Trigger warning: suicidal ideation, mental health and mood disorders.
Elizabeth Farrelly’s article in the Sydney Morning Herald today is a dangerous and, frankly, lazy piece of misinformation about mental health and mood disorders.
It also romanticises mental health affliction; its author condescends to “like depressives” (who cares who she likes? In fact, no: how dare she?) in a sense that may as well reduce complex mental health issues that cause very real distress and danger for sufferers, to an atavistic taxonomy of pathology still naming “buboes” and “humours”.
The piece goes on to reduce clinical depression to “despair” (inaccurate; my dad despaired for his dying mother two weeks ago, he is not and was not suicidally ideated) and as “less a treatable pathology than a spur to spiritual discovery” (simply wrong and trivialising, people both devout and irreligious suffer from mental health and mood disorders).
Being “a depressive” isn’t a personal bent, disposition or whimsy. It’s mostly a function of imbalanced neurochemistry, one that can often be greatly ameliorated with appropriate medication.
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I live with Bipolar Affective Disorder, type II. I’m also lucky enough to have some indicators for Borderline Personality Disorder. Yay, brain.
It’s common for type II bipolar to go undiagnosed for ages. Often ten years or longer. It has a higher frequency of suicidal ideation and suicidal behaviours as the ‘down’ phase tends to last longer and drop deeper than in type I (the ‘manic depression’ we casually misidentify when we think of bipolar) and is more likely to result in a sufferer’s death by suicide than many other mood and personality disorders.
It goes undiagnosed for ages mostly because — and people rarely talk about this — being manic/hypomanic can be fun. Sort of. You spray cash like a sailor on shore leave, feel cockier than Kanye whether it’s justified or not, you take risks like a Red Bull-addled extreme sports junkie, will sleep with anything that shows an interest and have an elevated energy that’s often socially contagious. You don’t go to a doctor when you’re that euphoric: you feel bulletproof.
People mostly present begging for help for mood disorders during down, depressed or suicidal phases. Without a broader context of a patient’s history, mental health professionals can easily mistake bipolar of either type for depression.
Also, type II sufferers by definition do not experience psychotic episodes or hallucinations and delusions (apart from a sense of grandiosity and invulnerability when ‘up’) whereas those with type I bipolar often may.
The antidepressant prescribed to treat the depression I presented with but didn’t have at 23 years of age was not only the wrong therapeutic approach for type II bipolar (usually treated with psychiatric counselling and mood stabilising drugs) but is contra-indicated for type II bipolar.
That is: the treatment I was prescribed made the ‘normal’ hypomania of my bipolar ‘up’ phases more intense and prolonged, approaching true mania.
For almost 20 years.
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I was profoundly suicidal from May–July of 2015. Unemployed and living off a credit card and convinced that I would not survive the year, I collapsed one day in June, in the middle of Flinders St in the Melbourne CBD, crying the kind of ugly, unselfconscious kicked-animal yelping that happens when you hit bottom.
In truth, I think I cried like this for about half of 2015. The tail end of my mis-medication had seen me lose: my partner of 6 years, the two best jobs I ever had, and I burnt through a five-figure windfall in under six months.
But this particular day was different. There was a new rattling wheeze I hadn’t heard before under the wails coming from my vocal cords and lungs. Even the consistency of my tears felt different, which I’ve since learned was not my imagination but a real thing. My forearms slumped, dead weights balanced on my thighs as I sat there on the steps of some corporate sliver, shoulders bouncing with the involuntary shrugs of my sobbing.
It was what it felt and sounded like to want death as a release.
I recognised it; it wasn’t the first time I’d felt it, but it was the worst in a decade. When I could breathe again, I went home and started writing my goodbyes.
*
Somehow, a new young GP treating me for something unrelated agitated on my behalf to get me an emergency appointment with a public system psychiatric Crisis Assessment Team. I would not have done this under my own steam. She pretty much saved my life.
The first proper psychiatric diagnoses of my life took place that July and September.
When identical diagnoses came back from three independent psychiatrists (two in the public system, one private) I felt:
1) nauseated by the idea that so much of the pain I’d caused and endured could’ve been avoided with a correct diagnosis;
2) distraught, thinking about how to possibly begin to move forward with my life;
3) angry, utterly livid with all the doctors who hadn’t noticed, who ‘got this wrong’ and left me to this traumatic, rollercoaster way of living for so long.
Imagine you’re not who you think you are. How do you address that?
Changing a drug regimen is the most basic thing of all; get the prescription, monitor the response, adjust, repeat. Confronting your self-perception? That’s heavy.
This wasn’t a “societal indictment” as Farrelly dismissed it this morning. It was very much a “personal issue”. As personal as it gets. Almost impossible to articulate to others.
Changing my medication gave me back my life when I was ready to throw it away.
I started writing this two years ago and shelved it until this morning’s piece annoyed me. Someone hours or days away from self-harm or even taking their own life doesn’t give a crap about bemused invocations of Descartes.
Not when prompt attention and medicine might actually help.
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The relief at finally knowing what I am, a person living with bipolar, and having a regimen of suitable medication to regulate my mood, can’t be overstated.
Mostly, I now exhibit the stability of ‘normal’ (i.e. broadly neurotypical) people (bipolar disorders affect only 1–2% of the population). My situation is managed and stable.
Getting well required me A) getting the right drugs, mood stabilisers rather than anti-depressants, and B) working through 20 years of behavioural stuff in therapy with a clear head, stuff that I had precipitated with the unclear one.
This is why I won’t hear someone shooting their mouth off about how ‘drugs aren’t the answer’. For some, they are.
I would not be here today, but for the intervention of a psychiatric assessment recommending changes to my medication.
There is no ‘one-size fits all’ solution, and a drug-free approach to dealing with mental health issues — depressive, whatever — has no moral, health or other kind of spiritual ‘superiority’ to a medicated life.
It is dangerous, even irresponsible, for Farrelly to suggest that depression can be encapsulated in some atavistic representation as mere “spiritual malaise”. Tree-changers have ‘spiritual malaise’. AFL players bored with football and dying to be baristas have ‘spiritual malaise’. This is not the same as what’s felt when you plan to take your own life.
Your neurochemistry is adjustable. If doing so enables to you live a life you love a little more, or even one you just feel capable of living, for fuck’s sake, adjust your neurochemistry.
If there’s a takeaway from this, it’s the importance of correcting the dangerous stigmatisation of people reliant on medication for their sound mental health or mood.
If you suffer from a mental health issue or mood disorder requiring ongoing medication, feel free to ignore the Farrellys of the world and heed the advice of appropriate medical and psychiatric professionals.
There is nothing ‘romantic’ about your suffering, and you are not obliged to project mental fortitude for the benefit of others.
Do what works for you, for your own mental health — if that’s ongoing medication, sod the haters.
Lifeline 131 114
Beyond Blue 1300 224 636
