Thursday, November 23, 2006

Event horizons

First off, thanks to everyone who has left comments on here while I have been unwell. The support has been almost palpable at times, and to have the demonstrated support of so many kind, decent, caring people has been therapeutic in the best sense of the word.

Danny, by the way, is a deeply decent, compassionate, emotional person, and someone who goes to considerable lengths to conceal the fact. Don't believe him. He said some stuff that made a lot of sense when I came out, and thanks to Sean, and SHP and Seamonkey... Thanks to everyone, in fact.

So. Random thoughts here. And in case anyone gets the idea that it’s roses, roses all the way, I may as well include some soundings from the bad days as well as the good.

Because there are bad days. Definitely. You don’t have to ask me about this. You could ask anyone else with a mood disorder about this, or my psychiatrist, or you can ask my niece or my wife or my friends and co-workers.

Bad days are to be expected, or course. If I’d broken a leg a few weeks ago I’d still expect pain, if I tried to run on it I’d still expect to stumble. It’d still hold me back.

And it does. Monday, for example. What went wrong Monday really went wrong Sunday night, when I didn’t sleep and I didn’t take the olanzapine I had been prescribed for this very eventuality. So Monday morning I was shrieking at my niece and Monday evening huddled on the phone with my heart pounding, and Monday evening raging and gibbering incoherently at my wife.

One of the things I have realized is you can almost measure the degree of my unwellness by how unwell I reckon I am. When I am well I believe I have bipolar disorder. When I am unwell I realize that the problem is not one of sickness or health, it is one of good and evil. Ludicrous as it sounds, that is what I was telling Sarah Monday evening.

Times like that I can understand why people don't take the tablets. It's not only the usual things that stop people taking the tablets (psych meds have all the qualities needed for non-compliance: they have side effects, they have to be taken for long periods, they often have to be taken more than once a day and if you don't take them, often nothing all that bad happens in the short term. In fact, if you don't take them, in the short term, things can become utterly fantastic).

But it's also the fact that people don't want to take stuff for conditions which they do not believe they have.

The weird thing is me - and a number of other people I know who have this - believe we have an illness only when we are not having an episode of it.

This is strange but true. When I am well I know i have bipolar disorder. But when I am acutely unwell, either what is wrong with me is too fundamental for medication to affect (the low) or there's nothing wrong with me at all (the high).

I suspect that “insight”, which to doctors means roughly the patient's understanding that he or she is ill, is a much rarer thing than we doctors take it for. It is unpleasant to believe that you are unwell, and unpleasant thoughts are ... well, unpleasant. That's why breaking bad news is so hard, so important a skill, and why on the wards and in the clinics you can hear people (mostly concerned relatives) saying things like "He says it's only a few cancer cells - that can't be serious, can it?".

In the mood and cognition disorders there is an additional difficulty. I think most people are cognitively set up to believe they are well, to believe that what they believe is true, if you follow me, and that their feelings are "to be expected" responses to outside events. Admitting and keeping admitting and understanding that that is not the case, coming to believe that, although you believe and feel a certain way so strongly, that it is not true.... - it's more than hard, it's un-natural.

It's hard to come up with an example, but - you know when you’re in a train and there's another train next to you and the other train moves and for a moment you get the feeling that it is your train moving? Until inertia and time and the smiles of your fellow passengers tell you it's not the case?

Well, I can tell that the moving train is an illusion, but I can’t as easily dismiss the alterations in the appearance of things when I am down or up. I can't convince myself that the people who show me every outward sign of affection do not secretly despise me. I cannot believe I have not disappointed everyone I have ever met. I cannot believe that the wrongness, the twistedness, the sour, heavy, dark cold inside of me is not detectable by everyone with whom I come into contact.

I don't know. Not a particularly good day today, either, although that CBT starts tomorrow, and that may at least partially explain it. Monday Sarah was able to sit with me and calm me, which I suspect is another strain on a relationship that I have recently put under a fair amount of pressure, but I would rather talk to her than take anti-psychotics. The weird thing is I was almost able to pin-point the moment when I went from believing "I am a venomous creature and any contrary thoughts are meaningless" to "I am someone who is depressed and these contrary thoughts are a symptom of that depression." And somewhere in there would have been this quantum state, partial awareness, a phase exactly balanced between insightlessness and insight.

You know something, I was thinking the other day about some people I know who have some sort of mood disorder and who are in some way high achievers. All of us in different ways: one is an academic who regularly receives university prizes, another dresses impeccably, another probably by now some kind of craniofacial surgeon, a fourth someone who works with people on the fringe of society. Not high achievers in the narrow sense of the word, but people who go above and beyond.

And I was thinking about black holes, the places, if they are places, where stars consume themselves, tear themselves apart, those black pits into which limitless amounts of matter, stars and planets and everything the collapsed star can grasp pours.

The thing is, we can see where black holes are. If your eyes could see the right kind of light, light in the far ultraviolet and Xrays (and I have heard that if you stand in the dark for long enough you can see X-rays) - then you could see where a black hole was by the blazing, the burning up of objects as they fell into it and were consumed. Paradoxically what looks from the outside like a very bright star can can in truth be a black hole.

Anyway - and I don't know if this is an analogy that can be sustained - there is a reason that those people I mentioned are achieving in the way they do. There is a reason they spend hours at the laboratory or in the operating theatre or in front of the mirror.

The reason is that horror, that absence, that lack, that black hole that lies (in both senses of the word) at the heart. If they didn't have that absence, that cold darkness inside themselves, then they wouldn't be burning up everything to make themselves shine.

The thing you cover up, drown out, distract with fire and noise.

Anyway. I am going to go off and take the prescribed (and non-stupidifying) medications. Will post soon.

Tuesday, by the way was better, and so have most days been. This is a normal progression back to health, and I am better today than yesterday, and so on.

By the way, anyone know how to update the links here? I've asked Chad a number of times and he keeps telling me and I keep forgetting. And get a map and some other stuff?

Thanks for listening,



Blogger Niamh Sage said...

Wow, that was amazing, BJ. That analogy with the black hole - wow. And more wow. Every time I come here I feel as if I understand a little bit more.

I know how to update/change the links on your template. I'll send you an email. I imagine adding a map will be something along similar lines (i.e. adding a link for the map to your sidebar), but I'm not sure where the maps come from. Maybe someone else knows?


11:23 PM  
Blogger Benedict 16th said...

One patient recently described how he could see this green light thru his eyeballs going thru in slices... when he had a sinus CT scan...
I couldn't argue with him, sounded reasonable. Only thing is, I thought an H2O oxygen excitation* by xrays is usually a 460nm transition (try and google that!) which is blue. Maybe he had been watching too much Matrix?


* p-state hydrated electon - I could be wrong that came out from under more than 12 years of mental detrius

12:10 AM  
Blogger Foilwoman said...

BJ: I think everyone, to some degree, has the black hole in the heart, the thing that they fight against so they are not pulled into the event horizon. For some it is stronger than others and for some the urge to fight is stronger than others. I'm glad you've got a good strong urge to fight. I think the stronger the gravitational pull, the harder one fights, and that's where a lot of the creativity comes from. Just a theory though, with absolutely no scientific evidence.

As for adding maps, if you mean a visitor map, you can simply click on one on someone else's blog and the site will give you the code to paste into your template. Does that help?

3:17 AM  
Blogger SEAMONKEY said...

That's a brilliant and beautifully expressed metaphor; though to my eye you're less a black hole than a supernova miraculously maintaining itself, never quite succumbing to its own enormous gravity.

2:25 AM  
Blogger Juanita J. Sanchez said...

Good insight. Thank you. It must be difficult to articulate and share, especially in the throes of it. I'm pulling for you, BJ.

12:52 PM  
Anonymous Danny said...

Awww man, don't be telling people I'm decent - I have a reputation of being a bastard to uphold and propogate - and yeah, I know I spelt that wrong, but it goes.

Seriously Doc, nothing makes me happier than seeing you smile and hearing you having a laugh. Best medicine there is.

Now let's go and spit off the balcony!!

1:52 PM  

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