What follows is a first-person account of breakdown including the graphic description of psychosis and self-harm. If you should ever need to talk to someone about your own or another’s mental health, call Lifeline on 13 11 14. If a life is in danger, call the emergency services on 000.
There’s a Camus quote that runs “Should I kill myself, or have a cup of coffee?”
One Tuesday morning, I ran out of coffee.
My relationship with the public mental health sector got serious two weeks before. I went to my regular psychologist appointment presenting with psychosis: hearing voices, seeing things that aren’t there, blacking out and losing time, etc., etc. As a trade-off for refusing to get in an ambulance should she call one, I allowed my psychologist to ring the crisis team from the local public hospital. They agreed to see me the next morning.
My mother polished the dining room table. I wondered if I should offer them tea when they arrive, or pack in case they take me away. I threw an Evelyn Waugh novel in an overnight bag. That would do.
The crisis team was less than helpful. At that stage I wasn’t experiencing thoughts of self-harm, and as soon as I reported as such, they tuned out. I was instructed to stay on my current medications and wait six months to see if there was a change. I would later find out that the team recorded “eccentric personality” as the suspected cause of my hallucinations. They didn’t want any tea.
I’ve sought treatment for major depression and generalised anxiety disorder for almost a year now. At the end of January my GP started me on Lovan, an Australian brand name for Prozac, known around the world as “sunshine in a pill.” A prescription like mine is common. Out of every 1000 adults in Australia, 89 of them are on anti-depressants at any given time. They stabilise mood, relieve anxiety and ease patients back into a normal sleeping routine.
Most of the time.
A frighteningly common side effect of anti-depressants is, in fact, suicidal thoughts. Most guidelines recommend that GPs monitor patients carefully for the first few weeks. I wasn’t informed of any of this and went back to my GP some weeks after starting Lovan to report that I felt more depressed, and was sleeping less than ever.
I was advised to double my dose. The week after the crisis team visited me, I all but stopped sleeping. Most nights I got less than an hour.
Hallucinations and delusions, as I’ve experienced them, are a mixed bag.
I had several hallucinations. On a train, the woman next to me opened up a newspaper, and on its pages were photographs of me. Once, while I was driving in the CBD, some of the buildings began to bend and waiver in the wind, like grass.
Voices come in two forms: indistinct and distinct. Indistinct voices are akin to a group of people whispering in the next room. They’re muffled, and, as the phrase hints, unable to be heard properly. Distinct voices have an even larger variance. Sometimes I could hear someone calling my name off in the distance, while being in an entirely empty house. Sometimes it would be a phrase overheard that day on an infinite loop inside my head. Sometimes I would be in the middle of thinking and something would snarl “STOP THAT” or “SHUT UP”.
They became more and more insidious. On that Tuesday, I was told to go to the bathroom, sit in the bath, take the nail clippers and tear open my arm with the blade.
There wasn’t one particular thing that went through my head when I decided not to kill myself.
I didn’t think about the friends and family I would leave behind, the job I would never have, the people I would never fall in love with, the things I would never see. I didn’t think about the countless times my family had referred to my uncle’s successful suicide as cowardly. I didn’t even worry about the physical side, the pain of dying, or the atheist’s fate of eternal emptiness.
I just thought: No. Not now. Not today.
Every second after that thought is what matters.
There’s no delicate way to tell the people you live with that you almost killed yourself two minutes ago, and now need to be driven to the hospital. This situation becomes even more delicate when you live with your parents.
I told my mother that I needed to go, but that I first needed to cut my nails so I wouldn’t scratch myself. On my request, she sat next to me so I wouldn’t do myself any harm.
I waited three and a half hours before I was seen to. An ED doctor tried to take a blood sample from my arm. Three needlestick wounds later, they left without their sample. That was on my request. I figured that after the day I had, I was entitled to be a bit of a diva.
I was eventually seen by two psychiatrists, one who spoke to me in calm dulcet tones and another who played scribe. I was asked the usual questions: medical history, drug history, relationship history, what kind of symptoms I was experiencing. I was told that I was either experiencing psychosis due to advanced depression, or I was in the early stages of schizophrenia.
They gave me new pills, told me there wasn’t a bed available, and sent me home.
At first, the new medication worked well. I started sleeping all night, every night.
It took Mum a long time to get over that day. For the next two weeks she took me everywhere with her. We were both afraid of what would happen if I was left on my own.
The hospital scheduled a follow up appointment a few days later with a different psychiatrist, who informed me of the prior ‘eccentric’ verdict and told me that I shouldn’t have turned up to emergency. That, mind you, was after I had called every psychiatrist in my area and begged for an appointment, and was told by several professionals to go to emergency.
The second psychiatrist didn’t see the need to give me a concrete diagnosis. “What difference would that make?”
Between the start of my psychosis and my appearance at hospital falls a month. I stopped eating, looking after myself, sleeping. I had to call in sick at work almost indefinitely. I’ve suspended my studies in the hope that I can get myself back to functioning before the start of semester two and my scholarship payments have been frozen.
I’m still no closer to a diagnosis. I still know very little about what’s going on.
Another aspect of psychosis is doubt. Doubt in what you’re seeing or hearing, doubt in what you perceive as reality, doubt that your symptoms (and even your doubt) are genuine. I have spent the last month questioning if I’m real, only to be told by a system not interested in treating me that buildings bending over themselves and voices telling me to shut up are just quirks.
I have begun to view this year as pre-attempt and post-attempt. At three weeks post, my medication started to become less and less effective. I slept less, and when I did, I had strange, multilayered and frighteningly lucid nightmares. The kind of nightmares wherein you scream, this is a dream, I will wake up very soon, but you never do. Or you dream about waking up, only to find that you’re still trapped, still running from yourself.
Even when you do wake up, how can you be sure? Some of my dreams are so realistic, I’ve found myself searching my phone for text messages I remember receiving only to discover that they never existed.
As my psychotic self begins to seep back in at my edges, both ‘relapse’ and ‘recovery’ become dirty words. Everyone walks on eggshells around me. Even I’m starting to. I have no idea what’s even wrong with me. I have no idea what’s going to happen over the next six weeks, or six months.
I can’t even put my name on an article detailing my experiences. What if someone I work with finds it? It’s self-evident that “often loses touch with reality” doesn’t look that great on resumes.
Is it starting to seem hard to find a happy ending to this story?
There is one.
I mentioned earlier that I’ve suffered from anxiety for a long time. Probably all my life, on one level or another. A very common part of anxiety is feeling as if you’re a burden on everyone around you, that you’re just a little too needy to be likeable. It’s a metaphorical voice in the back of your head whispering that everyone hates you. In my case, that became a literal voice.
This experience might not ever turn off that voice, but it’s given me a logical argument against it. I had to shadow various family members for two weeks, family members who were more than happy to accommodate me. The few friends who knew what was going on contacted me every day to find out how I was going.
The happy ending is not finding out that people like me. It’s being made aware that I’ve always got somewhere to go, whether that’s towards recovery or relapse.
This is really what I’m getting at. I survived, and that’s great, but the mental health system wasn’t the most helpful apparatus in the process of surviving. I shudder to think about the thousands of individuals out there who have a mental illness and are homeless, or estranged from their families.
What happens to them when they’re told they just have an eccentric personality, and there’s nothing that can be done? What happens to them when the medication starts to stop working? Or they’re sitting on the edge of a bath somewhere?
I’m not an expert, but surely there’s something we can do. This is a problem that can be if not fixed complete, minimised a great deal. I think, more than anything, we need to grow up as a society and learn to talk about mental illness. Admitting that you hear voices should not be one of the scariest things a person can do. We need to create a culture where individuals can be taken seriously and kept safe.
I used to complain that I never had a ‘great formative experience’. This would not have been my first choice. Or my second. And I’m not going to pretend that what hasn’t killed me has only made me stronger. But I’ve learnt a lot. And I am better equipped for the next time it happens.
Only you know what is normal for you. If you feel that something isn’t right, speak up about it. Kick and scream until someone hears you. Don’t wait until it’s too late.