Being a patient

Anyhow, I had put down my symptoms of lack of motivation, anhedonia and exhaustion to work related fatigue. However the symptoms became much more obvious when a friend, their family and my family went to a cottage in north Wales; a relaxing summer holiday with very close friends. The removal of the daily job framework made it obvious that there was nothing left to give. Not wanting to go out, not wanting to play with the children, not wanting to do anything, just sit on a sofa, not talking, hardly moving, and no wish to do anything at all. After the week, a holiday from hell, for those around me as well as me, we returned to Edinburgh. And as we had a free Sunday afternoon my wife and I took the kids to see Shrek 3. I don’t know if you’re familiar with it, but towards the beginning, Shrek is at his children’s birthday party, loses it and smashes the cake and storms off. I broke down in tears at this point, sobbing my way through the rest of the movie. I still don’t know how I stayed there for the rest of the film.

On getting home. My wife Nikki pulled me aside “You’re ill” she said. I tried to deny it tears rolling down my face. I’m just tired. I just need a rest. Back and forward. It’s more than that. No, it’s not. It is. I’m just tired. No, she said. And then the words that I still remember “If I was like you are a now and you begged me to go and see your doctor. I would go and see them.” This hit home. The next morning I saw my GP and out came the pourings of an addled depressed mind. Suicidal thoughts. Well, in fact, homicidal thoughts. I’d been thinking about and planning driving my car, off the motorway at high speed. Either into a concrete overpass column, into or off a motorway bridge. Something with my medical experience that I knew would be fatal.

I hadn’t truly realised at this point that in fact for the preceding years, I’d had periods of hypomania. These periods had always been put down to my normal hyperactivity, my normal personality but on reflection, they were hypomania. I was always looking for extra things to do, or spending (a dopamine hit), and not necessarily completing tasks fully. Although interestingly at work I always managed to finish things and so therefore was known as a completer. A reliable dependable set of hands. However, at home there was increasing difficulty or lack of motivation. This meant giving the love and attention that my wife, daughter and son deserved was increasingly challenging. Leading to strained relationships and a feeling of abandonment (Well, this was my perception). My befuddled brain meant work became increasingly difficult. A body riddled with tiredness , dragged into work daily, with prayers for an easy day, and no challenges. (Difficult in my specialties). However, using psychological techniques that I’d learned from personal reading, including chunking, prioritisation and single task fixing with rapid task switching, I managed to work. But with utter mental and physical depletion by the end of the day. Gradually, I was noticing I was putting tasks off and the time away from work was just for sleep and survival.

My mood during my first episode of depression was unipolar. Just the lows. Seeing my GP, with my wife there for support, I vaguely remember sitting, sobbing, not really being able to speak well and filling in a PHQ-9 depression questionnaire. I think I managed to communicate my tortured suicidal soul with ticks and some hieroglyphs. The bullet was out of the gun but they were still in my possession. This was enough to merit immediate assessment by the Intensive Home Treatment Team (IHTT). An amazing multidisciplinary psychiatry team who’s aim was to provide virtually hospital in-patient care in your home. This was the start of a very slow turn for the better.

My memories of this time are fragmented and poor. However, I do recall a mandatory walk daily with the team. I think the doctor even wrote a prescription for it. Half an hour, whatever the weather, doesn’t matter how far or how slow. I kept to this including a memorable trip round Arthur’s Seat during an absolute downpour, where both myself and the IHTT nurse returned literally soaked to the skin. The nurse had to return to the IHTT base and borrow some dry clothes.

There were of course the drugs. A cornucopia of medications. Diazepam, temazepam, chlorpromazine, escitalopram, mirtazepine, quetiapine are the ones I recall. A cocktail designed to relieve mental distress, suppress horrible thoughts and alter brain biochemistry. Additional occupational therapy to attempt to structure the day and allow healing time to pass as well as give purpose was the lynchpin of my treatments. Up till then I wasn’t even aware that there were psychiatric occupational therapists (OTs). These skilled individuals hail back from after the First World War where disturbed soldiers returned home with ‘shell-shock’ (Post Traumatic Stress Disorder PTSD) and were put in institutions. Therapists realised that giving activities, tasks, exercises and reintroducing daily routine restored a purpose in life and helped rehabilitate these poor souls.

For me I think I was fairly catatonic for days maybe weeks. The medication being used as a chemical club, to relieve emotional pain but also remove active suicidal drive. Slowly I emerged from this state. Days then weeks and months passed with a very slow but steady recovery

But there was a blip, a telltale sign, as we know now. Several months into treatment as my depression lifted I went for a walk with my wife and sister in law. I vaguely remember it being out in the countryside, sunny and nice. Apparently though I didn’t stop talking for the entire eight mile walk. And it was to my sister in law, not to my wife, who incidentally is a GP. Her response at the end of the walk to my wife was “he’s a bit high”. Unbeknownst to me, my wife questioned this mood change with my consultant psychiatrist even asking him directly if this could be bipolar type 2. My wife is a very clever person. However, his response was adamant. “No, this is a flight to health.”

Unfortunately, within a week I developed a paranoid psychosis and the bipolar question was dropped. The delusion was painfully directed at my wife, who I thought wanted me dead and to run off with my work colleague boss. Those mixed up thoughts and beliefs were fueled by his calls to my wife to inquire how I was and what support he could give. Unfortunately, the paranoia worsened. As I became increasingly wary and suspicious of anyone I would encounter, other than the members of the IHTT, I started wearing hoodies to protect my head from the thoughts ‘they’ were putting there. And from ‘them’ reading my mind. It is so difficult to describe because at times you know these thoughts are illogical and wrong, but at others they are an unshakable truth.

Again, memories around this time are poor but slowly I recovered. But I’m not sure my wife ever has. My period of paranoid psychosis meant she feared for her and my children’s lives. And they moved out of the house for their own safety.

I think it was about 18 months in total before I was well enough, rehabilitated and had returned to work and a more regular life. My wife bears the scars of one of the worst periods of her life. The only blessing was that the kids who were very young don’t really remember much, other than Daddy being unwell and a period where he just was always sat on a sofa and would cry if they came to hug me.