Psych Wards 101

If you’ve read too many depression memoirs, as I have, you might feel a little disillusioned when you enter an NHS psychiatric ward.

In Darkness Visible, William Styron’s hospital offers peace, tranquillity and art therapy. In Shoot the Damn Dog, Sally Brampton’s ward has yoga instructors and group talking treatments. The hospital in Girl, Interrupted is portrayed as some kind of high-security Butlins.

Here’s the thing: the people who write depression memoirs tend to go private.

There was no yoga on my NHS psychiatric ward, although there were people in fixed, uncomfortable postures, like the girl who sat in the corridor each day with her knees under her chin; or Maxine, who lay morosely across a couch in the sitting room that was too narrow for her wide body. It wasn’t yoga, but you got the sense that these postures were thousands of years old.

There was no art therapy there. There was a ‘games and craft room’, which had a bookcase holding half a dozen Jeffrey Archer novels and a copy of the Psalms with a burn mark on the bottom. The room boasted three adult colouring books and a shelf of incomplete, boxed board games. I managed a couple of games of Scrabble with a lady called Felicity. We pooled the few remaining tiles that we found in three separate copies of the game, which meant that some letters were disproportionately represented. We had an abundance of Es and Os. They kept appearing in every pick until my whole tile rack resembled an agonised wail. We could rarely get words that were longer than four letters, and this made the resulting board look cramped and tightly clenched, like a fist.

Hospital, in other words,  is not a haven. It’s upsetting. It’s noisy twenty four seven. It would no doubt make some depressed people worse. So why do so many people ask to be admitted? What does it have to offer?

Letting it be

If you volunteer to go into hospital, you are making a choice. You are choosing to sacrifice freedom of movement, freedom to decide when and where and what to eat, and freedom to define your own mental wellbeing, in exchange for the one freedom denied to you in the real world: the freedom to let the mask slip. It’s okay to not be okay in hospital. It’s expected. This can be an almighty relief.

Routine

A psychiatric ward is not a place of healing or inspiration. First and foremost, it is a place of holding, where nurses wait for the passion of suicidal zeal to simmer down into stable, stagnant unhappiness. The psychiatrists who treat you and the nurses you are assigned do not work towards the eradication of depression, or complete wellness or a total reversal of fortunes, but towards stability. In hospital, constancy and routine are the furthest reaches of ambition. If regularity and order have been lost from your life, it is a good place to be.

Support

Poor mental health is an epidemic, and in the community, I felt as if I had to compete with other sufferers for support. My requests for help more often than not resulted in my file being passed endlessly between the GP, Crisis Team and Community Mental Health Team – less a record of a patient, more a weapon in the ongoing tribal warfare between the three.

It’s a different story in hospital. Help is concentrated there. I had a physical health check-up and the offer of debt help from a specialist, who could also advise on benefits.  I was  assigned a nurse who was available to sit with me and talk. I had a care plan on discharge. Getting into a psychiatric ward can be as difficult in the 21st Century as getting out of one was in the 19th, but if you feel you are being dismissed by care providers in the community, securing a bed may be worth the fight.

Access to the good pills

When I was admitted, I hadn’t slept properly in weeks. Zopiclone, a powerful sleep aid which is guarded like the crown jewels by GPs, was given to me each night without question. It didn’t so much lull me to sleep as wrestle my head to the ground and hurl it over a cliff into unconsciousness. At that stage of insomnia, you have to use force.

I was also able to discuss medication with a specialist who understood it. My psychiatrist was kind enough, but singularly interested in the effects and side effects of what she prescribed. When she asked, ‘How are you?’ she meant, ‘How is Aripiprazole affecting your neurotransmitters?’  When I replied, ‘I’ve felt better,’ I meant, ‘Aripiprazole makes me so insatiably hungry I ate a kilogram of chocolate and then felt sick from over eating and utterly ravenous at the same time.’

I began to feel like a stew on a hob, passively allowing her to adjust the seasoning of my mind to taste. My contact with her was therefore somewhat dehumanising, but I never felt that she intended it to be so. Dehumanisation was simply another unwanted side-effect of treatment. Other psychiatrists, it seemed, quite consciously treated patients as if they were less than human.  One patient claimed she had been told that, ‘If you want to commit suicide you should just do it.’ Psychiatrists can help, but they specialise in chemistry, not empathy.

I went into hospital naively hoping to be transformed.  I came out with new medication, a few scrabble victories under my belt and a desire to never, ever set foot inside such a place again. These things, in themselves, were much less than I had sought, but they formed a part of the patchwork that made up my recovery.

 

Mindfulness

In 2011, I was asked to participate in an experimental NHS course called Mindfulness for Depression. Back then, mindfulness was not yet mainstream. Adult colouring books promising instant zen had not yet landed on the shelves of Rymans, and living in the moment and paying attention were good ideas, rather than million dollar industries. I’d never heard of mindfulness, and the word instantly troubled me. I already felt full to the brim of ‘mind’; positively bloated with it, but I turned up at the clinic for the first session anyway and tried to keep my full mind open.

The course leader introduced herself as Doreen. She looked much too young and happy-go-lucky to have such an austere name. She skipped around, all fringe and leggings, handing out meditation CDs to her sceptical looking participants, most of whom were no-nonsense Scousers still in their outdoor coats.

The theory, she explained, was that through mindfulness, we would learn to pay attention. I winced.  I have always been wary of that phrase. I associated it with stern French teachers and huffy driving instructors. Pay attention meant the end of daydreams and the beginning of strained concentration on irregular verbs and clutch control. But I kept listening.

If we pay attention to the world, she said, we can train ourselves to disengage from the direct experience of our thoughts and emotions – for it is in direct experience, apparently, that pain dwells.

Without further ado, she asked us to cup our hands. She fetched a packet of what looked like raisins – yes, yes, they were definitely raisins – out of her gym bag and placed one in the centre of each of our upturned palms. She did it somewhat reverently, as if we were at communion.

‘We are going to practice paying attention to our raisins,’ she said, with perfect seriousness. But we could pay attention to anything and everything, it didn’t have to be raisins, or indeed dried fruit of any kind. It could be the taste of a cup of tea, the scent of washing up liquid, the sensations within our bodies. To live mindfully was to live in the moment, with whatever was at hand.

‘Look at the raisin with wonder,’ she went on. ‘Imagine you’re a child seeing a raisin for the first time.’ When did I first see a raisin? I remember pouring them out when I was a kid, when I was helping Grandma with her Christmas puds. The mixture was always too heavy to stir and I always got told off for not using enough elbow grease.

‘If your mind has wandered,’ she said, ‘gently escort it back to the raisin.’ Hang on a minute, how did she know my mind had wandered? Maybe she could tell by my face. Must keep a poker face. Is this a poker face? If I was playing poker right now, could she tell what cards I had by the frequency of my blinks?

‘If your mind has wandered again, gently bring it back to the raisin. Lick the raisin. How does it taste?’ It… well… it tastes like a raisin. Do raisins count towards your five a day of fruit and veg? I know baked beans count, weirdly, but….

‘Now, listen to the raisin.’ Hmmm. I held it to my ear, but could hear nothing but the smirk of the lady next to me. Doreen could hear it too, but she merely smiled, raisin to ear, and kept listening.

‘Now,’ she said. ‘What did you notice about your raisins?’ The answer was absolutely bloody nothing. But I did notice that paying attention for any length of time was nigh on impossible.

One things I loved about the course was Doreen’s openness to our resistance. We could tell her that ‘paying attention’ bored us rigid and was too damn difficult, we could announce triumphantly that mindful meditation helped us to fall asleep (after she had told us time and again that this was absolutely not the point), we could tell her that the sight of raisins triggered traumatic childhood memories and leave the room in diva-like disgust. We did all of these things and more. She seemed to like it when we scoffed, as if she understood that our extreme reaction was merely a part of the process.

After all, resistance to mindfulness makes absolute sense. It is not necessarily relaxing. It is, at first, deeply frustrating and has no tangible immediate pay off. The first time you attempt formal mindfulness meditation (in which you’ll be asked to do something ghastly like pay attention to the quality of your breath for twenty whole minutes) your thoughts will almost certainly wander onto what else you could be doing with that time. You will ache to turn off the irritating guided meditation CD, to tell the American speaker to stop talking in cliches, turn on your laptop and do everything you’ve been putting off for six months, whether that’s spending last Christmas’s Argos voucher or switching energy supplier. But if you’re doing the meditation right, you will ‘mindfully pay attention’ to that compulsion, and you will stubbornly, indefatigably bring your attention back to your breath.

Despite our struggles, by the end of the course, we were all converts. We were getting better at something, we were progressing, and that felt good. Someone asked Doreen how to ‘go further’ in mindfulness. She answered with trademark wisdom: ‘In order to deepen your experience, you have merely got to practice it.’

I’ve tried, since the course, to practice regularly.  And although it is not a panacea, living more mindfully has been beneficial in a number of ways.

To start with, it has taught me that the connection between the mind and the body is more profound than I had ever before realised.  I have heard a hundred times that exercise, healthy eating, and dressing with a little thought can boost one’s self esteem.  I have acted on all of these titbits of advice and discovered them all to be quite correct. But by doing regular body scan meditations (in which you sit upright and focus attention on the sensations in each area of the body in turn) I realised that I could make myself feel stronger and more dignified merely by arranging my limbs into an upright posture that embodied strength and dignity. I discovered that, by focussing on the goings on of my body as opposed to the activities of my mind, I could gain an intense and longed-for feeling of respite from the latter. Best of all I reawakened to the fact that I was more than a mind, and that my body was more than just an elaborate plinth for the contents of my troublesome skull. It was a gangly, achy, tingling mass of flesh, and was equally, if not more, interesting.

I have always known that depression’s power fluctuates, but I had never fully grasped that its power directly corresponds to the importance I placed on the what was going on around me. It is entirely relational. If the world is considered dull and unworthy of consideration, then depressive thoughts become the centre of attention, and they thrive off attention.  But if the world is big and engaging, depression’s power shrinks.

Mindfulness may not be a magic cure. It has not defeated depression once and for all, but it has caused it to recede, and that’s more than I had hoped for.

Dissociative Disorder

To discover the name of an affliction is to be slightly reassured. If a problem can be bound and encased in words, it is not bigger than words. If it can be described, it is, by extension, not beyond our understanding, and can in theory be managed.

In 2000, I typed my new and unnerving symptoms into the new and unnerving internet. ‘Sense of distance’, I wrote. ‘Things aren’t real’. ‘Senses dulled’. The web, which, from its early days, excelled in diagnosis, gave me the title I was looking for: Dissociative Disorder.

If discovering the name of a problem can be comforting, capturing the essence of it in a decent metaphor can bring further solace, a further sense of mastery. For this reason, I’ve tried, over the years, to capture the essence of the disorder in less clinical language.

I have thought of it as a mist, a burqa worn on the inside, a veil covering all the senses. It is doubt made palpable. When I explain the disorder to a non-sufferer using one of these descriptions, they seem to garner a loose impression of what I mean. They hold a fragile, vague, incomplete understanding, patched up with guess work.  This description can also be used to explain how the sufferer experiences the entire world.

One morning, I woke up, and my surroundings had taken two steps back. I had had dreams more vivid and convincing than this. I got dressed and went into the living room. Intellectually, I knew that my sister was in the arm chair, nibbling a piece of toast with jam and watching The New Adventures of Superman, but I felt as if she was galaxies away. I knew I was as ‘present’ as I had ever been, but it was as if my skin and eyes and taste buds were no longer tools for experiencing the world but thick, downy duvets that I had retreated behind.

I must just be tired, I thought. I drank Red Bull on my way into school the next day, and got an early night. The following morning, I felt the same. In school, I stared at the graffiti on my desk. I tensed every muscle in my skull and tried to shatter the screen with force. It bent but did not break. I felt frightened, but at the same time, anesthetised. The emotions that were so intense a few weeks ago were now blunted.

This anesthetised feeling is the entire raison d’etre of the disorder. It does not begin life as a problem, but as a solution to the problem of overwhelming emotion. Faced with the tidal wave of unpleasant feelings that were part and parcel of adolescence, my mind built a sea wall. It rejected the sources of these emotions, but it lacked the precision to single them out, and so issued a blanket ban on everything.

Vladimir Nabokov wrote: ‘Unless a film of flesh envelopes us, we die. Man exists only in so far as he is separated from his surroundings… Stay inside or you perish. Death is divestment. Death is communion.’ Dissociative disorder is a mind’s an admission that the film of flesh is insufficient. It is another layer of separation to prevent the peril of communion.

The significance of the change hit me one weekend. My family and I went on an outing to Rivington Pike. This is a Lancashire landmark, and we loved to fill empty Sundays by climbing it. Hundreds of other local people did the same. As a kid, I decided that it was distinctly less boring than most other hills. Half way up, there was a hidden Japanese-style garden with fountains and a pond. The garden and the rugged woodland which surrounded it created a pleasing contrast between wildness and gentility. At the hill’s base, motorcycle gangs in leather sipped Earl Grey inside a tea shop, echoing this contrast.

My family and I would reach the top and sit on the side of the hill just below the summit to dodge the wind, which was usually strong enough to lift a greyhound off its paws.  We would eat our sandwiches stoically, silently, in formation, pointing out landmarks across the county: The Reebok stadium, Blackpool tower, the sprawling, curling housing estates of Bolton. That particular Sunday, I came to a disturbing realisation: my mind hadn’t just shrunk away from the boring bits, but the beautiful bits, the awe-inspiring bits: the height, depth and breadth of the entire world. This familiar, beloved view was now as moving and engaging as a sound stage.

When the panic receded, I realised it wasn’t quite as bad as all that. It was not the disorder itself that caused the most distress, but my belief in is power. That day on Rivington Pike I believed I had lost my chance to experience any of life’s riches. I had not. I have had the disorder for half my lifetime, and it has not prevented me from making lifelong friends, from falling in love, from learning or growing. It is not bullet proof glass, as I first feared, but a ‘semi permeable membrane’. Love can get through. Joy can get through.

A few months ago, my friend Laura called me from London. After swapping news, she sheepishly asked me, ‘Do you ever feel like the world is a million miles away? Like… you’re not really here?’

She was expecting blank incomprehension followed by a weak attempt to empathise. What she got was an abridged version of this post.

That day on Rivington Pike, I would never have believed the disorder could bring me closer to anyone or anything. But fifteen years later, a friend had found herself lost within the mist and I was able to reassure her that there was nothing, really, to fear. It was a peculiar paradox: we were three hundred miles from one another, and had been brought closer by our shared sense of isolation. It was comforting to learn that friendship, and the desire to connect, can outsmart anything the mind can produce to prevent connection.

The fog of Dissociative Disorder may disappear one day, it may not. Even if it never shifts, it will not have had the final word. The mist can be isolating. It can be terrifying. But I merely had to look around to see that I wasn’t alone within it.

The Cellar

As a child, I imagined that my moods were the storeys of a house.  When I was ecstatic, I pictured myself dancing on the roof tiles like a chimney sweep in Mary Poppins. When life was generally fine, I dwelled on the first floor. When I was sad, but not irredeemably so, I pottered about on ground level. It was a melancholy and boring place, but there were other people milling around, windows letting light in and stairs that I could ascend.

But this house had a cellar. It was a dark, dank hollow. There were no bottles of wine or tumble dryers or rusty bikes or other distracting remnants of the adult world within it. Inside it, a person’s senses were consumed with the basement alone: the darkness of it, the smell of it, the threatening sound of everyone else’s footsteps overhead. It was a place that took me out of contact with any comforting person or thing. The basement had a staircase, but, as in a dream, something unspoken rendered an occupier incapable of using it. My childish conception of this hidden, frightening, neglected place was my first encounter with depression.  I hadn’t yet entered the basement, but knew I had the capacity to do so.

I have told this story many times to different doctors in response to the question, “What do you think has caused your depression?”  I have concluded by saying that the basement is not a place that has magically appeared after a traumatic event – a job loss, a death of a loved one, or a relationship failure. Depression is an in-built dimension of my mind, a part of my personality. On the whole, they have found my  response unsatisfactory – the kind of throwaway, resigned-to-misery comment that is often made by the clinically depressed. If pushed, I’ll sometimes give in and recite neat little half-remembered trigger points.  Bullying. Appearance. Shyness. These things have all affected me deeply at different times, but I am not plagued by these things now. They dissolved into long-term memories many years ago. The only honest answer to that question is, “This is how I am built. For me, depression is a steady state, not a big bang”. This is not a statement of dull resignation. It is a statement of insight. As accepting the nature of my own mind – light and dark – was the first step towards minimising the power of its shadowy parts.

Right now I’m dwelling on the ground floor. I can appreciate the cooling cup of coffee on my desk, the way my fancy new wall clock worked right out of the box, and look forward to my boyfriend coming home for lunch. I can dwell in the present moment with the little, friendly, modest things for company.

I like it on the ground floor. But getting here was not easy. This blog is about how I found my way out of the cellar, and how I avoid the pull of the hollowness beneath me. I hope some of what I write will be helpful for you.