Why I Went to a Psychiatrist in the First Place

You can fool yourself on a lot of things. Even unintentionally.

For all the years since I was seventeen, I had mood swings that were damaging to me in every part of my life and it never occurred to me that there was a problem. Never. But that sort of luck does not last forever.

In October 1996, I lost the capability to cope. Or rather, I was doing so much that I couldn’t cope with it all. At the time I was the manager of the major downtown park in my city – a high maintenance, long hour, high stress job.

I was also the secretary of the Planning Society in my country; was instigator for setting up a web site for my old high school; was laying the groundwork to open my own company offering City Planning services; was helping rewrite the payroll software for the family business; and together with a close friend had just finished coordinating one of the largest celebrations ever held in my country of the Hindu festival of Divali.

I can do all this when I’m in my hyperactive (hypomanic, mildly manic) state. But my mood swings are fairly rapid. So for one week I would be hypomanic and really capable and efficient. Then the next week I would be depressed and accomplish very little. And then the mood swing cycle would start over.

For a while the amount of work I accomplished in the hypomanic parts of my mood cycle was able to compensate for the periods of depression in which I did very little. However, by October 1996 my depression episodes had become severe enough that I stopped going to work during them. So work and undone tasks started to pile up.

And then my depression episodes got really bad.

Sometime in November 1996 I disappeared for two weeks. No one could find me, not the people at work, not my friends, not my parents or my brother. No one. My parents thought I had been killed by car-thieves. When I eventually resurfaced, in apparently good order, my family was too happy to see me to ask many questions – none of which I could answer sensibly anyway. I was the prodigal son returned.

I took back up life as normal. The vast majority of the people either didn’t notice I was missing or thought I was just working so hard that I didn’t have time to go out with them. I was the manager at my workplace so no one questioned my disappearance. And incredibly, I didn’t think anything was wrong. It was as if there was this blind spot over my memory that prevented me from seeing what had happened and realising I needed help (I still have trouble remembering such episodes).

My parents persuaded me to see a psychiatrist, an old skinny man a generation or two before my time who asked me a few questions, explained in a perfunctory manner that depression could be alleviated by medication, and prescribed Paxil, an antidepressant. By the end of the session, I had decided that I did not like him, that I clearly could not be suffering from depression, and that this was a waste of my time. But I got the medicine anyway, took it for a week, and then stopped it when it seemed to have no effect.

Christmas 1996 was a miserable time. Everything limped along at work. Nothing went badly but none of the plans I had for making Christmas special took place. I knew things were not right in my life but I was unable to do anything about it. My life felt broken, as if pieces of my dreams and plans and work and social life just lay scattered on the floor with nothing holding them together and no connection between one piece and the others. All I felt I was doing was dealing with what seemed to be crisis after crisis.

I also felt as I if I was an observer of my own life, standing behind a piece of glass and watching myself stagger through daily life. I knew exactly what was wrong but I was unable to reach through the glass to get the me who was living to change habits or actions.

I remember Christmas being lustreless. I dutifully purchased Christmas presents, at the last moment, gave them out and received my presents in return. There was no joy, no fun in seeing my niece and nephew get their presents – indeed it was almost unbearable to be in the noisy house with my parents and brother’s family and I escaped as soon as it was polite.

In keeping with my fluctuating moods, between Christmas morning and the following afternoon I somehow arranged with my cousins to have an Old Year’s party at my house. I remember it as special because my grandmother attended and surprised all her grandchildren by dancing through the midnight hour and keeping up with the best of us until the party finished around 3:30 in the morning.

Within the first week in January my grandmother became gravely ill and about one month later she died peacefully and I think happily in her bed surrounded by her sons and daughters and clouds of her grandchildren and angels.

When you are bipolar, you are often asked what stressful events in your life might have triggered your mood swings. I suppose that it could be said that Christmas 1996 and January 1997 had quite enough happenings that could cause my mood swings. But while I certainly grieved for my grandmother, it never felt as if any of these circumstances were causing my mood swings. And I was already having a pretty difficult time before my grandmother died.

During January and February 1997, nothing changed to improve my overall situation. My alternating periods of depression and hypomania were causing my work and my life to get more and more out of control in spite of the best I could do. I was sane in the conventional sense in that if you had spoken to me you would have seen me (more often than not) as an intelligent person with a good grasp of the problems and conflicts in my life and with an excellent grasp on how I should be solving them.

The problem was that I just wasn’t solving my problems at all.

I did not see my problems as anything other than overwork and procrastination on my part. What was actually happening was that I made the standard mistake of seeing each symptom of being manic depressive as a separate problem and not seeing the larger picture in which all the symptoms were connected. I was applying patch after patch to each problem / symptom as it happened without realising that I needed to fix a much larger problem.

And because I was blind to the larger problem, I did not realise that the very nature of being manic depressive would inevitably cause my method of patching up each crisis to fail.

By the end of February 1997 I had reached a position where I was not being at all successful in clearing up my problems. I would gain some ground during my hypomanic week but then fall even further behind during my depression week.

I know what failing is like because I’ve often been there. But back in 1997 it had reached an extreme stage. All my projects at work or outside of work were failing. Not most. All.

In a way that was mostly ok. Problems can be fixed. What was intolerable was that I couldn’t fix them. My projects weren’t failing, I was. During my depression episodes I felt that I would never be of value to myself or anyone else ever again. In my hypomanic periods I would scramble feverishly and in vain to do something, anything, to shore up the things I was doing. And while I was doing this I was also standing on the sidelines watching in horror as everything that gave my life meaning lost familiarity, faded, failed, and became meaningless.

By March 1997 the depression episodes had become ascendant and began to last more than one week. I began go out with my friends less, and do everything less. My house began to look like a student’s apartment as dirty clothes and dishes piled up and books sprung up everywhere all covered with dust. My garden transformed itself into a small forest. I began to live on fast food and I put on quite a bit of weight. I began to think of my house as a haven, a cave to which I could retreat at the end of work and where I stayed until I was forced to go to work. On weekends I did not emerge until Monday morning, and then only very reluctantly.

And eventually I stopped going to work. It didn’t happen all at once, but rather I would reach to work later and later until finally a day would arrive when I didn’t make it in at all. And on the days I didn’t make it in I would disappear. Basically, I would roam around the country in my car without telling anyone where I was – anxious because I was doing something I considered wrong, but not being able to stop what I was doing or even think coherently about it.

It turns out this anxiety is an inherent symptom of my depression, but I did not know that at the time and just chalked up my disappearing as yet another personal failure. Cowardice was added to my list of character flaws.

This disappearing or not wanting to see or meet with people got stronger the worse in each successive depression episode. In a way this felt like a reasonable response – my disappearing was something very stupid, I had no answer for it, and I really did not know how to explain it to anyone. The same anxiety that made me it impossible for me to go to work and caused me to disappear made it difficult to return home on afternoons to face the answering machine, my parents, a concerned friend, anybody. Eventually I started leaving home at seven in the morning and returning after midnight just to avoid having to talk with anyone.

And finally, one day in May I just did not return for two weeks. I almost did not return at all.

I usually tell people I don’t know what I do when I disappear and then reassure them that I did not do anything stupid. The fact is that I can remember everything I do when I disappear, but it is an odd sort of memory. Even immediately after it happens, it feels as if it happened a long time ago. I remember it as if it was an old home movie faded with time and with tears and other imperfections in the scenes. It takes quite a bit of effort to pull what has happened to the forefront and answer any questions about the times when I disappear.

Also, I remember these memories suffused with anxiety or terror to a level that has to be experienced to be believed. My mental state was close to how we think about an animal’s awareness, without true conscious thought, just an instinct for food and comfort and sleep. During the periods I disappeared, I don’t think I really ever thought about anything at all, and my intelligence was just used to solve immediate instinctive problems of finding food, etc..

I don’t try to remember or explain any of these times to anyone. One does not describe the antechamber of the court of madness to anyone.

I reentered the real world two weeks after I disappeared, when I crashed my car at about four o’clock one morning. I had managed to skid off the road, jump clear over a ditch, miss a piece of iron that would have ripped out the underside of my car (and probably me), run over four saplings and stick the front of the car about four feet off the ground on a fifth. I came away completely unhurt.

Even then I was at the stage of walking away from the wreck and continuing my disappearance. Fortunately, or unfortunately, a good Samaritan had been driving behind me. To my great annoyance at that time, he insisted on helping me disentangle my car and then calling someone to help me. He may have saved my life because I have never been sure what would have happened if I had walked away from the wreck.

My father came to collect me.

In all the favours that my parents have ever given to me, I don’t think any have ever matched the one they bestowed in not questioning me about what had happened over the two weeks I had been missing. I suppose they had their ideas or their worries but they never tried to verify any. They just accepted me back and wrapped their wings around me to protect me from the next few weeks.

I tried to continue my work. But my depression was too profound. About ten days after my return and trying to do basic work in office, and not really succeeding, I handed in my resignation. And then I did nothing for many months.

Actually, shortly afterwards I started to see a therapist who had been recommended by a close friend. I was jobless and I knew that something was wrong that needed to be fixed. But I still didn’t feel anything important had happened. Like all previous memories, this last episode had very quickly faded into relative insignificance. So once the anxiety wore off and I felt less stressed, I started questioning the need to be in therapy.

I was not in denial. I simply did not see that there was a problem.

Nevertheless I enjoyed therapy very much. My therapist and I met twice a week and after the usual first sessions in which nothing productive happened (I was defensive and uncomfortable), I started to admit that perhaps I was having problems. Over the course of a few months I began to feel that I was getting somewhere. The therapy did make it easier to handle the changes in mood. However, the mood swings did not stop, and as I started back to take on additional projects in my hypomanic periods the stress started to build again.

I suspect that I would have given myself another breakdown and scared everyone again if I had not gone on vacation in November 1997.

My vacations are my relief valves. I go on them, visit friends and come back refreshed to take on the world. Only this time it did not work out. Instead of my usual energised self, I found myself unable to enjoy spending time with my friends or indeed unable to coordinate my sightseeing schedule. When my friends weren’t with me I was very close to being a zombie, unable to decide what to do or go visit. I was in Toronto, but I don’t think I saw or enjoyed much of it at all.

I had promised very close friends in Miami I would visit them after Toronto on the way home, but I was so apathetic and full of anxiety about talking with people that I was unable to make the simple call to tell them when I would be arriving. Needless to say they were both annoyed by my basic discourtesy and when I did arrive in Miami was told off by them both for it.

You can always say you gave up a job because it was too stressful. Or that your memory loss is “just one of those things.” Or that you and your lover broke up for real or stupid reasons. Or that things are sliding because you are overworked or tired. But I had a difficult time explaining to myself why I was treating friends I valued so much so cavalierly.

Changing one’s life doesn’t happen all at once; it happens piece by piece. Nevertheless, if there was a single point I would point to and say – “There, that was when I admitted I was ill” – it was at the realisation that I could lose real friends if I didn’t fix myself.

When I returned to Trinidad, I asked my therapist to recommend a psychiatrist so I could be prescribed antidepressants. Four months before I would never had considered this, but the time spent in therapy had acclimated me to the concept. I still didn’t think I suffered from depression or manic depression, but I did think I needed something to tide me through.

The psychiatrist spent far less time in diagnosis than I expected. I was asked questions about myself, which I could readily answer since I had discussed most of them in therapy already. I was given a list of questions about mania and depression to answer, which showed clearly I was both, but not to any severe degree. What was also abundantly clear was that I moved from one state to the other quite rapidly. And in what I thought was an extraordinarily short period of time I was diagnosed as Bipolar II, possibly Cyclothymic.

I have never been satisfied with that initial diagnosis, even though it has been borne out as true. I have always felt that if I was going to be told that I was going to be crazy for the rest of my life it should certainly take more than one hour. And it should certainly be a more, well, technical process than chatting pleasantly with a very nice guy. I don’t think I have ever forgiven him for my diagnosis, and it probably was the major factor in eventually changing to another psychiatrist. Bearers of bad news often do get executed.

And so I started taking medication. The next pages are the experiences with those.

Taking Medication for the First Time

31 October 1997

I’ve taken medication (Tegretol) for the first time and it is like…
A bucket of cold water thrown on an overheated footballer
Being able to think now!
Putting on shades to blank out the glare
Sanity after years of insanity
A space of calm in the ocean with the sea raging just outside

I can hear myself think calmly now. I can coordinate my physical actions now. I can focus on one thing and remain with it now. I can…I can finish my sentences now! Continue reading Taking Medication for the First Time

Taking Medication, Take Two

Below are short notes that I kept for two months while on medication. There is a jump in the date from the previous page – I started to take medication last November but stopped a few weeks afterwards. And then started and stopped a few times between then and now. Apparently over fifty percent of the people stop taking their medication. So, if nothing else, I’m with the crowd.

We tend to think of the medication as being a solution, like aspirin for headaches, but it isn’t so simple. Taking medication does not automatically mean that we will get better. Or even that we will feel better at all. The interaction between the drugs and our moods can be a lot more complicated than that, as I found out. The Tegretol did affect my standard two week cycle of mood swings (one week manic, one week depressed, no time normal), but, well, read for yourself… Continue reading Taking Medication, Take Two

Stable and Reflective

27 June 1999 – Diary
Since I came back from New York two weeks ago, life has been wonderful. I wonder if it feels this way for everybody else. If I choose to do something I can do it without a fight. There is no secondary pressure stopping me from doing it.

I think – “Let me make sure that the company’s radios are in order” and I can handle it – getting the information I need, making a decision, and implementing it – without being caught in indecision or being stuck on the simplest information or being sidetracked by something completely different. I can start something…and I can finish it. You cannot believe how difficult that used to be in the past. Continue reading Stable and Reflective

It’s OK to be Depressed

29 July 1999 – Diary
I’m back to being out of control, drifting. Definitely depressed. Just as I thought things were going to work out. My mom is worried that that things have taken a turn for the worse, but I have been here before, it’s all familiar territory. I am annoyed though, and upset that stabilising over the long term is apparently going to take much longer than I had hoped.

I’ve traced the start of this mood swing from about three weeks back. I was in charge of the office and the work was extremely high stress and I then I became mildly depressed. No reason for the depression; the moods swings come and go regardless of what I am doing. But I had to spend so much energy concentrating to make sure the work got done that I couldn’t find the focus necessary to continue taking medication. Continue reading It’s OK to be Depressed

Just When I Thought I was Stable

It is ever so with things that Men begin,
there is a frost in Spring,
or a blight in Summer,
and they ever fail of their promise.
— J.R.R. Tolkien’s “Lord of the Rings.”

13 August 1999 – Diary
It’s been a week since I have written in my diary. The upswing that started last weekend did not quite work and I spent the earlier part of the week depressed. Mildly, but enough to affect functionality at office. Came out of it on on the 11th Aug when my aunt and cousins came to spend the night. Like before, the presence of people around me tends to pull me out of depression.

The way I have been feeling over the last three weeks is peculiar. Continue reading Just When I Thought I was Stable

Lives of Quiet Desperation

21 August 1999 – Diary
Feeling much better this morning. Opened my door, saw the list of things I need to do for my life to get going again. It’s a mile high.

Closed the door and went back in bed.
I think I’ll get up tomorrow.

22 August 1999 – Diary
Feeling much better this morning than yesterday. Was able to make it to the pool for the first time in nearly a month. Only did half as many lengths as usual, but the exercise makes me feel much better. In addition, the feeling that I am able to take some control of my life again has lifted my spirits.

However I only made it to the pool because I want to look good for C.. I worry a little about using this as my reason for starting back exercise because it has the potential for my becoming dependent on C.. Not a good thing in a relationship – it causes unnecessary strain. Not to mention that it stings my independence to have to use a crutch to get back to exercise. I should have enough self discipline to just start up. But alas, I don’t, and much as I dislike the situation, I’d rather get the exercise.

23 August 1999 – Diary
This has got to be the worst I have felt since I disappeared in 1997. I’m failing so soon after I thought I had got it right. The way I lived my life in June and early July was the way I wanted to live my life. And now this.

Objectively what I am now going through is no worse than my January 99 episode. It’s really how I am reacting to it and how much worse it compares to how good (good good, not manic good) I was feeling in June.

I’m also the closest I’ve been to giving up since I tried killing myself in 1997. If I could just shut down completely I would, but I get hungry and people keep intruding. I’m just tired of trying ways to survive and watching them fail. I’m also tired of not being sure of what works and what doesn’t. And I’m lonely of not having someone to talk with, to just be an ear for me.

What I really feel like doing is spending two hours hiking to Paria beach then settling myself crosslegged into the sand and remaining there until the sun’s glare makes me blind and all I can hear ever again is the roar of the waves and I become just one more piece of driftwood upon the sand.

People keep on coming into my house to try to fix things – clean the sink, iron my clothes. But I keep on thinking how blind they are. The house isn’t the problem. I want to yell at them, “Don’t fix the house, fix me!”

Fix me

A Day in the Life of a Manic Person

27 August 1999 – Diary
Finished work at 10:30 pm Thursday night. Came home and worked on my web site until 3:30 am. I had gotten e-mail from a friend who said to be careful that the web site does not take over my work. Well, it hasn’t. Unfortunately it has taken over my sleep instead. Got up at 5:30 am on Friday to go to work. Since I only had 3 hours sleep the night before, today is going to be very interesting as no sleep pushes me towards mania.

It is drizzling slightly, the sky is a clear light grey, it is cool outside and the streets are empty. Feels like Christmas.

Had two cups of coffee between when I arrived to work at 6:30 am and 8:15 am. Strong coffee. Am now jumpy and wandering about the office waiting to visit a client. I have started being garrulous and I have to watch what I am saying to the office staff. Continue reading A Day in the Life of a Manic Person

Here I Start Again…again

To fight aloud, is very brave –
But gallanter, I know
Who charge within the bosom
The Calvary of Woe –

Who win, and nations do not see –
Who fall – and none observe –
Whose dying eyes, no Country
Regards with patriotic love –
— Emily Dickinson

29 August 1999 – Diary
I spent the night by my friend. I didn’t go partying because everybody else cancelled out, including myself. I was relieved because I had had visions of collapsing of exhaustion on the dance floor. So I and my friend chatted until about midnight and then went to bed.

This morning I feel better. Rested and more calm. I stick my tongue into the darker parts of my mind, probing to see if there are any are any sore spots and twinges of pain. So far, so good.

I’m not exactly calm. Continue reading Here I Start Again…again

Been There, Done That, Got a T-shirt

If we can’t take our lives
with a large dose of humour,
we are in big trouble.

4 September 1999 – Diary
A while back I applied the catch phrase to myself when I was talking with a friend. She was describing her inability to take her antidepressants (the “I just can’t” problem) and I pulled out the “been there, done that, got a t-shirt” line.

We both thought it was hysterically funny at the time. And it’s hard not to miss the black humour.

But she also thought it was a much better concept than “surviving” a depression episode. And she’s right. I’d rather feel that I’ve just come back from a trip as a tourist to a faraway land than feel as if I have survived, well, a war or something. It makes a dramatic difference to my perceptions and the way I feel about myself.

I bring this up because up to yesterday afternoon I was feeling very low indeed. Not depressed low, but helpless low. I felt that each time I tried to make a step forward I tripped up.

And I was despairing that I would ever be able to hold my job or something of equal caliber again. My confidence was at rock bottom and I was seriously thinking of setting my goals and aspirations lower.

Basically I was planning to settle for being mediocre.

I was thinking that if I got a job with lesser responsibilities, I could handle it and I would feel good about myself. Sounded reasonable. Sounded logical.

But the fact is, on some days I can’t make it out of the house. It don’t make no difference how easy the job is – if you don’t get there, it don’t get done. And really, no job has few responsibilities. All they have is different responsibilities.

So getting an easier job would probably not have made much difference to my confidence. All I would have done in setting my sights lower, is to set myself on the path of true failure.

My conceptualising was not abstract. I had already set things in motion to change jobs.

But I was reading the book “Transforming Madness” by Jay Neugeboren and the following passage caught my attention;

“…true recovery begins not with diagnosis, but with a shift in one’s identity and sense of self….people with histories of mental illness and institutionalization often get stuck, and stop believing that they can improve and recover…This passivity, which the literature…calls ‘learned helplessness,’ is at least as lethal as the disease.”

Getting stuck doesn’t just mean thinking that you aren’t capable. It can be, as in my case, thinking you are a failure because of the expectations of other people that are extremely difficult to fulfil. Part of the reason I feel as a failure at work is because my family expects me to do so well.

Last week I felt as helpless as I have ever felt in my life. But I’ll be damned if I’ll ever be passive about living my life again. I came close to giving up last week and it isn’t going to happen again.

Which brings me back to the journey I have just returned from (otherwise known as depression). I refuse to accept that I have “survived” anything. I went out exploring the world. I’m back, I have tales to tell, I have more than a few curios. I’m glad to be back to my comfortable flat, I have to go through the mail that has piled up and pay the bills, and I have to do laundry and reconnect with work and friends again.

If I left at an inopportune moment, well, it’s unfortunate, but I couldn’t resist going. I’m unrepentant about leaving, and I’ll do it again when the next journey beckons. You can think me irresponsible if you want, but some trips are irresistable.

defiantly yours
jinnah