Sunday, February 18, 2007

Fog

Hail,
I went over Jeremy's today. Jeremy is a friend of mine, someone who's appeared in this blog a number of times before, so heavily disguised I suspect his age, race and sex have changed more frequently than anyone else's. It was Jeremy (at that time tall and red-headed) whom I had detained in the Royal earlier this year, five o'clock in the morning, late autumn, the night of the first real rains. It was Jeremy, who at the time was on five different psychiatric medications and was still deeply, deeply unwell, whom I drove to Clearwater a few months later where he was detained again. It is Jeremy, who when he is well, is arguably the smartest human being I know.

(At Uni he got the science prize for each year he attended, and the Honours prize, and numerous offers from numerous places to do his PhD, and there were three separate boards with his name on scattered around the science wing, and so on. Incandescent bright. Thank God he wasn't in the same year as me).

Anyway, since earlier this year Jeremy has been unwell. There has been a lot behind this. He moved here from the East coast, that's a big stress. He got a new employer. His ex-wife, a brainless and vicious narcissist, married again, which knocked him around a bit, because he's only ever been a one-woman man. A variety of things.

So since early last year he's been unwell. He is on onlanzapine and amisulpiride, which are two antipsychotics, two antidepressants and a mood-stabiliser/anticonvulsant, what he describes as "handfuls of tablets" a day. His psychiatrist is one of the best in the state, and what few guidelines exist for the treatment of the 'difficult' bipolar patient suggest precisely what Dr Bedlam is doing.

And they also suggest maintenance ECT (electro-convulsive therapy, the old electric shock treatment), which is what Jeremy's getting. Currently* three times a fortnight - Mondays and Fridays on one week, Wednesdays on the next. Lately things have been going downhill, so Dr Bedlam has switched things back to twice a week - Mondays and Fridays. This fits in nicely with our study days on Tuesdays.

Tuesdays I do pharmacology and he studies to get into medicine.

Now, some readers may find this difficult to deal with. This is a man who has not really been mentally well for close on a year. In that time he has been hospitalised more than five times and detained twice. He suffers delusions, sees things that aren't there, has fragmented sleep, impaired concentration, inappropriate guilt, frequent thoughts of self-harm. He is certainly not well enough to practice as a doctor in his current state. However, in his defence, when he is well, he's cardiologist or neurosurge material.

Anyhow, I went over there today, a day after his ECT. His father, an amiable and unobtrusive man, was there, pottering around in the background. Jeremy poured me a coffee.

"Do you have it black or white?" he said.

"Black" I said. It's been black since adolescence. With the ECT you have to tell him some things every month.

"How's your cousin?" he asked. "Tell him thanks for the barbeque"

"Good, good". A few visits ago Jeremy had come up to our place for a BBQ, sat and chatted with our friends for a few hours, ate lamb and fresh fruit and drank his allocated one standard drink, went home and had ECT. The next day he came up to visit again, saw the chairs and tables scattered around and asked if we'd had visitors.

"No worries"I said. And we discussed the football, and whether it was worth getting Foxtel, and a few completely normal things like that, and he seemed superficially well. And then he talked about the exam (the medicine one) and the questions they were going to ask.

"They have a section on current events" he said. "I know nothing about current events".

"Relax" I said. I've been doing a lot of de-panicking with Jeremy. He's not used to not knowing stuff. "It's not current events as such"

"Uh huh"

"It's not like the latest half a percent interest rate rise and so on" I went on. "It's more about big themes. They have some texts and you have to read and respond, compare and contrast. It's about how well you can express yourself, argue a point, that kind of thing."

"Big themes" he repeated. He seemed reassured. "The big stuff. Self-expression, constructing an argument...Good....good."

I have been spending a fair part of the last few months reassuring him. He seemed reassured by what I had said. I have to tread carefully with this. If there's something he can't remember and he asks I always tell him, but I try and balance that with putting it in context, stopping him panicking or falling into despair.

I warmed to my task. "Like they won't ask you about - I don't know - they won't ask about who heads the House of Representatives in the US, or the name of the socialist candidate in next year's French elections. They won't ask that. It's more if you're arguing something maybe you'll do better if you can mention some seminal event."

"Excellent" he said. "So just the very basic stuff. Like what?"

"Like the twin towers. September eleventh, that kind of thing."

"Mmmm" he said, and looked at me. "What happened there?"

Smartest guy I know.

See, a year ago I was all for ECT. I say "all for ECT" not in the sense that ECT sessions should be slathered about like shampoo and that every home should have one. But I thought ECT was under-rated and under-utilised, compared to either unmedicated severe prolonged mental illness or to the pharmacological treatments for those severe prolonged mental illnesses.

Deep, prolonged depression is hideous in ways words cannot describe, it is a season in the abyss, a growing old in the dark and the cold, a deep somatic loneliness that holds your heard like a fist. I have almost never been sick, aside from the bipolar, but people who have been have told me they would rather have would rather have almost anything else - dental or renal pain, acute pancreatitis, one of those "just a virus"'s that turns you into the living dead for a month - than depression.

And as stated too many times here - the drugs make you fat and sexless, they give you diabetes and make your hair drop out, they make you sweat and give you pimples and make you nauseous from the moment you wake up until the moment you go to sleep. That's not counting the more unusual side effects, such as the less-kinky-than-it-sounds "taste perversion" (paroxetine and others) or drooling, delirium and death (clozapine).

But ECT. The more I see the less I like. And admittedly this is just one person, and it's one person getting a shitload of ECT, more than once a week for more than six months. And it's someone who's also really depressed - and depression affects your concentration, your memory, your interest in things around you.

But he was smart, confident, clued up and aware. Knew lots about politics (voted conservative, but came from a very rich family), could talk about stuff. All of that seems gone.

I don't know. I don't know what the answer is for him, I don't know what's going to be tried next. But things aren't going that well. The exam's in two months, if he fails he'll fall apart. I'd be feeding him sardines and breaking out the horse tranquilisers, I'd be hospitalising the entire family like I hear some places in India do, I'd be trying bloody anything. Because it's not working.

And if Jeremy was here he'd tell you.

Thanks for listening,
John.

*Don't you dare

5 Comments:

Blogger Benedict 16th said...

I've sent you emails and URLs on this, sure it's a bit less mainstream than ECT, get your trick-cyclists to talk to my trick-cyclists.

See this New Scientist article

Also on Ketamine.com

And real references not only available but been emailed to you.

Benedict

9:46 PM  
Blogger Juanita J. Sanchez said...

Yes, I think depression is entirely underrated -- as in the fact that people don't realize its destructive potential, or the hell it creates within a person. Until you've seen or experienced it, there's a temptation to believe that the depressed person can just "snap out of it." It is truly one of the worst diseases.

12:56 AM  
Blogger Bronze John said...

Hail Bene',
It's not me who has to be convinced, it's Jeremy's psych., and he is not in the habit of running his decisions past me. I don't know if the current therapy (lamotrigine plus a MAOI plus olanzapine plus amisulpiride plus something) is working (sample space of one), but I'd be giving it a look.

John

10:10 AM  
Blogger Bronze John said...

Hail Juanita,
I think things are slowly changing. As I said, I haven't had much discomfort in my life (Sarah, on the other hand, has had three out of the top five or something), but depression would be up there.

I don't know. I just wish it would hurry up and sod off.

Thanks,
John

10:13 AM  
Anonymous dd said...

Heartbreak can take us into very dark places... places that science just hasn't been able to address... places art may heal more than we realize. It't gotten me through some of my darkest moments and helped me see the light.

4:58 AM  

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