/ 12 October 2009

My inconvenient truth

The day I returned to Tara for the second time, I felt as if my gut was being wrenched out. As I slung my bag out of the boot and my dad handed me the pot plant I would put next to my hospital bed, I watched him cry softly as he said goodbye and his daughter went into the ‘madhouse” — again.

At that moment I was paralysed by the dread of what awaited me. It sickened me to the core to sense my parents’ agony — and knowing that I was the cause of it only deepened my despair.

Let me paint a picture of what was happening: as 2003 dawned I was a bright, vivacious journalism graduate — fresh from Rhodes — and back in Jo’burg to start my first job as a writer for a mining consortium.

I was thrilled to be back in a buzzing city after my years in the small town of Grahamstown, as well as the prospect of being a professional and earning a salary. But the chemicals in my brain were up to something.

I was once again falling prey to the bipolar demon, although it was only later that year that I was formally diagnosed as a sufferer of this monstrous mood disorder.

Early into my new job I became deeply depressed and overwhelmed by my new life. Things big and small took their toll — traffic jams, not knowing quite where I fitted in at the company and leaving the safe confines of a cosy university.

One day I walked out the office and never went back. My mood declined rapidly. I was doubled over as a shivery, sobbing bundle in my parents’ bed by day as I felt myself slip further and further into the prickly, dark abyss of desperation.

Going to shower, brushing my teeth, even eating became insurmountable tasks. Simply existing became too painful. Having suffered from recurring depression since I was 15 and first admitted to Tara after a cocktail of Prozac and Lithium failed to lift my mood, my 2003 episode was not a phase my psychiatrist or my parents took lightly.

I was whisked off to Tara as soon as a bed was available. I had no choice: tens of thousands had already been spent on keeping me sedated in a private hospital and I was becoming violent and selfdestructive — smashing glasses against the wall and banging my head on the table until my skin split.

I needed to be confined in a safe place where I could convalesce over a few months and, hopefully, get my debilitating chemical imbalance righted with effective medication. But these hopes were crushed as soon as I was admitted. I had signed my life over to an excruciating hell I had little choice about getting out of.

My parents could no longer contain me at home, the medical aid had dried up and a state institution was the only option. And I had to stay there until the hospital saw fit to discharge me.

I was taken off all the medication I had been on before I was admitted and an attempt was made to tame my wild moods and relentless depression with 40mg of Prozac. Considering that six years earlier a psychiatrist had failed to ‘cure” me with 120mg of the stuff, it was hardly likely that a third of the dose would get me right.

In fact, giving a bipolar patient an antidepressant can be very dangerous. It can further destabilise his or her mood, causing an artificial high while the patient very often remains depressed. This mixed state became the tormented twilight that characterised my second Tara admission.

I felt like an animal trapped in a poky cage. For three weeks I was placed under ‘special observation” and not allowed to leave the ward. I became increasingly skittish and paced the clinical corridors like an incarcerated beast, or at best a hardened criminal, being punished for the most heinous of crimes.

I endured nine weeks of this and was not once seen by a doctor. It was also telling that the standard prescription for most people in my ward was this elixir of 40mg of Prozac. Perhaps it is no coincidence that it’s also a very cheap treatment option — in state mental hospitals patients don’t often have the luxury of choice.

In Tara I felt as though the ‘real” me — if one had ever existed — had died. I, whose daily bread and butter had been words, started to battle to string sentences together, let alone write anything coherent.

I believed I would leave hospital a vegetable, brain damaged and reliant on my parents for support. When they could no longer handle me, I would have to beg on the streets, or, maybe I would harness the last scrap of energy I had and finally end my life. This, it seemed, would be the ultimate salvation.

But after I was finally discharged a miracle happened. I made contact with a psychiatrist who for the first time was able to give me a proper diagnosis — bipolar mood disorder — and prescribed an excellent and appropriate combination of mood stabilisers, an antipsychotic and an antidepressant.

It took time, but the old me came back. And she came back in such fine form that when my sister returned from spending a year in the United Kingdom (she had missed my annus horribilis) she said: ‘It’s like someone’s switched the lights on inside you.” Three extremely good years followed.

I found another job as a sub-editor at a magazine and moved up the ranks, eventually occupying a relatively senior position for my age. I had a few bouts of depression during these years but it did not get out of control. Sadly, my luck didn’t last.

After three years the heavy depression began to claw its way back into my life and my mood yoyoed dramatically. I had to return to hospital and the experimenting by doctors to find the right mix of medication began in earnest — again.

I’ve never gone back to Tara but in the past four years I’ve been institutionalised about 10 times, taken countless combinations of drugs and made a few serious attempts to take my life.

I’ve tried hanging myself, engorging poisonous plants and taking overdoses. But I am still alive. I don’t find living easy these days.

There are times I hate being in public, wishing I could wear a mask or a potato sack to shield the world from what I perceive as my awkward, ugly frame.

I often feel repulsed by who I am, by what I have become. The handful of tablets I take twice a day help me function and work, but I see myself as far from normal.

Swinging between fits of excitement and black voids of desperation makes fitting into a routine and seeking out relationships very difficult. And my pervading sense of self-loathing often sees me denying myself the very things I crave most — such as love and acceptance. It’s a lonely existence but one to which I have to succumb.

At least I have a voice and have finally told my story — one that I have been so ashamed of
and hidden from others for so long.

Bipolar mood disorder
Bipolar mood disorder is the new name for what was called manic depression, write Qudsiya Karrim and Jane Baldwin.

It describes the extreme mood swings — from depression and sadness to elation and excitement — that people with this illness experience.

Research shows that this disorder is associated with a chemical imbalance in the brain. Examples of extreme behaviour include:

  • Elevated moods, such as ‘feeling on top of the world”;
  • A reduced need for sleep;
  • Irritability with those who disagree with or dismiss their sometimes unrealistic plans;
  • Rapid thinking and speech;
  • A lack of inhibition such as spending large amounts of money; and
  • Grandiose plans and beliefs.

It is common for people experiencing mania to believe they are unusually talented or gifted or are kings, film stars, prime ministers or important religious figures.

The two main types of bipolar mood disorder are Bipolar I and Bipolar II.

  • People with Bipolar I experience at least one lifetime episode of mania and usually episodes of depression.
  • People with Bipolar II experience episodes of depression plus episodes of a mild form of mania called hypomania.

Bipolar disorder affects about one in 100 people. Men and women are equally affected. Although the disorder has been seen in children, the usual age of onset is late adolescence and early adulthood.

Bipolar disorder is similar to other lifelong illnesses, such as high blood pressure and diabetes, in that it cannot be ‘cured”. It can, however, be managed successfully with a combination of proper medical treatment, such as mood stabilisers, psychotherapy and lifestyle management, such as a regular sleep schedule and exercise.

Only 27% of South Africans reporting severe mental illness ever receive treatment, meaning that nearly three-quarters are not accessing any form of mental healthcare. There is a considerable shortage of psychiatrists and psychologists in the public health sector.

World Mental Health Day 2009 is on October 10. This year organisers will draw worldwide attention to the challenges of integrating mental health into primary healthcare.

The SA Depression and Anxiety Group will host 45 nationwide workshops and talks on Mental Health Day free of charge to the public.

For more information, call 0800 70 80 90 or 0800 1213 14 toll free. — Information from www.mental-healthmatters.com ;www.bipolar.com.au/understanding and the SA Depression and Anxiety Group.

The author of this article has subsequently chosen to remain anonymous. The article was changed on February 02 2012.


M&G Newspaper