time the door was slammed in my face was perplexing. I was too ill to properly care or understand whether or not this was regular protocol on acute psychiatric wards. But after it repeatedly happened to myself and others, I got the message: there was not a culture of care here. My psychotic state had me believe that any malpractice coming my way was only a reflection of the hideous things I'd done, and harmfully perpetuated my delusion that I wasn’t ill; I was evil. After all, the reason the nurse slammed the door is because I asked for help. Surely that was evidence for my dogma that they’d got it wrong when admitting me to hospital – I wasn’t mad; I was bad. This delusion became particularly ossified in Ward One and subsequent door-slammings felt rightly deserved.

While I was lucky to receive regular visitors, others were not as fortunate and spent alldayeveryday without any meaningful social interaction. I remember fondly one woman whose family had abandoned her after she was admitted to the ward as they "didn't want the stigma". Her husband had died two years before she arrived at Ward One and she hadn’t left the house since his death due to extreme anxiety. Learning that she had been on the ward for several months, I asked her whether she’d been offered any therapy.
“What’s that?” she responded, with complete sincerity.

Another woman, one of the youngest on the ward, came to me bright-eyed one afternoon with the exciting news that her mum was on her way up from England to visit her. A few hours later, however, I saw her again with crimson cheeks and a bellyfull of frustration and hurt. She told me that the staff denied her mum's visit. When I asked what reason they gave, she simply said "none". I'm not exactly sure what happened but whatever it was seemed inconsistent with their general approach of indifference towards visiting policy, based on the absence of a visitors' book and checks for contraband. While enormously grateful for the number of visitors I received, I wasn't too thrilled one afternoon when an unwanted visitor managed to enter the ward and find me.


The solidarity among the patients was remarkable. One of the women in my dorm came to me one evening to ask if I wanted to start a revolution with her. She was upset because she'd overheard one of the nurses refer to us as "One Flew Over the Cuckoo's Nest". Asking what kind of revolution she had in mind, she argued that smoking cigarettes in the bathroom would probably be the best start. This was a minor act of rebellion but it felt like a lot when the only access to fresh air we had was a small, gated smoking area attached to the dining room. One of the male patients used to put out seed in the centre of the area so that birds would fly over the gate, into our capricious orbit. They'd always fly away again shortly after they'd had their fill but had us held in shared silence whenever they reappeared. 

This unity continues beyond the ward walls and former patients have continued to campaign for better treatment. Muirhead, for example, has campaigned relentlessly via blog posts and complaints to NHS Fife, Fife Council, Scottish Government, MSPs, Mental Welfare Commission, Scottish Human Rights Commission, and Scottish Public Services Ombudsman (SPSO). In 2014, Muirhead won an Ombudsman complaint and received a written apology from Fife Health Board. 

I supported family members in and out of the psychiatric system, from 1970 in every decade until the present day, believing in mental health recovery. And survived psychoses and coercive drug treatment, in 1978, 1984 and 2002.
— Chrys Muirhead

An unwaged carer, Muirhead says her plans for 2018 include continuing to research and evidence safe houses for psychosis as alternatives to psychiatric inpatient treatment for people in mental distress. Muirhead also drew up an internal redesign of Ward One following her experiences as a patient in the ward. I hope to catch up with her soon to learn how the plans are progressing. 

 

Internal redesign of Ward One, by Chrys Muirhead

 

If I'm exposing the malpractice of Ward One, I also have the responsibility to acknowledge its positive aspects. I remember one nurse who was kind and helped me to sleep. The cleaners talked to us with gentleness as they emptied the bins in the female dorm. But that's about all I can recall. Any strength or sustenance I received inside Ward One came from fellow lunatics.


Three days after I was admitted to Ward One, I finally met my psychiatrist. My dad and I both agreed that it would be harmful for me to stay there any longer and relayed this to him when we met. After describing the malpractice I'd witnessed, the psychiatrist appeared shocked that this sort of praxis existed in the ward. He said that he was sorry and surprised to hear this, and that he'd flag it up with the ward manager. I intend to follow this up soon to see whether this complaint was indeed handled. My fingers are crossed as I liked this psychiatrist - he seemed well-intentioned. I was discharged with a prescription of my old anti-depressants as well as an anti-psychotic to calm the intensity of disturbing thoughts and anxiety.

My mum was down in England for work at the time so it was just my dad and me in the house and neither had a clue what was happening. The old meds had worked well for past obsessions and I was waiting with hunger for them to kick in. While the atmosphere at home was more comfortable, I became progressively unwell and reality became more distorted. My dad, who had taken time off work to look after me, tried unremittingly to still my distress but, despite his ardent efforts, I wasn't picking up. Thinking a change of scenery might help, he drove me down to Dumfries to visit my grandparents. My mum met us there and my parents did their best to console me in my psychotic state but I squirmed deeper into an untappable space. At this point, my Dad phoned his psychiatrist friend who thought, from my dad's description, that it sounded like there was something else other than my OCD going on. When my dad relayed this to me, I was adamant that I wasn't unwell and that this pain was punishment for being an abusive person. An abusive person who needed to die immediately. Locked into the disturbing grip of a mixed depressive episode, my mammoth sense of guilt was accompanied with a raw impulsivity which meant that I couldn’t be left alone. A few hours after arriving in Dumfries I was admitted to my second psych ward under 24-hour watch.


WARD TWO

My first impressions of the ward were much better than those of Ward One. Opened in 2012, it was a fairly new building with a more homely feel than I expected, and each patient had their own ensuite bedroom. The first few days of my stay there were packed with professionalism and care. Each patient had their own assigned nurse for the day so there was a marked improvement in staff-patient interaction from the first ward. Being on 24-hour watch provided respite to my family and they were encouraged by the conduct and warmth of the nurses. The morning after I was admitted, I had a brief consultation with a kind and approachable psychiatrist with a comforting Scandinavian lilt. He took me off the antipsychotic (apparently the dose they’d put me on in Ward One was too low to have any effect), increased my dose of antidepressants, and continued my prescription for sedation. The first few days on Ward Two were close to what I now know I needed: regular sedation to get me through the "crisis period", and a "break" from everything while I regained some strength.

The problems arose when they assigned me a different psychiatrist. By the time I had met Dr X., I had been given effective sedation and was much more comprehensible and communicative than when I first arrived. In laughably sweet conjunction with my worsening delusion that I'm not ill; I'm evil, Dr X. told me that she didn’t think I was ill enough to be in hospital, and that if I really wanted to kill myself, I would have done it by now. If this is a particular psychological tool used by psychiatrists, I'm not sure, but my unstable state of mind took it to mean "She’s right. I deserve to die, I’m not dead yet, so it has to be done now". Dr X. increased my dose of antidepressants, took me off 24-hour watch and all sedation: a most lethal mix to someone with undiagnosed bipolar disorder. I returned to my room with a chemically-distressed brain and a top class line from a professional, perfect for flirting with my psychotic state and dangerous impulsivity. 

After a week of being on Ward Two, I was determined to go home, especially as Christmas was approaching and I couldn’t stand the thought of any more forced festivities. In my discharge meeting, Dr X. confessed to me, my mother, and a nurse that she had been "cruel" in her approach, laughing it off as she explained. Now that I'm able, I will shortly begin the complaint procedure and will make sure that Dr X. is aware of the risk she put me at. I'll also ask why she thought that it was acceptable to make inappropriate illness-targeted jokes and comments, disparage what I did for a living, and treat my mother with a level of rudeness I've rarely, if ever, seen. I will also be asking why, in a room of approximately fifteen other health professionals involved in my care, nobody challenged Dr X. on her controversial approach. This should not be allowed to happen again to any patient under the care of this psychiatrist. 

 
 The hospital, worth £29 million, opened in 2012 and looks disturbingly like Teletubbie Land. 

The hospital, worth £29 million, opened in 2012 and looks disturbingly like Teletubbie Land. 

 

The morning I left, one of the female patients I’d spoken to a few times was being taken over the road to another hospital ward for her first treatment of electroconvulsive therapy (ECT). Elvis hovered in the background, doing his usual pacing of the corridors, singing I'm So Lonesome I Could Cry to other patients as they passed him. Other patients scuttled out the wards and back home as their psychotic episodes lifted or their detoxes finished. While I didn't appreciate him fully at the time, I often think of Elvis jiving through the corridors, singing sad hits in a place where there is a disproportionately high portion of the audience with depression and loneliness. I hope he took my advice of sticking to the more upbeat classics. I also hope he got those black Crocs he wanted and that he's not too disappointed that you can't get them in blue suede.  


Once I was back at my grandparents’ house, my mixed depressive episode of bipolar disorder lasted for another week or so. I was now under the care of the local Crisis Team and while their home visits were regular, they didn’t seem to help much, other than when they occasionally provided some soft sedation. The antidepressant, Sertraline, usually takes about four to six weeks to kick in and I'd only started taking it again for about a week and a half. Not knowing that it was worsening the manic symptoms of my mixed depressive episode, such as impulsivity and psychosis, I continued to take ever-increasing doses of the drug. I lost a lot of weight and became very weak at this time due to an inability to eat or sleep. I fluctuated between states of catatonia where I couldn't move or speak, and states of dangerous impulsivity towards my body, based upon my unrelenting delusion. The best description of this time I’ve probably heard came from my mum who likened it to international torture methods. “Darling, you’re being brainwashed, pumped full of strange chemicals, sleep deprived and starved. No wonder you want to die”.

Two of my oldest friends came to visit on several occasions and their familiarity stirred the woman under the illness. Claudia, with her outstanding reserves of empathy, has always known exactly how to make me laugh, even when I’m in the gutter. I’m not sure how she does it, but her school kids are lucky to have a teacher so plugged-in. Although she was born two years after Road Dahl’s Matilda was published, I’m convinced that Claudia was Dahl’s Miss Honey muse. My other friend, G, drove six hours in one day (on two occasions) just to spend a couple of hours with me. Although they were short visits, they were hugely important to me and she helped me to remember who I was. My friend Indra told me to think of it like a bad drug trip - you do what you need to do to get through, knowing that it will be over eventually. As usual, Indra's pearls proved true and I woke up one morning leading up to Christmas feeling the best I'd ever felt. 

"David Bowie appeared to me in a dream last night!", I spouted at my dad, heart and head aflame. He smiled at me. He looked different. For some reason, I have a memory of him polishing shoes and stopping to appreciate the "miraculous" improvement to my health, as my late grandfather described it. 
"I prayed to all of my heroes and Bowie answered, good lad," revelling in the wonderful absurdity of it all. 
Being the year of the death of several of my dad's heroes, he followed up with: "Good job it wasn't Leonard Cohen, in your recent state". Even if it had been Cohen, shifting along the recesses of my dreams, reciting dark prose, the point remained: I was better. Not only better, but the best. Suddenly everything "made sense" and I felt galvanised from the adversity. I stood starry-eyed on my grandparents' back lawn with a new, kaleidoscopic view projecting colour on the once black crevices of my mind. Something had happened that woke and roused me. While I like to think that Bowie had a part to play, the real reason for my elevation was that the anti-depressants had induced a state of hypomania. 

While I had a week with Ziggy in the stars, it left as soon as it came, and I was soon back in the trenches of mixed depression. I became more and more delusional, offering to pay for my family to go on a skiing holiday to Switzerland if they "wouldn't mind" taking a small detour to Dignitas. Like determined amphibious excavators, they tried to dredge my delusional swampland in loving and creative ways, but I was too tightly caught in the undergrowth to respond to their efforts. Not even the inexhaustible resilience and tenacity at the yolk of my family could hack into my locked, delusional state but they did keep me physically safe. My family members took turns in watching me and my dad and brother were particularly good at handling my impulsivity. It overpowered us all one afternoon, however, when I managed to lock myself in a room with one clear purpose in mind.

The A&E staff was excellent and, as far as I remember, discharged me with the sedatives I greatly needed. I returned back to my grandparents’ house and slept for a week, finally waking up without the fever to die. Over the next couple of months I recuperated with my parents in our village, caught up with old pals, and spent much time with my godkids and their lovely mum who live just round the corner. These two months of quiet family living were soft and restorative, bringing me closer to independent living and back to academic life.  


Back to work and down the rabbit hole

March came round and I decided to go back down to Sheffield to settle in for a few weeks before returning to my PhD. As I prepared to go back to work, I became worried that my colleagues would think it was the upgrade process that had "tipped me over the edge". It’s true that stress and sleep are two of the most likely factors to induce a manic or depressive episode, but it wasn’t the PhD itself that did it. In fact, my ten years in academia have been a glorious outlet for my mental health and I was determined to get back into my thesis after my leave of absence. From the fat bouquets of flowers and sincere get well messages, I guessed that my colleagues were probably aware that I’d been in a psych ward, but I wasn’t sure how much they knew. I thus steeled myself for an unknown and perhaps, unsettling, reception as I came back to the office after a five month hiatus. It couldn't have been easier for me and many colleagues showed active support, concern and sensitivity, while my supervisors and lovely administrator eased me back in with kindness and enthusiasm. 

Having returned to work and back on the highest dose of my old, reliable antidepressant, it seemed that things had picked up. I was eager to pass my PhD upgrade in the May, which I was attempting for the second time and hopefully in a much better mindset than the last. Fortunately, I was intent on getting back into my work and I enjoyed spending time on it. The time I put in became more and more, however, and I was soon unable to stop. While I didn’t realise it at the time, my writing started to stray from what was required and I went further and further down the rabbit hole. When I flick through my notepads of that time, I don't recognise the handwriting as my own and can't remember how, why or where the thoughts and connections between them came from. 

 
31820688_2013798305549887_7428184661857140736_n.jpg

Manic musings, 12th May 2017

 
With mania, you have an intense sense of well-being, energy and optimism. It can be so strong that it affects your thinking and judgement. You may believe strange things about yourself, make bad decisions, and behave in embarrassing, harmful and - occasionally - dangerous ways. Like depression, it can make it difficult or impossible to deal with day-to-day life. Mania can badly affect both your relationships and your work. 
— Royal College of Psychiatrists

My writings initially sprouted from the political philosophy texts I'd been reading in preparation for the PhD upgrade. These ideas were spurted over pages and pages which look disconnected to a non-manic eye. Indeed, it’s often difficult to make out my patterns of thought when I look at those writings. But that’s one of the distinguishing features of mania: there is no rhyme or reason to it. I was consumed and intoxicated by the links and connections burning their way across my synapses. It felt like a look into the divine, a beautiful secret that nobody knew, and I soon stopped caring about prosaic concerns. Words thrust off pages to flirt with lyrics I didn't realise I knew and danced with conversations, facts, images, concepts and memories, to give me a view so pure. Sunsets felt like they were just for me. A close friend and colleague told me that she became particularly concerned when I approached her, wired and wild-eyed, to tell her all about one of my "theories". She said it wasn't so much what I was saying that she found worrying, but the way I was explaining it. Our normal mode of communication was temporarily embalmed in my racing thoughts, flight of ideas and pressurised speech. 


Tripping the light fantastic

When I wasn’t writing I was socialising and engaging in risky and pleasure-seeking activities. Colours were brighter, sounds sharper, and touch more sensitive. I felt like Patron Saint of the Windswept and Interesting but was more like Patron Saint of the Waifs and Strays. When manic, you increasingly lose touch with everyday concerns. Sleep became a foreign concept to me and I dismissed it as a waste of time. I didn’t understand why people would choose to sleep if they could be awake, living their ridiculously short existences. I would get a feeling I could only describe as "itchy blood", where I felt something itchy running through my veins, unable to relieve or scratch it, being liquid in constant motion. I'd experienced itchy blood for about ten years, and first came up with the phrase when trying to describe to myself what I was feeling. Most recently, I'd experienced the sensation in my mixed depressive episode so it was intoxicating to feel it again without the low mood, and I responded to it in various ways.

Writing was the main outlet but I often found the physical act of it restrictive as my hand couldn’t keep up with my thoughts. Every idea was paramount and had to be communicated to everyone. Other outlets to my itchy blood weren’t so straightforward, however, and I ended up in several dodgy situations, particularly with men. Mania can also result in over-committal or taking on new projects. For example, I was temporarily convinced that I was going to be the first female Olympic indoor rock-climber even though I'd never even been to a climbing wall. 

Several of my colleagues and friends showed concern during this time and asked me if everything was ok. My reaction was one of confusion, usually followed with the response “Of course I’m ok! I’ve never felt better in my life!”. I became increasingly perplexed by these questions and decided to stop going into the office. If I worked from home, there would be no distractions or people encouraging me to slow down. I felt myself getting increasingly agitated when people told me they were struggling to follow my train of thought. I locked myself in my flat, determined to write and finish a screenplay called Ship of Fools at the same time as preparing for my PhD upgrade. Piloted by mania into a euphoric blue hole, I managed to finish the screenplay but at a cost to my health. 

Bipolar disorder is a condition of extremes. A person with the condition may be unaware they’re in the manic phase. After the episode is over, they may be shocked at their behaviour. However, at the time, they may believe other people are being negative or unhelpful.
— NHS

It takes on average twelve years after the onset of depression for individuals to receive a diagnosis of bipolar disorder. People are often misdiagnosed with depression as this is the only half of the illness the doctor sees. When you’re spinning plates so magnificently and living feels like being on a permo at Woodstock, it doesn’t occur to you that anything is wrong, let alone go to the doctor. It's worrying that not one of the many psychiatrists I saw in Scotland was able to recognise that I was experiencing a mixed depressive episode of bipolar disorder; it's encouraging that it was recognised so quickly in Sheffield. 


Getting aboard the ship

Luckily I had an astute CBT therapist who expressed concern to my doctor that there may be something other than OCD going on. I met with my GP who gave me an emergency referral for an appointment with a psychiatrist. As is so often the case with "emergency" referral waiting times, my appointment with the Community Mental Health Team wasn't for another few weeks. In the meantime, I would sit my PhD upgrade meeting for the second time. I had agreed with my supervisors to send them my materials before submitting them to the upgrade panel and one of them replied asking me to come and see him the following day. Thinking I would only have a few adjustments to make, I was surprised when my supervisor said that he didn't feel comfortable putting me forward for the upgrade in the condition I was in. The fact that I wasn't well could apparently be seen in my work and communication and I'm so grateful to him for recognising this, as my loss of insight would have likely made me sit it regardless.   

Having decided not to go forward with the upgrade and remembering that my emergency psychiatric appointment was the next day, I decided to have my "hen night" as I expected to be married to some new drugs following the meeting. Like many hen dos, it was febrile and turbulent, and I didn't get home until about 8am. My appointment with the psychiatrist was at 1pm and I remember thinking at the time that three hours was plenty of time to sleep, especially as I’d been “functioning so well” on less. Setting my alarm for eleven, I managed to get a few hours of rest. I woke up feeling distinctly disoriented and scared, while waiting for my two dear and very hungover friends to take me to the appointment. 

 
 The sky as we were getting in the car to go to Ward Three, undeniably gorgeous to both manic and non-manic eyes (image: Indra Mangule)

The sky as we were getting in the car to go to Ward Three, undeniably gorgeous to both manic and non-manic eyes (image: Indra Mangule)

 

I can’t remember much about the assessment. I remember answering a series of questions and getting frustrated and weepy when the psychiatrist didn't understand. Indra tells me that I mentioned David Bowie. I wish I remembered that. It got to the point that my friends graciously took over as I was too confused and distressed to communicate properly with the psychiatrist. They did a stellar job, particularly considering this was a new situation for all of us which they had to handle with the grimmest of hangovers. One of them told me later that they'd had to discretely excuse themselves to go and have a tactical spew in the bathroom - I was majorly proud. After my friends, psychiatrist, family, and hospitals had liaised for about six hours, a bed finally became free in one of Sheffield's acute admissions wards. Walking up to the entrance with my two pals, I started freaking out because I was having a hallucination of an enormous, terrifying bronze tortoise squatting on the grass right in front of us. All was cool - turns out the hospital just has garish taste in garden furniture.  


WARD THREE

I confessed to the staff on Ward Three that I was apprehensive about being on a psych ward again, following my experiences of the previous two. Their professionalism is to be commended. The night I was admitted, I met with another psychiatrist who gave me a thorough assessment and sedation for my mania. After sleeping for almost a full night, I woke up to two female voices on my right, one of which was complaining about a new patient who'd been making a lot of noise during her sleep. Poor woman, I thought. I'm glad I wasn't woken up. I suddenly realised that she was talking about me and hazily remembered a nurse coming to me in the night to soothe my manic shouts and ramblings, present even in the space between sleep and wakefulness. 

By the time I'd apologised politely for my disruptive sleeping behaviours and made my way down to the dining room for some breakfast, my mum had arrived from Scotland. We were told that the psychiatrist would be with us shortly and were asked to wait in a room near the dining area. A few minutes later, a tall, elegant, well-dressed woman walked sanguinely into the room, offering her hand to both of us. She was friendly and efficient and I remember being very impressed. Minutes later, one of the nurses came in to speak to her - perhaps with my blood test results, I thought - and they both left the room, the nurse smiling as she closed the door behind her. 

Confused, we continued waiting until another woman, wreathed in smiles, entered the room with an outstretched hand. Enthusiastic to speak with the psychiatrist about my prognosis, we started chatting away until we were interrupted again, this time by a man who introduced himself as my psychiatrist. Our game of Patient or Shrink? ended when he produced my file and gave us the results we'd been waiting for. As I remember, the psychiatrist had quite an dishevelled look which meant that I trusted him instantly. He confirmed that I have bipolar affective disorder and should begin medical treatment immediately, both to temper the episode and to stabilise my mood in the long-term (prophylaxis) . 

The psychiatrist advised that I should be put on a mood-stabiliser and gave my mother and I information on each of the potential drugs for us to go away and discuss together. The physical tests to determine whether I was able to take lithium had come back all clear so I was able to start it immediately, if that is what I wanted. I was keen to take lithium over other mood-stabilisers as I'd heard of its long-term success in treating bipolar disorder and I also liked that it's a naturally occurring mineral - not a manufactured drug. It does come with some considerations if you're a woman of child-bearing age, however, which is why the doctor gave me an opportunity to talk it over with my mum.

 
 Salt mining at Bolivia's Salar de Uyuni, the world's largest salt flat. It contains more lithium carbonate reserves than anywhere else in the world (image: Jo VH/ Flickr )

Salt mining at Bolivia's Salar de Uyuni, the world's largest salt flat. It contains more lithium carbonate reserves than anywhere else in the world (image: Jo VH/ Flickr )

 

Taking lithium in early pregnancy increases the risk that your baby's heart might not develop properly and both your and your baby's lithium levels could become dangerously high in labour itself. There is also an increased risk of stillbirth and infant death soon after birth, and breastfeeding sadly isn't an option as the drug can pass into your breast milk in high enough amounts to be dangerous to your baby. Being single and on contraception at the time, I was grateful for these points of consideration, but my main priority was to get better. Lithium therapy also involves having a lot of blood tests and drinking copious amounts of water to make sure the levels of lithium in the body don't become toxic. A lot of people pitched this as a negative to me but I was actually quite keen that it would mean seeing medical professionals even more regularly and I was optimistic that it would provide me with some structure. That night I started taking lithium and a reduced dose of antidepressant to try to bring me back down. 


The next week was spent in Ward Three with the intention of getting my mania under control and starting lithium therapy, which initially involves a lot of observations, blood tests, hydration management, etc. I was quite happy to stay on the ward as it had a therapeutic environment the other two didn't and it also gave me the space to stabilise in a safe environment. I continued to write when I was in hospital but the racing thoughts and impulsivity softened. I still felt like it was crucial to work on and communicate my "theories", but at least I was managing to eat and sleep a little thanks to the lithium. Besides, I got on well with the other patients, giving me the opportunity to socialise rather than lock myself away and write. It turns out that the tall, well-dressed woman who had introduced herself to my mum and me was also experiencing an episode of bipolar mania and she took me under her wing with a no-nonsense approach. 

It felt as though Ward Three had more patients, but I'm not sure whether that's true. But I certainly remember there being a lot of adults of all ages with varying mental health illnesses. Most people struggled to remember being admitted or were confused about why they were there. The majority of people experienced psychotic symptoms and many of the men had paranoid schizophrenia. Despite having terrifying delusions and hallucinations much of the time, the good old homegrown Sheffield socialist values inspirited many patients to sustain their narratives of resilience. While political arguments and speeches were often shaken up with a touch of psychosis and didn't always make total sense, we sat together, listened carefully and cheered, applauded, and saluted nonetheless. 

Top tip if you ever find yourself in a psych ward: don't bring up politics unless you're prepared for a lengthy and intense discussion about the New World Order. One morning, I mentioned an article I'd seen in the Independent about Theresa May's plans to create a "new internet" that would be controlled and regulated by the government. By dinner time, patients were being told to come and speak to me because I "knew all about" what the NWO was up to. I assured them that my field of research was pretty specific and didn't include NWO activity, but the paranoia persisted for many of the patients. Indeed, conspiracy theories can weave in menacingly to people's psychotic beliefs, inducing deep paranoia and fear. Others had different delusions and, while you might not think it's possible for two Jesus Christs to occupy the same psychiatric ward, I can assure you it's not uncommon to hear cries such as "No, I'm the Son of God, ya twat!". 

I met some hardy people during my time on Ward Three, both patients and staff. There were regular therapeutic workshops, generous kitchen staff eager to see that everybody was well-fed, and a level of autonomy and respect given to patients that I hadn't sensed in either of the first two wards. It appeared to be a well-run ship. By the end of my week there I couldn't have been more satisfied with the care that I'd received, and was quite sad to leave many of the friends I'd made as one of the nurses piled me and all my flowers into a taxi before squeezing in next to me. 


Rethink

As the taxi pulled up to a large Victorian house cuddled by sycamores, I thought that the driver must have taken us to the wrong address. Located in the heart of a leafy conservation area, it looked like any of the other grand houses dotted along the curve of the long, residential road. There was no big sign reading CRISIS HOUSE, but I suppose that was the point: it was a supported transition between hospital and home. Rethink, formerly known as the National Schizophrenia Fellowship, provides over 200 mental health services and 150 support groups across England, helping thousands of people each year across the nation. The drive to establish the organisation came from the 400 replies journalist, John Pringle, received after the publication of his leader column in The Times about his son's experience of schizophrenia. In 2002, the organisation was renamed "Rethink" to reflect the expansion of its "work across mental health issues beyond schizophrenia". 

Rethink provides various services in Sheffield, including Sheffield Crisis House: a 6-bed supported accommodation unit, offering recovery-focused intensive support to adults experiencing mental health crises. The service provides intensive one-to-one support, exploring a person’s mental health crisis and self-management techniques. The organisation also provides a 24 hours a day, 7 days a week telephone support service, and manages several flats in Sheffield with daytime support for adults with severe and enduring mental health problems. Staff provide 24-hour emotional and practical support to help people resolve their crises. Services have been co-produced and developed alongside people with experience of mental illness and many of the staff members were former service users, which instilled a notable sense of trust and security. Personally, I think there was an almost perfect helper-helpee symbiosis at Sheffield Crisis House and an accent on outcome-focused, personalised support planning. Rethink worked closely with the Home Treatment Team, comprised of doctors, nurses and social workers, who visited the house regularly to take my bloods and see how I was progressing. 

 
 In the garden of Sheffield Crisis House

In the garden of Sheffield Crisis House

 

My friends were majestic, as ever, and took me out  to enjoy the weather as we approached the hottest June in forty years. They always made sure, very sweetly, that I was drinking enough water to keep my lithium levels regulated and made an effort to engage with others in the Crisis House. My sleep was still patchy, waking up during the night from lithium sweats and hypomanic gusto. Considering the recuperative nature of the Crisis House, I spent more time alone than I did in hospital, so I didn't get to know the other residents as well. While I remained pretty high, I was happy to get rest in such halcyon surroundings, but unfortunately not everybody in the Crisis House had a positive time. Most had severe past or ongoing familial problems and/or little knowledge of what was happening to them. Some women had taken themselves away from their children to "protect" them from the strange and bewildering trajectories of their respective illnesses. One developed a strong delusion that her child had become possessed by the devil and slept with rosary beads every night. She told me she was going to leave early, before the allocated week of recovery ended, and she did. I think of her often, where she is, and recall her terror as she grafted hard for her family within the sharp grip of hallucinations. 


Beyond the diagnosis

The Home Treatment Team continued to visit me once I'd returned home from the Crisis House and focused on my lithium therapy, including managing the unpleasant side effects of starting the treatment. They visited so regularly that my ten-year-old neighbour and I started referring to them as "the vampires". Largely unconventional vampires, they came to take my blood during the day and hung (upside down) around for a while to chat. Once the blood tests went from daily to weekly and then weekly to every three months, I decided to go back up to Scotland for the remainder of the summer before returning to my PhD after my second leave of absence. 

After I’m out of the haze and remember me as I was when I was ill, I get a feeling I’ve only known otherwise when I was young and watched my wee brother handle pain. Whether Michael had a nosebleed or heartache, my hands and feet would go numb, my heart purred, and a sickly lightness filled my head. This feeling has revisited me frequently during the past year as I remember the unhinged, undiagnosed woman I was, and feel like her protective older sister. As well as feeling protective of our unwell selves, we with bipolar often feel guilt and shame at how we behaved when we were manic. But then we get better and start to grieve the mania and eventually crave it. Sadly, many people with bipolar stop taking their meds during these craving periods and doing so is very likely to end in relapse.

Summer back in Scotland was a tonic and the light nights harmonised with my lithium levels, making me strong and stable with two feet back on the ground. While I'd decided to put my dating life on hold for a while, it didn't stop me from bumping into a curious stranger at Ladybank train station. With a heart as kind as his eyes, and a very convenient two degrees in psychology, Lew grounds me in a way I've never known. 

In September 2017, I returned to the PhD and started a nine-week bipolar self-management course. The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – suggests that treatment for bipolar disorder should include both talking treatments and medication. When in the throws of mania or depression, people tend to be unresponsive to talking treatments, and the primary focus is getting a manic or depressive episode under control with psychiatric medication. Once in a period of convalescence, however, there are several types of talking treatments effective in managing bipolar disorder. Psychoeducational groups such as the bipolar self-management course in Sheffield are particularly effective and the group became an important staple in my routine and rehabilitation. There were about fifteen of us on the course but, considering the mercurial nature of bipolar disorder, there was never a full house every week. If someone was missing one week, others in the group took concern and would get in touch with them. A few of us decided to keep in touch after the course had finished and I also found solace and friendship in Bipolar UK support groups in Sheffield and Dundee. 

 Many people with bipolar use this scale on a daily basis to monitor their mood and can often prevent an episode of hypomania or mild-moderate depression from escalating to mania or severe depression.  

Many people with bipolar use this scale on a daily basis to monitor their mood and can often prevent an episode of hypomania or mild-moderate depression from escalating to mania or severe depression.  

Thanks to the switched-on Sheffield psychiatric services, modern medicine and the simple goodness of people, I was eventually able to sit my PhD upgrade with a less hindered mind and a successful outcome. With the Panel satisfied with my research, I moved back up to Scotland to do my fieldwork for which I spend most time digging through SNP archives at the National Library of Scotland. 


Although I was desperately ill and can’t remember everything of my TripAdvisor tour of British psych wards, I’m glad to say that I’ve retained rare and warm memories from my time in all three hospitals. The bulk of these lie in the frank kindness of patients, staff, family and friends, and float like oil in my mind, slippery and hard to touch, but still visible, bobbing on water. As I approach my first "bipolar birthday", my zeal for exploring counternarratives has grown and I'm looking forward to seeing how this project develops. 

While it's important to challenge customs of malpractice, it's just as important to recognise their underpinnings. Across Britain, NHS cuts, low-wages and zero-hour contracts have engendered cultures of indifference, and even malpractice. I don't think that all of the nurses on Ward One arrived with this attitude, and I don't doubt that many of them have been sucked in by pack-mentality or struggle to challenge pre-existing structures, particularly if newly-qualified. In Ward Two, the majority of nurses and carers seemed well-intentioned but struggled to challenge the controversial approach of my psychiatrist. While it's no justification for malpractice, we must recognise staff concerns, at both micro- and macro-levels if we are to expect any tangible development in the operation of NHS psychiatric wards.

There is great substance to the conspicuous notion that it's just as important to give positive feedback as negative. Despite these cultures of indifference, there have always, always been bright and bold individuals who attend, on autopilot, to all types of pain and injustice. Perhaps I'm naïve or unjaded, but I like to think that providing positive feedback and praising hard NHS workers has the potential to reinforce and sustain their good practices. On both sides of the patient-staff "divide" exist pockets of resilience and a proud sense of social justice, evidenced both by individuals and by organisations like Rethink and Bipolar UK. Let's collectivise these cultures of resilience to stare down stigma, austerity, and malpractice towards adults in acute psychiatric wards in the UK.


If you'd like more information on bipolar disorder or other mental health conditions, please visit our RESOURCES page. Alternatively, get in touch at info@shipoffools.net for a chat or brainstorm.