Summer and Antipsychotics in the City

What it’s like to really lose it.

When I try to explain to people what happened to me the summer when I went insane, I have what is the fairly common experience of anyone who’s been through a traumatic event: it feels as though I wasn’t the person it happened to. It happened to someone who was me, but not me. Trying to picture that person now, I brush over recollections of terror and see an image of myself that never comes quite into focus, like waking with hazy memories of having met yourself in a dream.

There were three nights in Sydney last summer when the temperature hovered around forty degrees even in the middle of the night. Those three nights stretched into a week — the hottest week in 150 years of keeping records. We lived at the time in a house in the city that had last been renovated sometime in the 1970s. Lacking any way of circulating the broiling air, it was well designed for trapping heat in every crevice.

There are always a couple of nights during a Sydney summer when you can expect to try to pass the time experimenting with ways to keep the heat down (put your sheets in the freezer! Liberally sprinkle your bed with icecubes! Press your face against the bathroom tiles!), while accepting that you are not going to get much sleep. The night air crackles with the whine of mosquitoes and the faint hum of televisions next door. The heat breeds a kind of delirious camaraderie in the city where the next day everyone stumbles around wearing the same half-stunned expression on their face.

That first night I did not sleep at all. I did not sleep at all the second night either. By the third night I was getting close to seventy-two hours without sleep and I was losing my mind. It was shortly after I stopped sleeping that I lost the ability to read.

Seventy-two hours without sleep had flipped a switch in my brain. Or as the nurse from the mobile psychiatric unit at my local doctor’s described it, my mind was a lawnmower engine and someone had pulled too tightly on the ripcord. Now the engine was spinning without being slowed or stopped. Clinically I was in a state of heightened, sustained panic. ‘The good news is,’ she said, ‘that people can’t stay in the state that you’re in forever. The body can’t take it, it’s going to pass.’

I thought, crazily, of the times when the inability to sleep doesn’t pass. And when it doesn’t pass, people die from it, from a very rare disease called fatal familial insomnia. I’d read about it once, somewhere, and my mind kept dredging up this one fact: that people can die from lack of sleep. I was going to die from lack of sleep. ‘There’s something your doctor can give you to help you,’ she said.

So I walked out of the doctor’s surgery with two doses of the atypical antipsychotic Seroquel in my pocket. My doctor, having seen me arrive at her door incoherent and unable to stop crying and quickly thereafter making a call to the psych ward, insisted on driving me home. She looked over at me as I got out of the car when we arrived at the house. ‘You’re going to get through this. I promise. I won’t let anything happen to you.’ At that moment, that did not seem like something that was even remotely possible.

In the days before I finally submitted to being taken to the doctor, I had descended into a state that I would describe as being akin to a really, really bad acid trip. That’s what sleep-deprivation psychosis does to you. It’s why sleep deprivation is such an effective torture technique. At one point I had been so seized by a terror of my own imminent death that I was compelled to call almost every person in my life and tell them that I was sure I was going to die that afternoon. I didn’t know at the time I was suffering a sleep-deprivation psychosis, I just thought that I had wholesale lost my mind, and that thought was terrifying.

When you first stop sleeping you can develop all kind of symptoms. Auditory and visual hallucinations and vomiting are some; I got all three. As the temperature hovered above forty-three degrees, this only served to compound my delirium. I didn’t know any more whether I was asleep or awake. I was seized by a choking, irrational fear and intrusive paranoid thoughts. Particularly distressing among these thoughts — which were bullet-proof in their certainty — was that my boyfriend was going to leave me. My boyfriend, who left work to look after me, who went out for bags of ice and jury-rigged an air conditioner from an electric fan, who cooked a light dinner every night in the hope that I would eat something, who plied me with cold packs and combed my hair with his fingers. He was going to leave me because I was an insane person. This logic was sound.

I lay inert on the couch pretending to read Patti Smith’s Just Kids while swallowing the rising terror I felt at not being able to follow the sentences. I couldn’t follow the individual words; they floated on the pages disconnected from one another. Trying to comprehend a single paragraph eventually proved so distressing I had a full-blown panic attack. Afterwards I thought I could stave off the terror of not sleeping by watching television. Perhaps I’d be lulled by the comforting predictability of the procedural dramas I loved to binge on from time to time. The actors on the screen looked so ridiculous standing on the set in their costumes, pretending to speak the lines someone else had written for them while they smirked at us. This was all I could see. I could not see the presentation of a make-believe storyline and the fictional world as offered up to us, the audience. I could only see people acting. Everything looked sort of see-through, like looking top-down at a diorama. Everyone knows this about film and television, but had they ever really seen it, like this? The whole thing was so phoney! As I sat there staring at the screen while the cut-outs moved around saying their pretend words, I hastily scribbled down a note (one of the many ludicrous, barely legible thoughts I catalogued) to remind myself to lift the lid on this fraud as soon as the unable-to-read thing had passed. ‘Expose entertainment complex conspiracy,’ it read.

The panic was rising in my chest again — the pinpricks at the backs of my legs, the dryness in my mouth — so I turned off the television and rolled towards the wall, where I fingered the patterns in the brickwork. The panic was a familiar, smothering feeling to me now.

Andy was reading in the armchair beside me. I was crying again, for some reason that made sense somewhere in my desperate mind. ‘I think we should break up,’ I said. ‘Hmmm,’ he said. ‘I don’t think so, honey.’ ‘I’m not the sort of person you should be with,’ I said. ‘What if there is something really wrong with me? With my mind?’ ‘I won’t leave you, even if there is,’ he said. I thought about this. It didn’t make sense. ‘I think we should break up,’ I whispered. He sat beside me, reading in the chair.

The next day I went to the doctor.

Seroquel is prescribed for people with schizophrenia and bipolar disorder. It is a powerful antipsychotic. It blocks dopamine receptors in the brain that, when working excessively, can trigger manic episodes or exacerbate schizophrenic symptoms. It was the drug my father had been taking in the months before he died, when I was twenty-two.

I was afraid of taking the Seroquel, not only because I didn’t know what it would do to me, but because if I took it, perhaps I would be fulfilling a family pattern. Perhaps I had developed bipolar disorder, too. I knew that this thought was what was really at the root of my panic.

‘Just take it,’ Andy said. ‘I’m here with you, it’ll be okay.’

The dose I was given was just 50 milligrams — enough, my doctor said, to reset the motor in my mind like a circuit-breaker, so I could sleep. People who need to take it to treat their schizophrenia take seven times that amount every day. I have never had an experience that was comparable to the night I took an antipsychotic.

At first nothing much happened. In the space of about thirty minutes I did become relaxed in a way I hadn’t known in days, maybe years. We thought then it might be a good idea to get into bed and watch something we both enjoyed, which in our nerdy way was Frasier. I’ve seen every episode of Frasier, it’s a show I would say that I know pretty well. But soon I was asking things like, ‘What did he just say, before that?’ ‘Where are they meant to be?’ ‘Who is that?’ ‘What show is this?’ I started to feel afraid when I realised I couldn’t grasp anything for more than a moment, but that feeling too passed as soon as it arose. Then a crystal clear thought pushed its way into my mind: I can only have one thought at a time. That is how the drug works. I can have one thought at a time. I wasn’t afraid then, and I fell into a dark, heavy and dreamless sleep. When I woke the next day, in the late afternoon, I felt rested for the first time in a week. I cried a little, such was my relief.

My recovery would take some time. I felt at times as though all the skin on my body had been grazed over with sandpaper, and that even the faintest breeze would pass right through me, straight to my nerve endings.

My doctor sent me to a psychologist who would help me work through the crushing anxiety attacks I was plagued with after the episode. My sleep remained patchy and I often struggled to get through the days without my mind wandering in a panicked loop. I was in terror of having another episode. I was in terror of being diagnosed, like my father, with bipolar.

‘You don’t have bipolar disorder,’ she said. ‘But you do need medication to treat your anxiety, which is severe.’

The therapist wrote me a very basic list of things to do every day, so I could feel as though I had accomplished something as each day passed. I’ve kept the list for those times when I let myself feel as though I’m not doing quite enough — not working enough or writing enough. The first thing on the list to cross off was: Get up. Then came: Brush teeth, shower, get dressed, eat breakfast. Walk around block twice. Read two pages of a book. Make lunch. Eat lunch. There was a time when these things were the pinnacle of achievement in my day.

After a few weeks I began to return to normal functioning by increments, but I was very concerned about my ability to do my job. The summer break was ending and the TV show I worked on would be going back into production. It was a highly visible, high-pressure job that had always brought its own stresses and it was sometimes difficult, but it was manageable and rewarding and I loved doing it. It was what I did. But after the psychotic episode, I began to feel as though I didn’t have a skin of the proper thickness, and I wasn’t so sure I could still muster the level of brashness required to stand in front of a camera.

In the office I told my boss what had happened to me. It told him I still wasn’t quite myself. He said that whatever I needed to do to get better was fine, to work less or more, or from the office or from home, as long as I kept him up to date on how I was coping. He also said something to me that I haven’t stopped thinking about since. ‘Happy is more important than successful,’ he said. ‘By any measure.’

I got better. My doctor prescribed medication to quell the anxiety that was my genetic legacy. I ate better. I quit smoking. I worked on cognitive therapies with the psychologist. My sleep pattern returned to normal after about six months, and in this respect and so many others I was lucky — severe knocks to the brain’s sleep centre can wreak havoc with people’s sleep patterns for as long as several years, during which time they are tormented by regular bouts of insomnia. The show wrapped up and we’d done some good work on it. I travelled on a story to Miami and New York, where a girlfriend from high school gave birth to her first child, a boy whom I saw in the downtown Manhattan hospital when he was just six hours old. In Thailand I married my two oldest friends in front of everyone we knew on a small moonlit beach. These were all things that were before me those nights and days in the summer when I lay gripped by a psychosis I was certain at the time was permanent.

The year ended and we decided to leave Sydney. We both quit our media jobs and left our house in the city because rent was too damn high. And there were other reasons. Even though we lived in the same house, we felt we barely saw each other. So we moved 1000 kilometres away to another state, to live in a country town where the rent is cheap, the sky is huge, and the garden we never had in the city provides our cat with a bewildering perplexity of sensory stimuli; where everything is slow and there is time and the air smells clean; and where, if we’re really lucky, we might strike gold in the old alluvial fields that lie everywhere around us.

© Elmo Keep 2012